As a parent of a child that came to me at an early age, well before school, I can say without a doubt that severe ADHD is clearly identifiable well before a child is 4 years old.
This is not a surprise to anyone that has a young child with ADHD.
This article also glosses over the fact that if a child is born and needs to be in the NICU, there's clear evidence that the drugs they have to give the child to save their lives will cause ADHD, and for a child that is predisposed, make it worse.
Yes, trauma causes concentration issues.
No, it's not easily confused with real ADHD.
They say ADHD is over-diagnosed.
I say brain-damage in newborns from METH is being under-diagnosed, to "save" the feelings of the biological mothers, only to be "discovered" when a child starts school.
I don't think we can have a real conversation about ADHD until we gain the ability to have real conversation about METH.
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Trauma based ADHD is very prevalent among children exposed to domestic and community violence, and child maltreatment. These children are misdiagnosed. In my experience, they present as unable to concentrate and are very poor sleepers at night, usually because they are "on guard" for anything perceived as threatening. Often,some of these kids have learned violence is how you solve problems as well, definitely not teacher's favorites !
However, kids who do not suffer any of the above do have ADHD and learning differences too. They also can be diagnosed much earlier than 4 or 5. It is not as simple as assuming environment is the hidden answer here. For many kids it is... but not all by any means. During my career as a mental health clinician specializing in kids 0-6, these children easily stood out. I've also had kids who really did not progress in treatment until they were medicated! That should bring on another chorus of naysayers. Bottom line, careful diagnosis, thoughtful treatment, including mental health and occupational therapy can be very helpful. It is also not to be forgotten that even when parents hear about the link btw trauma and
adhd, nothing changes. I look forward to hearing more about this study. As the parent of a girl who was attention deficit without hyperactivity and central processing challenges who is now a college graduate and incredible mother, I've seen both.
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I am a mental health therapist and I work with teenagers who have been diagnosed with ADHD. They all have suffered serious trauma, primarily in their familial relationships. I continue to wonder why we automatically accept that a "disorder" is labeled as biology and fail to consider the environment. How parents are, with themselves, with each other, and with the world around them affects their children.
What things in the environment helped shaped the brain to become susceptible to ADHD? Dr. Gabor Mate has written an impressive book on this matter that strongly suggests that ADHD is not a biologically inherited disorder, but instead shows we all have the predisposition to the illness. It is our early environment and early relationships that affect the brain's ability to feel safe and stay focused on certain tasks. It's an enlightening read, and I believe that we will be seeing more ADHD in the future, likely because of trans-generational trauma and a multitude of stress in our environments. https://drgabormate.com/book/scattered-minds/
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Brains of preschoolers diagnosed with ADHD are different on MRI. Our diagnosis of, and our tolerance of, school kids with ADHD, however, is culturally determined, as this 2006 study by Baydal shows:
'The authors examine how many Aboriginal children attending two reservation-based elementary schools in Northern Alberta, Canada, would demonstrate symptoms associated with ADHD using standardized parent and teacher questionnaires.
Seventy-five Aboriginal children in Grades 1 through 4 are tested. Seventeen of the 75 (22.7%) Aboriginal children demonstrated a match on parent and teacher forms, with T-scores greater than 1.5 standard deviations from the mean on the Conners' ADHD Index, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Hyperactive/Impulsive Index, DSM-IV Inattentive Index, and/or DSM-IV Total Combined T-score.
The number of Aboriginal children found to have symptoms associated with ADHD is significantly higher than expected based on prevalence rates in the general population.
These findings suggest either a high prevalence of ADHD in Aboriginal children or unique learning and behavioral patterns in Aboriginal children that may erroneously lead to a diagnosis of ADHD if screening questionnaires are used.'
Baydala, Lola, et al. "ADHD characteristics in Canadian Aboriginal children." Journal of Attention Disorders 9.4 (2006): 642-647. https://www.ncbi.nlm.nih.gov/pubmed/16648231
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Can anyone tell me if the Mahone study is examining children with the inattentive type of ADHD? Thanks.
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Of course we shouldn't consider any disease to be "real" unless we have actual objective evidence. But that also means that all those people with migraine headaches and the overwhelming majority of people with low back pain don't have real disorders as there are no objective findings for their problems.
Or is it only mental disorders that we should hold to this higher standard?
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I believe the best use of ADHD meds is in conjunction with expectations that are developmentally appropriate, clear and consistent; exercise, good sleep and diet; skills training including mindfulness training, et alia—rather than hoping meds will “fix it” without a lot of effort by parents, educators, clinicians, and the person with ADHD.
Done right, the meds can help an ADHD child or adult focus enough to learn useful strategies. Together, those can make a huge difference.
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I know that parents of ADHD kids are adamant about how medication has helped their children, particularly in school. I understand why they would give medication because falling behind in school at an early age is a serious problem and most kids never catch up. But I am still not convinced that ADHD is a disorder. Perhaps at another time in history being easily distracted may have been an evolutionary advantage, increasing chances of survival. So I'm not sure that a different brain means that it is a dysfunctional brain. It may be a normal brain that is just different. The real issue is that these people are at a disadvantage in our modern era of sit down schooling and jobs. So the question becomes do we fix the issue by giving medicine to individuals that don't fit in or do we change our society's priorities. The first is obviously easier but I'm not sure it is a good thing.
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From Cary mom: "But I am still not convinced that ADHD is a disorder". This is clearly your opinion, but what is your scientific background and medical training that would give it credibility?
From the study's author:
“This is very much a biological disorder,” Dr. Mahone said, and it’s clearly possible to distinguish A.D.H.D. from normal 4-year-old behavior. “Very clear evidence of things happening differently in the brain helps us reinforce that this is a very real condition with onset very early in life.”
ADHD has been noted since 1902, and studied fairly intensely since the 70s and 80s, and especially in the 90s. It's still under study and of course there is more to learn, but doctors know quite a bit about it today.
Most of us have to go with the best consensus science that degreed experts can give us. And our kids need jobs and that requires they make it through schools as they exist today. Which clearly requires kids to focus and concentrate for extended periods, especially in college.
We can't wait for society to change its priorities, which takes decades if ever, and such may not be practical anyway, as most professional jobs require considerable ability to focus and concentrate. So I don't see how what you are suggesting is practical.
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To understand ADHD as a disorder, you have to remember that this is distraction on steroids not just shiny penny distraction. I was diagnosed with ADHD when I was 20 as a college freshman, now I am 40. I graduated from high school with a 2.5 GPA. I maintained a low GPA (with significant help) the first two terms in college. I was diagnosed and put on meds right before spring term. I will tell you it was like having a huge spotlight turned on and my grades went up a full point in just three months...And stayed there until I graduated. I could focus for the first time, for a significant period of time (I didn't know this was how other people normally did things). But more importantly, I was able to move from step 1 to step 2 to step 3 to step 4 instead of my ADHD version of step 2 to step 4 to step 1 then step 2 again and then step 8 of another project and then step 5 of the original project. It's exhausting. It kills your self esteem. It's frustrating for you and people around you. I am very excited to see this work happening because things could have been a little easier growing up if people understood what was really going on.
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My ex-husband was an adult diagnosed with ADHD although it was before we met. His stories of pre and post medication were very much like yours. Before he was diagnosed he had very low self esteem surrounding his abilities in school.
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Thank you for doing this research and improving our medical knowledge on this neurological condition.
From what I've seen first hand raising a couple of boys I have no doubt there is a biological basis with significant differences among children with and without the condition, as these scientists are discovering from their scans.
I've raised two sons. The older, now 37, did not have ADHD. The younger, now 27 has ADHD, with the classic symptoms of limited attention span and ability to focus, and hyperactivity. They are both smart and intelligent.
But the difference in their journeys, in their challenges and obstacles have been significant, especially with regard to school.
Yet both made it through college, and the one with ADHD just got his Master's degree. But for him it's been a lot harder, longer to complete college and a lot more challenging.
Yet with the help of some medicines that worked fairly well for him from age 8 on -- (concerta and more recently strattera, and these were not perfect and had some unwanted side effects, but other meds were a disaster) -- he's come a long way.
But this research may lead to new knowledge, therapies and behavioral interventions that help much more than what is available today. Good luck with your further researches and studies. A lot of kids, parents and teachers will ultimately benefit...and be grateful.
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