ADHD requires multifaceted treatment approach

By Ashli O’Connell (8/22/04)

As a child Dennis Swanberg was the life of the party, but he couldn’t hold his own in the classroom. “I read too fast and didn’t understand what I had read by the time I was done,” he says. “I couldn’t concentrate long enough to comprehend anything. Everybody just thought I was a goof-off. But I studied harder than any of my friends, and I was not making it.”

The worst point came when his third-grade teacher announced to the class that he had done poorly on a state achievement test. “By third grade, kids are starting to label each other as smart or dumb,” he says. “I found my self-image beginning to crumble.”

Not knowing where to turn for help, Swanberg began to compensate with his greatest strengths: humor and sports. He went to college on a football scholarship. Today Swanberg is an ordained Southern Baptist minister, Christian comedian, television host and author. Not until his own son began struggling with similar problems did Swanberg learn he has Attention Deficit Hyperactivity Disorder (ADHD).

Swanberg chronicles his family’s experience in a 2003 book, Why ADHD Doesn’t Mean Disaster. “Sometimes I wonder what would have become of me if I had been uncoordinated or never set foot on an athletic field,” he says.

ADHD is a neurobiological abnormality affecting around 4 percent of school-age children. The condition manifests itself through three behavioral symptoms: inattention, hyperactivity and impulsivity. There are two primary types — one with hyperactivity and one without, formerly known as ADD (Attention Deficit Disorder).

The problem with ADHD, ironically, is not that children can’t focus; it’s that they pay attention to everything, according to Dr. Lee Wetherbee, clinical director at EMERGE Ministries in Akron, Ohio. “All the distractions in the room, everything out the window — they have ideas popping into their heads and they can’t screen out all the noise,” he says. The disorder typically leads to problems in the classroom and difficulty relating to other children and adults.

Though some have dismissed the validity of ADHD, most doctors and mental-health professionals validate the condition. “ADHD is the most researched diagnosis of childhood,” says Wetherbee. “If it didn’t exist, we would know it by now. It is also a very complicated issue, and it’s difficult to diagnose well.”

Parents of ADHD children are often left with difficult questions about how best to treat the condition. In some cases the answer is medication, for others behavior modification techniques. Regardless of the treatment chosen, experts agree that children with ADHD need parents who are advocates for their education as well as their physical, spiritual and emotional health.

The first step for parents is to obtain an accurate diagnosis. Wetherbee recommends consulting a pediatrician or psychologist with specialized training. “There are a lot of things that look like ADHD that aren’t,” he says. “Some well-meaning people will check symptoms off a checklist and jump to the conclusion that it’s ADHD.”

Once diagnosed, patients face a variety of treatment options shrouded by controversy. The primary medications used in treating ADHD are stimulant medications based on the generic methylphenidate — the active ingredient in Ritalin. Some nonstimulant medications are now available as well. Wetherbee recommends looking at medication as only one part of a treatment plan that includes increasing physical activity and soliciting parent training and family counseling.

Dr. Keith Mather, a pediatric hospitalist and a member of the Assemblies of God HealthCare Ministries board, cautions parents not to avoid medication based on rumors they have heard. Mather says the real issue is determining whether side effects are worse than potential benefits. And that can only be determined on an individual basis.

The primary side effects are appetite suppression and emotional instability. There is also a concern that patients can become dependent on the medication rather than developing discipline and concentration skills. At the same time, failure to treat a child may result in trouble with relationships with peers, poor academic and job performance, increased incidence of depression and an intense sense of failure.

In many cases, medication isn’t necessary. Behavior modification techniques work well, particularly with the nonhyperactive cases. Often a different style of teaching will make all the difference for an ADHD child. This is why experts recommend thorough medical and psychological testing before a treatment method is chosen.

It was a new teaching method that rescued 15-year-old Josiah (last name withheld). A shy and introverted child, Josiah’s academic and social problems in school began in kindergarten. He struggled to keep up academically and failed to connect with peers. Teachers often called him a “daydreamer.”

Throughout the years, Josiah’s parents attempted various solutions, even moving to a new town so they could enroll him in a smaller school district. Josiah’s teachers lightened his workload and transferred him to smaller classes.

Still, Josiah struggled. By the end of fourth grade, his mother says he came home with migraine headaches every day and suffered with Irritable Bowel Syndrome. “I was losing him physi- cally,” says Laurie. “He was totally withdrawing, and the school told me he was going to be one of those who fell through the cracks.”

Laurie and her husband, Tony, decided to try homeschooling. “When I started working with him one on one and removed him from the negativity of other students treating him like he was stupid, his self-confidence absolutely soared,” Laurie says. “I’ve been able to help him find his strengths and work with him on his level. Not only is he now getting his education, but we also got our son back.”

Wetherbee says Christian parents must tap into the power of prayer in dealing with an ADHD child.

“These can be tough children to raise,” says Wetherbee, who has a son with the disorder. “They are also tough children to be. They may be ostracized by their peers because they can be annoying to be around and they may have a tough time connecting with other kids.”

Wetherbee emphasizes that parents should separate their child’s behavior from their character. “Children with ADHD typically have big hearts and really want to follow the rules,” he says. “However, in their enthusiasm they may repeatedly commit transgressions, but feel bad every time. Parents have to get to know how their individual child learns and functions best, then adapt to that. Lots of prayer and support from other parents of children with ADHD is the key.”