There are lots of misconceptions about ADHD. UPMC Behavioral Health Therapist, Rebecca Abel, MSW, LSW discusses its signs and symptoms and what treatment can look like for children and their families.

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– [Narrator] This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.

– It’s a common condition, but there are many challenges in diagnosing and treating ADHD. Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Rebecca Abel. She is a behavioral therapist with UPMC. Thank you so much for joining us today.

– Oh, I’m glad to be here.

– So, let’s begin with the very basics. I think everybody hears “ADHD.” What does it stand for, and really, what does that mean?

– ADHD is attention deficit hyperactivity disorder, and what it is is a neurodevelopmental disorder. It’s genetic and is also hereditary. And there are three types of ADHD. One is inattentive, the other is impulsive-hyperactive, and the other one is combined. In the inattentive type, what exists is issues with paying attention, losing things a lot, inability to do tasks that take a lot of mental effort. There’s also issues with paying attention in general. There’s issues with everyday activities. You may go to brush your teeth, and you go into the bathroom, you come back out, and you didn’t do that; you washed your face only. The other things are are hyperactivity-impulsive. So, impulsive behavior is doing things without thinking. Hyperactivity, you continually move, like you have a motor inside and you can’t stop. And kids will climb. They’ll not be able to sit in their seats. They’ll fidget a lot. They’ll talk excessively. The other things, too, is their impulsivity cause them to interrupt and be intrusive. You can have either one of those, or you can have a combination of those. One way that you can kind of understand how an ADHD brain works is if you cross your legs and start spinning your right foot, and then try to write your name. So, it’s trying to get your brain to choose different situations at one time, and that’s exactly how the ADHD brain is working. So if you can imagine living like that, it’s very difficult.

– What do you want to say to parents about what sort of conversations should they be having with their doctors, and what should they be doing if they think they’re seeing some of these signs?

– One thing as a parent you can do is start to keep track of these signs. If the teacher gives you reports, keep track of those reports. If you see that there is something going on that’s consistent, the next step is to talk to your pediatrician possibly. And they may send out some reports to the teachers and/or have you fill out some papers. At that point, you can either go that route, or you can just get scheduled for a comprehensive evaluation. And that can help with getting diagnosed.

– Do children normally say to their parents, I can’t concentrate in class? Is there self-awareness among kids that there’s something going on there?

– It depends, sometimes, on the situation. More than likely, younger kids don’t necessarily see it. They just think they’re having fun. A lot of times, people think they’re the class clown, so it’s funny. They talk a lot, but if they’re very bright, it doesn’t really affect their grades, bu it affects maybe other people around them. So, I don’t see that they necessarily know that they’re not being able to focus. They just realize that these things are seen, and they just think that this is a normal part of things. I think as people get older, they kind of realize this. Sometimes, the teens will come to say, “Oh my, I just realized I’ve been working so hard, and I’m still not, you know, I’ve decided I’m going to start studying more, and I don’t get the good grades. What’s going on?” And then they kind of look at things. And, even, I’ve had people in college, because if you’re very bright, what you can do is continue to do well because you’re kind of self-teaching yourself and maybe not focusing in class, but you can go back and you can kind of teach yourself these things. But, sooner or later, it usually catches up somehow because it’s very difficult, if you’re not getting treatment for ADHD, or learning different skills, to maintain that. But the way to really know a diagnosis for ADHD is to get a comprehensive evaluation. When you talk to a therapist and you gather that collateral information, such as reports, self-reports, reports from teachers, reports from even parents, as they get older, to some of the teens or college students, can give some information. And then the diagnosis is made.

– So how is it that this is often misdiagnosed or not diagnosed until later?

– Well, sometimes, there are issues with either people having more the inattentive type, which doesn’t show as much. With children, the people that get told by teachers and such that there’s issues are the hyperactive kids that are running around or doing something, or behavioral issues that come from this. And those are the ones that are usually found. With inattentive, it’s not found as quickly because it’s just not paying attention. And what happens is the person just feels like maybe they’re either lazy, or stupid, or they just can’t get it. But, meanwhile, they’re really struggling because it’s a neurodevelopmental issue. This also occurs a lot in females as opposed to males because females have more inattentive type. So, then, later on in life they get diagnosed with possibly a mood disorder or something like that. And then what happens is in doing the comprehensive evaluation, they find that there’s other issues with ADHD.

– Right. And that’s interesting. Is ADHD more prevalent in boys than in girls?

– Diagnostically, yes. About three to four boys get diagnosed as opposed to one female. There is not necessarily enough data around to know exactly why that happens, but it could be just the diagnostic criteria that we look at and/or how ADHD presents in females differently than males.

– What are some of the biggest misconceptions about ADHD, do you think?

– One is that it’s behavioral or bad parenting that causes ADHD. That’s not true. It’s a neurodevelopmental. The parenting and/or the behaviors are just things that you see that happen because you have ADHD. It doesn’t cause ADHD. The other thing is that someone who has ADHD is just stupid, or dumb, or lazy, and that’s not true at all. Many very, very bright people have ADHD, and I’ve worked with people who were lawyers, who were researchers, who were doctors, and they just had ADHD. The other thing is that you outgrow ADHD, and you don’t. The neurodevelopmental part, yes, it gets better, but there’s still issues with the brain and the neurotransmitters that still occurs. So, therefore, it doesn’t go away. You can be more mature and maybe have more skills that you’ve developed, but you still do have ADHD.

– And so once you do have a comprehensive evaluation and once someone is diagnosed, what does that treatment look like?

– At the Center for Children and Families, where I work, we’re an outpatient clinic that treats children and families. Once the evaluation is done, then we do a treatment plan. We look at where you are with your skill level, and what you understand and know about ADHD, because education is a big part of treating someone with ADHD. And the psychoeducation around understanding ADHD, understanding that someone’s not necessarily lazy or stupid, or they don’t want to do it. It’s just possibly getting started is a problem. Understanding, too, that your expectations for that person at that age may not be exactly where they are because of the neurodevelopmental factor of this. So, having some understanding of ADHD is a good place to start. You need to work on skills because executive functioning is something that ADHD affects.

– What do you mean by executive functioning?

– Executive functioning is a part of your brain that kind of helps you get organized. I mean, coming here, we all had to get up, get ready, make sure we get here on time. It’s difficult for someone with ADHD to be able to have that organization to time out things. Their concept of time can be off. They can think something takes 10 minutes, it really takes a half an hour or something like that. And all those things can just add up and get in the way of kind of functioning in society. So, those skills have to be taught as opposed to come naturally. Looking at what skills are needed in the house and what, as a family, what you need.

– Is medication always a part of treatment, or is it therapy first, and then if that doesn’t work, medication comes in?

– It depends on the patient, it depends on the skill level, and it depends on the severity. And, actually, you can make that choice as to if you’re interested in medication or not. Medication is helpful. There are stimulants, which have a long history and a long research value that people have seen success with. When we’re concerned about quality of life, that’s something that we assess and suggest possibly looking into medication. It allows the child, or the teen, or even young adult or adult to focus more. And when you can focus more, you can learn skills much more easily. I know that there is sometimes fear of medication, and that can occur, but I also have seen a lot of success with people that do take medication.

– Is ADHD treatment lifelong? Typically, if you receive treatment, then are you good to go, or is it treatment that you continue to receive throughout life?

– It varies. Younger kids, yes, it lasts a little bit longer just because their skills. And because it’s hereditary, of course, sometimes parents are struggling with the same skills, so it may be more support as children are younger. As they get older, it’s not as much. And sometimes, it’s like any other therapy. You work on skills, you’re doing really well, then you maybe you don’t need therapy at that time. Sometimes, things that worked in the past don’t continue to work, so it’s OK to come back to therapy and get those skills again and then move on. So, yes, you can have therapy possibly for the rest of your life. It doesn’t mean you’re in therapy for the whole life.

– What’s a good day for you? When are you happy on the job?

– A good day for me is when they don’t need me anymore. So, I always say my job is to not be needed anymore. And when I see that they know that they did this — I’ve worked with them, but that they actually have the skills and have the ability to get better.

– Well, Rebecca Abel, we thank you so much for coming in and spending time with us today. Some really good information. We thank you for your time.

– Thank you.

– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

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UPMC Western Psychiatric Hospital is the hub of UPMC Behavioral Health, a network of community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors. Our mission is to provide comprehensive, compassionate care to people of all ages with mental health conditions. UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. We are here to help at every stage of your care and recovery.