There are different types: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, and Combined Type. It's either a 314.01 or a 314.00.
We'll not split hairs on diagnosis, though. Not today.
Did I ever tell you this story? (Let's change all the details, so even if it seems like it's you, no, it's definitely not you).
The story goes back to the early eighties when I was a young therapy doc. No idea what I was doing. That's how it feels all the time when you're a young therapy doc.
A couple of alcoholic parents come in with two little boys, ages 6 and 8, wild and crazy. Seemed to me, happy. The parents say, "The school insists we put our boys on medication. At least J, the older one. They'll wait on H."
J is eight and he has been a problem for as long as they can remember. Born on the move. These days he probably wouldn't have survived first grade without a drug to slow him down.
"But," the parents tell me, "We're alcoholics (in recovery for ten years) and we don't want to use any medication. We want to teach our kids how to behave and how not to behave. Can you help us? We'll work with you a hundred percent."
Well, sure. Glad to help.
(I quake, Uh, how should I know if I can help you?)
Meanwhile, the kids are literally climbing the walls of my office, swinging from the rafters. This is how I assess ADHD with hyperactivy. If they're climbing walls, standing on top of your desk, jumping on the sofa, then MAYBE there's a hyperactivity problem here.
We go to work on it. Both parents enforce the behavior modification program, my first, developed on the spot. Been using it for years, I say. (At this stage of my career, I have been using it for years. One day I'll make a video* demonstrating how it's done. You'll see me. I'll be the one talking to you in a ski mask.)
The teacher worked with us.
The grandparents had us covered.
The babysitter came to the therapy.
And it didn't take all that long for them to become new kids. Unrecognizable, nice kids. Productive, good students.
It's surely what someone used to say It takes a village stuff. She's totally right. But this isn't a political endorsement of any kind. It's an ecosystem endorsement.
Find your people and use them. Is that always possible? Aren't there other variables? What if people in the family, parents, especially, don't get along or have mental illnesses, personality disorders? What if? What if? What if?
Most likely that's the case, right? Everyone needs therapy. The specifics are what we call the big confounders. They make therapy more difficult. But not impossible.
All I'd like to suggest in this post, really, is that before the physician prescribes even the newer, better medications, that a good psycho-social history is in order.
More than once in the past few years I've seen an overweight adolescent girl who says she just developed what she is sure is ADHD.
She wants me to tell her pri-care to prescribe Ritalin or another drug to help her focus in school. A good student, a girl like this now has a boyfriend problem, or parent problems, and oh, definitely a weight problem. And trouble in school, a new problem. But if I get to know her (we talk girl talk) it's the weight that's freaking her out. I get it. She wants drugs to kill her appetite, slim down. Good drugs.
There's all kinds of prescription medication abuse going on out there.
Should we give children speed for obesity? Medicate children for carrying the emotional intensity of their family systems? It can be hard to differentiate hyperactivity from anxiety. But it's not my call. I'm not an MD. And neither are teachers calling for the med-evals, insisting, sometimes.
Maybe for some kids it is genetic and there is a need for medication. I don't know.
But I humbly suggest that a family assessment is in order before a doctor writes a scrip, and that parents look hard into other strategies of behavioral change.
Hyperactive kids can be nervous, angry kids, too. Treat them. Treat their parents. Get it all done the first time around. Shop for good therapists.
Parents should address all of the problems in the family, and all of the problems in the eco-system (school, church, etc.) that might be contributing to symptoms in their children.
It only makes sense. Of course, medication is so much easier, right?
* blee neder no promises