Aug 18, 2018 5 min read

Getting your kids into a new routine for the start of the school year is no easy task. Different sleep schedules, homework and after-school activities can throw everything out of whack. It takes a few weeks to get back into the swing of things, but some children just can’t seem to settle into a routine or settle down at all.

How are parents supposed to know when there may be a problem? Allegheny Health Network Child and Adolescent Psychiatrist Dr. Gary Swanson says, “It’s interesting going back to school. We tend not to see people so much in the summertime, but after they’ve been in school four, six, eight weeks and there start to be problems, teachers will report back that they’re having a hard time. Parents will then look for information.”

Swanson says whether your child has attention deficit hyperactivity disorder (ADHD) or is just rambunctious is a very complicated question and a diagnosis takes time.

“The problem with ADHD is that it’s not like my eyes, which I can say I can’t see straight and the doctor can adjust and ask is this better,” says Swanson. “ADHD is a very subjective diagnosis. You have to have a number of symptoms of hyperactivity, impulsivity, inattention, kids being distracted and unable to stay on task. It has to be sort of more than the usual for their developmental age.”

Swanson says trying to gauge that is very difficult. Teachers are often a tremendous source of input and can often notice if a child is having difficulty compared to other students. At the same time, Swanson warns, that doesn’t mean the kid with the worst attention span in the class has ADHD.

“We’ll talk with kids and observe them in our office when we’re trying to do evaluations to try to get a sense of whether the inattention is global and problematic and interfering with their functioning,” explains Swanson. “But there’s always going to be a subjective quality to it.”

Sometimes inattention isn’t noticeable until children are a little older. Signs of an attention disorder can show up as struggles at school or in social situations, when reading, trying to focus on a task or even when playing sports.

So how does a doctor diagnose ADHD?

“I need to think about all the things that might be going on,” says Swanson. “Maybe it’s ADHD or maybe he’s anxious, maybe he has a reading problem or a kid picking on him at school.”

Swanson begins by ruling out other possible contributing factors first.

If the diagnosis is ADHD, what comes next?

“Once I’m convinced it’s ADHD, there’s a lot of education for parents and children as to what it is and isn’t,” says Swanson. “It isn’t that you’re not smart, it’s a problem focusing and paying attention. It isn’t necessarily something that you see all the time. Clearly, if a child is trying harder, attention can be better.”

For instance, a child may focus better when playing video games because he or she is more motivated to pay attention to that as compared to doing homework.

Next comes the decision on treatment options. Swanson says most parents are reluctant to go right to medications.

“I don’t see a lot of people knocking on my door begging for medications,” he says. “Most parents are apprehensive.” Instead, many ask about counseling and behavioral interventions.

“The bad news is those kinds of interventions can be somewhat helpful but they only work for reducing the symptoms about ten percent,” says Dr. Swanson. “They’re not particularly effective. Medicines work much better. They have a better efficacy rate. Turns out they can be extremely effective.”

That being said, Swanson is quick to note he has nothing against using skill-building exercises and educational accommodations. Medicines aren’t perfect and don’t always work or don’t work all of the time. Often, a combination of treatments offers the best results.

For all we read and hear about ADHD, its prevalence is still fairly low. Swanson says he’s seen some estimates ranging from 5 to 10 percent of children, but he thinks 3 to 5 percent is a more accurate representation.

“I think there is more awareness of ADHD and more parents are at least receptive to that intervention,” he adds.

What has risen, he says, is the number of children with ADHD who are getting treatment for it. He cited a survey about 20 years ago on children with ADHD showing only 10 to 20 percent were taking medicine.

“Most of them weren’t getting help or effective medication,” says Swanson. “Now, the numbers are closer to 50 to 60 percent of kids getting treated for their ADHD with medicine. That still means a huge number are not. So if you look at prescriptions written for kids versus how many kids probably have ADHD, it’s not as many as you would expect, but it’s certainly more than it was.”

ADHD is thought of as a developmental problem – not that a child does not have an attention span, just that it’s slower to develop compared to other children that age. Swanson says this has to do with the frontal lobe of the brain not getting fully wired until adulthood.

“We see people with ADHD slower at connecting that frontal lobe, but we still expect it to happen along the way,” he says. “At least 50 percent of people outgrow ADHD and don’t have symptoms as grownups. Probably 95 percent of kids who have ADHD won’t take medication as grownups.”

Finally, Swanson encourages parents to take advantage of the vast amount of information and support available on the subject. But, he warns, you have to weed out the good and bad information and be wary of those offering quick fixes for the problem. If you have concerns, he recommends talking to your pediatrician first.