Posted in Behavior, For Nurses, Health, Pediatric Nursing, Therapy

ADHD or “Quick Brain” and Trauma in Kids

Thoughts From A Pediatric Psychiatrist 

Some Health Professionals believe that Attention Deficit Disorder (ADHD) is misleading in itself – they believe a better name for ADHD would be — QUICK BRAIN.

  • ODD (oppositional defiant disorder) typically goes along with ADHD
  • Low Frustration is also a typical symptom of those diagnosed with ADHD 
    • Child becomes Easily frustrated when you TAKE away the video game
    • Child becomes Easily frustrated when it is TIME for bed
  • Another common finding in kids with ADHD — they are ANGRY but also HEARTBROKEN
  • Quick Reactions to Emotions is another common trait in those with ADHD

“ADHD is an Explanation NOT an Excuse.” 

ADHD

  • LACK of CONTROL of Attention
  • Under Attend to things OTHERS want you to focus on and Over Attend to things YOU want to do.
    • If a child likes Legos – they will be very focused while building legos. 
    • Same Child shows no focus during math class. 
  • AVOIDANCE– like behaviors or OVER Attending like behaviors?? 
    • A child is brought by a parent to psychiatrist intake – the child is in the waiting room reading a book of interest. When it is time to walk into the psychiatrists office the child has a hard time breaking focus from their book. *This could either be an avoidant behaviors (reading the book in waiting area not wanting to visit psychiatrist) or a over attending behavior of being super focused into a book of interest. 
  • THINKING about the WRONG thing. 
    • During Science class the child is thinking about baseball. 
  • All Brains are UNIQUE
  • No Brains are good at Everything!
  • ADHD Brain is Good At: 
    • Creativity
    • Innovation
    • Athletic
  • ADHD Brain Not very Good At:
    • Organizing
    • Planning
    • Categorizing Stuff
    • Memorizing (ADHD child may be the last one to learn the names of all the states)
    • SLOW things
  • QUICK BRAINS: If their brains get BORED they start looking for things that are EXCITING —> child starts to MOVE around, CHAT with others etc. This happens because they Can’t be excited when doing something boring! 
    • Sometimes an ADHD child does better if allowed to MOVE around, Doodle etc. (sitting on a yoga ball, given fidgets etc.)
  • QUICK BRAINS have a TOUGH time doing SLOW STEADY work every day. 
  • QUICK BRAINS have trouble regulating EXCITABILITY (too much sound or sight) – This is part of the EMOTIONAL problem. REGULATING EMOTION is hard. 

Kids with ADHD & Trauma

Kids Who have experienced trauma are set up for diagnosis of – But it does not mean they automatically should have a diagnosis of Depression and/or anxiety. Your psychiatrist should not be QUICK to diagnose and label your child with such diagnosis on the first visit. Try starting ADHD medication – See what happens with the medication – see what moves forward and what lags behind – whatever is found to lag behind would be a secondary diagnosis. 

  • Depression
  • Anxiety 

Kids who have ADHD diagnosis and have experienced trauma sometimes STRUGGLE with WILLFULNESS. It happens that when these kids are given EXCESSIVE SUPPORT  it can EMPOWER these kid – kids will actually feel empowered. The result is that the average demand is not being met when in reality these kids are 10% smarter than the average. We need to assume that these kids are capable and bright. OVERDOSE OF EMPATHY .

Starting Medication for ADHD

Use the Sequential checklist – Emotional/Behavior NICHQ Vanderbilt Assessment Scale for both Parent and Teacher **If you are going to ask a teacher to fill this out make sure that you TRSUT this individual. 

The NICHQ Vanderbilt Assessment Scales were developed through the Attention Deficit Hyperactivity Disorder (ADHD) Learning Collaborative project. This resource is used by healthcare professionals to help diagnose ADHD in children between the ages of 6 and 12. 

  • Total number of items scored 2 or 3 in items 1-9: _____  (ADHD, predominantly inattentive type—6 or more symptoms)
  • Total number of items scored 2 or 3 in items 10-18:_____  (ADHD, predominantly hyperactive-impulsive type—6 or more symptoms                                                                               
  • Total number of items scored 2 or 3 for items 1-18:_____  (ADHD, combined type—6 or more symptoms of both types)
  • Total number of items scored 2 or 3 in items 19-26:_____  (oppositional defiant disorder screen—4 or more symptoms)
  • Total number of items scored 2 or 3 in items 27-40:_____  (conduct disorder screen—3 or more symptoms)
  • Total number of items scored 2 or 3 in items 41-47:_____  (anxiety/depression screen—3 or more symptoms)

Older Child:

  • 1-9 = 8 — (ADHD predominantly inattentive type—6 or more symptoms)
  • 10-18 = 4(ADHD, predominantly hyperactive-impulsive type—6 or more symptoms)               
  • 1-18 = 12 — 10 (ADHD, combined type—6 or more symptoms of both types)
  • 19-26= 2 or 3 —(oppositional defiant disorder screen—4 or more symptoms)
  • 27-40 = 1 (contains forced sexual question) — 1 (conduct disorder screen—3 or more symptoms)
  • 41-47 = 4 — 4 (anxiety/depression screen—3 or more symptoms)
  • Diagnosis: ADHD, combined type – anxiety/depression OR  ADHD, combined type – oppositional defiant disorder – anxiety/depression

Younger Child:

  • 1-9 =  3 — (ADHD predominantly inattentive type—6 or more symptoms)
  • 10-18 = 8 — (ADHD, predominantly hyperactive-impulsive type—6 or more symptoms)  
  • 1-18 = 11 — 12 (ADHD, combined type—6 or more symptoms of both types)
  • 19-26= 8 — (oppositional defiant disorder screen—4 or more symptoms)
  • 27-40 = 3 (sexual force & property destruction on purpose) —(conduct disorder screen—3 or more symptoms)
  • 41-47 = 6 — (anxiety/depression screen—3 or more symptoms)
  • Diagnosis: anxiety/depression – conduct disorder –  ADHD, combined type – oppositional defiant disorder – OR anxiety/depression – oppositional defiant disorder – ADHD, combined type

The Difference Between ODD and Conduct Disorder: Article by Empowering Parents

ODD is characterized by a child or teenager who fights against authority figures, such as parents and teachers. Kids with ODD often lose their tempers, argue, resist rules and discipline, refuse to comply with directions and in general have a low frustration tolerance. The defining characteristic is a fight against being controlled. 

Conduct Disorder is used to describe an older child or adolescent who has moved into a pattern of violating the rights of others: intimidation or aggression toward people or animals, stealing or the deliberate destruction of property. The DSM-5, a diagnostic handbook used by mental health professionals, describes these individuals as having “a callous and unemotional interpersonal style.” It means a lack of empathy—not understanding or caring about how their behavior may physically or emotionally hurt others.

A key difference between ODD and conduct disorder lies in the role of control. Kids who are oppositional or defiant will fight against being controlled. Kids who have begun to move—or have already moved—into conduct disorder will fight not only against being controlled, but will attempt to control others as well. This may be reflected by “conning” or manipulating others to do what they want, taking things that don’t belong to them simply because “I want it,” or using aggression or physical intimidation to control a situation. 


Scoring Instructions for the Vanderbilt Assessment Scale—Parent Informant: The Vanderbilt Assessment Scale has two components: symptom assessment and impairment of performance. 

For the ADHD screen, the symptoms assessment component screens for symptoms that meet the criteria for both inattentive (items 1-9) and hyperactive-impulsive ADHD (items 10-18). To meet DSM-IV criteria for the diagnosis of ADHD, one must have at least 6 responses of “Often” or “Very Often” (scored 2 or 3) to either the 9 inattentive or 9 hyperactive-impulsive items, or both and a score of 4 or 5 on any of the Performance items (48-55). There is a place to record the number of symptoms that meet this criteria in each subgroup.

The Vanderbilt Assessment Scale also contains items that screen for 3 other co-morbidities: oppositional defiant disorder, conduct disorder, and anxiety/depression. 

For the oppositional defiant disorder screen there must be a score of 2 or 3 on 4 of the 8 items (19-26) on the subscale and a score of 4 or 5 on any of the Performance items (48-55). 

For the conduct disorder screen there must be a score of 2 or 3 on 3 out of the 14 items (27-40) on this subscale and a score of 4 or 5 on any of the Performance items (48-55). 

For the anxiety/depression screen there must be a score of 2 or 3 on 3 of the 7 items (41-47) and a score of 4 or 5 on any of the Performance items 48-55).

More on Scoring Instructions: Here


 Diagnosing ADHD

Deciding if a child has ADHD is a several step process – there is NO single test to diagnose ADHD, ANXIETY, DEPRESSION and certain types of learning disabilities can have SIMILAR symptoms. 

The American Psychiatrist Association;s Diagnostic and Statistical Manual, Fifth edition (DSM-5) is used by mental health professionals to help diagnose ADHD. It was released in May 2013 and replaced the previous version, the text revision of the Fourth Edition (DSM-IV-TR). This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities will help determine how many children have ADHD, and how public health is impacted by this condition. 

There were several changes in the DSM-5 for the diagnosis of ADHD: symptoms can now occur by age 12 rather than by age 6; several symptoms now need to be present in more than one setting rather than just some impairment in more than one setting; new descriptions were added to show what symptoms might look like at older ages; and for adults and adolescents age 17 or older, only 5 symptoms are needed instead of the 6 needed for younger children. 

Source: Behavioral Health Center, Sarasota FL

Author:

Mother, Pediatric Nurse and a Trail Blazer for Positive Change.

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