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A
young mother who we will call Samantha (not her real name) came to my
office the other day and started the conversation with the following: “I
just spoke to my 8 year old son’s teacher. She told me that she thinks
he should be tested for ADHD because of the difficulty he is having
concentrating in class. I don’t want him to be labeled at such a young
age, but I don’t want him to fail his year either. Can you help me?”
ANALYSIS
OF THE SITUATION
I would like to share
my response to Samantha with other parents who may be facing similar
concerns with their own sons or daughters.
First of all, Samantha,
let me reassure you that you should not panic just because your child may
have ADHD or ADD. In fact, researchers in the
United
States
have
recently discovered that that certain parts of the brain in children with
attention deficit hyperactivity disorder develop more slowly than other
children’s brains, and that anywhere from 14 to 35% of children with
ADD/ADHD will fully overcome the symptoms by age 27.
Dr. Philip Shaw of the
National Institute of Mental Health lead a team of researchers who found
that these regions of the brain developed more slowly in children with
ADHD.
In what has been called
the most detailed report of its kind, Dr. Shaw’s research team used MRI
scans to measure the cortex thickness at 40,000 points in the brains of
over 200 children with ADHD and over 200 children who were developing
normally. The scans were repeated up to four times over a 15 year period.
In
particular, the scientists measured the thickness of the cortex, which is
the brain’s outer layer of gray matter, in different parts of the brain
at different points in time as the children grew up. The cortex thickens
as the brain develops, but after reaching its peak thickness it thins as
the brain matures.
What
the researchers found was that in the brains of children and adolescents
with the disorder, more than half of the cortex did not reach peak
thickness until around the age of 10 and a half, nearly three years later
than was the case in normally developing children.
The
lag was most pronounced in the prefrontal areas of the brain which control
many cognitive functions that are implicated in ADHD. These include areas
of the brain that are responsible for: impulse control; organizational and
attention skills; working memory, which is the ability to hold information
and manipulate it at the same time; and some higher order motor functions.
Development of
the higher-order functions and areas that coordinate those functions with
the motor areas was especially delayed in ADHD children while the only
part of the brain that matured faster in these children was the motor
cortex which might account for the restlessness and fidgety symptoms
common among children who are diagnosed with ADHD.
The most promising
discovery made by the scientists is that brain development in the ADHD
children followed the same basic sequence as in the more typical children.
While it is true that as many as two thirds of all children with ADHD will
still have a lot of symptoms as adults, researchers are hoping to study
those who do outgrow the disorder to determine what the brain did to
correct the problem. It is possible that at some point in the future they
will find a way of boosting the recovery process through some sort of
intervention.
RECOMMENDATION
The
first thing you should do, Samantha, is go to your doctor and see if he
can confirm that your son has ADHD. If you feel that his restlessness is
affecting his performance at school, then your doctor may recommend some
medication to control his behaviour while in class. We want to make sure
that your son achieves the maximum level of success in school so that he
feels good about his academic accomplishments.
While
the behaviour is being controlled through medication at school, I would
advise that you allow the medication to wear off by the time his personal
tutor arrives in the evening. I want the tutor to help your son with areas
of his actual school work in which he is having difficulty, but moreover,
I want the tutor to develop skills in your child that will stimulate those
areas of the brain that are slow in developing. For example, your tutor
will do some activities that help your son develop the ability to focus
his attention on certain tasks for short periods of time. We will show him
how to take notes or how to do things that will prevent him from getting
distracted so easily. The tutor can talk to you about setting up some kind
of reward system so that your son begins to look forward to working at
home and with his tutor.
Our overall objective
is to allow your son to identify those areas and topics in which he is
extremely interested and then have the tutor develop the desired skills
while your son is in his “own element”.
We will actually use his hyperactivity as a strategy to develop
skills.
While the tutor is
working with your son once or twice a week to “exercise” those parts
of the brain that are developmentally delayed, the medication will help
your son “perform” well for his teachers in school, thus ensuring that
he will get good grades as he progresses through the school system.
Hopefully, your son
will be one of those children who “grow out” of ADHD and by the time
he is a teenager or young adult it will no longer be necessary for him to
remain on medication. The skills he has been working on with his
“personal learning coach” will then take over and he should be able to
pursue his education and career goals. |
