Understanding ADHD

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On September 30, 2014, Carolina Parent hosted a live Facebook chat with Dr. Rebecca Jackson, Center Director of the Brain Balance Center of Cary, on understanding ADHD. Here's a transcript of the conversation (this transcript has been edited for clarity and grammar):

Carolina Parent Magazine: Welcome to the Carolina Parent and the Brain Balance, Cary, North Carolina"Understanding ADHD" LIVE Facebook chat! Today we'll be talking with Center Director, Dr. Rebecca Jackson, about all things related to #ADHD.

READERS: Ask a question as a comment below this post and don't forget to REFRESH your page!

Welcome, Dr. Jackson! Thanks for joining us today. Onto the first question: What are signs that my child has ADHD?
Brain Balance, Cary, North Carolina: Signs of ADHD: Some of the obvious are increased energy, lack of break or impulse control, distractibility. Some less obvious signs can also be hyper-focus (can get engrossed in something they love). We will often see signs of emotional immaturity, can struggle more with peer interactions on things like ready body language and understanding personal space and boundaries. The region of the brain impacted in ADHD also impacts areas that involved body coordination, high over view comprehension, math story problems, etc.

Carolina Parent Magazine: Is ADHD hereditary?
Brain Balance, Cary, North Carolina: Current research on ADHD is looking less at genetics and more at environmental concerns for why we are seeing the rise in ADHD statistics (and NC is considered the highest in the country in a recent survey). So while there can be familial component it is not thought to be ingrained in our genetics. This means we can see more of this in the same family, but is still not being thought of as truly genetic. Science is really looking at many environmental concerns that are impacting the brain and our development, especially in utero. The good news also is that since it isn’t ingrained in our DNA it gives us more opportunity to CHANGE and REDUCE the symptoms related to ADHD!

brain-balance-facebook-chat_001.jpgLauren Isaacs: How early can a child be diagnosed with ADHD? What should parents be looking for in their children's behavior or development that might get them an early diagnosis?
Brain Balance, Cary, North Carolina: There is varying opinion on the age that a child should/could be diagnosed. Personally I do not like to see this prior to school age for a formal diagnosis, although we are seeing it younger every day. ADHD are going to be behaviors and lack of attention across many environments, and not just in one – in school, home, with friends, etc.

Heather Hardison: I have a son who is ADHD. how can I help him?
Brain Balance, Cary, North Carolina: At Brain Balance we starting with a very involved, non-invasive functional assessment to see what area of function are working really well, and what areas are not. Then our program is tailored to address those specific needs, to ultimately strengthen the regions of the brain that are not giving adequate control currently. By doing this we can see a reduction in the symptoms, and often the child no longer qualifies for the ADHD label.
Brain Balance, Cary, North Carolina: Other things to do are keeping your child as physically active as possible! This engages area of the brain that do attention/focus/impulse control. A good routine, healthy food avoiding food dyes, preservatives and other offenders particular to your child (each child is different in what they react to food-wise and while gluten and dairy are common offenders, it is not gluten and dairy alone for everyone.
Brain Balance, Cary, North Carolina: Minimizing screen time can also be very important for all kids, but especially a child with ADHD. Screen time can actually over-ride the brain metabolic capacity, and can lower engagement of regions of the brain that do self-regulation and behavior control. (I loved the article the other day talking about how Steve Jobs didn't allow his children much in the way of screen time!)
Lauren Isaacs: I just read a Wall Street Journal article about the benefits of exercise and education for #ADHD kids (and all kids, really).

Carolina Parent Magazine: Can high-functioning students have ADHD? How can we know?
Brain Balance, Cary, North Carolina: Absolutely high functioning kids can have ADHD. In fact it is incredibly common for a child with ADHD to have above average intelligence. ADHD does NOT mean the child is not bright, talented, gifted. It means there are areas of the brain that are immature, but these are only small pockets. These areas can have an impact on attention, comprehension and other areas of school, which can impact a child’s school experience, friend and even athletic experience, but does not mean the child has a lower IQ.
Brain Balance, Cary, North Carolina: To truly know if a child has ADHD I recommend an assessment from a professional. Right now the diagnosis is being made off of many subjective pieces, and science is working hard to quantify this in a more objective manner. Through brain scans we can see physical differences in the brain and the number of connections, but unfortunately these tests are cost prohibitive. Someday soon though there will be more objective pieces available! For now seeking out a professional that involves as much data as possible to make a decision is important, not just going off from one or two observations.

Beth Poland Shugg: Are there ADHD medication combinations that create dangerous side effects?
Brain Balance, Cary, North Carolina: Certainly. These days we are seeing more and more drugs layered on top of one another. A student we saw recently started on one med, this med created a tic as a side effect, so another med was given to address the tic. While a tic may be a common side effect of some ADHD medications, it should NOT be happening. It is a sign that the dosage is too high, or perhaps the medication is not the right one in the first place. Always consult your physician, and be sure they know ALL of the medications involved, and be sure to share any side effects you are seeing. Also, if you are not comfortable with your treatment recommendations do not be afraid to get a second opinion, or change physicians.

Susan Waller Hearn: How early can a child be tested for ADHD?
Brain Balance, Cary, North Carolina: This answer will vary some depending on the practitioner as is there is no one set age. At Brain Balance we test as young as 4 years old, but not younger.

Sue Chen: How does diet/nutrition influence ADHD?
Brain Balance, Cary, North Carolina: Diet and nutrition will certainly not cause ADHD but it can exacerbate symptoms. Understanding how your child's body reacts to foods he/she eats can be a very powerful tool. I like using IgG Food Sensitivity testing for this (which is different than a classic IgE allergy test). The IgG tests are not perfect, but they can give us a really great sense of if a child is having an immune system reaction to foods they are consuming, and how severe. This once again can help to create a plan for a parent to more successfully navigate life with a child struggling with ADHD.
Sue Chen: Thank you!

Sherry Franke: How is Brain Balance different for an ADHD child who attends OT, PT or some other type of therapy? Won't those help him/her?
Brain Balance, Cary, North Carolina: Absolutely OT/PT can be helpful and beneficial for a child with ADHD. How Brain Balance is different is that we are focusing on what area of the brain is not functioning properly to create a LIST if symptoms, rather than focusing on each individual symptom. By working to address the UNDERLYING problem we actually see a reduction across the board in symptoms – social, academic, attention, etc. Each child we work with is different, but we see fantastic results on a daily basis! Go to our Facebook page later today and we'll share an awesome story a family sent us just yesterday of a child that completed our program more than 6 months ago and the differences they are seeing!
Sherry Franke: That sounds great! Thank you! 

Rachel Towry: Is ADHD considered to be on the Spectrum?
Brain Balance, Cary, North Carolina: Good question! No, ADHD is considered to be separate from Autism Spectrum Disorders. That being said what we are seeing neurologically speaking is that there are some similarities between the two, however Autism is going to be more areas of the brain impacted more severely.
Rachel Towry: So how can you know if they have both or just one?
Brain Balance, Cary, North Carolina: A professional assessment. Certainly you can have a child on the spectrum that will also display symptoms of ADHD, but not all children on the spectrum will. At Brain Balance in Cary or Wake Forest our assessment is $300 and takes roughly 3 hours. This assessment will let us know which areas of function are being impacted, but more importantly to me, it gives us a road map of how to create CHANGE that is lasting. Our goal is to not give families strategies to compensate for the challenges, but to actually increase engagement of the brain so that the struggles reduce significantly.

Terri Warren Amer: Have you tried the Brain Balance therapies on adults with ADHD, too? If so, have they been effective?
Brain Balance, Cary, North Carolina: These same concepts can be applied very successfully with adults. Unfortunately Brain Balance only works with children at this time. I would seek out a functional neurologist to help with adults (Dr. Darci Dane in Wake Forest is incredible and people come to her from all over to work with her). Hopefully down the road we will have a separate program at BB for adults as well. In science we used to believe that you couldn't change much past puberty and we now know this is completely false! Our high school and college kids over the summer had some of our most remarkable and exciting changes!

meet-the-expert_001.jpgHeather Hardison: How do I handle them, teach, help them?
Brain Balance, Cary, North Carolina: First with a great deal of love. This is not an excuse to let them get away with anything, but remember that this child literally is not using his brain in the same ways as his peers. He is not trying to be naughty, but simply requires more re-direction. The book Disconneted Kids, by Dr. Robert Melillo (the guy that created Brain Balance) is a great book for parents to read to help understand where these things are coming from. In the meantime, physical activity (are you noticing a theme with my answers?), visual cues, a routine schedule, healthy diet and consistency in parenting and between parents are helpful. There are a million ideas of parenting techniques, etc. My focus is always un increasing brain activation to give the child the tools to succeed, THEN implement the new discipline strategy, or talk about behavior, etc.

Carolina Parent Magazine: Do certain foods harm children with ADHD? For example, does sugar affect them, or is that a fallacy? How does diet/nutrition influence ADHD?
Brain Balance, Cary, North Carolina: There are a lot of foods that we eat daily that are harmful to all of us. Sugar impacts the brain in much the same way as drug substances such as cocaine. This creates a burst of energy, then a subsequent low, as well as having a negative impact on memory. This is especially hard on a child who already struggles with the area of the brain that does break and impulse control, as well as self-regulation, or how you handle yourself when you are upset.

The foods we eat provide our brain and bodies with the tools it needs to grow and develop. All of our brains function better when fueled by whole foods and a balanced diet. This topic alone could be discussed for hours. I think a balanced whole food diet is necessary for everyone to function at his or her best. I also think understanding your child’s specific body and how it reacts is also crucial. Each of our systems tolerates things differently. My daughter can handle gluten, but not dairy, and my son is the opposite. We didn’t fully realize this until we looked at lab work to see how their system reacts to things. Making these changes allowed us to see positive changes in our kids, that motivated us to continue eating this way (which has become much easier than years ago!).

Carolina Parent Magazine: Are ADHD medicines overprescribed?
Brain Balance, Cary, North Carolina: Personally I do feel that the use of ADHD medication is more common than ideal. This is not judging any parent for making the incredibly difficult decision to put their child on medication (there can be enormous pressure from outside sources, as well as stressful home environments). The thought for learning is that a child who can’t pay attention will struggle with learning. Long-term studies looking at medication usage is not showing a long-term increase in academic success (three years after beginning medication there is no difference is school scores for medicated vs. non-medicated for ADHD). You need to remember that the medication is simply a Band-Aid, not a solution (again, there are absolutely times in life where a Band-Aid is necessary!)

Carolina Parent Magazine: Is therapy the first route to try? When should medicine be considered? Or, should they go hand-in-glove?
Brain Balance, Cary, North Carolina: To truly understand ADHD science is studying the brain and we are learning there are physical differences in the brain of an ADHD child. A recent U of Michigan study shows that key brain connections are slower to develop in the brain of an ADHD child. While medication can certainly help to minimize some of the symptoms medication does not change/increase/mature the connections in the brain. There are absolutely times when medication is needed for a child to function in school, etc. However, to me it is so important to understand the medication is not changing WHY you are seeing this in the first place. Specific stimulation to the immature regions of the brain work to increase connections and functions, so that hopefully the child can function successful without the need for medication.
Brain Balance, Cary, North Carolina: It would be my hope that there is always something in addition to the medication being done, again to not only address the symptoms that can make classroom and home life stressful, but also working to address the underlying cause behind why these symptoms are present in the first place.

Brain Balance, Cary, North Carolina: A couple of my thoughts in general in understanding ADHD. My heart goes out to the child with ADHD. This does not make them a bad kid, or you a bad parent. This literally is a child that does not have the same "tools" to navigate life as their peers. This can make disciplining the child more difficult, school, homework, chores, friends and so many things more difficult. I hate for kids to be signaled out frequently for negative reasons, at home or in the classroom, but unfortunately this can be the reality for a child with ADHD. This can impact a child's sense of self, their willingness to challenge themselves, etc. At Brain Balance we work extremely hard each day to change things permanently for kids struggling with ADHD, so that they can have the same tools as their peers for success.

Katina Baker Faulkner: What can parents do to positively foster the social skills of their ADHD children- especially teens?
Brain Balance, Cary, North Carolina: Physical activity brings stimulation to some of the areas of the brain involved in ADHD, so keeping kids up, active, moving is beyond important! Minimize screen time as much as humanly possibly in today’s world of technology. Face to face time (not chatting via FaceTime, Skype, etc.) is important. Give your child as many opportunities to interact, and after talk to them about what they noticed, how they felt, how other people responded, etc. Proprioception is also frequently negatively impacted in ADHD, this complicates a child's ability to read non-verbal communication and understand personal space and boundaries. Activities involving balance (jumping on a trampoline, balance beam, exercising on a bosu ball, yoga, etc.) are all great activities that force us to use this area of the brain to strengthen it.
Brain Balance, Cary, North Carolina: Once there is better activation of these areas of the brain the teaching and communicating you do with your teen to help them navigate and understand social situations will become more effective.
Katina Baker Faulkner: Thanks Dr. Jackson!

Sherry Franke: Someone told me to wait and see how my ADHD son's school year goes first. Is there a benefit to bringing him in for an assessment at Brain Balance? Or should I wait, like my friend said?
Brain Balance, Cary, North Carolina: I never want to wait. If there is something I can do now that will only help my child succeed more, why wait. ADHD is areas of immature brain development. This means the longer you wait the larger the gap, which means it will take more time down the road to address. If you're not sure of what you are seeing, simply start with an assessment. There is NO obligation to go further than the assessment, and it will provide you with an incredible amount of information to help you understand WHY you are seeing what you are seeing. For me, I'd like a child's energy and focus to go into learning, and living life as a child, rather than having to work extra hard to pay attention, follow along, keep up with notes, etc.
Sherry Franke: That sounds like a good plan. Thanks, Dr. Jackson!

Susan Waller Hearn: Do you have canadian locations or affiliates? Would the testing you do be different than that done by a pediatrician?
Brain Balance, Cary, North Carolina: Unfortunately, we do not have any Cadadian locations or direct affiliates. Our recommendation would be to get the book 'Disconnected Kids', since it was written for parents that are not able to get to a center. As for our testing it would be quite different and more extensive than what is typically done in a pediatricians office.
Susan Waller Hearn: Thanks.

Becky Poland Korom: What do you do when the extreme emotionalism surfaces and tiredness frustration and medication wear off all set in at once and it's a perfect storm of chaos and crying for me and my son? His therapist suggested a "kicker" pill but I'm already not crazy about the meds he is on. Help? I wish is known about this live chat earlier I'd have planned my sat around it. I have so many questions.
Brain Balance, Cary, North Carolina: Ahhh! The stress in the situation you just described is enormous, for both you and your child. Another medication is an option, but again, at this point you are working hard to cope with a symptom of a greater underlying problem. Frontal lobe is the area of the brain responsible for self-regulation and it is immature in ADHD. Try getting him to do something completely different that has him move. Jump on a trampoline, swing and run. Get him out of the moment and have him use his muscles. Easier said than done I know, and depending on where the meltdown occurs not always possible. Once he calms down have him do some deep breathing exercises. As silly as this sounds it can be very important. When he is melting down to that degree his body is in sympathetic "fight or flight" mode, and there will be no reasoning or effective talking with him. Give him time to allow his system to calm and re-set. Diaghpramatic breathing helps to calm the sympathetic NS and calm the child.
Becky Poland Korom: It's so overwhelming and I feel so helpless when he becomes so distraught…. I'll try the breathing and redirection techniques. Thank you so very much!!
Brain Balance, Cary, North Carolina: Our time is up, and I know you have more questions. We do free consults at Brain Balance anytime and are happy to spend all of the time you need. You can call the center at 919-851-2333 to ask questions and to schedule a consult.
Becky Poland Korom: Such a good resource. Thank you!

Carolina Parent Magazine: I think that about wraps it up! Unfortunately we've run out of time, but what great questions you've all contributed! Thank you so much to Dr. Rebecca Jackson for your time answering these important questions. For more information about Brain Balance, Cary, North Carolina, head to their website.

And here are some questions listed below that we didn't quite get to during the chat, but that Dr. Jackson was able to provide answers for:

Does playing video games exacerbate the ADHD condition?
Because of the areas of the brain impacted by screen time and video games you will often seen an increase in negative behaviors after screen time. Screen time stimulates some regions of the brain and shuts down others. The area of the brain that is responsible for self-regulation is an area that is shut down by screen time, thus the negative behaviors.

I have a very rambunctious, high-energy child. Is this just boy behavior, or is this something beyond an 8-year-old boy?
Great question and hard to say without additional information. Every 8-year-old boy can be challenging in their own way. If you are concerned I would encourage you to have your child assessed. At Brain Balance our assessment takes into account gender and age, so we can directly address this very question. Typically there will be a list.

Is ADHD more common in boys or girls? Do ADHD symptoms differ in boys and girls? If so, does brain development play a role?
ADHD is more common in boys by almost 4:1. The symptoms are really the same regardless of gender. A large focus in research right now is looking at how stress factors in utero impact the development of a baby. Stress in utero can be emotional stress as well as many other things our bodies perceive as stress (toxins in the environment, getting sick, leaky guy from the mother, physical stress). What we are seeing is that stress converts estrogen to testosterone and this impacts the developing male fetus differently than a female.

How will ADHD impact my child long-term? How does it impact learning, friends, behavior, etc.? Do symptoms of ADHD change as children grow older?
Absolutely symptoms can change, because ultimately our coping strategies will improve with age and time, and 50% of children with ADHD are expected to out grow it. The good news is ADHD is no longer considered to be a “life sentence,” at Brain Balance we are targeting the areas of the brain involved and working to mature and changes these functions, to ultimately reduce the symptoms related to ADHD, so hopefully going forward the child has less to cope around.

How ADHD impacts friends: ADHD impacts areas of the brain that deal with break and impulse control, as well as reading non-verbal social cues, understanding personal space and boundaries, among other things. All of this can certainly impact age-appropriate social interactions.

How ADHD impacts learning: Again, immature areas of brain function will involve the frontal lobe which gives us attention and focus as well as comprehension. You can see a child that is an excellent reader, but struggles more with answering questions about what they read (main idea), or can do math, but struggles more with reading problems. You can also see delays in fine motor skills, so this child may try to avoid writing tasks. Written expression also involves areas of the brain frequently impacted in ADHD. By stimulating and strengthening these areas of the brain you can work to drive forward success in these areas.

Can children "grow out " of ADHD?
Recent research is showing 50% of kids outgrow ADHD. My concern is youth is the foundational time for learning, for developing self-esteem, and the confidence to achieve your goals. Adult statistics in ADHD show a higher rate of divorce, an impact on jobs and future earnings. For me, my goal is to help as many kids as possible now so that things are in place more successfully going forward, and you don’t have to “wait and see” if the child will outgrow ADHD.

I’ve heard that there is a condition known as ODD – oppositional defiance disorder. Is this true and if so, what is it and how does it relate to ADHD?
ODD is a true diagnosis, and while there can be a high correlation between ADHD and ODD this is not causation. In other words you can see many kids that qualify for both labels, but just because they have ADHD does not mean they will also have ODD.

Is prescription medicine always necessary for children who have ADHD? Are there long-term side effects for those who do take prescription medicine?
The choice to medicate is between the physician and the parent and it should always be a choice, albeit a difficult one to make often. Medication taken long term always comes with side effects and is certainly not a perfect solution. There are many different choices of medications and dosages on the market and it may take time to find the right balance for your child. At Brain Balance our goal is to positively impact the areas of the brain impacted in ADHD so hopefully the child can be successful on a lower dosage, or possibly without meds at all.

Why has there been such a rise in ADHD diagnoses in the past decade?
There has absolutely been an increase in awareness, which will drive up the diagnosis, but I do genuinely believe there are far more kids presenting with developmental concerns than in previous generations. Science is really looking hard right now at in utero development as well as how movement patterns and stimulation in infancy help to build and develop the brain. We are learning more every day about how so many of our environmental toxics are impacting development found even in our foods, and home environments are negatively impacting brain development.

Is there a trend toward homeschooling ADHD children/teens?
There seems to be a larger trend towards homeschooling in general, and certainly in the ADHD population. Schools today place huge demands on kids to NOT MOVE for hours on end. Kids and humans by nature are active beings. Creating an environment for kids to move actually increases activation of the brain involved in attention/focus so kids do better after movement! Homeschool provides parents the flexibility to create this environment in a positive way. Homeschooling is not for everyone (myself included) so look for other opportunities for physical activity for your child, 10 minutes of physical activity before school in the morning, burpees while doing homework, stair sprints before studying spelling, etc. Get creative and have fun with this!

Categories: Development, Early Education, Education, Health and Development, SK Development, Sk Education, Special Needs