By Amy Harris
All children learn and develop in different ways and at different rates. Some children reach developmental milestones when expected, and others do not. Sometimes delays or difficulties are the result of neurodevelopmental disorders. Attention-deficit/hyperactivity disorder (ADHD) is a very common neurodevelopmental disorder. Scientists believe ADHD has a strong genetic component. With early identification and treatment, children can thrive. However, without correct and early identification and treatment, a child who has ADHD can experience serious consequences, including school failure, depression, conduct problems, failed relationships, and substance abuse. Signs of the disorder are sometimes present as early as age 3.
Many of the symptoms of ADHD overlap with symptoms of childhood traumatic stress. Child traumatic stress is a psychological reaction in some children to a traumatic experience they have witnessed or in which they are involved. Traumatic experiences can affect the brains, minds, and behavior of even very young children. Children who have survived trauma may have difficulty paying attention, can act impulsively, or have trouble sitting still (sometimes called hyperactivity) – all also symptoms of ADHD.
Some other common symptoms of ADHD are often forgetting or losing things, squirming or fidgeting, talking too much, making careless mistakes on schoolwork, taking unnecessary risks, having trouble taking turns, and being involved in frequent conflicts, disagreements, and even fights with others. ADHD symptoms can continue into adulthood.
Teachers may be the first people to notice if a child is struggling to learn and interact with peers. The Individuals with Disabilities Education Act (IDEA) is a federal law that requires school systems to identify and evaluate children whom they believe may have a disorder. Under IDEA, a child may qualify for special services if they have ADHD, and if the ADHD significantly impairs academic performance. Parents also have the legal right to request an evaluation by the school for their child at any time. Services are provided free of charge for children who are diagnosed with ADHD.
Some parents who are not familiar with ADHD, special education programs, or laws requiring identification and evaluation may refuse evaluation and treatment suggested by schools. They may incorrectly believe that their child will simply grow out of their behavior without intervention. Jesse Applegate, Portland Public Schools Director of Special Education, said that receiving a diagnosis about a beloved child often distresses parents: “It can feel like we’re saying there’s something really horribly wrong … it can be scary.” However, Applegate said that individualized plans and services available through special education are helpful, and are “intended to support students, to keep them in regular classes, learning with their friends and peers as much as possible.”
Melissa Hoskins, Clinical Supervisor at Maine Immigrant and Refugee Services (MEIRS), a provider of whole family services, behavioral health services, and youth programs in the Lewiston area, agrees that parents often are upset when the school first suggests evaluation. However, she encourages them to work with schools, saying that refusal just delays diagnosis, treatment, and early interventions that can help a child. Services can help a child reach their potential.
Parents new to the U.S. system may mistrust, or even be insulted by the request to evaluate their child, and may refuse, fearing labeling or discrimination
Evaluating whether a child has ADHD requires specialists – maybe a psychiatrist, a psychologist, a social worker, a pediatrician or family doctor, a neurologist, an audiologist, or an ophthalmologist. The process is intimidating, and even American-born parents who are accustomed to navigating the U.S. education system can become fearful; for foreign-born parents, the idea of screening for a disorder or disability may be completely overwhelming.
Refugee and immigrant families may not be familiar with special education programs or the legal requirement for educators to request evaluation if a disability or disorder is suspected. Also, many refugee and immigrant parents are already exhausted by the struggle to secure housing, food, employment, and immigration status for their family, and yet another problem to face can be daunting. Parents new to the U.S. system may mistrust or even be insulted by the request to evaluate their child, and may refuse, fearing labeling or discrimination.
The most common treatments for childhood ADHD focus on symptom management through therapy and/or medication. For younger children, healthcare providers usually recommend behavioral therapy rather than medication. Behavioral therapy provides parents and children with techniques to teach and reinforce positive behaviors, and communication and problem-solving strategies. Eating a nutritious diet, participating in daily physical activity, limiting daily screen time to less than one to two hours, and getting enough sleep can also all make coping with ADHD easier.
ADHD is a disorder, and not something to be ashamed of. But, according to Bethany Cianciolo, a licensed counselor providing behavioral therapy to families through Gateway Community Services, “the stigma in many communities surrounding mental health and neurodevelopmental diagnoses keeps immigrant and refugee families from getting the support they need.” And although medication can be helpful in the treatment of ADHD for many children, frequently community members do not agree with children taking medication.
Some schools in Maine employ a Family and Community Engagement Specialist (FCS), whose work is to connect parents, school, and communities. Unlike U.S.-born parents, who are often raised to advocate for their children in school, people from other cultures may not be accustomed to asking teachers, administrators, or healthcare providers questions. But schools, healthcare providers, and behavioral health counselors in the U.S. are looking for parents and families “to be partners, to try to understand what the diagnosis means, and to know that they have the right to ask for more information, testing, or to say no to treatment,” explained Maureen Clancy, Portland Public Schools Language Access Coordinator.
The work of an FCS includes explaining the U.S. educational system. “These FCSs are so much more than interpreters,” Clancy said. “They facilitate parent meetings, work as cultural brokers, help to arrange healthcare appointments for evaluations, and provide psychoeducation to children and families about the world of special education – a world that becomes very complicated, very quickly, for families.”
Both ADHD and child traumatic stress can co-occur with other conditions, such as anxiety, depression, or other learning disabilities. Studies of US-born children and teens indicate that up to 60% of youth with ADHD may have at least one additional disorder. And life stressors such as housing insecurity can worsen underlying mental health and ADHD symptoms.
The exact cause of ADHD is unknown, but researchers and doctors say there is a connection with a person’s genes. Research is ongoing. The good news is that – whatever the cause – early and successful diagnosis and treatment can make a huge difference.