“Ryan” is 9 years old and has alot of energy. Does he have classic ADHD?
“Ryan” is a bright, beautiful handful
(disclaimer: this photo is not really “Ryan”)
His teachers say he is easily distracted and often obstinate with them (although, when you ask his swim coach, he doesn’t think that this is true). Ryan has trouble paying attention in most classes, but has no problems tinkering with bikes and lawn mowers for hours. He also can play video games for long periods (when allowed to). His room is very messy. Ryan can be very impulsive and often doesn’t pay attention to how his actions affect others or his own future. He doesn’t track his homework well, but gets great test scores — A’s and B’s mostly.
Ryan’s teachers say he should be tested for ADHD (guess what their Vanderbilt scores are likely to show), but mom is a little confused. She has heard from others that “he has a lot of energy, but he is a good kid and will probably outgrow it.” Ryan’s parent do think this just may be his temperament and that things may be OK with time. But they also see some potential problems: he is not getting good grades in school, he is sometimes making people at school mad at him, and he is getting more and more frustrated. He seems to be in conflict with others a lot and is increasingly feeling like he doesn’t belong. Mom and dad wish he would be better about homework, and taking care of things around the house like cleaning up after himself and putting things away after he uses them. Dad is getting a little tired of having his tools lost.
Ryan had a friend like him that was put on Ritalin. Things got better in a lot of ways for Josh, but he seemed flatter and less engaged. Ryan’s parents are concerned about life long stimulant medication and him losing the essence of who he is.
The description of Ryan certainly fits the classic ADHD profile. But it brings up a number of questions:
- Is Ryan headed for trouble? Or will he outgrow his symptoms?
- If he is headed for trouble, should he start medication? What are the upsides and downsides of medication?
- Are Ryan’s symptoms mostly from his genetics? Is this just his personality or really a disorder?
- Are these symptoms environmental: problems with diet, sleep, exercise, or media related?
- Was there something in Ryan’s early history – prenatal, birth, and early childhood – that could be contributing to his symptoms?
- Is there some kind of food sensitivity or allergy causing this?
- Is this simply an issue of “bad fit” with his school situation?
- Any of his symptoms coming from his home situation and/or parental response to him?
- What role is the broader culture playing, if any, to Ryan’s challenges?
It is important to explore each of these areas when working with someone like Ryan and his family. It is definitely true that we all have genetic tendencies for certain aspects of attention, self-regulation, and executive function. And none of these are simply good or bad; they usually come down to a matter of fit with our environment.
Next week I will describe in more detail the specific brain scan findings we would likely see in a child like Ryan. I will follow up by providing you a summary of some amazing work done by Thom Hartmann. Thom has brought together an amazing amount of research from the diverse fields of genetics, cultural anthropology, sociology, and geology to help put ADHD in a biological and cultural context. He makes a great case for us seeing the classic ADHD tendencies as potentially beneficial as long as we match the environment to support their eventually gifts.
After these blogs, I will help you understand Ryan through a different lens: the Chinese Medicine system. This system helps us see the strengths and challenges of different personalities, and helps us as parents and caregivers chart the most compassionate and helpful way forward.
So stay tuned for this next series of blogs!
Chris White MD
Providing Holistic ADHD Care to Families in Need