Wednesday, August 10, 2011

No my kid is not just a little a**hole.

My child is one of the many children in North America to be diagnosed with ADHD (about 3% to 5% of children in the United States are diagnosed with ADHD).

It goes without saying that my daughter is all sorts of wonderful, but raising a child with ADHD is challenging to say the least. Perhaps made harder still by the ever present controversy out there regarding whether ADHD is in fact a "real" medical condition or not. Unfortunately ADHD easily invites doubt as it has so many different facets and sub-types. You can be either ADD (attention deficit disorder) or HD (hyperactive/impulsive disorder) or ADHD (attention deficit hyperactive disorder). Where once we thought of ADD/ADHD being defined as a disorder having to do mostly with attention deficit, we are now told in actual fact that it is "hyperfocus" that better defines the "attention deficit" subtype to the disorder. With ADD/ADHD's seemingly constant evolvement and with all these variables at play, not to mention the stigmas attached to it, it tends to reason why so many might question its validity. However, ADHD is recognized as a mental health disorder. It has been acknowledged by major health organizations, including the National Institutes of Health, the W.H.O. and every other major professional medical, psychiatric and psychological association or organization out there. And there are studies showing not only a genetic link to the parents but also reports of a recent scientific study showing it may in fact be (in some cases) stemming from, but not limited to, large and rare variants in the DNA of children affected with ADHD, also known as genenomes called CNV's.

Yet with all this information available to us, it's legitimacy is still doubted. Add to the equation that my child is a girl with ADHD, and I am faced with the even bigger challenge of convincing others around me that she has this condition, even with a diagnosis from a psychiatrist in hand.

Unfortunately ADHD is often overlooked in girls and very often misdiagnosed as a learning disability and/or immaturity issue. Statistics showing that as many as 50% to 75% of girls will not be diagnosed till the age of 12, if at all (boys are diagnosed usually by their 7th birthdays if not beforehand). Although we now know that ADHD is not a gender specific disorder, it is still easy to find misinformation that says "statistically" boys are three times more likely to have ADHD than girls. Boys are not statistically more likely to have ADHD than girls, it's that ADD/ADHD is more likely to be recognized in them and therefore diagnosed. Girls have a tendency to present the symptoms of this condition differently then boys. They are not necessarily hyperactive or disruptive, two of the most common characteristics of ADHD. Or it may be that the way they are hyperactive and disruptive is not what we typically consider ADHD to look like.

The plain fact is that in this still very much male dominated society, girls are just expected to behave. Girls with ADHD are harder to pin point because mostly they *do* "behave", at least better then what one expects of a child with ADHD to behave like. When my daughter is at school it's hard to tell that she has ADHD because they keep her busy with daily activities. The outdoor physical activity she receives three times a day allows her the opportunity to release much of her hyperactive energy at school and therefore helps to balance her reactivity and quell her disruptiveness. She is still disruptive to a certain degree (certainly more obviously on a rainy day when they haven't allowed her outdoor recess), but when asked to sit down and work, she "behaves", for lack of a better term. When they do reading circle or she is granted time on the computer to play games her focus is fine, more then fine, her focus is great. She gets straight A's in Drama, Arts and P.E. Her attention deficit is not apparent in her getting up from her seat or acting out, she doesn't do this. Instead she is hyper talkative with her neighbors and unable to concentrate on the work in front of her or finish the work at the same speed as her peers. As a result she doesn't complete work sheets and gets below average grades in literacy and mathematics. And because she doesn't present ADHD the way they assume it should be she is not considered to have ADHD. Due to her low grades and inability to articulate her needs and wants properly she is assumed, like many young girls with ADHD, to be developmentally immature and have a learning disability (as a side note, LD's are often found in conjunction with ADD/ADHD). They don't know what the mornings are like before she gets to school, the need for the exact same ritual so we don't falter and trigger a meltdown. They don't know how she falls apart when she gets home because she's exhausted from working SO hard to keep it together all day at school. They have no idea that she has trouble getting along in her peer groups. That the little girls don't really accept her because she is too in your face and active for most of them, and that even though the little boys let her play because she plays the same way as them, they don't form intimate relationships with her because they are 7 years old, and she is: a girl. They don't know that she thinks of herself as dumb.

The bottom line is that as "a girl with ADHD" she falls into a crack where in lieu of others seeing that she has this condition she is all to often under estimated, and yet concurrently over expected to act like other little girls do. Whatever that is.

Personally I do see how there might be a lot of bullshit ADHD cases (which could easily be put into an "over diagnosis" category) if people are assuming their child(ren) have ADHD without a formal diagnosis and are instead reading the easy to find online "ADHD tests" (go ahead and Google it, I dare you) and are self diagnosing their children. And I like to think that it's hard to accept ADHD as a condition in my daughter's case because she is a fantastic, spunky, imaginative, sweet and clever little sprite who is mostly well behaved (and who wants to always be well behaved anyways?).

As parents dealing with a diagnosis that in general society is hard to accept, and even less accepted in her gender, we are working with getting to know the disorder and separate her from it. Making sure that we do not define her as a child with ADHD, which is hard not to do when (shamefully) embarrassed by your child's disobedience, but instead to define our child as an individual who also happens to have ADHD. We aren't in the least concerned for her future, we know she will learn to manage her ADHD and that she will be successful in whatever she chooses. In the meantime we are learning to not be embarrassed by her misbehavior and alternately be conscious and respectful in our requests and even (dare I say it?) demands of her. Every "no you can't do that" must be followed by a "because...". We can't just shuffle her along at our pace, we need to understand she moves at her own rhythm and needs early and repetitive (but gentle) prompting to get going where we want to go. We've learned, or are learning, not to sweat the small stuff and to pick our battles well. Moving through life this way can be virtually exhausting, but it's worth it. She reaps the benifits, as do we. Her ADHD does cause her to be extremely impulsive, hyperactive, reactive and have little to no boundary awareness or control. And we are beginning to grasp that we can't always suppress or guide her hyper activeness or emotionality in the direction we want. We have three other kids; we can't do it all, not all the time. It’s likely that others might sometimes become ‘put off’ by her "obnoxiousness" (hyperactivity), her "rudeness" (unable to respond or appearing to not be listening because she's processing a thought or listening to something else) or her "over sensitivity" (reacting to not being understood or not being able to explain herself clearly). We understand that sometimes we will be put off by it, even though we know she has a disorder that makes it difficult for her to stop acting that way.

Luckily she is mostly well behaved, not only because she's expected to by society, or because we are working really hard to parent her the right way, but because she is in fact just a super cool kid. She might not have close friends at school, but she does have best friends. She might not get straight A's in every subject, but she is one of the smartest people I know. She proves this to me each and every day in the things she says and her insatiable love of learning.


And yeah, sometimes she's just a little asshole. But she's our little asshole and we love her to bits.