ADHD: ask the expert: a couple of tools to halt it’s rise...
ADHD is a very complex disorder with no known single cause. Research suggests that it is caused by a combination of genetics, physical environment and also psychosocial factors. So, in light of that, I had a quick Q&A with one of Better Babies Expert Advisors Christophe Sauerwein to see what (if anything) as parents we can do to potentially reduce the risks from a pscyosocial perspective.
Is ADHD on the rise or is it just that we are better at diagnosing it?
Christophe says: Both. The statistics show that currently around 10-15% of children are affected. That is a lot and it has risen over the last few decades. There are many causes, likely in combination with each other, however, part of the reason it is on the rise is modern times/modern environments. In fact, there is an association with ADHD and early internet use. Specifically allowing too much screen/internet use from too young age. That isnt to say technology shouldn’t be used at all, but issues like ADHD are certainly compounded by overuse of technology too early in development. So, although it has become an everyday tool to us it is something as parents we need to be very mindful of as it can be damaging.
Its worth noting a study in the Journal of Attention Disordered reported that ‘48% of children with ADHD…reported ≥2 hr of screen time on an average school day. The rapidly growing use of screens by children of all ages, from TV and gaming in older children, to use of iPads by infants <1 year of age, is of increasing concern. A recent meta-analysis confirms a small but reliable association of screen time with increased symptoms of ADHD’ (1)
Ok, so limiting exposure to technology too early is key - what are some of the other causes/things we can do?
Christophe says: There is certainly a part played by genetics. However one environmental element that has been shown to have an effect is too much stress and hyperarousal (hyperarousal: hightened anxiety - click here to read much more from Christophe about this and how you can reduce it). It has also been associated with unpredictability, disorganisation and instability in the family unit. So, keeping a calm, organised, predictable and routine based environment particularly in the early years is a great start. It may seem obvious but research has shown that not having that can exacerbate ADHD in a child.
This in fact links back to the issue with screen time: research has shown that too much exposure can illicit a state of ‘hyperarousal’ which is what you want to avoid particularly in the early years:
It is known as ‘the fast-pace arousal-habituation hypothesis’ and it builds on the role of cognitive and excitative response states. In a nutshell it suggests that fast-paced media forces children to repeatedly shift their attention and renew their orienting responses, which by definition increases arousal. If you have frequent exposure, children may become used to this to this fast pace and produce less arousal. As a result, children’s baseline or normal arousal levels may decrease, which may ultimately lead to ADHD-related behaviors as they seek to increase this. (2)
One of the other explanations around why screen time is a problem is the ‘scan-and-shift hypothesis’ which argues that the fast pacing of media prevents children from developing attentional focusing skills and forces them to constantly shift their attention. This hinders a child’s capacity to engage in activities that require more concentrated attention. (2)
Are younger children more suceptible to excessive screen time?
In terms of developmental susceptibility, academics have hypothesized that young children are more susceptible than older children to the effects of screen media on ADHD-related behaviors. The argument is that young children are less capable of controlling their arousal levels and therefore, the effect of media on children’s media-induced arousal may be stronger for young children than for older children. Some studies have backed this theory up, but so far there is not enough emiprical evidence to formally confirm this. (2)
Some research has also suggested boys are more suceptible than girls although more evidence is needed and there are many other factors.
What are some of the early the signs and symptoms to watch out for?
Generally speaking it is characterised by physical agitation, impulsive behaviour, undirected violence, restlessness and general mood instability. There can also be signs of obsession (which is why it has historically been confused with OCD) but this is typically more fleeting. The dominant factor tends to be difficulty concentrating for long periods.
One other thing to watch out for, particularly in older kids is hyper vigilance (obsessively checking safety and security) this is usually linked to family instability and associated with ADHD.
What are some of the best ways to avoid it developing in a child?
Christophe says: There is of course a genetic element but parenting certainly plays a role. First and foremost stability, security and present parenting is a great start. Reliability and repetition, making a child feel secure and that they know (as much as possible and with a healthy degree of flexibility) what is coming next - particularly in the earliest days is important.
Next, equally important, but increasingly hard in our modern times to achieve: ensuring that you’re not distracted when you’re with your children is very powerful (click here to read much more from Christophe on how to achieve this - well worth a quick read and super practical!). Finally, none of us live in an entirely stress free environment. It is an unrealistic goal (not to mention not representative of life!) but reducing unnecessary stress in the environment (unpredictability, arguments, hostility, distraction, impatience and negativity) as much as you can is a great start. We all have our bad days but if you’re striving to keep those to a minimum, acknowledge them and apologise for them then you’re doing great.
This is backed by research that shows ‘parent factors”, such as parental temperament, parenting stress, family conflict, unresponsive parenting, and chaotic parenting are negatively linked to ADHD-related behaviors and that responsive parenting can suppress ADHD-related behaviors.’ (3)
What happens if you have a child with ADHD. How best to treat it?
Christophe says: It cannot be cured by medication which can also have nasty side effects. Medication simply suppresses the symptoms. Psychotherapy and improving the environment is a much better course of action. Diet is also a proven tool - avoiding processed food, additives, colourants and foods high in refined sugar has to be a priority. Research has backed this up. (Article coming on the power of antioxidants in this specific case).
Action points and takeaways:
limit screen time particularly in very young children
Avoid too much unnecessary stress or ‘hyperarousal’ in a young child by keeping the home and family environment as calm, organised and as stable and reliable as possible.
Children pick up on negative and hostile situations so ensuring that the inevitable disagreements and arguments that happen in every home happen away from them is important.
Present and calm parenting is key. To learn more on how to achieve this increasingly difficult task click here but essentially it is all about taking time as you shift between your various roles as a parent, friend, partner, career person, chef etc! Christophe calls it ‘the transition’.
Routine is beneficial for young children
Diet is important: avoiding processed foods, additives, colourants and foods high in refined sugar or sweeteners should be a top priority.
Reading stories together using books vs screens is old school but effective when it is done regularly in developing attention in a non arousing manner. Even better if done at a regular time every day (ie. before bed) as part of a normal routine.
If you suspect your child may have ADHD then ensuring they get proper psychotherapy and seek expert help should be a priority.
(1) TONG L, XIONG X, TAN H: Attention-Deficit/Hyperactivity Disorder and Lifestyle-Related Behaviours in Children: PLoS One: 2016: 11(9)
(2) BEYENS I, VALKENBURG P, PIOTROWSKI JT: Screen media use and ADHD related behaviours: Four decades of research: Process Natl Academic Sciences USA: October 2018: 115(40): 9875-9881
(3) JOHNSTON C, MASH EJ: Families of children with attention-deficit/hyperactivity disorder: Review and recommendations for future research: Clinical Child Family Psychology Review: 2001: 4: 183-207
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