Originally published in Canadian Military Family Magazine, Fall 2019.
When a child presents with difficulty paying attention in their daily activities, the first thought a parent has is "Does my child have Attention Deficit Hyperactivity Disorder"? ADHD is diagnosed based on presentation, rather than physiological or structural changes. In other words, there is no bloodwork, scan or biopsy that can be done to diagnose ADHD. In its truest form, ADHD is a brain-based disorder that is caused by changes in dopamine levels, a hormone and neurotransmitter. That being said, there are many other elements to consider that can present similarly to ADHD but require different means of treatment. This is especially important to consider if you have a child who does not respond to traditional ADHD medications.
Sensory
Our sensory system provides us with information about what is going on around us. A healthy brain is able to filter out information which is not important and can focus on what we need to pay attention to. In some cases, these messages get crossed and a child is unable to filter out background noise such as the noise in the hallway, the birds outside or the hum from the fluorescent lights, making it very challenging to pay attention in class.
Vision
There are two parts to vision that I consider. The first is how clearly each eye sees an object at a distance, this is referred to as “acuity” and what is checked by an optometrist at a regular eye exam. The second is how well the eyes work together. This is called “teaming” and, for some children, this can be a huge challenge leading to double vision, headaches and the inability to pay attention when reading, printing, or copying from the board.
Gut Health
Our gut is made up of billions of microbes, some good and some bad. When the “bad” microbes take over, it can lead to changes in attention. Remember when I said that ADHD is based on dopamine levels in the brain? Approximately 50% of our dopamine is made in our gut (and 90% of our serotonin, which is our happy hormone!)
Primitive Reflexes
All babies are born with a set of primitive reflexes that are designed to assist with survival in the first year of life. Typically, these reflexes go away by around one year of age; however, when they don’t go away they can lead to challenges such as the inability to sit still, difficulty using the upper and lower halves of the body together (making sitting at a desk challenging) or using the right and left sides of the body at the same time (such as when holding a piece of paper while printing or cutting).
Too much screen time
Children who exceed the screen time guidelines are at a greater risk of developing issues with inattention. With exposure to screens, the mind is primed to expect information at a very fast pace; when information is presented at a regular pace in the classroom, the brain struggles to keep its focus.
Sleep
Poor sleep, or lack of quality sleep, can lead to changes in our ability to focus. If you have concerns regarding your child’s ability to fall asleep or stay asleep, or if your child is restless, snores or coughs while sleeping, talk to your doctor about a referral for a sleep study.
Mood Disorders
Depression and anxiety are commonly diagnosed in children with ADHD, but which comes first? A child who is experiencing a mood disorder may appear inattentive as they’re struggling to be interested in a topic, or their mind is too busy racing with other concerns. Stress at home can also have an impact on a child’s attention span.
Poor Breathing Patterns
Believe it or not, mouth breathing can lead to difficulties with attention. Mouth breathing leads to a smaller airway, as well as snoring, chronic fatigue, and brain fog, which all contribute to a child's ability to focus.
Trauma
Adverse experiences in utero and early in life can lead to physical and chemical brain changes that alter behaviour. Intergenerational trauma can also lead to ADHD-like symptoms as many as four generations after exposure.
If your child does not respond to traditional ADHD medications, or if medications are not a good fit for your family, it is important to consider that one of the above elements may be the issue. Speak to your family physician or pediatrician about establishing an appropriate treatment plans that meet your child’s individual needs and ensure that your child is successful in school and life.