Selected Podcast

ADHD - What's Really Going On in the Brain

ADHD (Attention Deficit Hyperactivity Disorder) is one of the most commonly diagnosed mental disorders in children. Children’s of Alabama clinical psychologist Dr. Wayne Fleisig breaks down what’s really happening in the brain of a child with ADHD, and how to help parents overcome challenges at home, in the classroom and beyond.

For more information about ADHD (Attention-Deficit/Hyperactivity Disorder), Dr. Fleisig recommends these resources: (special education law and advocacy site for children with disabilities) (Alabama Disabilities Advocacy Program site for help with special education plans in Alabama) (Children and Adults with Attention-Deficit/Hyperactivity Disorder site for support and information)
ADHD - What's Really Going On in the Brain
Featured Speaker:
Wayne Fleisig, PhD
Wayne Fleisig, PhD, is a clinical psychologist at Children’s of Alabama with a special interest in children with ADHD (attention-deficit/hyperactivity disorder). Dr. Fleisig graduated cum laude from Dartmouth College in 1985 with a BA in psychology and then earned his PhD from the University at Albany, State University of New York (Presidential Fellowship) in 1993.  He wrote a syndicated newspaper column from 2000 until 2006, and has been a monthly guest on “Good Day Alabama” (WBRC Fox 6) since 1997.  Dr. Fleisig has served on the Parents Magazine board of advisors since 2010.  In 2016, the Alabama Psychological Association recognized Dr. Fleisig with an award for promoting the field of psychology to the general public.

Tiffany Kaczorowski (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Tiffany Kaczorowski. ADHD, behavior problems, anxiety and depression are the most commonly diagnosed mental disorders in children. And today we're focusing on ADHD or attention deficit hyperactivity disorder. Joining us today, is Dr. Wayne Fleisig. He is a Clinical Psychologist at Children's of Alabama, with a special interest in children with ADHD. Dr. Fleisig has been working with kids for 30 years now and has served on the Parents Magazine Board of Advisors since 2010. Welcome Dr. Fleisig.

Wayne Fleisig, PhD (Guest): Thank you for having me.

Host: So, let's start off with a definition of ADHD. What is it?

Dr. Fleisig: Symptoms include problems with attention, hyperactivity, impulsivity, or acting without thinking. Now, of course, you know, children in general are not world renowned for being great at those kinds of things. It's just when it's more severe and more significant than other kids, and when it interferes in their life and causes distress, that's when we start looking for ADHD.

Host: And how many children have ADHD?

Dr. Fleisig: It's estimated that about 8% of children have ADHD. So, it's a very prevalent thing. And so it's very important that parents know about this.

Host: But there are different types of ADHD, right?

Dr. Fleisig: We used to call it ADHD and ADD. Now it's all called ADHD. There are three different types. One is inattentive type. One is primarily hyperactive type. And one is combined. When you have inattentive type, you're looking at things such as difficulty paying attention or making careless mistakes. Trouble staying focused. The kid doesn't seem to listen when he's spoken to, doesn't follow through with instructions or complete schoolwork problems, organizing, avoiding, and disliking tasks that required sustained mental effort, loses things a lot, easily distracted, forgetting. So, when we're talking about hyperactive or impulsive, we're talking about kids who fidget, aren't able to stay seated. They run about or climb when it's not appropriate, they're unable to play quietly. They always seem like they're on the go, as if driven by a motor, they talk too much. They blurt out things. They have difficulty waiting their turn, and they also interrupt or intrude on others. Now, obviously, kids with ADHD will not have all of these. But for inattentive type, you need six of those that I mentioned earlier, and then hyperactive impulsive type, you need six of those latter ones and combined type is a combination of those two.

Host: So, what should parents be looking out for? What's the difference in you know, when it becomes ADHD, when it's, when it's more of a problem?

Dr. Fleisig: Right. And this is why it's so difficult because everybody has this to some extent. It's when it's more extreme or causes bigger problems or bigger distress that that's when we start looking for these things. Now, unfortunately there's not a lab test for this. We gather information from parents, teachers, from the kid himself, and we'd make the diagnosis according to that.

Host: And you had said earlier when we were talking, that the name, attention deficit is a little misleading.

Dr. Fleisig: It is. So, so let me tell you, what's really going on here and let's start from the beginning when somebody is born, you know, if they want something, they can't stop themselves, they can't hold back. They can't look at the future or anything like that. They want what they want and they want it then. And if they can't get it, they get upset and they cry and things like that. As people get older, they have more of an ability to wait on things. And as you get even older, you become an adult, you have more of an ability to wait on things and being able to wait on things often gives you better results because you don't act impulsively.

And you think about things before you make your decisions and you can get better consequences because you're, you're thinking about things, you're remembering, you're planning, you're organizing, you're processing new information. You're thinking about the future and you are basing your decisions on a lot of information.

The crux of ADHD is that when I have ADHD, my mind does not allow me to stop between my want or my thought and my action. And so I don't stop long enough to be able to think, remember, plan, organize, process new information. Basically it's like the brakes on the brain are not working well. So really ADHD should not be called ADHD. It should be called difficulty stopping and giving yourself enough time to think disorder. But that's too hard to say. And this is what's confusing to parents. They often think it's about attention, but it's really about the inability to stop, so you can spend some time thinking

Host: And to make a correct judgment or to think about consequences.

Dr. Fleisig: Right. Right. You know, think about it this way. It's kind of like when you drive in a fog, you can see two feet in front of you and two feet behind you and you can just see where you are then. And that's all you see. And you go, wow. It looks great. Two feet in front of me, two feet behind me. Let me go. The problem is that there's tree three feet in front of you. When I have ADHD, I'm only looking right there at the right now, and all my decisions are based on that. So, I'm not remembering a lot of important information from the past. I'm not processing a lot of information now. I'm not thinking about the future. It's all about the right now. And all my decisions are based on what works well for me right now. And I just make bad decisions.

Host: When do parents usually first start noticing this, or are we noticing kids having these types of symptoms in the schools once they get to pre-K or kindergarten?

Dr. Fleisig: Some kids you can tell from day one, I mean, parents come in and say, man, from day one, I knew this was going on. For a lot of other kids, you don't notice it until the demands of life get bigger. So, you're in preschool. You're allowed to run around and do this and do that. But once I start getting to kindergarten, I'm supposed to be sitting there and I'm supposed to be paying attention. And that's when the parents may start noticing it more. But then when you ask them, a lot of time to say, yeah, I kind of knew this earlier on, but I just didn't even realize that it was a problem.

Host: So, I would imagine for parents, it can also be very frustrating for them as they're trying to parent this child. And if they have other children they're trying to parent as well.

Dr. Fleisig: It is very frustrating because everybody has these traits to some extent, we all sometimes forget things, don't, don't think about things and act impulsively. And so we just assume that, hey look, it's just the same as the rest of us. And we, we think it's not real. But there's a lot of evidence and more and more each day, that it's a natural physiological difference in the way parts of the brain function. And the fact is it's just more extreme than other people have.

So I, for example, as you can see, I wear glasses. So, I have some vision problems, but you know, I wear my glasses and I focus hard on my work. I can drive and I can do my paperwork. But I wouldn't say to somebody with way more extreme problems, somebody who, for example, is visually impaired or is blind; I wouldn't say, well, just put on your glasses and drive, because we know it's a whole different ball game there. It's more extreme. And that's the thing with ADHD. Yes, we all have these problems to some extent. But it's just way more extreme when we have ADHD, you know, you can say, well, I just focus harder and pay more attention so I can do it. So, you should be able to do it also. And that's the frustrating part to parents because they think the kid just needs to focus more and concentrate more.

And the other part that is very frustrating is it seems like these are purposeful actions that the kids are doing, because look, I've told him a thousand times not to do this and he still did it. So, he must be doing it purposely. But we have to remember that he's not stopping and thinking and remembering those 999 times that you told them before. And so it's not a purposeful thing. Again, going back to me with my glasses, if I took my glasses off and I stepped on your foot, you'd think it was purposeful until you realize I'm not wearing my glasses. And then you say, oh, well, that's what it is. It's not a purposeful thing.

Host: So, talk about the importance of recognizing and diagnosing ADHD early on.

Dr. Fleisig: You know, the thing about ADHD is a lot of parents just think, well, it's not that important. You just, you know, he's a little hyperactive, it's not a big deal, but there's some debate on whether people outgrow this or not. My feeling is that most people do not outgrow it. They may learn to compensate over life or they may choose jobs or situations that doesn't become as big of a problem. So, they may not get a job that's so detail oriented, but one that it's more conceptual and things like that, but it is a very significant thing. It's not a death sentence, but it definitely causes significant, significant problems if it's not well-treated. People who have ADHD, when it's not well treated, have much higher rates of failing school, dropping out of school, injury from accident, attempting suicide, getting involved with crimes, drugs, and alcohol. They may be sexually active, too early. They don't take good care of their health. They may be involved in car accidents, problems on the job, in marriages. When you think about it, to do well in all those areas, you have to stop and think. You know, oh, I don't want to do the schoolwork. Well I have to think about what my future will be. Why do people get involved with drugs and alcohol?

It feels good now, they're not thinking about the future. Why do people get involved in crime? They think they're not going to get caught. I'm angry at my boss. I can't just yell at him every time, I have to think about the consequences. And when you think about it in these ways, it can also shorten my life expectancy. If I'm involved in crime and driving too fast and involved with drugs, it can shorten my life expectancy. So, it is a significant thing and we do have to take it seriously. Fortunately, it is one of the most treatable things that we have in the area of psychology and psychiatry. And we have great optimism when we work with kids ADHD.

Host: So, what types of treatments are available? What types of things can you do early on?

Dr. Fleisig: Well for many kids with ADHD, the most successful approach is a combination of working with a psychologist or a therapist on issues such as parenting, behavior management, individual therapy, and a medical professional to discuss the possibility of medication. When medication is warranted, the job of the medication is to kind of act like brakes on the brain. It helps the child be able to stop, so that he can then use his thinking. Additionally, many kids with ADHD would qualify for special education services through the school. So, the school can work to make certain changes, to best educate the child in a manner that best fits him and his specific individual needs.

Host: I've had some friends who've been told maybe by a preschool or kindergarten teacher that you might want to look into ADHD. It seems your child has difficulties in the class concentrating and focusing that type of thing. Is that oftentimes when parents hear it the first time?

Dr. Fleisig: Yeah. Again, when the kid is at home and he's just running around playing with his brothers and sisters, you may not notice it as much, but when he's in a structured classroom, the teacher who has a lot of training and has spent many years working with kids can see some of these differences. So, that is a time that often parents hear about it first. Yeah.

Host: So, what are some other areas that parents experienced? Some other frustrations that parents have?

Dr. Fleisig: So, other adults will look at your child and just say that he's lazy. He's, he's a bad kid. He's not motivated. And they think that giving a medication is just the easy way out and they don't really understand what's really going on here. And parents then start feeling guilty for themselves. They say, well, everyone else's kid, you know, acts this way. My kid acts this way, is it because I'm a bad parent and no, this is not from bad parenting. Many kids who have ADHD, this is just the way they're born. It tends to be genetic, tends to run in families. Raising kids with ADHD is very, very difficult. You know, all of these problems are very frustrating and you may feel like, oh, well, I'm failing as a parent. And you know, my kid is just a bad kid. But you have to stop and take a step back and say, well, gee, maybe this is ADHD. Maybe it's something that we really need to get assessed and treated, and that it's not that he's doing these things purposely. It's just, this is ADHD rearing its ugly head.

Host: As a psychologist, how long does it typically take to be able to diagnose a child with ADHD? What's that process like?

Dr. Fleisig: So, we want to gather a lot of information. As I said, there's no lab test for this or anything like that. We really want to spend a lot of time gathering information. We'll get information from the school. We'll get information from the parents. We'll get information from the child. We'll observe the child, we'll ask questions. So, you really want to spend your time gathering the information. You want to rule out other things. And you want to be really sure about this because it is an important thing to get right.

Host: And I would assume that a child who has ADHD, would then become an adult with ADHD. And so that needs to be managed throughout their lifetime.

Dr. Fleisig: Yeah. As I said before, there is debate over whether people can outgrow this or not, but for many people it's a lifelong disability. You know, I need my glasses and I'll need them my entire life. I'm not going to outgrow this. But there are ways to work on it and manage it. And ADHD is not something that we fix or cure. Again, going back to my eyes, they don't fix my eyes, but they manage it with glasses. Same thing with ADHD, we don't fix ADHD. Doesn't go away. We learn ways to manage it through behavior management, coping skills, some people require medication and it's something that we can manage. When we work with kids with ADHD, we're very optimistic about this because it's very debilitating, but it's one of the most treatable things that we work with.

And so we have a lot of optimism for it. If you feel your child may have ADHD, it's important to consult with a professional who's qualified to diagnose this. Many of the kids who have ADHD are referred to us from pediatricians. The parents come into the pediatrician's office and say, my child's having a problem with this or that. As you said before, sometimes teachers can point it out to the parents. It's important to find somebody who is qualified to do an assessment, who spends a lot of time working on ADHD, because you want to get a thorough, good assessment. Also if a child does have ADHD, school can be very difficult.

And so you may want to pursue a special education services through the school system. There are things such as IEPs which is an individualized education plan or a 504 plan, which schools can provide appropriate services to kids with ADHD, if they qualify. So, you would want to contact the principal at the school. I recommend you always do it in writing, so there's a paper trail.

Host: You had given us a few websites. First is Wrights law. That's W-R-I-G-H-T-S law, wrights Explain what that is.

Dr. Fleisig: Wrights Law is a website that is made by a special education person and an attorney, and it's just chock full of good information. You can type in questions there about special education rights, and it's just really has a lot of information there.

Host: And then for Alabama, ADAP, And that is for the state of Alabama special education.

Dr. Fleisig: Right, every state is required by federal law to have an organization such as ADAP, which helps people with disabilities get appropriate services. So you can contact them. It's free of charge. They also publish a book that talks about the special education rights in the state of Alabama. And I believe you can download it off their website. And so again, it's a resource for parents to contact if they feel they need to.

Host: And then on the national level, Chadd,, and that is a great resource. I gathered some information myself on parenting a child with ADHD from there.

Dr. Fleisig: You know, when you're a parent of a child with ADHD, there's a lot of good information out there, but also a lot of bad information out there. So, you want to make sure that you get good information from reputable sources to help your child as best as you can.

Host: Okay, thanks so much, Dr. Fleisig for joining us today.

Dr. Fleisig: It's my pleasure.

Host: Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at children' pediatrics.