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Diagnosing ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurological conditions that affects between 3 to 6 percent of school-aged boy jumping on couch children.  Children with this condition exhibit significant issues with their ability to pay attention to tasks, inhibit their impulses and/or regulate their behavior.   In order for the diagnosis to be made, one has to witness significant impairment in regards to attentional regulation and/or activity level within multiple settings.  This means that the child must exhibit the concerns within the home, school, after-school program, sports team, etc.  In reality, the diagnosis can be made by a pediatrician or health care provider that is able to ascertain levels of functioning in the various domains by observing behavior or collecting parent and teacher report forms.

In the Neuropsychology Department at North Shore Pediatric Therapy, we focus on a comprehensive evaluation of a child’s functioning, including cognitive functioning, academic achievement, attentional regulation, executive functioning and social/emotional functioning.  Now, if the diagnosis can be made by a parent and teacher report, one must ask why a comprehensive evaluation should be mandated.  The answer to this is that over 45% of children that have been diagnosed with ADHD meet clinical criteria for multiple neurodevelopmental conditions.  Children with ADHD often present learning disabilities, emotional concerns and deficits with social regulation.  Sole treatment of the inattention may improve attentional regulation; however, there are other unaddressed concerns that may still linger.

Research has continuously demonstrated that the most common treatment of ADHD is a combination of pharmacological intervention, behavioral therapy, parent training, and teacher education.  Pharmacological intervention consists of stimulant medications that help to improve the child’s ability to attend to tasks.  A recent research article, which was even reported in an October edition of the Chicago Tribune, indicated that the majority of children who have been diagnosed with ADHD and are prescribed medication report significant improvement within their daily lives.  In the past, the main identification of improvement within children with ADHD was based upon teacher report.  Parents can now feel comfortable when asking their child if medication is helping. Behavior therapy focuses on the modification of the child’s environment to improve the frequency and duration of positive, on-task behaviors while extinguishing negative behaviors.  Parent and teacher education has a primary intent on discussing expectations within the home and school settings as well as possible modifications to ensure success.


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What Does my Child’s ‘Engine Level’ Refer to?

Many therapists use the term ‘Engine Level’ throughout your child’s therapy sessions, and possibly within her goals as well.  ‘Engine Level’ refers to your child’s energy level and the way her body is feeling in various environments and in various times throughout the day.  A child’s body is typically functioning at one of three ‘Engine Levels’.   Ideally, the goal is to be at the ‘just right’ level, in which your child can accomplish the most and focus on the task at hand.

Below are some explanations and examples of how your child’s engine level can be moving too fast, too slow, or just rightHappy child jumping

  • An engine level which is too fast means that you might notice rushing; distractibility; decreased body awareness; and decreased organization.  This might look like your child is running around aimlessly, touching her friends and neglecting personal space, or ignoring instructions and what her body should be doing.
  • An engine level which is too slow means that you might notice low energy and decreased endurance, inattention, and that your child is lethargic, sleepy, or unmotivated.  This might look like your child is slouching or falling out of her chair, propping herself up or leaning on a peer, not listening, or not attempting the task at hand.
  • An engine level which is just right means that you might notice that your child is refreshed and energized, that she is alert and ready to focus on the task at hand, and that she is aware of how her body is moving around her environment.  This might look like your child is maintaining an erect posture at the table to complete her homework or engage in mealtime, and she is correctly following directions and using her listening ears.

Try to use this ‘Engine Level’ lingo in a consistent manner so that your child can ideally develop increased body awareness and self-regulation.  Make sure you provide your child with examples of how your own body is feeling, or how you perceive her body to be feeling, so she can best understand what you are referring to (e.g. “It looks like your engine is moving too fast.  Your body keeps falling out of your chair.  Why don’t you stand-up and do 10 jumping jacks, and then try sitting in your chair again.”)  Stay tuned for my next blog on strategies to obtain a just right ‘Engine Level’.

Reference: Williams, Mary Sue and Shellenberger, Sherry. (1996,) “How Does Your Engine Run?”:  A Leader’s Guide to The Alert Program for Self-Regulation.  Therapy Works, Inc.

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