PITTSFIELD — School psychologist Kevin Tobin has seen it again and again in 26 years working at Pittsfield Public Schools: Students who struggle with focus will be challenged in school.
Tobin knows students with the A.D.H.D., or attention deficit hyperactivity disorder, will be challenged more than others to get through the school year as they struggle through persistent patterns of inattention or hyperactivity.
“It's not a problem of knowledge,” Tobin said. “They have as much IQ as others. But putting that knowledge into practice ... there is a disconnect between knowledge and execution and doing your part.”
According to a recent federal study, and in spite of skepticism by some psychologists, the number of students diagnosed with the neurological condition has increased by double digits in the last five years to 11 percent nationally.
A.D.H.D. is a neurological condition that impairs a person's impulse control and attention skills.
Parents in 2007 reported that approximately 9.5 percent of school-age children 4 to 17 years, or 5.4 million, have been diagnosed with A.D.H.D., according to the federal Centers for Disease Control and Prevention. The latest federal figures, following a review of more than 76,000 parents between 2011 and 2012, identify 11 percent, or 6.4 million children, have been diagnosed, according to raw data that was reviewed by the New York Times in March.
Local psychologists openly question the increasing national numbers, which include a 16 percent increase since 2007 and a 41 percent rise in the last decade.
Psychologists say symptoms can be confused with everyday acts of childhood, which includes recurring daydreams, fidgeting, or not being able to follow through in classrooms.
In most cases, an A.D.H.D. diagnosis is provided through observable conditions. It can require meeting up to 17 criteria across three categories — older adults need to meet fewer categories — in the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual.
This edition has updates for a diagnosis: Children can be diagnosed up to age 12 rather than by 5; several symptoms must be observed in more than one setting; and new symptoms have been added.
But some child psychologists feel A.D.H.D. may resemble other common conditions enough to make them uncomfortable.
A.D.H.D. can also easily be confused with post- traumatic stress disorder, anxiety, or learning differences. Other factors that can contribute to A.D.H.D. symptoms include the environment, family relationships and food.
In some cases, parents may even advocate for an A.D.H.D. diagnosis to create a false sense of security about a child who is acting up.
“They want to be labeled, but it's very dangerous ... It can also be a way to avoid the more difficult issues about what's going on,” said Stockbridgebased psychologist Dr. Jonathan Arnoff.
Child Psychiatrist Dr. Brenda Butler, of Berkshire Medical Center, questioned members of her profession she felt were too ready to diagnose A.D.H.D., saying a full review from “pre-pregnancy forward” should be understood before a diagnosis is provided.
She said diagnosing a child could be counterproductive.
“I personally feel it's an over-representation of the actual number,” Butler said. “In some cases it might not be an accurate diagnosis, or there is a different diagnosis that hasn't been made.”
Arnoff said older children are often times more ready to correct problems, because they recognize there is a problem. Young children could be more likely to be diagnosed with A.D.H.D. because they are over-stimulated at a young age, he said, and food and chemicals could also have a contributing effect.
He works with patients to recognize signs, create an action plan, and then repair or correct their actions.
Back to school
For students grappling with A.D.H.D., school psychologists say the school year can present significant challenges. Students can struggle with their self-esteem, face a higher risk of disciplinary action, and need a support group in order be successful. Support from parents and teachers and positive reinforcement will be essential for these students to get through the school year. Without that support, students can fall in a trap of academic struggles that leads to acting out and disciplinary issues.
“If you can't focus and learn, you can't access the curriculum,” said Ann Marie Carpenter, the unit leader for school psychologists and school adjustment counselors in Pittsfield Public Schools.
Tobin, the school psychologist for the schools, said it requires a team effort to help young adults through an A.D.H.D. diagnosis. He said he works with about eight students at Pittsfield High School with A.D.H.D., and he's skeptical about the increasing numbers, but added that the challenges these students face are real.
Low academic scores can result in low selfesteem and they could be challenged developing friendships. He hears about hopelessness and frustration.
According to Carpenter, Pittsfield Public Schools host workshops for teachers to help them through a diagnosis.
Carpenter said teachers can provide students preferential seating, or in rare cases they'll hand out beepers that, for example, can buzz every 15 minutes to allow the student to see if they are on task with a checklist.
Individuals dealing with more severe cases of A. D. H. D. are most commonly prescribed Adderall, Ritalin, Concerta, or other types of medication.
Medication might be an option for some students, Tobin said, but it still doesn't guarantee success. That requires repeated practice, which can be easier said than done for someone with A.D.H.D.
“None of those things will make you a great artist, writer or anything because that makes you required to sit, plan and be organized,” he said.
Signs of inattention ...
People with ADHD show a persistent pattern of inattention and/ or hyperactivity-impulsivity that interferes with funcitoning or development. Here are some symptoms:
Often fails to give close attention to details or make careless mistakes in schoolwork, at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted.
Is often forgetful in daily activities. From the Centers for Disease Control and Prevention.