A Look Into ADHD Diagnoses and Treatments in Delaware

According to the CDC, scientists continue to look for better solutions to prevent and manage ADHD symptoms. Here, local experts weigh in.

Two deaths devastated Amanda Stanfield’s family in 2019: one a good friend and the other a beloved family member. It was especially tough for her then-9-year-old daughter, Braelyn, who suffered a complete breakdown.

Soon after, it became apparent that Braelyn’s challenges were rooted deeper than in grief when she was diagnosed with attention deficit hyperactivity disorder (ADHD) and autism. It was the beginning of a new journey for the Frankford–based family as they searched for effective treatments and support.

Part of that journey for mom Amanda was a discovery about herself, she says. “[As] I started researching [ADHD]…something seemed familiar about the difficulties Braelyn was having in school.” It was a lot like her own experience as a child. A consultation with her doctor confirmed it: She too had ADHD.

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Concerning statistics

Thousands of Delawareans face similar challenges with ADHD, according to local experts. The disorder is increasingly turning up in conversations in school offices and social media videos. You might have heard parents discussing it during a kids soccer game or seen conversations in Facebook groups.

One sign of the times: The COVID-19 pandemic saw a sharp increase in people seeking out ADHD drugs, especially young adults and women, The New York Times reported, citing FDA research.

Assessing this disorder can be quite elusive, as it revolves around interpreting symptoms arising from the brain’s wiring. Consequently, much hinges on the accuracy of understanding and diagnosis. Recent statistics from the Centers for Disease Control and Prevention (CDC) indicate that approximately 11%—equivalent to 20,000—of children in Delaware have received an ADHD diagnosis. According to the advocacy organization CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), at least 80% of adults with ADHD in the U.S. remain undiagnosed. That would mean tens of thousands of adults in Delaware are dealing with symptoms that can make navigating even simple life scenarios incredibly difficult.

It can be hard to untangle ADHD from other issues at the best of times: Anxiety causes a lot of the same problems with focusing, multitasking and emotional regulation.

But are cases of ADHD actually increasing?

A look at the numbers

An uptick in cases might be a result of experts changing the way they diagnose, explains Cami Winkelspecht, a child clinical psychologist in Wilmington. She also points to increased awareness and less stigma. “But there hasn’t been a big jump.”

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In 2007, 12.6% of children in Delaware were given an ADHD diagnosis, according to the CDC. In 2011, that number was 12.8%. A Statista analysis put the tally at 12.1% from 2016 to 2019.

From 2020 to 2022—the height of the pandemic—the CDC’s survey found a similar number nationwide, with 11.3% of children receiving a diagnosis.

Lockdown was certainly enough to make people wonder about their state of mind. They juggled Zoom screens, dinner orders and waiting on hold for unemployment benefits while trying not to trip over the dog or the kids. It was, to put it mildly, distracting.

But perceptions about possible ADHD didn’t necessarily pan out, Winkelspecht says, based on the statistics.

It can be hard to untangle ADHD from other issues at the best of times: Anxiety causes a lot of the same problems with focusing, multitasking and emotional regulation, explains Wendi Schirvar, a clinical psychologist with Beebe Healthcare in southern Delaware. Or, people might have unresolved trauma, sleep apnea, early dementia, stress or hormonal imbalances.

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What to know about ADHD

ADHD’s more pronounced symptoms in children are well known, with kids often unable to sit still, disrupting class, throwing tantrums or failing to complete basic tasks. But as Schirvar has seen, ADHD often doesn’t go away, and adults with ADHD may struggle to focus or keep track of routine duties.

Symptoms of ADHD include impulsiveness, disorganization, poor time management, difficulty focusing or multitasking, poor planning and trouble managing emotions, Schirvar explains.

Sometimes people can actually “focus,” she adds—just not on what they’re supposed to be doing.

“People will say ‘I don’t have ADHD; you should see me focus,’ or ‘You should see my kid focus on a video game; I can’t get them [to stop],’” Schirvar notes. “But that can actually indicate hyperfocus, when a person has trouble prioritizing what to focus on.”

Confusingly, the term “attention deficit disorder,” or ADD, which many people still use carelessly to describe everything from an actual diagnosis to a tendency to lose their keys, has fallen out of favor in the medical field. ADD refers to a subset of the symptoms, not including hyperactivity, and is now considered only one expression of ADHD.

Getting to the root of the cause

All the buzz about ADHD raises many questions: Did stress and social isolation somehow trigger it during the pandemic? Are kids watching too much TV? Is it something in the water?

While environmental factors like chronic stress and diet can amplify symptoms, experts agree they are not generally seen as a main cause.

“ADHD is not caused by too much screen time, poor parenting or eating too much sugar,” a Nemours Children’s Health fact sheet states. “It’s an actual brain dysfunction…a brain constitution that develops from birth,” Schirvar agrees. “So it’s not something that somebody acquires later in age.”

While Schirvar dismisses numerous studies linking environmental factors like red dye to ADHD, a 2021 report conducted by the State of California’s Office of Environmental Health Hazard Assessment indicates that children who ingest synthetic food dyes can experience hyperactivity and other neurobehavioral issues.

Another study from the Journal of the American Academy of Child & Adolescent Psychiatry showed that restricting such synthetic food color additives from children’s diets resulted in a reduction of ADHD symptoms.

“There’s definitely a genetic component,” adds Chelsea Hastry, a doctor certified in pediatrics and internal medicine with ChristianaCare. “Parents and children often both get a diagnosis.” The exact cause, however, is unknown. Hastry thinks we need to be open to exploring further research on other possible contributors.

If you suspect ADHD is a modern malady caused by hectic lifestyles or diagnostic fads in psychology, history indicates otherwise. The signs have been there for centuries, although doctors used different terms in the past.

Hippocrates, the pioneering Greek physician from the fourth century B.C., described a condition similar to ADHD, which he thought was caused by too much fire in the humors, according to two Spanish researchers, José Martinez-Badía and José Martinez-Raga. In their 2015 analysis, they listed other descriptions used since then, including “disease of attention” (1798), “the nervous child” (1848), “simple hyperexcitability” (1899) and “hyperkinesis” (20th century).

Given that ADHD isn’t contagious or caused by stress, you wouldn’t expect to see a lot more people suddenly reporting it. Delaware experts agree there hasn’t been a rise in cases so much as changes in the way it is understood and diagnosed.

“Previously, if you carried the diagnosis of autism spectrum disorder, it was sort of mutually exclusive, and you couldn’t also carry the diagnosis of ADHD,” Hastry says. That would have left families like the Stanfields having to “pick” one or the other.

“Public awareness plays into it as well,” Hastry says. “Teachers [and parents] are now more aware of it, and more in tune to what to look for.”

Like Amanda Stanfield, many adults whose ADHD was overlooked in childhood are now being diagnosed. That’s partly because of the way people expect boys and girls to behave, Hastry says. “[Some] studies show that perhaps females internalize symptoms a little bit differently, a lot of times maybe having more symptoms of anxiety or other comorbid mental health conditions…and that it wasn’t the outward, standing on the chair, getting disruptive in class, shouting out things.”

Girls who struggle with other symptoms, like difficulty paying attention or forgetting daily routines, might not be as easily noticed, Winkelspecht points out. “And, nobody expects 8-year-olds to be organized anyway, so they might not stand out.”

Alli Williams is head of the Pilot School in Wilmington, focusing on students with learning differences and serving a significant number of students with ADHD. She emphasizes to teachers that it is important to catch symptoms in girls early. “[Don’t just ‘give it time’ because [the behavior] is not annoying you…or classmates. It still might be disrupting learning,” Williams says.

Searching for solutions

Many people turn to the internet to diagnose ADHD or learn how to treat it, but that can be a problem, Winkelspecht says.

“The [number] of professionals providing that [vetted] information on YouTube is actually quite small,” she says, citing researcher Russell Barkley, who offers videos, as a trusted source.

If you do receive an ADHD diagnosis from your healthcare provider, there’s a basic approach, our experts agree.

“The best evidence-based treatment for ADHD…is the combination of medication and therapy to learn the skill deficits,” Schirvar says.

Amanda Stanfield wishes she’d had some kind of medication when she was in school… “and the majority of my life,” she says. “My life is so much better now that I’m medicated. I know how to control it.” She also sees a difference in her daughter Braelyn. “She’s able to focus…prosper…just thrive in life.”

However, Braelyn had to try seven different medications to find the right one. Additionally, what works for one patient might not work for another.

But pharmaceuticals might not be the only answer.

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Finding alternative answers

“Two of the greatest interventions for all brain-related symptoms are activity and sleep,” Schirvar says. Conveniently, regular exercise aids in better sleep. Of course, a diverse and healthy diet has also proved helpful.

Some studies have found omega-3 fatty acids (salmon, fish oil, flaxseed oil) might help, or that combinations of caffeine and L-theanine (an amino acid and natural relaxant) could boost focus.

Madhuri Sharma, MD, founder and CEO of Flow Integrative Medicine & Direct Primary Care in Wilmington, believes in a food-as-medicine approach, incorporating a whole-foods anti-inflammatory diet with a variety of fruits and vegetables. Additionally, Sharma says, “Eliminating artificial additives like MSG, colors and sweeteners, as well as refined and processed foods will improve gut health, and further strengthen the gut-brain connection.”

Sharma suggests testing and repleting micronutrient deficiencies, such as B vitamins, vitamin D, magnesium and zinc, can improve symptoms of ADHD and optimize physiologic functions.

“Timing of meals to have a heavy lunch, medium breakfast, and light dinner, as well as fasting from 7 p.m. to 7 a.m. will help to support your body’s natural circadian rhythm and optimal production of hormones,” she says.

“Mind-body therapies such as meditation, breathwork and/or yoga [can] help with attention and focus and can also decrease stress. Additionally, regular exercise can improve behavioral, cognitive and physical symptoms of ADHD.”

The Stanfields have also adopted habits (Post-it notes, reminders, structured routines) to help with daily tasks and to calm their minds when they begin to feel overstimulated or overwhelmed.

While research for solutions is ongoing, people should advocate for themselves to find a therapy or therapies that work. Amanda Stanfield also wants people to better understand those with ADHD. “Information doesn’t sink in the same way for people with the disorder,” she says. “[Others] have to step back and learn how that person thinks and how that person learns.”

To support families dealing with ADHD, Williams and Winkelspecht have started a Delaware chapter of CHADD (chadd.net). Meetings provide supports for those dealing with ADHD, from educational sessions to opportunities for connecting and sharing. “Our hope was that they get good education and good community,” Winkelspecht says, “but leave with some tips that they can implement in their day-to-day lives.”

Related: 11 Ways to Promote Brain Health in Delaware

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