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Attention Deficit Hyperactivity Disorder
(ADHD/ADD)

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder where children consistently display certain characteristic behaviors that are long term, excessive, and pervasive, and appear before age 7 and continue for at least 6 months. In order to qualify for an ADHD diagnosis, the behaviors must create a real handicap in at least two areas of the person’s life such as school, home, work, or social settings. Typically, the onset of ADHD occurs when the child is approximately 18 months of age and will be more noticeable by age three years.

ADD is a term used by many to describe children who are missing the "hyperactivity" portion of ADHD, however, the official clinical terminology, regardless of whether they display hyperactivity, is ADHD. ADHD has been recognized as a "disability" in the ADA, IDEA, and Rehabilitation Act of 1973.

The cause of ADHD is unknown, however, it is believed to be the result of a chemical imbalance in the brain with a strong genetic basis. What is known, is that ADHD is not the result of poor parenting, too much TV, poor teachers and schools, too much sugar, or food allergies. It is estimated that 4-6% of the population in the United States have ADHD, affecting as many as 2 million children. Boys are three times more likely than girls to be affected by the disorder.

 

Features and Characteristics

There are four classifications of ADHD: Inattentive, Hyperactive/Impulsive, Combined, and Not Otherwise Specified.

Those with Inattentive ADHD display at least six of the nine characteristics as follows:

Those with Hyperactive/Impulsive ADHD display at least six of the nine characteristics as follows:

Those with Combined ADHD meet the criteria for both Inattentive and Hyperactive/Impulsive ADHD.

Those with Not Otherwise Specified ADHD display some of the characteristics seen in the other types, however, do not have enough of the symptoms to reach a full diagnosis. The symptoms they do have, however, disrupt everyday life.

 

Diagnosis

There is no single medical test for diagnosing ADHD, however, clear-cut diagnostic criteria have been developed and are listed in the Diagnostic and Statistical Manual of Mental Disorders, which is published by the American Psychiatric Association. For an individual to be diagnosed with ADHD, comprehensive evaluations must be administered including ruling out other possible causes for the child’s behaviors, a family history, ability tests, achievement tests, and a collection of observations taken from individuals who are close to the child. Psychiatrists, psychologists, pediatricians, and neurologists can all diagnose a child with ADHD (Note: psychologists are unable to prescribe medication.).

 

Treatment

ADHD is not a disorder than can be cured; it is instead managed and treated over time. Medication is often used to treat ADHD. Stimulant medications, such as Ritalin and Dexedrine, are the most commonly used drugs. Ritalin and Dexedrine have excellent safety records when used and monitored correctly by a physician. These drugs are likely to improve some of the symptoms of ADHD in 90% of the children.

Usually, drug treatment is not enough. Often times, teacher and parent training as well as family or individual counseling may be necessary. Behavior therapy is also helpful to help modify inappropriate behaviors and to deal with the emotional effects seen in individuals with ADHD.

In addition to medication and therapeutic measures, other important things can be done such as providing a supportive environment for the child, and teaching him or her organizational skills, study skills, memory skills, and time management skills. Medication will often be helpful if used when the child is trying to learn these skills in that it can decrease the impulsivity/hyperactivity, increase the child’s attention, and reduce aggressive behaviors, allowing the child to better concentrate at the task at hand.

Since the behaviors associated with ADHD can have a substantial impact on the child’s education, experts have identified the following classroom characteristics which best promote educational success for many children with ADHD: predictability, structure, shorter work periods, small teacher to pupil ratio, more individualized instruction, interesting curriculum, and the use of positive reinforcers. They also identified a number of things the teacher can do when working with a child who has ADHD: have positive academic expectations, frequently monitor and check the child’s work, give directions with clarity, have warmth, patience and a sense of humor, be consistent and firm, have knowledge of different behavioral interventions, and have a willingness to work with a special education teacher.

Parental guidance and support is crucial for the child with ADHD as well. Parents should receive training as to how to apply strategies to manage their child’s behavior. Parents are often taught several methods to assist their child. Following are some examples:

 

What to Expect

Most children with ADHD can be taught in a regular education classroom with modifications made to the classroom setting, the addition of support personnel, and/or special education programs provided outside of the classroom. For children who are more severely affected by ADHD, a special education classroom may be necessary.

Unfortunately, children with ADHD are at risk for school failure, emotional difficulties, and significant negative adult outcomes in comparison to their peers. However, with the early identification of ADHD and the proper treatment, support, and education, the child can overcome many of the difficulties and achieve success.

ADHD does not have a significant affect on intelligence. In fact, many individuals with ADHD are highly intelligent and are highly creative and intuitive. However, due to their inability to concentrate, their true potential is often times never reached and they may wind up becoming underachievers.

Hyperactivity is often improved at puberty and there may be a reduction in symptoms of ADHD when the individual reaches adulthood. In addition, with the appropriate help, they can learn to suppress and channel their hyperactivity into more acceptable behaviors such as exercise.

With so many American children having ADHD, research on the disorder has become a national priority. Scientists are dedicated to understanding the workings of the brain and to developing preventive measures and new treatments.

 

Personal Stories

He was a quiet little guy when my (now-ex) husband and I met him 12 years ago, but the quiet didn't last long. We soon felt like we were raising the white tornado. Our 5-year-old daughter was lively and outgoing, but our new son, age 2 1/2, was something else - even for a 2-year-old!

D.A. rarely napped, seldom slept through the night, was advanced for his age with anything that was mechanical or that had to be assembled (blocks, Duplos, puzzles). He played briefly but intensively with one thing, left it, and moved on to the next. He put things away if supervised intensively, but minutes later, they were out again. He loved climbing to the very top of the jungle gym. When angry, he threw things with force and accuracy - a 2-foot-long plastic semi missed my head only because I ducked. Spanking only made him angrier.

A friend with four boys of her own nicknamed D.A. "boy to the 10th power" because of his energy level. Ear infections and things that had happened to him before he became our son had delayed his speech and kept him away from other kids. He didn't know how to play with others, which became a problem in preschool. In gymnastics, he was fearless and excelled... but couldn't keep his hands to himself.

We started taking him to an excellent child psychologist at 3 ½ years of age, and began using behavior modification, time-outs and rewards. They helped a little, but D.A. still was a very difficult child. Everyone "knew" why: Because he'd been abused; because he was adopted; because we spanked him too little; because we spanked him too much; and because our marriage was in trouble.

Before he turned 4, the psychologist was saying he thought D.A. had ADHD, but that no reputable pediatrician would prescribe medication for a child younger than 6. If he did have ADHD, we'd just have to tough it out.

D.A. had just turned 5 when the preschool principal called and said, "I'm sorry, but if we lose one more kid because of D.A., we'll have to lose D.A. instead." The next day, the gymnastics coach called and said he was moving my son back to a younger class because the older group he'd been put in was tired of him poking and punching them.

In tears, I called the psychologist and told him I didn't think we could wait another year - that D.A.'s life was falling apart, and the rest of the family's with it. He agreed to talk to our pediatrician about a trial of Ritalin. I was extremely reluctant to put my child on such a medication so young, but decided to try. (It was four more years before my husband and I separated, but he took little or no part in parenting either child, and wasn't interested in reading what little information was available on ADHD.)

From the first dose, Ritalin helped my son to focus and to control his behavior. In hindsight, we should have used higher doses in his earlier grades in school. I also should have followed my hunches about the possibility of learning disabilities (which frequently go along with ADHD), and I should have confronted the school district in legal proceedings the first time they refused to follow federal laws regarding treating ADHD as a disability if it interferes with learning. But this was an emerging area of the law - and still is, and it was difficult to find anyone to help me.

Fast forward to 1999: My son, now diagnosed with moderate-to-severe ADHD, dyslexia, moderate dysgraphia, as well as some hearing impairment, is a freshman in a private school. He also has been found to have a gifted-level IQ, but because of his disabilities, has struggled in school.

Still, I am optimistic that he will learn and thrive in a way that he could not have if he had been born even 10 years sooner. So much more information is available now, and medications are better. - E.M.

My 17-year-old daughter, Sheila, has ADHD. We recently went over her fifth 504 Plan. A 504 Plan is for students who do not qualify for special education, but still need changes in their educational program in order to succeed.

One of Sheila’s major problems is organization. Although she was diagnosed 10 years ago, she is still very poor about turning in completed homework. She usually does her homework, but, between the time she finishes it and the time to turn it in, she loses it.

Another problem Sheila has is that she tends to give up. If she has a few assignments out or her grade is slipping, she will give up. I stressed this problem with her teachers this year so Sheila can avoid the usual D's and F's on her report card.

Although others disagree with me, I feel college will be much easier for Sheila. Why? Because, except for math classes, there is very little homework in college. Most college classes rely only on test grades and this is where Sheila excels. - Amber Woolsey

 

Resources

If you are interested in meeting other parents and individuals who are involved in raising a child with ADHD, the following listserv is available:

ADHD email discussion group - To subscribe, send a message to listserver@ourfriends.com, leave the subject field blank and type the following in the body of the message: "SUBSCRIBE ADDPARENTS " (without the quotes).

For more information on ADHD, please see the following helpful references:

 

The Disorder Zone has been created for educational purposes only and is not intended to serve as medical advice. The information provided in The Zone should not be used for diagnosing or treating a health problem or disease. It is not a substitute for professional care. If your child has any health concerns, please consult your health care provider.

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