Attention-Deficit & Hyperactivity

by Gary E. Dudley, Ph.D.

Attention-Deficit Disorder is a clinical syndrome that occurs in 4 - 7 % of children. It is usually diagnosed at the time of school enrollment, or soon thereafter. In some cases, it involves hyperactive behavior (ADHD), in some it does not (ADD).

Most ADD children are easily distractible. Many children with ADD (especially when the disorder is not diagnosed and treated early) develop an assortment of behavioral disturbances which can affect social and emotional growth.

The overwhelming majority of Attention-Deficit-Disordered children are not mentally handicapped in the sense of mental retardation. Most are of average or above-average intelligence.

Some academic difficulties can develop for these children because of their distractibility and inefficient learning strategies. This is often how their problem comes to the attention of parents or teachers. However, they also attract attention due to their difficulty or complete inability to sit still, follow simple directions to the finish, or even to engage in a mutual discussion in which they listen, then respond, then listen, etc. These kids may have difficulty keeping friends for the same reasons.

When emotional problems develop, it is important to remember that the problems are a result of the academic and other difficulties these youngsters experience, rather than some form of "mental illness."

How Do You Get ADD?

The exact cause of Attention Deficit Disorder is unknown.

It has been argued that the prenatal and/or perinatal environment may involve a subtle brain insult. In fact, a previous diagnostic label for ADD was "Minimal Brain Damage." However, there is insufficient evidence that these children are actually brain-injured or impaired.

Heredity is another possible factor in the etiology of ADD. It is common to find more than one ADD child in a family, and often one or both of their parents recall having similar difficulties as children. A third etiological factor may be simply a slower rate of maturation.

What To Do About ADD

If you suspect that your child is experiencing symptoms associated with ADD, psychologists and pediatricians are the primary professionals who can diagnose and treat the disorder.

A complete developmental history, a survey of the child's behavior in situations at home and at school, as well as a battery of psychological tests, in conjunction with a neurological screening exam and medical evaluation, establishes the diagnosis. We prefer to be certain before diagnosing a child with ADD, as this has many implications for his or her educational plans and how we address their problem therapeutically.

It is also important to involve the school personnel in the overall management of this problem, as they will have the most difficulty keeping the child focused. A psychologist can provide valuable feedback to the school and can assist them in behavioral management planning, if needed.

A variety of other learning problems may be associated with ADD. For example, one child may have difficulty processing information that comes in through hearing (so will have difficulty following spoken instructions), another child may have trouble with visual-spatial analysis (so will have trouble learning letters, reading and writing), etc. Each child should, ideally, be tested and evaluated comprehensively, and have an individualized plan developed for his or her treatment and behavior management.

In addition, parents often need help in managing the behavior of these special children. Some discipline techniques that work well with other (non-ADD) kids, will not work with ADD children. Also, ADD kids can sometimes create disruption and chaos within the family, because their behavior can be extreme and because they seem to require so much extra attention and effort from the parents. Other children can feel neglected and can easily develop resentment towards their ADD sibling. Family Counseling can often help the family to be more understanding and accepting of the ADD child and to become partners in helping that child manage his or her behavior.

Recent hypotheses have suggested that vitamins, special diet and/or allergy treatments may be helpful in the treatment of ADD. To date, no studies have confirmed these hypotheses.

Many ADD kids, and some ADD adults, are positively affected by medication that stimulates the central nervous system. The two most common drugs in use for ADD are Methylphenidate (Ritalin) and Amphetamine (Dexedrine). In a non-ADD person, these drugs would speed up most nervous system functions including thought, behavior and physiological processes like heart rate. However, true ADD people have what is called a "paradoxical effect" in that the stimulant drugs slow them down and calm them.

Some ADD children seem to "grow out" of the symptoms as they get older. A closer look at these kids, including through the use of psychological tests, often reveals that they still have ADD, but that they have learned ways to compensate for their difficulty in sustaining their focus. Some of these kids, who took medication when younger, can do well without medicine by the time they reach adolescence.