ADHD is a neurological disorder-a difficulty with brain functioning. The problem, researchers believe, involves faulty neurotransmitters (molecules that send messages to the brain) that cause three key ADHD symptoms: distractibility, hyperactivity, and difficulty with organizing, processing, and synthesizing information (known as executive functioning). Studies of twins and adopted children have shown that the disorder has a strong genetic component (Sprich, et al. 2000).
Detailed brain studies show that certain parts of the ADHD brain are smaller than in control brains. In addition, ADHD brains seem to receive less blood flow than controls and work less efficiently.
ADHD has Three Subtypes:
Hyperactive-Impulsive. The hyperactive child fits the common image of an ADHD child-always on the go, impulsive, blurts out thoughts, and impatient. Parents might say, "Billy's motor has two speeds: high and off."
Inattentive. More common in girls, inattentive traits include trouble with concentrating and distractibility. Children with this type of ADHD cannot seem to get organized, often lose or forget things, and leave tasks undone. In the classroom, inattentive children are labeled "dreamers" or "underachievers"; they don't cause trouble, but can't seem to stay focused on the task at hand.
Combined. The most common type of ADHD involves hyperactive-impulsive and inattentive features.
Children with ADHD tend to get less hyperactive over time, but problems with paying attention and other executive functions can persist or worsen. Teens with ADHD have problems with executive functioning, integrating past learning with present, and managing emotions.
A child with ADHD may:
* fidget with hands or feet, or squirm when seated
have trouble staying seated
* be easily distracted by external stimuli
* find it hard to wait for his or her turn in games or group activities
* blurt out answers before questions are completed
* have trouble following instructions
* find it hard to sustain attention in tasks or play activities
* shift from one uncompleted task to another
* have trouble playing quietly
* talk excessively
* interrupt or intrude on others
* not listen to what is being said
* forget supplies for tasks or activities
* engage in physically dangerous activities without considering the possible consequences
*According to the American Psychiatric Association, at least eight of these symptoms must be present to diagnose ADHD.
Symptoms of Other Problems
Hyperactive, impulsive, and inattentive behaviors in adoptees and other children can also result from different causes. For instance, a child who is in foster care or an abusive home may act out feelings of sadness and anxiety through distractibility, defiance, and an inability to sit still. Placed into a frighteningly familiar or unfamiliar setting, the child may be hard pressed to control alternating urges to fight, freeze, or run away.
Learning disabilities may also provoke ADHD-like symptoms. A child who cannot keep up with other children in class may exhibit impulsive, attention-getting behavior to divert attention from his inability to master a skill. Another learning disabled child might simply tune out when the work gets too hard.
Health problems can also affect children's attention span. Attention lapses can result, for instance, from seizure disorders. Hearing problems can affect children's ability to pay attention.
If your child shows signs of ADHD (see symptom list), seek help. Contact a qualified health professional-psychologist, psychiatrist, pediatrician, neurologist, clinical social worker, etc.-who knows a lot about ADHD. A diagnostic evaluation should delve into the child's medical, social, and academic history; assess the severity of the child's behaviors at home, school, and other places; and screen for other problems. Knowledge about conditions (learning disabilities, depression, oppositional defiant disorder, etc.) that often co-exist with ADHD can help the professional suggest an appropriate course of treatment.
With proper treatment, a child with ADHD can develop a broader attention span, improve school performance, be less inclined to act impulsively, and enhance social interactions with family and friends. When not treated, ADHD can contribute to academic failure, family conflicts, high-risk behaviors, involvement in criminal activities, motor vehicle accidents, and drug and alcohol abuse.
In the late 1990s, the National Institute of Mental Health (NIMH), in cooperation with other national authorities, sponsored a treatment study of close to 600 children with ADHD. Initial findings (Jensen 1999) revealed that long-term combination treatments (therapy and medication) and just medication are more effective in reducing ADHD symptoms than intensive behavioral or community-based interventions alone. Children with ADHD and other emotional/behavioral problems, they found, do best with a customized mix of treatments.
Using Medication to Treat ADHD
The stimulant class of medications-including Ritalin, Dexedrine, Adderall and long-acting stimulants like Concerta and Adderall XR-are well-studied. The National Institutes of Health, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry all state that stimulants are the first choice in medicinal treatment of ADHD. According to the Attention Deficit Disorder Association (ADDA) and the NIMH, these stimulants help to control ADHD behaviors in nearly 90 percent of affected children.
In addition, recent studies by the NIMH and others have assured parents of ADHD-affected children that their children's chance of abusing drugs is actually less if they take prescribed stimulants. With the right treatment, children with ADHD can better control impulses, attend to tasks better, and establish healthier peer relationships. In short, they are more likely to make better choices and steer clear of drug abuse.
Used improperly, of course, all drugs pose a risk of abuse. Dexedrine may become addictive for some, so if your child already has a substance abuse problem, request a different stimulant. If medication causes your child to seem sedated (or zombie-like) or experience involuntary facial movements or tics, tell your doctor. He or she should act to correct the problem-by adjusting dosage amounts, changing medications, or recommending an alternate course of action.
When stimulants don't work or produce unacceptable side effects, certain antidepressants-most notably Wellbutrin, Effexor, and Desipramine-can be effective. Tenex and Clonidine, blood pressure medications, are also used sometimes, particularly for children who have tics or Tourette's syndrome. Several new medications are undergoing research trials.
When ADHD is first diagnosed, family therapy may be used to help parents and children understand the disorder and design a treatment plan. At home, you can implement behavioral modification programs to help to shape and control your child's actions.
When trying to modify your child's actions, start by thinking of an appropriate reward. Younger children often like to earn stickers, but an older child may respond better to earning points that can be traded in for a special privilege-time alone with parents, trips to the dollar store, having a friend over, etc. Avoid food rewards since children may choose junk food that will worsen hyperactivity.
Next, pick a behavior you'd like to work on and start small. Maybe you would like your child to stay seated at the table through dinner. First, ask your child to sit quietly for five minutes-use positive directives: "sit quietly," for instance, instead of "don't squirm." If he's still sitting when the timer rings, praise him and allow him to pick out a sticker for his progress chart. If he cannot meet that goal, reduce the initial time and then gradually increase it. Ask the school to follow the same drill at lunch.
Once the first behavior has improved significantly (for example, the child can sit quietly at the table for 10 minutes), add a second goal and reward. Remember, keep reinforcing the first desired behavior (young children should be reinforced several times a day). If you stop, the undesirable behavior will come back. The key to success is ongoing patience, consistency, and reinforcement. It is a lot of work up front, but more effective over the long run than yelling and nagging.
ADHD and School
If your child cannot learn in a regular classroom setting, the Individuals with Disabilities Education Act requires that schools offer accommodations (as negotiated through an Individualized Education Plan) to address his or her special learning needs. Section 504 of the Rehabilitation Act also covers special services.
Ideally, your child's teachers should also be involved in helping to diagnose ADHD and implement behavior modification plans you may have in place. As suggested above, these plans must be followed consistently for a long time, even after the undesirable behavior stops.
Now more than ever, doctors, educators, and parents know the signs of ADHD and have access to a wide range of care options that can greatly improve life for children with ADHD and their families. With support, children with ADHD can learn to channel their abundant energy, vivid imagination, spontaneity, and ability to think outside the box into meaningful and personally satisfying pursuits. Families, in turn, can even more fully appreciate their children's unique perspectives and endearing qualities.
Jensen, Peter. (1999) "A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder." Archives of General Psychiatry 56 (December): 1073-86.
Simmel, C., D. Brooks, R.P. Barth, and S.P. Hinshaw. (2001) "Externalizing Symptomatology among Adoptive Youth: Prevalence, Pre-Adoption Risk Factors, and Eight Year Outcomes." Journal of Abnormal Child Psychology 29:57-69.
Sprich S., J. Biederman, M.H. Crawford, E. Mundy, and S.V. Farrone. (2000) "Adoptive and Biological Families of Children and Adolescents with ADHD." Journal of the American Academy of Child and Adolescent Psychology 39 (11): 1432-7.
1-2-3 Magic: Effective Discipline for Children 2-12, Thomas Phelan, 1996
Cognitive-Behavioral Therapy for Impulsive Children, Philip Kendall & Lauren Braswell, 1993
Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood, Edward Hollowell & John Ratey, 1995
Dr. Larry Silver's Advice to Parents on ADHD, 2nd edition, Larry Silver, 1999
Straight Talk about Psychiatric Medications for Kids, Timothy Wilens, 1998
Taking Charge of ADHD, revised edition, Russell Barkley, 2000
www.chadd.org is the home of CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder), a good place to learn about ADHD and find support groups in your area. You can also call CHADD at 800-233-4050.
The Attention Deficit Disorder Association can be found at www.add.org. Their site contains many useful articles about the disorder.
At www.addwarehouse.com you will find a wide selection of books and other items related to ADHD. Based in Florida, A.D.D. WareHouse can also be reached at 800-233-9273 or 954-792-8100.
Government publications on ADHD from the National Institute of Mental Health are located at www.nimh.nih.gov/publicat/adhdmenu.cfm.
At www.kidsource.com, simply search using the key word "ADHD" to find pertinent articles.