ADHD

ADHD

ADHD (attention deficit hyperactivity disorder) is one of the most frequently occurring childhood psychiatric disorders. Symptoms include not staying focused on a task, having trouble sitting still, and acting without thinking. These symptoms usually become evident in preschool or early elementary years, and can continue into adolescence and even adulthood. In many cases, the most effective treatments for ADHD include medications and behavioral therapies.

If left untreated, ADHD can have long-term effects on a child's ability to make friends or do well at school or work. Over time, children with the condition may develop depression , poor self-esteem, and other emotional problems.

A child with ADHD faces a difficult but not insurmountable task ahead. In order to achieve his or her full potential, the child should receive help, guidance, and understanding from:

• Parents
• Guidance counselors
• The public education system.

ADHD Symptoms

In many cases, ADHD symptoms appear over the course of several months, often with symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more. Specific symptoms include having trouble organizing activities, fidgeting, and excessive talking. Many normal children can have symptoms of this condition, but at lower levels, so it is important to get an accurate diagnosis by a qualified professional.

There are three subtypes of ADHD recognized by professionals based on symptoms of ADHD. These types are:

• Predominantly hyperactive-impulsive type (that does not show significant inattention)
• Predominantly inattentive type (that does not show significant hyperactive-impulsive behavior), sometimes called ADD -- an outdated term for this entire disorder
• Combined type (that displays both inattentive and hyperactive-impulsive symptoms).

Progression of ADHD Symptoms

Symptoms of ADHD typically appear over the course of many months, often with the symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more.

Different symptoms of ADHD may appear in different settings, depending on the demands the situation may pose for the child's self-control. A child who "can't sit still" or is otherwise disruptive will be noticeable in school, but the inattentive daydreamer may be overlooked. The impulsive child who acts before thinking may be considered just a "discipline problem," while the child who is passive or sluggish may be viewed as merely unmotivated. Yet both may have different types of ADHD.

What Are Not ADHD Symptoms?

All children are sometimes restless, sometimes act without thinking, and sometimes daydream the time away. When the child's hyperactivity, distractibility, poor concentration, or impulsivity begin to affect performance in school, social relationships with other children, or behavior at home, ADHD may be suspected. Because ADHD symptoms vary so much across settings, however, ADHD may not be easy to diagnose. This is especially true when inattentiveness is the primary symptom.

Because many normal children may have these possible symptoms, but at a low level (or the symptoms may be caused by another disorder), it is important that the child receive a thorough examination and appropriate ADHD diagnosis by a well-qualified professional.

Causes of ADHD

The exact causes of ADHD are unclear, although many people mistakenly believe that the disorder arises from social factors or child-rearing methods. Through research, scientists are refining their theories about the possible causes, some of which include environmental agents and genetics. Brain injury, food additives, and sugar are no longer thought to cause ADHD.

Possible Environmental Causes

There is little compelling evidence at this time that ADHD can arise purely from social factors or child-rearing methods. Most of the possible causes of ADHD appear to be related to neurobiology and genetics. This is not to say that environmental factors cannot influence the severity of ADHD, and especially the degree of impairment and suffering the child may experience, but that such factors do not seem to cause the condition by themselves. Knowing this can remove a huge burden of guilt from parents, who might blame themselves for their child's behavior.

Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the child. As a precaution, it is best to refrain from both cigarette and alcohol use during pregnancy.

Another environmental agent that may be associated with a higher risk of ADHD is high levels of lead in the bodies of young preschool children. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels of lead is not as prevalent as it once was. Children who live in old buildings where lead still exists in the plumbing or in lead paint that has been painted over may be at risk.

Genetic Causes

Attention disorders often run in families, so there are likely to be genetic influences. Studies indicate that 25 percent of the close relatives of children with ADHD also have it, whereas the rate is about 5 percent in the general population. Many studies of twins now show that the disorder has a strong genetic influence.

ADHD Brain Changes

Researchers are studying different areas of the brain to better understand the potential causes of ADHD. Children with ADHD are known to have a 3 percent to 4 percent smaller brain volume in all areas of the brain. Of these children, those who have not been treated with ADHD medications also show an abnormally small volume of white matter -- the part of the brain responsible for transmitting information. It is hoped that by better understanding these ADHD brain changes, newer and more effective treatments can be developed.

ADHD Treatment

As soon as a thorough, accurate diagnosis is made, ADHD treatment can begin. No single treatment is the answer for every child. Several factors are involved in determining which option is best, such as the child's needs, personal and medical history, and research findings. In many cases, a plan to treat ADHD consists of a combination of medications and behavior therapy.

Some of the therapy options used to treat ADHD include:

• Psychotherapy
• Behavior therapy
• Social skills training
• Support groups
• Parenting skill training
• Behavioral interventions.

Medications Used to Treat ADHD

Research has shown that treating ADHD with certain medications (stimulants, in most cases) and behavior therapies help children with this condition control their activity level and impulsiveness, pay attention, and focus on tasks. A few of the stimulants commonly prescribed for ADHD include:

• Methylphenidate (Ritalin^®)
• Dextroamphetamine(Dexedrine^®)
• Amphetamine (Adderall^®).

Despite data showing that stimulant medications are safe, there are widespread misunderstandings about the safety and use of these drugs for ADHD treatment, and some healthcare practitioners are reluctant to prescribe them. Like all medications, those used for ADHD do have side effects and need to be closely monitored.

Suggestions for Parents

Below are some suggestions for parents to help their child with ADHD and school:

• Learn about ADHD. The more you know, the more you can help yourself and your child.
• If your child has shown symptoms of ADHD from an early age and has been evaluated, diagnosed, and treated with either behavior modification or medication (or a combination of both) when your child enters the school system, let his or her teachers know. They will be better prepared to help your child come into this new world away from home.
• If your child enters school and experiences difficulties that lead you to suspect that he or she has ADHD, you can either seek the services of an outside professional or you can ask the local school district to conduct an evaluation. Some parents prefer to go to a professional of their own choice.

However, it is the school's obligation to evaluate children whom they suspect have ADHD or some other disability that is affecting not only their academic work but their interactions with classmates and teachers as well.

• If you feel that your child has ADHD and isn't learning in school as he or she should, you should find out who in the school system you should contact. Your child's teacher should be able to help you with this information. Then you can request -- in writing -- that the school system evaluate your child.

The letter should include the date, your and your child's names, and the reason for requesting an evaluation. Keep a copy of the letter in your own files.

• Until the last few years, many school systems were reluctant to evaluate a child with ADHD. However, recent laws have made clear the school's obligation to the child suspected of having ADHD that is adversely affecting his or her performance in school.

If the school persists in refusing to evaluate your child, you can either get a private evaluation or enlist some help in negotiating with the school. Help is often as close as a local parent group. Each state has a Parent Training and Information (PTI) center as well as a Protection and Advocacy (P&A) agency.

• Once your child has been diagnosed with ADHD and qualifies for special education services, the school, working with you, must assess the child's strengths and weaknesses and design an Individualized Educational Program (IEP). You should be able to periodically review and approve your child's IEP.

Each school year brings a new teacher and new schoolwork, a transition that can be quite difficult for children with ADHD. Your child needs lots of support and encouragement at this time.

• Praise your child when he or she does well. Build your child's abilities. Talk about and encourage his or her strengths and talents.
• Be clear, be consistent, and be positive. Set clear rules for your child. Tell your child what he or she should do, not just what they shouldn't do. Be clear about what will happen if your child does not follow the rules. Have a reward program for good behavior; praise your child when correct behaviors are shown.
• Learn about strategies for managing your child's behavior. These include valuable techniques such as: charting, having a reward program, ignoring behaviors, natural consequences, logical consequences, and time-out. Using these strategies will lead to more positive behaviors and cut down on problem behaviors.
• Talk with your doctor about whether ADHD medication will help your child.
• Pay attention to your child's mental health (and your own!). Be open to counseling; it can help you deal with the challenges of raising a child with ADHD. It can help your child deal with frustration, feel better about himself or herself, and learn more about social skills.
• Talk to other parents whose children have ADHD. Parents can share practical advice and emotional support.
• Meet with the school and develop an educational plan to address your child's needs. Both you and your child's teachers should get a written copy of this plan.
• Keep in touch with your child's teacher. Tell the teacher how your child is doing at home. Ask how your child is doing in school and offer support.

Suggestions for Teachers

Below are some suggestions for teachers:

• Learn more about ADHD.
• Figure out what specific things are difficult for the student. For example, one student with ADHD may have trouble starting a task, while another may have trouble ending one task and starting the next. Each student needs different help.
• Post rules, schedules, and assignments. Clear rules and routines will help a student with ADHD. Have set times for specific tasks, and be sure to call attention to changes in the schedule.
• Show the student how to use an assignment book and a daily schedule. Also teach study skills and learning strategies, and reinforce these regularly.
• Help the student channel his or her physical activity (e.g., let the student do some work standing up or at the board). Provide regularly scheduled breaks.
• Make sure directions are given step by step and that the student is following the directions. Give directions both verbally and in writing. Many students with ADHD also benefit from doing the steps as separate tasks.
• Let the student do work on a computer.
• Work together with the student's parents to create and implement an educational plan tailored to meet the student's needs. Regularly share information about how the student is doing at home and at school.
• Have high expectations for the student, but be willing to try new ways of accomplishing tasks. Be patient, and maximize the student's chances for success.

School and ADHD: A Final Thought

Never forget the cardinal rule -- you are your child's best advocate.