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Additional Information
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Attention Deficit Hyperactivity Disorder (ADHD)
is a condition that becomes apparent in some children in
the preschool and early school years. It is hard for these
children to control their behavior and/or pay attention.
It is estimated that between 3 and 5 percent of children
have ADHD, or approximately 2 million children in the United
States. This means that in a classroom of 25 to 30 children,
it is likely that at least one will have ADHD.
ADHD was first described by Dr. Heinrich Hoffman in 1845.
A physician who wrote books on medicine and psychiatry, Dr.
Hoffman was also a poet who became interested in writing
for children when he couldn't find suitable materials to
read to his 3-year-old son. The result was a book of poems,
complete with illustrations, about children and their characteristics. "The
Story of Fidgety Philip" was an accurate description of a
little boy who had attention deficit hyperactivity disorder.
Yet it was not until 1902 that Sir George F. Still published
a series of lectures to the Royal College of Physicians in
England in which he described a group of impulsive children
with significant behavioral problems, caused by a genetic
dysfunction and not by poor child rearing—children
who today would be easily recognized as having ADHD. Since
then, several thousand scientific papers on the disorder
have been published, providing information on its nature,
course, causes, impairments, and treatments.
A child with ADHD faces a difficult but not insurmountable
task ahead. In order to achieve his or her full potential,
he or she should receive help, guidance, and understanding
from parents, guidance counselors, and the public education
system. This document offers information on ADHD and its
management, including research on medications and behavioral
interventions, as well as helpful resources on educational
options.
Because ADHD often continues into adulthood, this document
contains a section on the diagnosis and treatment of ADHD
in adults.
Symptoms
The principal characteristics of ADHD are inattention, hyperactivity,
and impulsivity. These symptoms appear early
in a child's life. Because many normal children may have
these 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 diagnosis
by a well-qualified professional.
Symptoms of ADHD will 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 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. All children are sometimes restless, sometimes
act without thinking, 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. But because the symptoms vary so much across
settings, ADHD is not easy to diagnose. This is especially
true when inattentiveness is the primary symptom.
According to the most recent version of the Diagnostic
and Statistical Manual of Mental Disorders (DSM-IV-TR),
there are three patterns of behavior that indicate ADHD.
People with ADHD may show several signs of being consistently
inattentive. They may have a pattern of being hyperactive
and impulsive far more than others of their age. Or they
may show all three types of behavior. This means that there
are three subtypes of ADHD recognized by professionals.
These are the predominantly hyperactive-impulsive
type (that does not show significant inattention);
the predominantly inattentive type (that
does not show significant hyperactive-impulsive behavior)
sometimes called ADD—an outdated term for this entire
disorder; and the combined type (that
displays both inattentive and hyperactive-impulsive symptoms).
Hyperactivity-Impulsivity
Hyperactive children always seem to be "on
the go" or constantly in motion. They dash around touching
or playing with whatever is in sight, or talk incessantly.
Sitting still at dinner or during a school lesson or story
can be a difficult task. They squirm and fidget in their
seats or roam around the room. Or they may wiggle their feet,
touch everything, or noisily tap their pencil. Hyperactive
teenagers or adults may feel internally restless. They often
report needing to stay busy and may try to do several things
at once.
Impulsive children seem unable to curb
their immediate reactions or think before they act. They
will often blurt out inappropriate comments, display their
emotions without restraint, and act without regard for the
later consequences of their conduct. Their impulsivity may
make it hard for them to wait for things they want or to
take their turn in games. They may grab a toy from another
child or hit when they're upset. Even as teenagers or adults,
they may impulsively choose to do things that have an immediate
but small payoff rather than engage in activities that may
take more effort yet provide much greater but delayed rewards.
Some signs of hyperactivity-impulsivity are:
- Feeling restless, often fidgeting with hands or feet,
or squirming while seated
- Running, climbing, or leaving a seat in situations where
sitting or quiet behavior is expected
- Blurting out answers before hearing the whole question
- Having difficulty waiting in line or taking turns.
Inattention
Children who are inattentive have a hard time keeping their
minds on any one thing and may get bored with a task after
only a few minutes. If they are doing something they really
enjoy, they have no trouble paying attention. But focusing
deliberate, conscious attention to organizing and completing
a task or learning something new is difficult.
Homework is particularly hard for these children. They will
forget to write down an assignment, or leave it at school.
They will forget to bring a book home, or bring the wrong
one. The homework, if finally finished, is full of errors
and erasures. Homework is often accompanied by frustration
for both parent and child.
The DSM-IV-TR gives these signs of inattention:
- Often becoming easily distracted by irrelevant sights
and sounds
- Often failing to pay attention to details and making
careless mistakes
- Rarely following instructions carefully and completely
losing or forgetting things like toys, or pencils, books,
and tools needed for a task
- Often skipping from one uncompleted activity to another.
Children diagnosed with the Predominantly Inattentive Type
of ADHD are seldom impulsive or hyperactive, yet they have
significant problems paying attention. They appear to be
daydreaming, "spacey," easily confused, slow moving, and
lethargic. They may have difficulty processing information
as quickly and accurately as other children. When the teacher
gives oral or even written instructions, this child has a
hard time understanding what he or she is supposed to do
and makes frequent mistakes. Yet the child may sit quietly,
unobtrusively, and even appear to be working but not fully
attending to or understanding the task and the instructions.
These children don't show significant problems with impulsivity
and overactivity in the classroom, on the school ground,
or at home. They may get along better with other children
than the more impulsive and hyperactive types of ADHD, and
they may not have the same sorts of social problems so common
with the combined type of ADHD. So often their problems with
inattention are overlooked. But they need help just as much
as children with other types of ADHD, who cause more obvious
problems in the classroom.
Is It Really ADHD?
Not everyone who is overly hyperactive, inattentive, or
impulsive has ADHD. Since most people sometimes blurt out
things they didn't mean to say, or jump from one task to
another, or become disorganized and forgetful, how can specialists
tell if the problem is ADHD?
Because everyone shows some of these behaviors at times,
the diagnosis requires that such behavior be demonstrated
to a degree that is inappropriate for the person's age. The
diagnostic guidelines also contain specific requirements
for determining when the symptoms indicate ADHD. The behaviors
must appear early in life, before age 7, and continue for
at least 6 months. Above all, the behaviors must create a
real handicap in at least two areas of a person's life such
as in the schoolroom, on the playground, at home, in the
community, or in social settings. So someone who shows some
symptoms but whose schoolwork or friendships are not impaired
by these behaviors would not be diagnosed with ADHD. Nor
would a child who seems overly active on the playground but
functions well elsewhere receive an ADHD diagnosis.
To assess whether a child has ADHD, specialists consider
several critical questions: Are these behaviors excessive,
long-term, and pervasive? That is, do they occur more often
than in other children the same age? Are they a continuous
problem, not just a response to a temporary situation? Do
the behaviors occur in several settings or only in one specific
place like the playground or in the schoolroom? The person's
pattern of behavior is compared against a set of criteria
and characteristics of the disorder as listed in the DSM-IV-TR.
Diagnosis
Some parents see signs of inattention, hyperactivity, and
impulsivity in their toddler long before the child enters
school. The child may lose interest in playing a game or
watching a TV show, or may run around completely out of control.
But because children mature at different rates and are very
different in personality, temperament, and energy levels,
it's useful to get an expert's opinion of whether the behavior
is appropriate for the child's age. Parents can ask their
child's pediatrician, or a child psychologist or psychiatrist,
to assess whether their toddler has an attention deficit
hyperactivity disorder or is, more likely at this age, just
immature or unusually exuberant.
ADHD may be suspected by a parent or caretaker or may go
unnoticed until the child runs into problems at school. Given
that ADHD tends to affect functioning most strongly in school,
sometimes the teacher is the first to recognize that a child
is hyperactive or inattentive and may point it out to the
parents and/or consult with the school psychologist. Because
teachers work with many children, they come to know how "average" children
behave in learning situations that require attention and
self-control. However, teachers sometimes fail to notice
the needs of children who may be more inattentive and passive
yet who are quiet and cooperative, such as those with the
predominantly inattentive form of ADHD.
Professionals Who Make the Diagnosis.
If ADHD is suspected, to whom can the family turn?
What kinds of specialists do they need?
Ideally, the diagnosis should be made by a professional
in your area with training in ADHD or in the diagnosis of
mental disorders. Child psychiatrists and psychologists,
developmental/behavioral pediatricians, or behavioral neurologists
are those most often trained in differential diagnosis. Clinical
social workers may also have such training.
The family can start by talking with the child's pediatrician
or their family doctor. Some pediatricians may do the assessment
themselves, but often they refer the family to an appropriate
mental health specialist they know and trust. In addition,
state and local agencies that serve families and children,
as well as some of the volunteer organizations listed at
the end of this document, can help identify appropriate specialists.
To read the rest of this document, or more about this disorder
from the National Institute of Mental Health, please click
here: http://www.nimh.nih.gov/publicat/adhd.cfm#intro
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