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ATTENTION DEFICIT DISORDER
Nine-year-old Joshua was brought in for
therapy because of constant complaints by his teachers, starting
back in kindergarten. His parents were tired of the notes and telephone
calls three times a week. In kindergarten the teacher had complained
about Joshua's inability to sit still and how he always seemed to
be bumping into the other children or poking them. In grade one
the teacher complained that he hardly ever got his work done and
that he was disruptive in class. At times he was aggressive with
the other children. Joshua was suspended in the second grade and
now the school was threatening to send him to an "alternative
learning center." On the other hand, all of the teachers that
had worked with Joshua said that he could be a sweet cooperative
child, who seemed eager to please. Everyone agreed he is a bright
child who doesn't "work up to his potential." Joshua had
been labeled as mean, lazy, bad, and emotionally disturbed. Joshua
is none of these. He has an attention deficit disorder.
WHAT IS ATTENTION DEFICIT DISORDER?
Attention Deficit Disorder currently goes
by the name, Attention-Deficit/ Hyperactivity Disorder (ADHD). The
criteria for diagnosing ADHD are outlined in the Diagnostic and
Statistical Manual for Mental Disorders-IV, which is published by
the American Psychiatric Association. DSM-IV describes characteristics
of hyperactivity, impulsivity, and inattentiveness. Children with
ADHD are often described as not getting things done. They have attention
and concentration difficulties. They fail to complete chores, schoolwork
or homework and tend to wander off to other activities. A second
feature is impulsiveness. Children with ADHD seem to do things without
thinking or hesitating, which often leads to the aggression seen
in Joshua's behavior. Sometimes the impulsiveness leads to engaging
in physically dangerous activities. In addition, children with ADHD
often display a high activity level or fidgetiness, are always on
the go and hardly ever still, as if driven by a motor. The symptoms
of ADHD can be mild and interfere very little with the child's life,
or so severe that the child's daily activities are seriously disrupted.
Not all children with ADHD have all three of
the characteristics described above. Some children are predominately
inattentive, others are predominately hyperactive-impulsive, while
a third group has the combined type. This list of difficulties is
far from inclusive. Children with ADHD may also be forgetful of
information that is not salient to them (e.g., homework), disorganized,
they may fatigue quickly when expected to concentrate, process information
slowly, and some children are under active.
WHAT CAUSES ADHD?
You name it; it has probably been blamed
for causing ADHD. Bad parenting does not cause ADHD (so stop feeling
guilty!). Food additives, refined sugar and allergies have been
blamed for causing ADHD, but careful controlled studies have failed
to find a link. Most clinicians won't discourage parents from pursuing
these areas but they are not satisfactory solutions in themselves.
Most researchers now believe that there is a genetic predisposition
for ADHD, although it has also been linked to birth trauma and insult
to the fetus during pregnancy. There is a general consensus that
ADHD is a biologically based or neurochemical disorder.
IS ADHD SOMETHING NEW?
ADHD is not a new disorder. Reports describing
children with attentional difficulties, hyperactivity and impulsivity
go back to the 1800s. And yes, ADHD is a real disorder from which
up to five percent of school-age children suffer. It has gone by
a number of names, including hyperkinesis, hyperactive child syndrome,
and minimal brain dysfunction. A second category, Undifferentiated
Attention Deficit Disorder exists for children who do not meet all
the criteria of ADHD, but clearly have many of the problems associated
with ADHD.
HOW CAN I TELL IF MY CHILD HAS ADHD?
Diagnosis of an attention deficit disorder
needs to be made by a trained professional. Many physicians who
work with children are quite competent to diagnose ADHD. Mental
health professionals, such as psychologists and social workers,
who specialize in working with children can arrive at a diagnosis.
Diagnosing ADHD is both very easy and difficult. A child must meet
specific criteria listed in the Diagnostic and Statistical Manual
for Mental Disorders. That's the easy part. However, a number of
other childhood disorders and developmental delays can cause several
of the symptoms seen in ADHD. Thus, these other disorders must be
ruled out. Often a thorough history is enough to rule out other
diagnoses. In many cases, the child's teacher will be asked to provide
information regarding the child's behavior in the class. In most
cases psychological testing can be very beneficial. However, there
is no single test for ADHD. A brain scan will not reveal an attention
deficit disorder; it is not a typical part of an ADHD assessment.
HOW IS ADHD TREATED?
The first thing to realize is that there
is no cure for ADHD itself. Its symptoms, which may decrease with
age, but often persist into adulthood, can, however, be "managed."
There are three aspects of symptom management. First, parents and
children need to become educated about ADHD. A number of excellent
books are available and listed at the end of this article. Second,
positive behavior management techniques must be utilized. Parents
and teachers working with the child who has ADHD must use a firm,
structured, supportive and positive approach. It is helpful for
parents and teachers to attend courses, read books on ADHD and attend
a parent support group. The third and often most difficult aspect
of treatment for parents to accept is medication. The medications
used most often are called psychostimulants; of these, the most
well known is Ritalin. Much misinformation is circulating about
Ritalin, but there is also lots of good information. Parents should
talk to their physician and read some of the texts listed below.
Idle gossip, prejudice and talk shows are not good sources.
WILL MY CHILD HAVE A NORMAL LIFE?
Children with ADHD can lead happy and
productive lives. With appropriate treatment and management, children
can learn to manage and live with its symptoms. However, when children
with ADHD get labeled as bad, lazy, unmotivated and blamed for their
symptoms, then we can certainly expect a negative outcome, such
as substance abuse, school dropout, delinquency and depression.
If your child is having difficulties like Joshua's, please find
out how he or she can be helped.
HELPFUL BOOKS
For Children:
- Jumpin' Johnny Get Back to Work, by Michael
Gordon, Ph.D., order direct from GSI publications, (315) 446-4849
- My Brother's a World Class Pain: A Sibling's
Guide to ADHD/Hyperactivity, by Michael Gordon, Ph.D., also from
GSI
- Otto Learns About His Medicine, by Matthew
Galvin, M.D., 1988, Magination Press, New York, ISBN 945354-03-7
For Parents:
- Why Johnny Can't Concentrate, by Robert
Moss, M.D., 1990, Bantam Books, New York, ISBN 0-553-34968-6
- The Parent's Guide to Attention Deficit
Disorder, by Stephen McCarney, Ph.D. and Angela Bauer, M.Ed.,
1990, order direct from Hawthorne Educational Services (314) 874-1710
- Maybe You Know My Kid: Parent's Guide to
Identify, Understanding and Helping Your Child with ADHD, by Mary
Fowler, 1990, Carol Publishing Group, ISBN 1-55972-022-0
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