Is It ADHD or Just Inattention?
All toddlers and young children are active, excitable, and less than 100 percent attentive to what Mom and Dad have in mind -- you'd be worried if they weren't. But some children are dramatically more active, impulsive, and inattentive than other kids their age are, and that's when you might start to wonder, as a parent, if what you're seeing is attention-deficit hyperactivity disorder (ADHD).
The stereotype of kids who have ADHD is that they have trouble in school -- they can't sit still, can't wait their turn to talk, can't follow the teacher's directions, are always losing their jacket or backpack, and can't seem to get their homework done. In fact, the symptoms of ADHD show up in all the parts of a child's life.
What are the symptoms of ADHD?
There are three sets of behaviors that define ADHD: hyperactivity, impulsivity, and inattention. Here are some key signs that a child might be hyperactive and impulsive:
- He fidgets and squirms a lot
- He often gets up out of his seat
- He run or climbs excessively
- He has trouble playing quietly
- He always seems to be on the go or driven by a motor
- He talks excessively
- He blurts out answers
- He has trouble waiting for his turn
- He interrupts or intrudes often
Symptoms of the third set of behaviors -- inattention -- include:
- She makes careless mistakes
- She has trouble paying attention to a task
- She doesn't seem to be listening when spoken to directly
- She doesn't follow instructions
- She has trouble organizing
- She avoids or dislikes sustained effort
- She's always losing things
- She's easily distracted
- She's forgetful
When do the symptoms appear?
ADHD behaviors usually become apparent when a child is between 3 and 6 years old. Parents often notice the hyperactive/impulsive behaviors first, when a child is a toddler. Signs of inattention may not be picked up until children go to school, when they are expected to focus for longer periods of time than they may be at home.
But isn't that stuff normal?
There is obviously no child who doesn't display these behaviors occasionally, so the rule of thumb is that kids with ADHD display them three times more frequently than their peers do. Each child's behavior must be considered relative to others at her developmental level. And it's important to note that a child should be compared to others of her age -- not in her grade in school -- because a typical classroom has a spread in ages that may be significant developmentally.
One reason ADHD can be difficult to understand, and diagnose, is that it's what we call a "dimensional" disorder, which is to say that the behaviors involved are present in all children; the difference in a child with ADHD is one of degree. Think of them as the extreme end of a spectrum.
For instance, any child may want to borrow or use other kids' toys, but a child with ADHD constantly grabs toys from other children. Any child calls out or interrupts every once in a while, but a child with ADHD does it so often it's disruptive or annoying. Any child will occasionally fall down or have accidents, but a child with ADHD will have frequent accidents and may end up in the emergency room. Any child might occasionally dart away from a parent on impulse; a child with ADHD is so impulsive, parents need a leash to keep him from running into the street.
Another way to think of the difference is that although all kids may exhibit these behaviors, highly energized, active children without ADHD can usually focus when it is necessary to accomplish a goal. Kids with ADHD can't.
More ADHD Facts
Not all kids with ADHD are alike
Each child with ADHD has a different combination of symptoms, but these symptoms fit into one of three different subtypes. The first is the predominantly inattentive type, which was formerly called ADD. The second is the predominantly hyperactive/impulsive type. The third is the combined type, exhibiting all three of these areas. This is the most common type of ADHD.
Children with the predominantly inattentive subtype of ADHD are less likely to be disruptive in school, have outbursts at home, be very challenging for parents to manage, or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. A youngster may simply appear to be a daydreamer, absent-minded, or bored. Therefore, she may be overlooked, and parents and teachers may not notice that she has ADHD until she falls seriously behind in school.
Is it really necessary to treat ADHD?
Because many people tend to think of ADHD as a condition that affects just schooling (think: first graders who can't stay in their seats), you may wonder if the only point of treating it is so that kids can do well in school. That's one reason to treat it -- frustration and failure in school are not only painful for children, but can dramatically undermine their sense of self-worth -- but there are others, as ADHD affects all areas of a child's life. A child who's distracted or underperforming in school doesn't necessarily have ADHD; one of the diagnostic criteria for ADHD is that children have to be impaired in other settings besides school.
Symptoms of ADHD affect children outside the classroom as well. Parents will tell you how stressful home life can be when a child is unable to stop moving, focus on something important, finish what he starts, follow instructions, or think before he acts. Children with ADHD often have trouble forming and keeping friendships because they may be too aggressive, too talkative, too impulsive. Teenagers with untreated ADHD are more likely to abuse alcohol and drugs, more likely to get addicted, more likely to have early and unprotected sex, and more likely to get into car accidents. As they become young adults they have a harder time holding jobs, staying married, raising children, and even keeping out of jail.
Hyperactivity and impulsivity tend to wane as children get older, but the inattentive behaviors -- being disorganized and unable to finish what they start -- are more likely to persist into adulthood. The best estimate is that 40 percent of those who had ADHD as kids will continue to have impairment as adults.
The good news is that there are very effective treatments for ADHD, including medication and behavioral therapy in which children and their parents learn techniques for diminishing disruptive and impairing behaviors.
The most common medications prescribed for ADHD are psychostimulants, including methylphenidate (Ritalin) and dextroamphetamine (Adderall). What these drugs stimulate the brain's production of chemicals called neurotransmitters, which activate the areas of the brain that are responsible for attention and impulse control. They serve to focus the attention and curb the impulsivity and hyperactivity of kids with ADHD.
Medicating children with ADHD is a process of trial and observation, with overwhelmingly positive results; 70 percent to 80 percent of kids have an excellent response to their first medication, and 15 percent will respond well to a second. Although 20 percent to 30 percent are not helped by medication, or experience troublesome side effects, those effects are completely reversible by ending the course of treatment.
One promising therapy for youngsters with ADHD who are prone to outbursts and other disruptive behavior is Parent-Child Interaction Therapy, which trains parents to systematically cultivate desired behaviors and minimize undesirable or disruptive ones. PCIT doesn't eliminate the core ADHD symptoms, but it has been successful in reducing stress in the family, and helping children learn to control their own behavior to enjoy more positive attention from their parents.
For a first-person account from parents of a child with ADHD who participated in PCIT, as well as more information on the disorder, go to childmind.org.
Published with permission of the Child Mind Institute, 2011.