Could My Child Have ADD/ADHD?
Attention Deficit Disorder (ADD), now referred to by physicians as Attention Deficit Hyperactivity Disorder (ADHD), is a condition that affects about five percent of American children today. According to the National Institute of Mental Health, boys are two to three times more likely to suffer from ADHD than girls.
The classic signs of ADHD are a child's inability to focus and a tendency to act impulsively. Here are some other common symptoms:
- Inappropriate levels of activity
- Inability to sit still or pay attention in class
- Tendency to act "without thinking"
- Becoming easily distracted by irrelevant sights and sounds
- Rarely following instructions carefully and completely
- Often losing or forgetting things
- Frequent fidgeting and squirming
- Having difficulty waiting in line or for a turn
All kids exhibit some of this behavior at one time or another. So how do you know if your child is suffering from ADHD or he's just a wild kid? Children who are responding to stressful family situations, are bored in the classroom, or are passing through certain stages of development may, at times, appear inattentive, hyperactive, or impulsive. That doesn't mean they have ADHD.
But there are a few clues that may signal that your child's actions are a symptom of ADHD. You should consult with your child's teacher and pediatrician if his symptoms appear:
- Before age 7
- Continuously -- not just in response to a temporary situation
- To last for at least six months
- More severely than other children in the same age group
- In multiple settings (not just in the classroom or on the playground)
You should also consider talking with a mental health professional to rule out other possible psychological problems, such as depression or a learning disorder.
What Causes It?
Despite extensive research, doctors have been unable to pinpoint exactly what causes this disorder. However, recent studies have indicated that there may be some genetic and environmental roots. According to the American Medical Association (AMA), research now shows that some children may have actually inherited a biochemical condition that led to their ADHD. Other children with the disorder may have experienced abnormal fetal development and, as a result, suffered damaging effects on the parts of the brain that control attention and movement (the frontal lobe and basal ganglia).
New imaging techniques have also allowed researchers to take a look at these brain areas. The imaging has revealed that specific areas in these parts of the brain are 10 percent smaller and function with 10 percent less activity in children suffering from ADHD. It is not yet known whether this difference is a cause or an effect of the disorder.
What Are the Treatment Options?
At the beginning of treatment, your child's doctor should set three to six "target outcomes" -- or goals -- for your child's behavior. These goals will guide the treatment plan. Your child's target outcomes should focus on helping her function as well as possible at home, at school, and in your community.
The following are examples of target outcomes:
- Improved relationships with parents, siblings, teachers, and peers
- Better grades
- More independence in self-care or homework
- Improved self-esteem
- Fewer disruptive behaviors
- Safer behavior
Once these goals are established, your child's treatment plan will be set up to help your child achieve these goals. The most common treatment method involves using psychostimulants known as Ritalin (methylphenidate) and Dexedrine (dextroamphetamine). There are also some antidepressants often used to treat ADHD. Exactly how these medications work is unknown, but it's suspected that they control the neurotransmitters (substances that send nerve impulses) in the brain. However, medications often have side effects. Taken in normal doses, these prescription drugs can cause decreased appetite, stomachaches, agitation, irritability, and insomnia for some children. The long-term effects of taking these drugs are not yet known.
While these medications can improve some of the symptoms of ADHD -- such as impulsive behavior and inattention -- they are most effective when combined with what's known as behavioral treatment. In fact, the AMA reports that children who practice behavioral treatment in addition to regularly taking their medication do better in school and in social situations than those who rely on prescription drugs alone.
Behavioral treatment refers to rewarding children for appropriate behavior or performance. It's recommended that parents of children with ADHD undergo training in this treatment technique, since kids with ADHD are often not as responsive to common parenting practices -- especially punishment -- as other children. Seasoned parents may have parenting techniques that worked with older children, but these tactics may not be as effective in a child with ADHD. The right kind of behavioral treatment, in addition to medications, can help monitor a child's behavior, introduce problem-solving strategies, and self-reinforce his positive behaviors.
In addition to drug and psychosocial therapies, there also exists a long history of other treatments, including herbs, vitamins, minerals, biofeedback, and dietary solutions. Many of these therapies, although appealing, have not been proven to be effective.
Is It Being Overdiagnosed?
The question of whether ADHD is overdiagnosed or underdiagnosed is a difficult and controversial one. All kids exhibit out-of-control behavior at some point, so where do you draw the line and decide that the problem requires treatment? In truth, whether a child is officially diagnosed with ADHD and which treatment methods are selected are often determined simply by which doctor makes the diagnosis and her preferred methods of treatment.
The general rule is that doctors diagnose ADHD based on the appearance of symptoms, the degrees of impairment in the child's life, and the pattern of his behavior. But there is currently no single, reliable medical or psychological test to determine whether a child has this disorder and should be treated. According to the National Institutes of Health (NIH), parents, healthcare providers, educators, and policy makers are usually unsure of when and if ADHD should be treated, and if so, how, which treatments yield the best outcomes, and how the disorder can affect the child and his family -- whether treated or not.
The fact that prescription drugs, which often have side effects, are usually used as part of the treatment for ADHD makes it even more important to verify the diagnosis. Therefore, the NIH is in the process of developing more precise and standardized diagnostic criteria for this disorder.
Improving Your Child's Life (and Your Own!)
Having a child with ADHD can affect an entire family. But there are things you can do to minimize the difficulties that come with this disorder. By enrolling in parent education classes and support therapies, you can improve both your life and your child's. You will learn methods to teach your child how to stay organized, cope with frustrations, and develop problem-solving skills.
As your child's most important advocate, you must also learn to deal with the medical and educational systems to ensure the best situation possible for him. Find out what special services your child's school offers for kids with ADHD. Federal laws mandate educational help for many of these children. There may be adjustments in the classroom and the teacher's curriculum that could vastly improve the performance of a child with ADHD. If necessary, look into what your local school doesn't provide which may be required by law.
Another problem you may have to deal with is a common glitch in current ADHD treatment. Often, those doctors who diagnose a child with ADHD and those who implement and monitor treatment may not be the same people. As the parent of a child with ADHD, take it upon yourself to make sure that the doctors are taking a team approach in diagnosing and treating your child.
Here are some other things you can do to help a child with ADHD:
- Address the environment. Ask your child's teacher to place your child close to the front of the room. Also limit open spaces, which may encourage hyperactive behaviors, and try to reduce distracting stimuli.
- Provide clear direction. Keep oral instructions brief and repeat them as necessary. Provide written instructions (and review them orally) for difficult processes and break up tasks and into small steps.
- Stress success. Provide formal rewards (such as star charts) to reinforce specific positive behaviors. Always reward progress -- even if your child's achievement does not meet the goals.
- Stay organized. Establish daily checklists and help your child start a homework notebook. Remind her to consult these lists at the end of the day to make sure that everything is done.
- Work on writing skills. Encourage an older child to use the computer. Put less stress on messy handwriting or spelling errors and focus on content.
- Help control impulsivity. Urge your child to slow down when answering questions. Encourage her to check her homework before turning it in.
- Maintain self-esteem. Encourage performance in your child's areas of strength and focus on positive reinforcement. Avoid asking her to perform a task publicly that is too difficult.
- Design a specific behavior program. Target a few unacceptable behaviors with clear consistent consequences. If you're in public, try using hand signals to privately warn your child of inappropriate behavior.
- Teach your child to be an active learner. Encourage visual aids and hands-on experiences. Teach active reading (underlining), active listening (note taking), reading for detail, and subvocalization (whispering) as a memory aid.
ADHD is a disorder that affects the lives of many children and their families, but proper treatment and behavioral therapy can positively impact the lives and futures of these children.
Sources: National Institute of Mental Health; American Medical Association; National Institutes of Health; American Academy of Pediatrics
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.