Step back and imagine life on a fast moving carousel, where sights, sounds, images and thoughts are constantly changing. As you move around and around on this carousel everything blurs, your thoughts dart here and there, and you soon find yourself overwhelmed.
You have just experienced a moment in the life of someone with Attention Deficit Hyperactivity Disorder {ADHD}, a series of developmental deficiencies dealing with the regulation and maintenance of behavior. These deficiencies usually become evident in childhood and are probably chronic in nature. Although ADHD may improve as a child matures, the deficits continue -- sometimes into adulthood.
Even though people with ADHD may, at times, be able to sit still, plan ahead, finish projects and be fully cognizant of the world around them, to their families, friends, and teachers, the person with ADHD seems to exist in a cyclone of disorganized and chaotic behavior.
Once called "hyperkinesis" or "minimal brain dysfunction," ADHD is one of the most common mental disorders among children. It is estimated that ADHD affects three to five percent of all American children, and two to three times more boys than girls. On average, at least one child in every classroom in America need help for the disorder. ADHD often continues into adolescence and adulthood, and if not properly treated, can cause a lifetime of heartaches and broken dreams.
In the following pages, you will find answers to some of the most commonly asked questions about ADHD.
WHAT CAUSES ADHD?
One of the first questions parents ask when learning their child has been diagnosed with an attention disorder is "Why?" "What went wrong?" "Am I a bad parent?"
It's not important to place blame or look backward for possible reasons. It is more important for parents and family members to move forward and seek help for the child as well as the family.
As for what causes it, ADHD is biological and does not stem from the home environment. Just like children inherit their hair color and cheekbones from mom and dad, some inherit the ADHD trait as well. Not all children from troubled homes had ADHD. Knowing there's nothing they could have done to prevent ADHD can remove a large burden of guilt from parents.
See a child as a "chip off the old block" or "just like his father (or mother)" can blind parent to the need to get their ADHD child help. Sometimes parents find it hard to see their child's behavior as a problem because it so closely resembles their own, not recognizing their own ADHD disorder until one of their children is diagnosed.
In many cases, the school teacher is the first to recognize that a child is hyperactive and/or inattentive, and may consult the school psychologist.
WHAT ARE THE SYMPTOMS OF ADHD?
ADHD isn't like the flu or a broken arm. It doesn't have physical signs that can be seen in an X-ray or lab test. It can only be identified by observing certain characteristic behaviors which may vary from person to person.
At present, ADHD is a term applied to children and adults who consistently display characteristic patterns over a period of time. The most common fall into three distinguishable categories:
1. Inattention. People who are inattentive have difficulty keeping their thoughts focused for longer than a minute. You may see them focus on things they enjoy -- yet learning new tasks or completing new tasks is a struggle.
2. Hyperactivity. People who are hyperactive are described as "a worm in hot ashes," or as having "ants in their pants." Sitting still through school, movies, or car rides is a nearly impossible task. Hyperactive children constantly squirm in their seat or roam around the room. They might kick or wiggle their feet, touch everything or make noise. Hyperactive teens and adults often feel restless, and may always attempt to complete several tasks at once.
3. Impulsivity. When children are overly impulsive they seem unable to control their immediate reactions or to "think before they act," often blurting out inappropriate comments or do things like running into the street without looking. Impulsivity also makes it difficult to wait for things, as they want immediate gratification. As a result, they may take things from peers or siblings or become physically aggressive when upset or frustrated.
HOW ARE CHILDREN AND ADULTS ASSESSED FOR ADHD?
In the assessment of a person with ADHD, professionals consider several critical questions: Has the behavior been excessive, pervasive, long or short in it's duration? Is the behavior like that of others in their age group? Are the behaviors continuous and not in response to a situation?
When diagnosing ADHD, professionals in the mental health field consult a diagnostic manual called DSM (short for Diagnostic and Statistical Manual of Mental Disorders).
According to the DSM there are three patterns of behavior that indicate ADHD.
1. People with ADHD may display several signs of being continuously inattentive.
2. People with ADHD may have episodes of hyperactivity and Impulsivity.
3. People with ADHD may display all three types of behavior.
According to the DSM IV, signs of inattention include:
**Being easily distracted by insignificant sights and sounds.
**Ignoring details and making careless mistakes.
**Failure to follow instructions or guidelines.
**Forgetfulness of objects needed for a task.
Some signs of hyperactivity and Impulsivity include:
**Feeling restless
**"Fidgeting" with hands, feet or legs.
**Squirming, inability to sit still
**Blurting out answers before hearing the whole question.
**Difficulty writing.
Because we all display some of these signs from time to time, the DSM contains specific guidelines for determining when ADHD is indicated:
**The behaviors must have appeared before age seven, and continue for at least six months.
**In children, the behaviors must be more frequent or severe than other children the same age.
**Most importantly, the behaviors must create a handicap in at least two areas of a person's life as in school, homework, or social settings.
Therefore, someone whose work or peer relationships are not 'impaired' by these behaviors would not be diagnosed with ADHD. Nor would a child who appears overly active at school, but functions well elsewhere.
WHAT ELSE CAN PRODUCE ADHD-LIKE SYMPTOMS?
Many things can produce behaviors like ADHD. Anything from chronic fear to mild seizures can make a child seem overactive, argumentative, impulsive or inattentive. A death in the family or loss of a pet can make a normally cooperative child overactive and easily distressed in dealing with an emotional problem. An illness can make a child seem distracted and uncooperative, as can living within a family where there is alcoholism, drug abuse, or domestic violence. Imagine a child trying to concentrate in school when his or her own safety and well-being are in danger each day. Such a child is displaying the effects of other problems, not ADHD.
In some children, ADHD-like behaviors may be a response to failure in school. Perhaps the child is not developmentally ready for the class, or school, or ready to read and/or write.
It is also important to realize that during stages of development, the majority of children tend to be inattentive, hyperactive, or impulsive, but do not have ADHD. Preschoolers often display lots of energy, but this doesn't mean they are hyperactive. Teenagers often display inattentiveness and conflicts with authority as a normal course of events. It doesn't mean they are doomed to a lifetime of poor impulse control.
CAN OTHER PROBLEMS ACCOMPANY ADHD?
The difficulty in diagnosing ADHD is that it is often accompanied by other problems. Many children with ADHD also have a specific learning disability (LD) which means they have trouble mastering language and academic skills, typically reading and math.
ADHD isn't in itself a learning disability. Yet it can interfere with concentration and focus, making it increasingly hard for a child with LD to do well in school.
Of the more serious conditions accompanying children with ADHD is called Oppositional Defiant Disorder. Affecting primarily male children, this disorder causes them to overreact or lash out at parents, teachers, and peers when they feel bad about themselves. These children are stubborn, have angry outbursts, are defiant with authority figures, often take risks and destroy property. Sometimes this disorder progresses to more serious conduct disorders.
DIAGNOSING ADHD IN CHILDREN
The first step in diagnosing ADHD is to gather information that will rule out other possible reasons for the child's behavior. In the process, the professional (i.e. psychiatrist, psychologist, or therapist) checks the child's scholastic and medical record.
The professional gathers information to detect whether the home or classroom are stressful or chaotic, and how parents or teachers deal with the child in question. They may consider having a doctor or psychiatrist look for such problems as emotional or psychological disorders, poor vision or hearing. Since most schools screen for vision and hearing it is usually on the child's school record. A doctor might also look for allergies or nutritional problems like too much caffeine which would overstimulate the child.
The child's teachers are asked to evaluate past and present behavior on standardized evaluation forms to compare behavior with children of the same ages. These rating scales are subjective, however, since they only evaluate on the teacher's perception of the child.
The professional will also interview the family and teachers and others who know the child well in order to judge how severe and frequent the behaviors are. The professional will monitor the child's behavior during noisy or unstructured situations, or situations that call for sustained attention like reading and mathematical problem-solving.
The professional then puts together a profile of the child's behavior. The behaviors displayed by the child are observed as to how they match the DSM and how often they happen. The professional then asks himself/herself include if the behaviors interfering with the child's social, academic and home life. The answer to this question also helps assess whether the child's hyperactive, impulsive behaviors are long standing. If so, the child may be diagnosed with ADHD.
AVAILABLE TREATMENTS
Three medications in the class of drugs known as stimulants appear to be the most effective in treating ADHD in children: Ritalin, Dexedrine, and Cylert. For many these drugs have produced dramatic effects, reducing hyperactivity while increasing the ability to focus, work and learn.
Unfortunately, when people see such immediate improvement, they often believe medication is all that is needed. These medications don't cure the disorder --they only temporarily control the symptoms.
THE MEDICATION DEBATE
Ritalin and other medications have been under a great deal of controversy and media scrutiny. The side effects are often common with medications of this nature. While on these medications the child may experience loss of appetite, weight loss, and sleep difficulties. The benefits of these medications far outweigh the potential side effects, which are often controlled by reducing the dosage.
When a child displays improvement in behavior in school, parents and teachers most often give the credit to the medication for these changes. It should be noted, however, that these changes are the child's own abilities coming out due to the medication decreasing inattentiveness and allowing the child to remain focused.
NEW UNDERSTANDING
Life can be hard for children diagnosed with ADHD. They are often in trouble at school, can't finish games, and make new friends. And it's not easy coping with these frustrations daily. Many times they release the frustrations by fighting, destroying property, and displaying disrespectful or oppositional behavior.
It's also hard being the parent of a child who has too much energy, leaves messes, throws tantrums, and doesn't listen or follow directions. Parents of ADHD children tend to blame themselves for "not being better parents," and are often ridiculed by other parents for having a child who is out of control.
But the usual methods of discipline, scolding, and spanking have no effect on these children who have no control over their behavior. They don't choose to act this way. It's just that their self-control comes and goes. Out of frustration parents often find themselves spanking, ridiculing or screaming at their child. This type of response, however, leaves everyone more upset than before.
The good news is that once the child is diagnosed and receiving treatment, much of the turmoil within the family may fade.
Today we know that medication can help control much of the behavioral problems experienced by ADHD children and their families. But often there are areas that medication can't help. Because although ADHD primarily affects a child's behavior, having the disorder may have broader emotional repercussions like low self-esteem, depression, as well as other behavioral and emotional problems.
There are professionals who can help. Call your family physician for referrals to agencies in your area.
