Attention Deficit Hyperactivity Disorder (ADHD)

A child who frequently shows an inability to pay attention that isn't consistent with his or her age and impulsiveness may have attention deficit disorder (ADD). This may or may not be associated with excessive physical activity (hyperactivity). The combination is known as attention deficit hyperactivity disorder (ADHD).

An estimated five to 10 percent of school-aged children are affected by ADD. The condition usually appears before the age of four and always by the age of seven. However, children with attention deficit disorder that is not associated with hyperactivity may not be diagnosed until adolescence or later.

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Symptoms

These can be associated with excessive physical activity or not and include:

  • An inability to pay attention, including a lack of attention to details, difficulty sustaining attention, doesn't appear to listen when spoken to, often doesn't follow through on instructions and fails to finish tasks, has difficulty organizing activities and tends to avoid tasks that require sustained mental effort, loses things, is easily distracted and is forgetful.
  • Impulsiveness, including blurting out answers to questions that haven't been finished yet, has a hard time waiting his or her turn and often interrupts or intrudes on others
  • Increased rates of activity, which can range from restlessness to full hyperactivity
  • Hyperactivity may or may not be present. If it is the child will fidget or squirm, often leave his or her seat, runs about or climbs excessively, has difficulty engaging in quiet activities, is often on the go and talks compulsively
  • Reluctance to participate of respond

The inability to pay attention and the impulsiveness tend to make it difficult for a child to develop academic skills, the ability to reason or create strategies or to be motivated by school. Symptoms tend to be task and environment related.


Causes and Risk Factors

ADD tends to occur in families and is common in first-degree biological relatives. The combination of ADD with hyperactivity occurs 10 times more often in boys than girls.

The causes are not yet known. In fewer than five percent of children with ADD, signs of neurologic damage. The leading belief is that there are abnormalities in chemistry of the brain. Other factors (such as toxins, a lack of neurologic development, infections, prenatal exposure to drugs, injuries or environmental conditions) may also play a role.

Some experts believe that ADD is a difference rather than a disorder in the chemistry of the brain. This results in a different approach to learning, which requires more hands-on learning.

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Diagnosis

ADD is difficult to diagnose because there are no biological signs or neurological indicators to specifically identify it. No test for ADD has yet been validated. Identification tends to be subjective. The primary signs are behavioral and vary with time and conditions. In a doctor's office the behaviors involved may not be obvious.

Social and medical histories and school reports are essential for diagnosis.

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Treatments

Research has shown that children with ADD do not outgrow their condition, although hyperactivity may go away over time.

In adolescence and adulthood, the individual may experience academic failure, low self-esteem, difficulty developing social skills and building friendships. This can lead to depression, drug abuse problems and anti-social behavior.

Persons with ADD seem to adjust better to work than to academic or home situations.

Certain drugs paired with counseling seem to control symptoms best. Treatments that involve special diets, megavitamin supplementation and nutritional and biochemical interventions have been shown to be least effective.

With drugs used to treat ADD, different dosages have different effects on behavior, with lower doses having the best effect on learning and higher dosages having the best effects on behavior. Usually treatment begins with a low dose and is gradually increased until there is the most improvement in symptoms and task improvement with the least side effects.

Drugs are often prescribed to help the child only during school, with weekends, holidays and summer vacations free.

Counseling should include behavioral and cognitive therapies (such as goal setting, self-monitoring, modeling and role-playing) and should help the child understand ADD. Structure and routines are essential.

Classroom behavior is often improved by cognitive-behavior modification, self-monitoring techniques, environmental control of noise and visual stimulation, appropriate task length, novelty, coaching, and teacher proximity.

When difficulties persist at home, parents should seek professional help and get training to learn behavior management techniques. Behavior management techniques and contingencies such as token economies and self-monitoring with reinforcement often are effective. Children with ADD with hyperactivity and poor impulse control are often helped at home when structure, consistent parenting techniques and well-defined limits are established.

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