Specialty
What is Attention Deficit Disorder?
So many questions about A.D.D.: What is it? Is it being over diagnosed? Are too many prescriptions being written? How do you help children with this problem? Let's start with some attempt at a better definition. A.D.D. is not an inability to pay attention. Parents are forever saying to me that their child can watch a favorite video, build a complex leggos structure, use a computer, or draw a picture for hours, so how can I say the child has a deficit in attention? They are right. It is much better to think of A.D.D. (with or without hyperactivity) as an inability to delay responses, i.e., more of an impulse disorder than an attentional one. Such children tend to be drawn to the most interesting or novel aspects of their environment at any given moment. Instead of being able to shut off the "distraction" and stay focused on what they are "supposed to do", the child is unable to regulate their attention and just gets pulled to the more interesting event. It is not unlike the behavior of very young children and, indeed, this may be some type of failure to develop self-regulation of attention beyond that of infancy or toddler hood.
At present, we diagnose A.D.D. by a list of symptoms, meaning that it is not yet a "thing" for which there is a defining test. We rely on a detailed history and current observations by teachers and parents (usually collected on a checklist designed to assist in the diagnosis). It is possible to misdiagnose children especially those with a language processing disorder. The latter results in a child quickly losing an understanding of what is being said and then scanning around to find something more understandable and interesting. Also, if the evaluation is not thorough, children who are just anxious and/or depressed or those with a sleeping disorder or physical problem that causes discomfort could all be misdiagnosed. The issue is that our ability to pay attention is easily affected by many factors. However, if we carefully look for the evidence of impulsivity which is present in many aspects of the child's behavior, we are more likely to make an accurate diagnosis. Of course for a large percentage of A.D.D. children, the hyperactivity is obvious enough to make the diagnosis fairly easy.
It is estimated that approximately 6-7% of all children have A.D.D.. The sharp rise in children being diagnosed with this disorder, and the parallel increase in prescribing medication as a primary part of the treatment plan (usually stimulants such as Ritalin, Dexedrine, or Cylert) is the result of a more knowledgeable population of parents and professionals, not the invention of a convenient "excuse" for some children who have significant problems in school and/or at home. Sure, there will be some over identification but my experience is that this is a true disorder and we are just experiencing an explosion of research and information which is resulting in much more accurate recognition of the problem in both children and adults (probably 2/3's of children carry the disorder into adulthood and a significant percentage of children with A.D.D. will also have a parent with the same disorder). Although it has primarily been seen as a male disorder, this is probably because boys are more likely to be hyperactive and therefore referred for help more frequently. We are now realizing that girls have the distractibility problem much more often than recognized and the gender difference is less striking in current research.
The core issue of an inability to delay responses affects many aspects of the child's life. If feelings are rapidly discharged, the child will have difficulty learning to differentiate various emotions and will have greater problems in relationships. Impulsive reactions makes it more difficult to mentally absorb information resulting in poor memory, less insight, and difficulty in planning. Children with A.D.D. tend not to learn from experience, not to anticipate consequences, and to be very inconsistent in performance, all of which greatly frustrates the adults in their lives and results in substantial criticism. This leads to the high frequency of additional problems for these children. At least 60-70% will ultimately also be diagnosed as having depression, some form of anxiety disorder, a conduct disorder (anti-social behavior), and/or oppositional disorder. No wonder parents and teachers scream for help.
Treatment centers around the use of medication (which decreases, not increases, the likelihood of substance abuse in adolescence) and the following list of strategies: brevity (smaller pieces of information with reinforcement at each step), variety (repetition is a disaster for these children; they thrive on even small elements of novelty); structure (charts, lists, anything to help define what to expect and frequent review to help the child develop short-term coping strategies that will work; note that it is during transitions when the child often acts up so assistance is especially needed to give that situation some better definition for the child); identify and build off the child's strengths (find a way to work them into the task at hand; recognize and appreciate how hard it is for the child to cope with the demands of the day; give the child hope for the future); the need to be active (must allow movement, sometimes during the task a child needs to be up and about).
Remember this is a neurochemical disorder and the worst message to give a child is that he simply must try harder. A book title by Kelly and Ramundo says it best. "You mean I'm Not Lazy, Stupid, Or Crazy?!" There are many resources for parents and teachers such as ADD-IN and C.H.A.D.D. (local and national organizations) and excellent books and videos by people like Barkley, Fowler, Goldstein, Gordon, Hallowell, Ratey, Levine and many others. The best single resource for materials is the A.D.D. WareHouse catalogue (800-233-9273).
Back to Specialty | Back to ParenTalk
Top | Home | My
Practice | Parenting & Marriage Advice | Resources
| Contact
