Understanding ADD, Part I
Q. When can Attention Deficit Disorder (ADD) be detected in children? My daughter has always been high spirited, high strung and hard to please, even from birth. It's exhausting trying to keep her entertained and keep her from crying. I love my spirited angel, but I fear that she may have ADD or a behavior problem. At what age can I have this examined?
A. ADD is usually detected in children upon school entry, or between 5 and 6 years of age. This is because while the child is at home, parents are more accepting of a wide range of behavior in their child and the child is not required to conform to such a structured way of learning. When the child enters school, the child is required to conform and teachers are not as accepting of behaviors that don't conform to their perception of what is normal.
Three types of children are labeled with ADD. Some truly have a neurobiological quirk, causing them to think, act and learn differently. This is true ADD. A second group of children have what I call "situational ADD," a problem in their environment or a mismatch between child and school that needs to be corrected. A third group doesn't have ADD at all. They are just bright, energetic, creative children who act and learn differently. These children are exhausting to parents, challenging for teachers and just plain inconvenient, especially for a school system that rewards sameness and undervalues difference. These children are "differently abled," not "disabled." Bear in mind that ADD is not a deficit or disorder, it is a difference. These children need a different style of parenting and a different style of learning before this difference becomes a disorder or a disability. ADD does not always have the D-words -- deficit and disorder. Again, it is more a description than a diagnosis. It is also not a judgment whether the child is good or bad, just a term to describe how your child individually thinks and acts. The four features of ADD are selective attention, distractibility, impulsivity and sometimes hyperactivity, in which case it would be known as ADHD. Let's discuss these big four features.
1. Selective attention. This means a child goes from one extreme to another, showing the ability to intensely concentrate, or "hyperfocus," on something he enjoys doing, something he is good at or feels is relevant or interesting, yet becomes inattentive and tunes out things he finds routine or boring. While all children have difficulty concentrating on boring tasks, the child with ADD finds it nearly impossible. These children focus inappropriately. For example, send a child on an errand to his room to get something and he may get sidetracked watching a bug on the wall and forget why he was going upstairs in the first place. Or a child may focus on a bird playing in the tree outside rather than what the teacher is saying in the classroom. Again, this is more of a difference than a disability. The key to managing your child with ADD is to turn the possible liability into an asset. For example, because of the ability to hyperfocus (become extremely attentive to something that holds his interest), try to match the child with ADD to the task. For example, when I coach Little League baseball, I put the ADD child as pitcher, catcher or at first base where they have to pay attention. Never put a child with ADD in the outfield where he doesn't have to focus and can watch the birds and airplanes and truly be "out in left field." Veteran hockey team managers have long realized the value of positioning the child with ADD as a goalie because of their ability to hyperfocus.
2. Distractibility. Children with ADD have the inability to block out competing stimuli. They are filled with external and internal distractions. Even the growls of an empty stomach can distract them from doing homework or paying attention in class. They can't tune out competing stimuli, such as background noises, and they may be distracted by watching the insect on the wall rather than the teacher. This is why they need a structured learning environment in which competing stimuli are minimized.
3. Impulsivity. These children act before they think. They leap without looking. And it's the impulsivity that gets the child into trouble. This is not an excuse, but rather an explanation of their misbehavior. Because of their impulsivity, they are often unfairly labeled as a discipline problem. They need self-help behavior management tools, such as "count to three before..;" "always look before..;" and "think through what you're about to do..."
4. Hyperactivity. These children are not just more active than others, they are active at inappropriate times, fidgeting when they should be listening and sitting still. Many boys are prematurely labeled ADHD simply because they "can't sit still in circle time." Realistically, many boys are not ready to "sit still for circle time" until they are 5, or even 7, years old. Some children with ADD are not hyperactive at all. ADD is overdiagnosed in boys, yet is probably underdiagnosed in girls. Sometimes girls show a lot of distractibility and inattentiveness, such as "spacey Gracie," yet they are not labeled ADD because they are not hyperactive. Girls with ADD therefore tend to be mislabeled as "lazy" and "unmotivated" when in fact it is really ADD that causes their inattention and easy distractibility. Boys with ADD or ADHD tend to have more of a behavior problem, whereas girls with these conditions tend to have more emotional problems.
All children show some of these traits some of the time. A child with ADD shows most of these traits most of the time and to an extreme degree.