An Overview of ADD
His room looks like a bomb exploded in it. Grades plummet as he spends an entire evening on 10 minutes of homework. Routine tasks, such as picking up his clothes, waiting his turn and remaining seated, become increasingly impossible. Your child's frustration mounts as teachers expect him to cope with more independent tasks. His behavior begins to adversely affect his social, school and home life.
Suddenly his teachers, his school counselor and other parents thrust an acronym upon you: ADHD. But what is it and how do you know if your child has it?
"Attention Deficit Disorder [ADD] or Attention Deficit Hyperactivity Disorder [ADHD] doesn't just appear in adolescence, though this is the time many are identified," says Terry Matlen, MSW, ACSW, a psychotherapist in Birmingham, Mich.
Boys lead the ranks in the numbers diagnosed, but girls trail close behind. The disorder affects 3 percent to 5 percent of school age children, according to Children and Adults with Attention Deficit Hyperactivity Disorder. The current name, Attention Deficit Hyperactivity Disorder, reflects the inattention and distraction aspect of the disorder as well as hyperactivity and impulsivity.
"The hallmark symptoms of ADHD include distractibility, procrastination, hyperactivity, or in some cases the opposite -- sluggishness, inattention and disorganization," Matlen says.
Children with ADHD find it hard to sit through lecture-style classes. They daydream, fidget or pass notes instead of listening. Their grades, never at the top of the curve, now swing lower as behavior issues escalate. They often lose personal items, flit from activity to activity and go from being gregarious to reserved overnight, Matlen says.
"My grandson tries to do too many things at once and accomplishes nothing," says Jan Bailey of Norwalk, Calif. "During homework time, he talks on the phone, plays with Legos, looks at his novel, studies a bug crawling up the window or anything else that catches his eye. Like most children with ADHD, he's moodier than other kids his age, falling asleep and waking with difficulty."
A child with ADHD often spends his day fighting with friends. "They act without thinking, do silly things to get attention and misread or misjudge social cues," says Jerome Schultz Ph.D., clinical director and neuropsychologist at Lesley University in Cambridge, Mass. Yet social isolation from peers leads to low self-esteem and depression, he says.
Making a Diagnosis
Every child exhibits some of these behaviors at one time or another. However, for a child to be diagnosed with ADHD, his symptoms must be more frequent or severe than in other children of the same age. Symptoms must affect the ability to function in daily life and persist for an extended period. In addition, the behaviors must create significant difficulty in at least two areas of life, such as home, social settings, school or work.
It's important to rule out allergies and other factors that could make a child "look" like he has ADHD, Matlen says. "If your family doctor finds nothing physically wrong, then it's time to ask for a referral to an expert trained in diagnosing neurological disorders."
The disorder is believed to be caused by a difference in brain tissue or by disturbances in the production or use of certain brain chemicals, says Schultz. "Which is why it's so important to see someone who specializes in the diagnosis and treatment of these disorders," he says. It is also important to know how the disorder affects each child so that appropriate strategies can be used. "The method of treatment will be different for a child who is inattentive, but not hyperactive," Schultz says.
Studies show that untreated ADHD in childhood can lead to significant problems later in life, including substance abuse, dropping out of school and anti-social behavior, says Matlen. "They get involved in drinking and drugs at an early age as a way to self-medicate the ADHD or to handle social loneliness," she says.
After evaluation and diagnosis, parents need to make a decision about treatment, which can be as frustrating as the disorder itself. "It's not a matter of behavior management over Ritalin," Schultz says. "Home and classroom environments should be modified to provide as much structure as possible before medication is tried."
Steve Metz, father of a child with ADD in Manalapan, N.J., encourages parents to demand full testing and an Individual Education Plan for their child. "Present the school with a clear and precise diagnosis," Metz says. "Tell them what your child needs and what you expect. Learn what your child's rights are under state and federal law, and come up with a game plan to secure rights involving special education."
Parents also can try behavior modification, which attempts to alter behavior through providing positive reinforcement. "It begins by using something tangible like stickers, food or tokens given to reward desired behavior," Schultz says. "Gradually, as behavior changes, parents can offer less tangible rewards such as computer or TV time." The ultimate goal is to phase out the need for reinforcers, and have the child exhibit the behavior because he sees it as helpful or desirable, he says.
"Medications may be suggested, but they should never constitute the entire treatment program," Matlen says. If a doctor suggests a drug like Ritalin, Cylert or Adderall, it's important to understand that drugs don't offer a miracle cure. By toning down the child's need to be constantly on the go, medication allows time for him to work on behavior issues in a positive way, Matlen says.
Controversy surrounding whether or not to medicate confuse and frustrate parents and caregivers. Antidepressants, antihypertensives, stimulants and depressants are all used for ADHD, either alone or in combination with one another. Parents should discuss pros and cons with their doctor or mental health professional before using any medication.
Some parents turn to "natural" or "herbal" remedies. Yet these are not screened or monitored by the FDA, making it impossible to measure potency, says Matlen. "There have been no studies that show that 'natural' remedies work in treating ADHD, and parents should understand that natural remedies can have just as dangerous side effects as prescriptions," she says.
Medication won't solve a child's problems, but learning how to deal with the disorder empowers him to succeed.
"Parents form the first line of defense," says Metz. "They must set parameters of acceptable behavior and provide a caring environment in which ADHD is understood and adaptations can be made as needed."