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Understanding The Child With Attention Deficit Disorder

With Or Without Hyperactivity

Children with attention deficit hyperactivity disorder (ADHD) or without hyperactivity (ADD) can be a real challenge for their parents, teachers, pediatricians, and themselves. These children have trouble controlling their behavior and are at risk of doing poorly in school.


Attention Deficit Disorder without Hyperactivity
Children who have attention deficit disorder without hyperactivity (ADD) have the same symptoms as ADHD except they do not show signs of overactivity. They may appear sluggish, anxious, shy, or unmotivated. School problems are common and they are often labeled lazy.

Children with ADD need the same treatment as children with ADHD. They may respond well to stimulant medications and may also benefit from the various non-medication therapies. Talk to your child's pediatrician if you think your child has ADD.

In most cases, ADD can be substituted for ADHD in the information to follow.


What is ADHD?
  • ADHD is a behavioral problem.
  • Children with ADHD may also have a learning disability.
  • Children with ADHD are overactive, impulsive, and have trouble paying attention for more than a few minutes.
  • ADHD affects 3% to 5% of all school-age children and is more common in boys.
  • ADHD is very stressful for the child as well as the entire family.
  • Children with ADHD often know their behavior is disruptive, but they cannot seem to control it.
  • Parents need to understand this and give their children love and support.
  • Parents also need to work with their child's pediatrician, teachers, and counselors to learn how to cope with ADHD.

How Is ADHD Diagnosed?
There is no specific test for ADHD/ADD. It is diagnosed through both a professional observation and evaluation of the child's medical, academic, and behavioral history.

There are questionnaires and other diagnostic tools available that are helpful in making the diagnosis. Some of these tools are very simple to fill out (Connor's scale), while others are much more difficult to interpret.

It is common for it to take some time before a diagnosis of ADHD/ADD is accurately made.


Signs of ADHD
ADHD can be mistaken for other psychological problems, learning disabilities, or physical problems (vision, hearing). When a child is in a structured setting, doing something he/she is interested in, or receiving one-on-one attention, signs of ADHD may be hard to see.

To make the diagnosis of ADHD/ADD, it is important to confirm that a child's symptoms are present most of the day over a period of time, in a variety of environments and situations.

ADHD can be very hard to diagnose since it shares many of the same symptoms as other disorders. Symptoms of ADHD usually start before a child reaches 7 years of age and it is important to rule out other medical or emotional problems.

Children with ADHD have trouble paying attention, are impulsive, and usually very active. Some children, however, are inattentive and impulsive but not hyperactive. All children act this way once in a while, but children with ADHD act this way most of the time. The following list may help you determine if your child has symptoms of ADHD.

If your child has a significant number of these symptoms and these symptoms have lasted for 6 months or longer, discuss your observations with your pediatrician.
  • Signs of ADHD in Children 3 to 5 Years of Age:
    • Are constantly in motion
    • Find it hard to sit still at mealtimes
    • Play only briefly with toys, and flip from one activity to another
    • Have difficulty responding to simple commands
    • Play in a way that seems noisier than that of other children
    • Talk nonstop and often interrupt others
    • Have trouble sharing, waiting, and taking turns; often take things away from others with little regard for their feelings
    • Misbehave regularly
    • Have trouble keeping friends
    • Are described by teacher as "hard to handle" or "behavior problem"
  • Signs of ADHD in Children 6 to 12 Years of Age:
    • Often get into dangerous activities without thinking about what will happen
    • Fidget and squirm restlessly in seat and often wander around the classroom
    • Are easily distracted and do not finish assignments or chores
    • Have trouble following through on instructions
    • Play in an overly aggressive manner
    • Talk at inappropriate times and often blurt out answers to questions
    • Have difficulty waiting in lines or taking turns in games or group situations
    • Are disorganized and often lose things; make careless mistakes at school and home
    • Have inconsistent school performance
    • Are socially immature, with few friends and have a poor reputation among peers
    • Have been labeled by teachers as "unmotivated," "lazy," "a daydreamer," or a "behavior problem"

What Causes ADHD?
The causes of ADHD are not clearly understood. Some studies suggest the following:
  • Children with ADHD have problems with the chemicals that transmit messages in the brain (neurotransmitters)
  • If one or both parents have ADHD, their children may show symptoms.
  • Exposure to toxins may cause ADHD.
  • ADHD may be seen after childhood illnesses.
  • Developmental problems may be associated with ADHD.

Diagnosis and Identification of ADHD
Many children have moments when they seem "hyperactive," but true hyperactivity affects only about 1 in 20 children under the age of 12. However, if you think your child may have ADHD, discuss your reasons for thinking this with your pediatrician.

Although children can show signs of ADHD at an early age, a diagnosis is not made until they start school. This is because children with ADHD often have the most trouble with the structure of school and symptoms become more apparent in the classroom.

There is no single test for ADHD. The diagnostic evaluation starts when your child's pediatrician takes a complete health history to rule out any physical problems, learning disability, or other behavioral problems. Your pediatrician will also ask about your child's behavior at home and in school and may request more information from your child's teachers about school behavior.

ADHD can be hard to identify and it may take some time before it is diagnosed. Be patient and give your child a lot of emotional loving support until the cause of his/her problems can be determined.


Management of ADHD
A child with ADHD can create a lot of stress for parents and family. Without treatment, a child with ADHD will continue to be disruptive to the family. There are things that you can do, however, to help your child control his/her behavior.

Keep your child on a daily schedule. Try to keep the time that your child wakes up, eats, bathes, leaves for school, and goes to sleep consistent each day. Whenever possible, avoid putting your child in places that may be over-stimulating, like busy shopping malls.

Children with ADHD often get the attention of their parents when they do something wrong. It is important to reward your child with kind words, hugs, and occasional gifts for positive behavior. These kinds of positive reinforcement, and loving support from parents, family members, and friends, will help your child’s self esteem.


How Should I Discipline My Child with ADHD or ADD?
Parents often get angry with their ADHD child's behavior and may resort to physical punishment. Corporal punishment like spanking, slapping, or hitting is not advisable.

Instead, use more effective discipline techniques. For example, if your child's hyperactivity is frustrating you, try to ignore the behavior by walking away. If your child is overexcited, try using distraction with another activity.

If your child acts out with hitting or biting, you may need to remove him/her from the situation. Quiet time alone (time-out) until your child calms down is a better alternative to physical punishment. After your child has calmed down, explain to your child what was done that was wrong or unacceptable. It is equally important to explain the consequences of his/her inappropriate behavior.


The ADHD Child in School
Do not keep your child's ADHD a secret. A team approach is the best support for your child. Once a diagnosis is made, arrange a meeting with your child's school teacher(s), principal, school psychologist or counselor, and nurse. Work with the school team to help identify your child's strengths and areas of weakness. Arrange regular meetings with the team to discuss information about your child's progress.

The structure and rules of the classroom are often hard for children with ADHD. However, most children with ADHD can be taught in a regular classroom. Work with your child's teacher as classroom success may require a range of interventions. By understanding your child's struggle, the teacher will be better able to help your child do better in school.

Small group settings are easier for ADHD children to handle and should be used whenever possible. ADHD children tend to become easily distracted in large groups. They are easily bored and need constant reinforcement in order to complete tasks. For this reason, private tutors often work well. Many ADHD children get more accomplished in 30-60 minutes with a tutor than during an entire day at school.

It is important to remember that children with ADHD can do as well in school as their peers. ADHD does not mean a child is not smart. Children with ADHD may be disorganized and inattentive, but this is a result of the disorder, not their ability to learn. Once diagnosed and treated, children with ADHD can be helped to perform very well in school.

If your child's pediatrician, teachers, and counselors work together and your child gets a lot of support from family and friends, your child can achieve academic success. Talk to your child's teachers and pediatrician about any special programs they might know of for ADHD children. Traditional special education is usually for children with learning disabilities, which may not be the ADHD child's problem.


Treatment
There is no cure for ADHD, but there are several ways it can be helped. With the counsel and cooperation of your child's pediatrician, teachers, counselors, and family members, your child can lead a normal life in spite of this disorder.

Medication for children with ADHD should never be used as the only form of treatment. It is equally as important to work with teachers, counselors, and other family members to manage your child's behavior.


Medication

When used as part of a total treatment plan, medication can successfully improve your child's ability to cope with ADHD. Various medicines are used to treat ADHD, however there is no "quick fix" for ADHD. Finding the right medicine or combination of medicines and the right dose, is a process that usually requires adjustments over time.

Psychostimulants (Adderall, Ritalin, Cylert) are the first medications used in the treatment of ADHD. This class of medicines do not "stimulate" your child. They act by stimulating the area of the brain that has been shown to have low levels of neurotransmitters.

Neurotransmitters are chemicals in the brain that are responsible for sending information from one area of the brain to another. When one of these chemicals is in short supply or not working properly, a child will show signs of ADHD or ADD.

Stimulation of this specific area of the brain results in decreased impulsivity and hyperactivity, increased attention, and decreased aggressive activity. Children with ADHD are able to better control their behavior and may become quieter and more attentive.

For school-age children (over 6 years of age) , the following medicines can be used in the treatment of ADHD or ADD:

  • Adderall (combination of amphetamines)
  • Ritalin (methylphenidate hydrochloride)
  • Dexedrine (dextroamphetamine)
  • Cylert (magnesium pemoline)
  • Catapres (clonidine)
  • Tenex (guanfacine)
I usually recommend beginning with a trial of Adderall. The initial dose of Adderall is 2.5-5mg given before school. The dose can be increased 2.5-5mg every 3-5 days if there is no response. A second dose can be given 4-6 hours after the first dose. Most children will respond using doses less than 15mg two times a day.

The above medicines can be used alone or in combination. Trial and error will be the best way to determine which medicine is best for your child. It is important to return to our office 2-3 weeks after beginning treatment to help adjust your child’s dose, discuss school performance, and any concerns over possible side effects.

These medications are not addictive but occasionally have side effects. Side effects such as headaches, sleeplessness, loss of appetite, and depression may occur. These side effects are not common and are reversible when the medicines are stopped. Your child's weight should be checked regularly to monitor for possible weight loss secondary to appetite suppression.


Non-Medication Therapies
As a parent of a child with ADHD, you may hear about non-drug treatments. Many of these have not been proven to be effective. However, some of these therapies may be helpful in some cases. They include:
  • Play therapy: This may help a child who has fears and anxieties, however these are not the key problems among most ADHD children.
  • Special physical exercises: These try to improve coordination and increase your child's ability to handle activities that can overstimulate them. Most ADHD children do have problems in these areas, but this is not the cause of ADHD. While these exercises may help, they seem to work because they get parents to pay more attention to the child. This increases the child’s self-esteem.
  • Special diets: These are based on the unproven idea that certain foods cause ADHD. These diets look at specific groups of foods, such as additives, sugar, and foods that children are commonly allergic to, like corn, nuts, chocolate, shellfish, or wheat. While there is scientific evidence that these diets do not work, many parents strongly believe they help. Some of these diets are healthy and will not cause harm. If your child is on a special diet, discuss it with your pediatrician. Remember, no special diet alone can solve the problems of ADHD and should not be used as the only treatment for your child's behavior.
Parents need to be aware of treatments that may be dangerous to their child. These include megavitamin therapy and special vitamin and mineral supplements. Make sure you talk to your pediatrician before using any non-drug therapy for your child.


Summary

With early treatment, the outlook for children with ADHD is encouraging. Even though your child will never outgrow the ADHD, the behaviors that are problematic can be helped to provide better coping mechanisms later in life. It is easier for children with ADHD to find success once they are freed from the structure of the classroom.

Individuals with ADD choose careers that fit their behavioral styles such as entrepreneurs or work in the arts and entertainment fields. The help and support ADHD children receive today from their parents, teachers, and pediatricians can help them grow up to become successful and happy adults.


Books on Attention Deficit Disorder

Driven To Distraction: Recognizing and Coping with Attention Deficit Disorder
by Edward M. Hallowell MD & John J. Ratey MD

Answers To Distraction
by Edward M. Hallowell MD & John J. Ratey MD

Why Johnny Can't Concentrate: Coping with Attention Deficit Problems
by Robert Moss

Teenagers with ADD: A Parent's Guide
by Chris A. Zeigler Dendy, M.S.

Taking Charge of ADHD
by R. Barkley

Power Parenting for Children with ADD/ADHD: A Practical Parent's Guide for Managing Difficult Behaviors
by Grad L. Flick, Ph.D.

Putting on the Brakes
by Patricia O. Quinn, M.D. and Judith Stern, M.A.

Adolescents and ADD: Gaining the Advantage
by Patricia O. Quinn, M.D

Straight Talk About Psychiatric Medications for Kids
by Dr. Timothy Wilens


Additional Areas To Learn About ADHD:

Web Site on ADD: http://members.aol.com/PAR1957/ADD.html
Children With Attention-Deficit Disorders (CHADD): 800-233-4050 www.chadd.org
ADD Warehouse: 800-233-3273 www.addwarehouse.com


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