There are at least two million children and adolescents with attention deficit disorders in the United States. This large number of people which are affected by this disorder makes it something which we as a society must take seriously. In the following essay I will explore many facets of this disorder. These include: An overview of ADD/ADHD, the history of understanding this disorder, common symptoms, theories about why it occurs, how to diagnose it, medical treatments, non-medical treatments, and finally how it affects those who are afflicted with this problem.
It is estimated that between two and three percent of all student age children have an attention deficit disorder. This number is most likely only a partial counting of the children who struggle with this disorder, as almost half of all cases go undiagnosed. Boys are diagnosed with this disorder between five to nine times more frequently than girls. It is believed that many girls have this disorder but don t display the disruptive behavior which people often tie to ADD/ADHD. But what exactly is this disorder that I am talking about? ADHD stands for Attention Deficit Hyperactivity Disorder. This is the official term used to describe all attention deficit disorders. These include; the predominantly inattentive type (ADD), the predominantly hyperactive and impulsive type, and the combined type. These used to all be classified under the ADD title, but for
many children hyperactivity was the larger symptom than a lack of attention. Yet there are all kinds of children who exhibit different combinations of the symptoms which make up ADHD. ADHD is a, Developmental disorder characterized by inappropriate degrees of inattention, over activity, and impulsivity. (Rief, Checklist for Basic Information on ADD/ADHD) Yet ADHD is a disorder on many different levels. ADHD is A production disorder. It is not a problem of learning per se. A person with ADHD may know the information or material well; but it is a problem of being able to perform or output that information and to do so consistency. (Rief, Checklist for Basic Information on ADD/ADHD) ADHD is also a Physiological disorder causing difficulty with inhibiting one s behavior and impulses. self-control, and goal-directed behavior. (Rief, Checklist for Basic Information on ADD/ADHD) With ADHD the attention center of the brain is not working properly, which leads to these types of problems in performance and production. A common misconception about this type of disorder is that it only effects children. This is not true. ADHD is a lifelong disorder. Its symptoms persist into adolescents, and up to seventy percent of those afflicted continue to exhibit symptoms into adulthood. The hyperactive symptoms seen in children often translates into fidgetiness or other nervous behaviors in adults. Yet this much has not always been known about the disorder now referred to as ADHD.
ADHD has not always been so clearly understood. In the early nineteen hundreds, children were noted who were excessively active and distractible, impulsive, unruly, and difficult to deal with both at home and in school. Even though some of these children were of average intelligence, with no detectable physical problems, their symptoms were associated with brain damage. This link between hyperactivity and brain damage was strengthened during the nineteen-eighteen encephalitis epidemic when scientists noticed that children recovering from encephalitis displayed this type of behavior. Research involving animals and children with epilepsy and other central nervous system disorders strongly supported the link between hyperactivity and brain damage. In order to try to explain this type of behavior in children without any physical symptoms, scientists coined the terms minimal brain damage or minimal brain dysfunction . These people reasoned that these children were suffering from brain damage which was not detectable by medical tests. These terms were used to describe children who were hyperactive deep into the fifties. Doctors of the time recommended classrooms with little or no stimulation and though that the children would outgrow these problems. As early as nineteen thirty-seven, doctors found that by prescribing stimulant s, hyperactive children could be calmed. These reports received little interest from mainstream society. It wasn t until the nineteen fifties that the idea of medicating children of this nature became a viable alternative to simply waiting for the child to grow out of it .
During this period, research was also being done into the causes of this disorder and past myths were beginning to be challenged. The idea that this disorder was caused by brain damage was about to be replaced. Scientists saw that these children did not have brain damage, but that this had been falsely inferred based on their behavior. They noticed that, there was excessive motor activity, which brought the child into conflict with their environment. The new term for what we now know as ADHD became hyperkinesis, which means excessive motion . By the early nineteen seventies, however, scientists focused less on motor activity. Led by psychologist Virginia Douglas, scientists changed their focus to the attention span of children who exhibited this disorder. These people figured that it was not the excessive activity that brings the child into conflict, but rather the short attention span. They concluded that the children could not stop and reflect on the possible consequences of actions. Therefore they went through life acting impulsively, responding to whatever caught their attention immediately without thought of repercussions. This is where the current title of Attention Deficit Hyperactivity Disorder comes from. This is basically where the current ideas involving ADHD are from. The study of ADHD has been going on for less than one hundred years, yet so much has been learned about this disorder in such a short amount of time.
There are many symptoms which make it possible to identify
someone with ADHD. The following is a list of common symptoms associated with ADHD:
P does not pay close attention to details; may make careless mistakes at work, school, or other activities
P failure to complete tasks
P has difficulty maintaining attention in tasks or play activities
P does not listen when spoken to directly
P has difficulty organizing tasks
P is easily distracted
P unable to follow more than one instruction at a time
P fidgeting, squirming in seat, or moving constantly
P wandering, may leave the seat in the classroom when expected to stay
P has trouble participating in “quiet” activities such as reading
P runs and climbs in inappropriate situations
P talks excessively
P may blurt out answers before questions have been completed
P has difficulty awaiting turn
P interrupts others
n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n
P disruptive behavior
P sleep problems
P inability to delay gratification
P social outcasts or loners (possibly inability to play in groups but may perform in one-on-one situation)
P apparent disregard for own safety
P behavior not usually modified by reward or
P may have other specific learning disabilities
P failure to meet normal intellectual
(Rief, Checklist for Basic Information on ADD/ADHD)
Different children will exhibit different symptoms but if a child falls under about sixty percent of these, they most likely have ADHD. Not everyone who is overly hyperactive, inattentive, or impulsive has an attention disorder. Since most people sometimes blurt out things they didn’t mean to say, bounce from one task to another, or become disorganized and forgetful, how can specialists tell if the problem is ADHD? To assess whether a person has ADHD, specialists consider several critical questions: Are these behaviors excessive and long-term? That is, do they occur more often than in other people the same age? Are they a continuous problem, not just a response to a temporary situation? Do the behaviors occur in several settings or only in one specific place like the
playground or the office? The person’s pattern of behavior is compared against a set of criteria and characteristics of the disorder. These criteria appear in a diagnostic reference book called the DSM (short for the Diagnostic and Statistical Manual of Mental Disorders). According to the diagnostic manual, there are three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive.
Health professionals stress that since no one knows what causes ADHD, it doesn’t help parents to look backward to search for possible reasons. There are too many possibilities to pin down the cause with certainty. It is far more important for the family to move forward in finding ways to get the right help. Scientists, however, do need to study causes in an effort to identify better ways to treat, and perhaps some day, prevent ADHD. They are finding more and more evidence that ADHD does not stem from home environment, but from biological causes. When you think about it, there is no clear relationship between home life and ADHD. Not all children from unstable or dysfunctional homes have ADHD. Knowing this can remove a huge burden of guilt from parents who might blame themselves for their child’s behavior.
Over the last decades, scientists have come up with possible theories
about what causes ADHD. Some of these theories have led to dead ends, some to exciting new avenues of investigation.
ADHD Is Not Usually Caused by:
P too much TV
P food allergies
P excess sugar
P poor home life
P poor schools
(Rief, Checklist for Basic Information on ADD/ADHD)
One disappointing theory was that all attention disorders and learning disabilities were caused by minor head injuries or undetectable damage to the brain, perhaps from early infection or complications at birth. Based on this theory, as I have earlier stated, for many years both disorders were called “minimal brain damage” or “minimal brain dysfunction.” Although certain types of head injury can explain some cases of attention disorder, the theory was rejected because it could explain only a very small number of cases. Not everyone with ADHD or LD has a history of head trauma or birth complications. Another theory was that refined sugar and food additives make children hyperactive and inattentive. As a result, parents were encouraged to stop serving children foods containing artificial flavorings, preservatives, and sugars. However, this theory, too, came under question. In 1982, the National Institutes
of Health (NIH), the Federal agency responsible for biomedical research, held a major scientific conference to discuss the issue. After studying the data, the scientists concluded that the restricted diet only seemed to help about 5 percent of children with ADHD, mostly either young children or children with food allergies. In recent years, as new tools and techniques for studying the brain have been developed, scientists have been able to test more theories about what causes ADHD. Using one such technique, scientists demonstrated a link between a person’s ability to pay continued attention and the level of activity in the brain. Adult subjects were asked to learn a list of words. As they did, scientists used a PET (positron emission tomography) scanner to measure the level of glucose used by the areas of the brain that inhibit impulses and control attention. Glucose is the brain’s main source of energy, so measuring how much is used is a good indicator of the brain’s activity level. The investigators found important differences between people who have ADHD and those who don’t. In people with ADHD, the brain areas that control attention used less glucose, indicating that they were less active. It appears from this research that a lower level of activity in some parts of the brain may cause inattention.
The next step will be to research why there is less activity in these areas of the brain. Scientists hope to compare the use of glucose and the activity level in mild and severe cases of ADHD. They will also try to discover why some medications used to treat ADHD work better than others, and if the more
effective medications increase activity in certain parts of the brain. Researchers are also searching for other differences between those who have and do not have ADHD. Research on how the brain normally develops in the fetus offers some clues about what may disrupt the process. Throughout pregnancy and continuing into the first year of life, the brain is constantly developing. It begins its growth from a few all-purpose cells and evolves into a complex organ made of billions of specialized, interconnected nerve cells. By studying brain development in animals and humans, scientists are gaining a better understanding of how the brain works when the nerve cells are connected correctly and incorrectly. Scientists and research institutions are tracking clues to determine what might prevent nerve cells from forming the proper connections. Some of the factors they are studying include drug use during pregnancy, toxins, and genetics. Research shows that a mother’s use of cigarettes, alcohol, or other drugs during pregnancy may have damaging effects on the unborn child. These substances may be dangerous to the fetus’s developing brain. It appears that alcohol and the nicotine in cigarettes may distort developing nerve cells. For example, heavy alcohol use during pregnancy has been linked to fetal alcohol syndrome (FAS), a condition that can lead to low birth weight, intellectual impairment, and certain physical defects. Many children born with FAS show much the same hyperactivity, inattention, and impulsivity as children with ADHD. Drugs such as cocaine–including the smokable form known as crack–seem to affect the
normal development of brain receptors. These brain cell parts help to transmit incoming signals from our skin, eyes, and ears, and help control our responses to the environment. Current research suggests that drug abuse may harm these receptors. Some scientists believe that such damage may lead to ADHD.
Toxins in the environment may also disrupt brain development or brain processes, which may lead to ADHD. Lead is one such possible toxin. It is found in dust, soil, and flaking paint in areas where leaded gasoline and paint were once used. It is also present in some water pipes. Some animal studies suggest that children exposed to lead may develop symptoms associated with ADHD, but only a few cases have actually been found.
Other research shows that attention disorders tend to run in families, so there are likely to be genetic influences. Children who have ADHD usually have at least one close relative who also has ADHD. And at least one-third of all fathers who had ADHD in their youth bear children who have ADHD. Even more convincing: the majority of identical twins share the trait. At the National Institutes of Health, researchers are also on the trail of a gene that may be involved in transmitting ADHD in a small number of families with a genetic thyroid disorder.
For decades, medications have been used to treat the symptoms of ADHD. Three medications in the class of drugs known as stimulants seem to be
the most effective in both children and adults. These are methylphenidate (Ritalin), dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert). For many people, these medicines dramatically reduce their hyperactivity and improve their ability to focus, work, and learn. The medications may also improve physical coordination, such as handwriting and ability in sports. Recent research suggests that these medicines may also help children with an accompanying conduct disorder to control their impulsive, destructive behaviors. Unfortunately, when people see such immediate improvement, they often think medication is all that’s needed. But these medicines don’t cure the disorder, they only temporarily control the symptoms. Although the drugs help people pay better attention and complete their work, they can’t increase knowledge or improve academic skills. The drugs alone can’t help people feel better about themselves or cope with problems. These require other kinds of treatment and support.
For lasting improvement, numerous clinicians recommend that medications should be used along with treatments that aid in these other areas. There are no quick cures. Many experts believe that the most significant, long-lasting gains appear when medication is combined with behavioral therapy, emotional counseling, and practical support. Some studies suggest that the combination of medicine and therapy may be more effective than drugs alone. NIMH is conducting a large study to check this. Stimulant drugs, such as Ritalin,
Cylert, and Dexedrine, when used with medical supervision, are usually considered quite safe. Although they can be addictive to teenagers and adults if misused, these medications are not addictive in children. They seldom make children “high” or jittery. Nor do they sedate the child. Rather, the stimulants help children control their hyperactivity, inattention, and other behaviors. Different doctors use the medications in slightly different ways. Cylert is available in one form, which naturally lasts 5 to 10 hours. Ritalin and Dexedrine come in short-term tablets that last about 3 hours, as well as longer-term preparations that last through the school day. The short-term dose is often more practical for children who need medication only during the school day or for special situations, like attending church or a prom, or studying for an important exam. The sustained-release dosage frees the child from the inconvenience or embarrassment of going to the office or school nurse every day for a pill. The doctor can help decide which preparation to use, and whether a child needs to take the medicine during school hours only or in the evenings and on weekends, too. Nine out of 10 children improve on one of the three stimulant drugs. So if one doesn’t help, the others should be tried. Usually a medication should be tried for a week to see if it helps. If necessary, however, the doctor will also try adjusting the dosage before switching to a different drug.
Other types of medication may be used if stimulants don’t work or if the ADHD occurs with another disorder. Antidepressants and other medications
may be used to help control accompanying depression or anxiety. In some cases, antihistamines may be tried. Clonidine, a drug normally used to treat hypertension, may be helpful in people with both ADHD and Tourette’s syndrome. Although stimulants tend to be more effective, clonidine may be tried when stimulants don’t work or can’t be used. Clonidine can be administered either by pill or by skin patch and has different side effects than stimulants. The doctor works closely with each patient to find the most appropriate medication. Sometimes, a child’s ADHD symptoms seem to worsen, leading parents to wonder why. They can be assured that a drug that helps rarely stops working. However, they should work with the doctor to check that the child is getting the right dosage. Parents should also make sure that the child is actually getting the prescribed daily dosage at home or at school–it’s easy to forget. They also need to know that new or exaggerated behaviors may also crop up when a child is under stress. The challenges that all children face, like changing schools or entering puberty, may be even more stressful for a child with ADHD. Some doctors recommend that children be taken off a medication now and then to see if the child still needs it. They recommend temporarily stopping the drug during school breaks and summer vacations, when focused attention and calm behavior are usually not as crucial. These “drug holidays” work well if the child can still participate at camp or other activities without medication. Children on medications should have regular checkups. Parents should also talk regularly
with the child’s teachers and doctor about how the child is doing. This is especially important when a medication is first started, re-started, or when the dosage is changed.
As useful as these drugs are, Ritalin and the other stimulants have sparked a great deal of controversy. Most doctors feel the potential side effects should be carefully weighed against the benefits before prescribing the drugs. While on these medications, some children may lose weight, have less appetite, and temporarily grow more slowly. Others may have problems falling asleep. Some doctors believe that stimulants may also make the symptoms of Tourette’s syndrome worse, although recent research suggests this may not be true. Other doctors say if they carefully watch the child’s height, weight, and overall development, the benefits of medication far outweigh the potential side effects. Side effects that do occur can often be handled by reducing the dosage. It’s natural for parents to be concerned about whether taking a medicine is in their child’s best interests. Parents need to be clear about the benefits and potential risks of using these drugs. The child’s pediatrician or psychiatrist can provide advice and answer questions.
Another debate is whether Ritalin and other stimulant drugs are prescribed unnecessarily for too many children. Remember that many things, including anxiety, depression, allergies, seizures, or problems with the home or
school environment can make children seem overactive, impulsive, or inattentive. Critics argue that many children who do not have a true attention disorder are medicated as a way to control their disruptive behaviors. When a child’s schoolwork and behavior improve soon after starting medication, the child, parents, and teachers tend to applaud the drug for causing the sudden change. But these changes are actually the child’s own strengths and natural abilities coming out from behind a cloud. Giving credit to the medication can make the child feel incompetent. The medication only makes these changes possible. The child must supply the effort and ability. To help children feel good about themselves, parents and teachers need to praise the child, not the drug. It’s also important to help children and teenagers feel comfortable about a medication they must take every day. They may feel that because they take medicine they are different from their classmates or that there s something seriously wrong with them.
Life can be hard for children with ADHD. They’re the ones who are so often in trouble at school, can’t finish a game, and lose friends. They may spend agonizing hours each night struggling to keep their mind on their homework, then forget to bring it to school. It’s not easy coping with these frustrations day after day. Some children release their frustration by acting
contrary, starting fights, or destroying property. Some turn the frustration into body ailments, like the child who gets a stomachache each day before school. Others hold their needs and fears inside, so that no one sees how badly they feel. It’s also difficult having a sister, brother, or classmate who gets angry, grabs your toys, and loses your things. Children who live with or share a classroom with a child who has ADHD get frustrated, too. They may feel neglected as their parents or teachers try to cope with the hyperactive child. They may resent their brother or sister never finishing chores, or being pushed around by a classmate. They want to love their sibling and get along with their classmate, but this is difficult for them. It’s especially hard being the parent of a child who is full of uncontrolled activity, leaves messes, throws tantrums, and doesn’t listen or follow instructions. Parents often feel powerless and at a loss. The usual methods of discipline, like reasoning and scolding, don’t work with this child, because the child doesn’t really choose to act in these ways. It’s just that their self-control comes and goes. Out of sheer frustration, parents sometimes find themselves spanking, ridiculing, or screaming at the child, even though they know it’s not appropriate. Their response leaves everyone more upset than before. Then they blame themselves for not being better parents. Once children are diagnosed and receiving treatment, some of the emotional upset within the family may fade. Medication can help to control some of the behavior problems that may have lead to family turmoil. But more often, there are other aspects of the
problem that medication can’t touch. Even though ADHD primarily affects a person’s behavior, having the disorder has broad emotional repercussions. For some children, being scolded is the only attention they ever get. They have few experiences that build their sense of worth and competence. If they’re hyperactive, they’re often told they’re bad and punished for being disruptive. If they are too disorganized and unfocused to complete tasks, others may call them lazy. If they impulsively grab toys, butt in, or shove classmates, they may lose friends. And if they have a related conduct disorder, they may get in trouble at school or with the law. Facing the daily frustrations that can come with having ADHD can make people fear that they are strange, abnormal, or stupid. Often, the cycle of frustration, blame, and anger has gone on so long that it will take some time to undo. Both parents and their children may need special help to develop techniques for managing the patterns of behavior. In such cases, mental health professionals can counsel the child and the family, helping them to develop new skills, attitudes, and ways of relating to each other.
In individual counseling, the therapist helps children or adults with ADHD learn to feel better about themselves. They learn to recognize that having a disability does not reflect who they are as a person. The therapist can also help people with ADHD identify and build on their strengths, cope with daily problems, and control their attention and aggression. In group counseling, people learn that they are not alone in their frustration and that others want to help.
Sometimes only the individual with ADHD needs counseling support. But in many cases, because the problem affects the family as well as the person with ADHD, the entire family may need help. The therapist assists the family in finding better ways to handle the disruptive behaviors and promote change. If the child is young, most of the therapist’s work is with the parents, teaching them techniques for coping with and improving their child’s behavior.
Several intervention approaches are available and different therapists tend to prefer one approach or another. Knowing something about the various types of interventions makes it easier for families to choose a therapist that is right for their needs. Psychotherapy works to help people with ADHD to like and accept themselves despite their disorder. In psychotherapy, patients talk with the therapist about upsetting thoughts and feelings, explore self-defeating patterns of behavior, and learn alternative ways to handle their emotions. As they talk, the therapist tries to help them understand how they can change. However, people dealing with ADHD usually want to gain control of their symptomatic behaviors more directly. If so, more direct kinds of intervention are needed. Cognitive-behavioral therapy helps people work on immediate issues. Rather than helping people understand their feelings and actions, it supports them directly in changing their behavior. The support might be practical assistance, like helping children learn to think through tasks and organize his work. Or the support might be to encourage new behaviors by giving praise or rewards each time the person
acts in the desired way. A cognitive-behavioral therapist might use such techniques to help a belligerent child learn to control his fighting, or an impulsive teenager to think before they speak. Social skills training can also help children learn new behaviors. In social skills training, the therapist discusses and models appropriate behaviors like waiting for a turn, sharing toys, asking for help, or responding to teasing, then gives children a chance to practice. For example, a child might learn to “read” other people’s facial expression and tone of voice, in order to respond more appropriately.
Support groups connect people who have common concerns. Many adults with ADHD and parents of children with ADHD find it useful to join a local or national support group. Many groups deal with issues of children s disorders, and even ADHD specifically. Members of support groups share frustrations and successes, referrals to qualified specialists, and information about what works, as well as their hopes for themselves and their children. There is strength in numbers–and sharing experiences with others who have similar problems helps people know that they aren’t alone. Parenting skills training, offered by therapists or in special classes, gives parents tools and techniques for managing their child’s behavior. One such technique is the use of “time out” when the child becomes too unruly or out of control. During time outs, the child is removed from the agitating situation and sits alone quietly for a short time to calm down. Parents may also be taught to give the child “quality time” each day,
in which they share a pleasurable or relaxed activity. During this time together, the parent looks for opportunities to notice and point out what the child does well, and praise his or her strengths and abilities.
An effective way to modify a child’s behavior is through a system of rewards and penalties. The parents (or teacher) identify a few desirable behaviors that they want to encourage in the child–such as asking for a toy instead of grabbing it, or completing a simple task. The child is told exactly what is expected in order to earn the reward. The child receives the reward when he performs the desired behavior and a mild penalty when he doesn’t. A reward can be small, perhaps a token that can be exchanged for special privileges, but it should be something the child wants and is eager to earn. The penalty might be removal of a token or a brief “time out.” The goal, over time, is to help children learn to control their own behavior and to choose the more desired behavior. The technique works well with all children, although children with ADHD may need more frequent rewards. In addition, parents may learn to structure situations in ways that will allow their child to succeed. This may include allowing only one or two playmates at a time, so that their child doesn’t get over stimulated. Or if their child has trouble completing tasks, they may learn to help the child divide a large task into small steps, then praise the child as each step is completed. Parents may also learn to use stress management methods to increase their own tolerance for frustration, so that they can respond more calmly to their
child’s behavior. This way they are more prepared to deal with their child s behavior and less likely to respond with anger. Using methods such as these can make the act of living with ADHD as a part of your lifestyle much easier.
Throughout my in depth study of this subject I have learned much about ADHD and how it effects those afflicted with it. This has led me to better understand the difficulties facing those that are challenged by this disorder. I also realized that this disorder could be coped with by using medication, and other treatments. ADHD is a serious problem in our society, but by educating people, we can better diagnose, and help people living with this disability.