Attention deficit disorder
Inattentive, impulsive, in trouble
Attention deficit disorder and attention deficit hyperactivity disorder (ADD/ADHD) may go unrecognized for years, since its main signs inattention, impulsiveness, and hyperactivity often overlap with children's normal behaviors.
But children with ADD/ADHD who go undiagnosed and untreated can suffer profound impairments in their ability to learn and socialize. Unable to keep friends or learn easily, a source of frustration to parents and teachers alike, untreated children fall further and further behind at every meaningful developmental stage of life.
ADD/ADHD may persist into adulthood in possibly as many as 65% of childhood cases. As adults, their destructive behavior may alienate family and friends. They may not finish school or keep a job, and are also more likely to abuse alcohol and drugs and to commit suicide.
Currently, more than two million North American schoolchildren have been diagnosed with ADD/ADHD. Doctors are successfully treating many of them with stimulant medications such as Ritalin. But controversy continues about how doctors may overdiagnose attention deficit disorder, and how frequently they prescribe stimulant medications. Some people argue that medication is an easy answer that ignores more complex problems such as overcrowded classrooms and dissatisfaction with school.
Attention deficit disorder is a neuropsychological condition that affects children and adults. Its hallmarks are inattention, impulsiveness, and hyperactivity. But there is also a type of ADD/ADHD that causes only inattention, and since hyperactive behaviors are the most noticeable, it is easier to overlook children with this variation.
ADD/ADHD is often evident by age 4. However, doctors usually diagnose children around age 7 when problems erupt at school, where structured routines and mental requirements often make symptoms more noticeable. Many children with attention deficit disorder have symptoms through their teenage years and into adulthood. As adults, they may find more flexible situations for their needs, and recruit the help of loved ones to keep them on track.
Since attention is important in any mental task, attention deficit disorder can impair school and work performance over many years. Most children and adults can offset the "deficits" through organizational skills, behavioral techniques and therapy, and, in many cases, with the help of medications.
How Common Is ADD/ADHD?
Attention deficit hyperactivity disorder is thought to affect about 5% of school-aged children, and can affect people from early childhood through adulthood. In childhood, males are 2-to-6 time more likely to have ADD/ADHD.
Goals of Treatment
Researchers have not found a cure, but the available treatments can greatly improve attention span, reduce hyperactivity, stop disruptive behavior, improve ability to adjust and cope, and enhance academic performance.
Treatment for both children and adults is a true combination of behavioral, psychological, academic, and drug therapies. Applied properly, this treatment can make dramatic changes that will vastly improve social and intellectual growth.
|Drugs most commonly prescribed|
It may seem paradoxical, but stimulant drugs may relieve hyperactivity and improve attention. Although you should possibly talk with your doctor about potential side effects — such as weight loss, suppressed appetite, motor tics, and temporarily stunted growth — nine of 10 children improve on one of these drugs:
Ritalin is by far the most commonly used drug for attention deficit disorder (ADHD). In some cases, it will partly relieve symptoms after a single dose.
Drugs that have had some success treating attention deficit disorder, although the FDA has not approved them for that purpose, include:
Parents and teachers can learn practical techniques to encourage appropriate actions in children, such as waiting for a turn, sharing toys, and asking for help. Children with ADD/ADHD can also benefit from structured routines.
Counseling may uncover problems that contribute to ADD/ADHD. Adults with the disorder may benefit by talking about how ADD/ADHD affects their lives.
Academic or vocational counseling
Children might need and are federally mandated to receive assistance in class, while adults might require job training or re-education.
Activity & Diet Recommendations
You should "child-proof" your home to accommodate the increased activity of a child with ADD/ADHD without fear of injury.
No dietary changes have been proven to help attention deficit disorder. While many parents restrict sugar, believing it makes children hyperactive, studies show this is not true. Vanderbilt University researchers analyzed 16 studies and concluded that "sugar does not affect the behavior or cognitive performance of children."
Monitoring the Condition
Your doctor may request parent/teacher rating scales at diagnosis, again at two weeks after starting treatment, and regularly thereafter. Your child should visit the doctor every quarter to monitor side effects and the progress of the drug therapy. Some things your doctor will look out for:
- Increased blood pressure
- Abdominal pain
- Poor growth
In a substantial number of cases, doctors can gradually withdraw Ritalin after two years of continual use. If necessary, they can resume Ritalin therapy.
ADD/ADHD drug treatments may cause:
- Abdominal pain (unless taken with meals)
- Sleep disturbances
- Appetite loss
Untreated ADD/ADHD can lead to an increased risk of:
- Poor academic performance
- Parental neglect or abuse
- Social isolation
- Poor self-esteem
- Alcohol or substance abuse
Considerations for Women
Women with ADD/ADHD are less likely to be hyperactive.
Talk with your doctor. While no medication is absolutely safe, Ritalin is relatively safe to use during pregnancy.
Talk with your doctor. Medications may pass through the breast milk and harm the infant.
Last updated 27 May 2012
Abbreviations of Condition
- ADD: attention deficit disorder
- ADHD: attention deficit hyperactivity disorder
No one knows what causes ADD/ADHD.
Many researchers believe that ADD/ADHD may run in families; one third of children with Attention deficit disorder have a parent or sibling with the same problem. Other researchers point to psychosocial factors, including physical and sexual abuse, marital problems, and domestic violence. However, there is no clear relationship between home life and ADD/ADHD.
Drugs That Can Cause or Aggravate ADD
If a woman uses cocaine during pregnancy, the drug may cause the disorder in the child.
Risk factors include genetic and environmental issues, such as:
- Family pattern of ADD/ADHD
- Prenatal alcohol and substance abuse
- Prenatal birth complications and premature birth
- History of head trauma
- Marital discord and domestic violence
Attention deficit disorder may be associated with, but is not caused by:
- Learning disabilities
- Tourette's syndrome
- Mood disorders
- Oppositional defiant disorder
- Conduct disorder
- Sleep disorder
- Hearing loss
- Hearing or visual impairment
In addition, many of these conditions may mimic ADD/ADHD.
Symptoms & Diagnosis
There are three types of ADD/ADHD: inattentive, hyperactive/impulsive, and combined. A diagnosis of inattentive type requires six of these nine symptoms:
- Failure to attend to details
- Difficulty sustaining attention
- Not listening
- Not following through
- Having difficulty organizing
- Avoidance/dislike of sustained mental efforts
- Losing things
- Being easily distracted
A diagnosis of hyperactive/impulsive type requires six of these nine symptoms:
- Out of seat excessively
- Running or climbing excessively
- Difficulty playing quietly
- Being on the go
- Talking excessively
- Blurting out answers
- Difficulty awaiting turn
- Interrupting or intruding on others frequently
A diagnosis of combined type requires six symptoms in both types.
Conditions That May Be Mistaken for ADD
Many behaviors and neuropsychological disorders can share some features with ADD/ADHD, including:
- Oppositional/defiant behavior
- Learning disabilities
- Pervasive developmental disorder (PDD)
- Traumatic brain injury
- Attention lapses caused by petit mal seizures
- Hearing or visual impairment
Many of these conditions mimic ADD/ADHD.
How is ADD/ADHD Diagnosed?
Because there is no specific test or "marker" to identify ADD/ADHD, diagnosis is complicated. Your doctor should perform behavioral, medical, social, psychological, and educational tests. Your child must have symptoms in several areas of life school, play, family and they must be significant enough to disrupt his or her daily life. Consult a physician experienced in this specific diagnosis, such as a pediatrician, psychiatrist, psychologist, neurologist, or neuropsychiatrist.
- Your doctor may order a blood test to check lead levels, or other tests to look for other underlying conditions
- Your child's school may evaluate your child for a learning disability
- You and your child's teachers may complete behavior evaluation forms, both before and after therapy, to measure any changes
- Your doctor may order a psychosocial evaluation of your home environment
Biofeedback is a relaxation program similar to meditation, but instead of focusing on a mantra, you focus on an automatic body process, such as temperature, and learn to control it. Researchers at the Albert Einstein College of Medicine in New York gave 18 hyperactive boys one of three treatments: 10 sessions of biofeedback; a standard dose of Ritalin, a drug widely used to treat hyperactivity; or close personal attention, also a standard approach to hyperactivity. The result: biofeedback improved the boys' behavior as much as the other two therapies.
Food intolerance can sometimes play a role in ADD/ADHD. Naturopaths who treat illness through the natural healing forces present in the human body have had some success treating ADD/ADHD by eliminating dairy, wheat, corn, yeast, soy, citrus, eggs, chocolate, peanuts, preservatives, and artificial colors. If you're interested, consult a naturopath or clinical nutritionist for advice.
Herbalists recommend calming herbs for this condition, including kava kava, valerian, hops, catnip, passionflower, and lemon balm.
Self care & Prevention
Managing ADD/ADHD at Home
Though there is currently no way to prevent ADD/ADHD, you can help manage it in your child by:
- Immediately reinforcing good behavior with rewards and attention
- Making eye contact with each request
- Intervening quickly before misbehavior escalates
- Considering family therapy
- Considering joining a support group