While this may describe most young children on occasion, both factors are extreme with those who have ADHD. This behavior may vary according to situation and context (for example, behavior is typically worse later in the day, in the absence of adult supervision, and in more complex situations), and often shows comorbidity with various cognitive abilities. ADHD is diagnosed when a child exhibits six or more each of the Inattention and Hyperactivity-Impulsivity symptoms listed in the APA’s DSM-IV criteria for the disorder.

While ADHD is a very real disorder, the diagnosis is often suspect. Many argue that ADHD is often used as an excuse for parents to medicinally control children who either a) display behavior normal for young children; or b) have been inadequately disciplined in the traditional manner. Many adults have become intolerant of normal childhood behavior and are unwilling to discipline children, so they turn to Ritalin and other ADHD control drugs for surcease.

Prevalence and Gender Difference

Based on parental and teacher descriptions of behavior, the prevalence of ADHD in the juvenile population should be as high as 57%; however, ADHD is clinically diagnosed in only 2-6.3% of children. Younger children are much more likely to be diagnosed with ADHD, with rates falling by as much as half between preschool and the 6-12 year old range, and falling significantly again in adolescence, to 0.9-2% for girls and 1-5.6% for boys. Boys are roughly three times more likely to be diagnosed with ADHD than girls. However, this may be a function of how the diagnostic criteria are applied, especially since the gender differences even out once co-morbid conditions are controlled for.

The fact that ADHD prevalence decreases sharply with age underscores the contention that most accounts of ADHD are the result of adult intolerance for ordinary childhood behavior. Younger kids (especially little boys) are naturally more exuberant and noisy than older children, who are undergoing changes related both to physical maturity and enculturation that encourage more adult behavior. The fact that ADHD prevalence dives sharply at adolescence bolsters this argument.

Developmental Problems Associated with ADHD

Individuals with ADHD suffer from a variety of developmental and social defects, some of them quite severe. These include problems with the following:
·    Cognitive defects (deficits in intelligence, reading ability, poor time-sense)
·    Language (delayed onset, speech impediments)
·    Adaptive functioning
·    Motor development (delayed coordination, sluggishness)
·    Emotion (poor self-regulation, problems with frustration tolerance)
·    School performance (disruptive behavior, repeating grades, requiring tutors)
·    Task performance (poor persistence, decreased productivity)
·    Health risks (accident prone, growth delays, earlier onset of sexual activity)

These problems add up to poor motor coordination, poor academic performance, persistent social problems, and even reduced intelligence. Health may be compromised by proneness to accidental injury, especially when driving, as well as by sleep disorders.

The developmental problems associated with ADHD are significant and distressing, almost worse than the disorder itself, and this brings home the seriousness of ADHD. While ADHD may not be as prevalent as many parents and teachers would like us to believe, it’s clear that it can be a dangerous and debilitating illness.

Etiologies

The factors thought to be responsible for ADHD are both complex and multitudinous. One theory is that at least some ADHD symptoms are the result of brain damage, since they are similar to those arising from some types of brain infections and trauma. Neurological studies indicate a connection with dysfunction in the frontal lobes, which regulate attention and inhibition. Neurotransmitter deficiencies may also be responsible. Otherwise, some studies link ADHD to pregnancy and birth factors; younger mothers tend to have more ADHD children. ADHD may also have a genetic basis, or may be due to thyroid disorder, environmental toxins, or psychosocial factors.

That ADHD may be caused by a variety of factors, from brain dysfunction to social issues, seems most likely. Too often, researchers try to reduce complex issues to single causes, if only because a single cause would allow for a single “magic pill” solution. However, few things in the human realm — either medical or social — are ever that simple. What we identify as ADHD may be a constellation of related disorders that are lumped together under one term, much as lump together all the dozens of cancers under one term in general conversation. As our understanding of the disorder evolves, it may in the future become possible to discern and define the different types of ADHD based on cause, in a manner more specific than the divisions we use today.

Theoretical Framework

The theoretical framework underlying our current understanding of ADHD remains rather nebulous. Various theories have been put forth, most revolving around defects in behavioral inhibition, deficits in sensitivity to reinforcement, deficits in inattention, arousal, and inhibition in the absence of immediate reward, and neurological explanations for the observed behavior. It is obvious that poor behavioral inhibition is the most important behavioral factor in ADHD.

In light of this, one researcher, Dr. Russell A. Barkley, has developed a hybrid model that includes many of the features of previous ADHD models. His theory explains how behavioral inhibition (self-control) and motor control systems (such as persistence, sensitivity to feedback, and execution of responses) are interrelated to and regulated by four executive functions: working nonverbal memory, working verbal memory, self-regulation of effect/motivation/arousal, and reconstitution (internalization of play). He concludes that ADHD is a disorder of performance, not skill; that is, in their behavior ADHD sufferers are unable to apply previously learned knowledge (especially in the social behavior realm) to new situations, even though, at some level, they may realize exactly what they should do in such situation.

He suggests various ways to treat ADHD patients, both pharmaceutically and otherwise, especially in regards to making actions and their consequences more temporally contiguous. For the ADHD sufferer, punishment or reward must be immediate to be effective, since those with serious ADHD suffer from what Barkley calls a “myopia or blindness to time.” They do not see or understand distances that lie ahead in time.

The key to his theory is the concept of temporal blindness or myopia. Those of us without symptoms of ADHD can see ahead to the future; we not only see what we need to do to reach our goals or maintain the status quo, but have also internalize
d the concept of personal accountability. We understand the consequences of our actions, both good and bad. People with ADHD often do not, or are unable to apply the rules they have learned, and so may be blindsided by future events that others, with a minimum of personal inhibition, might have avoided. This theory seems make imminent sense, though of course the true test of Barkley’s theory is how well it fits the clinical reality of ADHD, and how well it stands the tests of time.

For more resources on ADHD in Children see WebMD , ADHD Treatment and National Institute of Health – ADHD

Do you despair of your child’s poor academic performance? Do parent-teacher conferences yield disturbing comments like the following? “Johnny has trouble focusing on simple tasks.” “Mary often blurts out answers and has trouble waiting her turn.” “Carl has difficulty following instructions.” Perhaps that same teacher has suggested your child may suffer from ADD. Perhaps you were already wondering yourself.

Definition Let’s start with a little bit of alphabet soup: The official term for what used to be called Attention Deficit Disorder (ADD), is now Attention Deficit Hyperactive Disorder, (ADHD or AD/HD). Why the change? Because we now know there are three main types of ADHD. One type is characterized by inattentiveness, one by hyperactive or impulsive behavior, and the third by a combination of both.

Warning Signs All children show these behaviors sometimes. When should you suspect these could be signs of a more serious problem? Specialists agree that at least six symptoms from one or both of the lists below must be present to consider a diagnosis of ADHD:

Signs of inattentive behavior:

1. Difficulty following instructions
2. Difficulty focusing on tasks
3. Losing things at school and at home
4. Forgetting things often
5. Becoming easily distracted or having difficulty listening
6. Lacking attention to detail, making careless mistakes or being disorganized
7. Failing to complete homework or tasks

Signs of hyperactive behavior:

1. Fidgeting excessively
2. Difficulty staying seated
3. Running or climbing inappropriately
4. Talking excessively
5. Difficulty playing quietly
6. Always seeming to be “on the go”
7. Blurting out answers or frequently interrupting
8. Having trouble waiting his or her turn
9. Interrupting or intruding on others

Specialists also look for evidence that these behaviors have continued for at least six months, and that they cause problems at both home and school. If you are kicking yourself for not seeing this problem sooner – don’t. Experts agree, it is common for these symptoms to go unnoticed until a child starts school.

Is ADHD Real? ADHD is very real. There is an overwhelming body of research and evidence supporting that conclusion. Brain scans show differences between the brains of children with ADHD and those without. We do not yet have all the answers, but we do know some things for sure:

• ADHD has its root in brain chemistry. There are many studies underway right now to understand exactly what happens in the brain’s neurotransmitters.
• Most people with ADHD have normal, or even above normal, intelligence.
• In many cases, ADHD is genetically inherited. If a parent or close relative has ADHD there is a 30% to 40% chance that a child will have the disorder. If one twin has ADHD, the other has a 50% chance of the disorder.
• ADHD affects 3% to 7% of school age children. Problems often last into adolescence. Two to four percent of adults have ADHD.
• There is absolutely no evidence that ADHD is caused by poor nutrition, poor parenting, drugs, allergies, or excessive TV.
• Special education legislation in the 1990’s increased school attention and services to children with ADHD. This has led some to conclude it is over-diagnosed. In fact, some studies concluded that ADHD may still be under -diagnosed.

How Serious is ADHD? Untreated ADHD can be very serious indeed. The most obvious problem is school failure. Other serious consequences include depression, problems with relationships, substance abuse, delinquency, risk for accidental injuries and job failure. Children with ADHD are more likely to suffer other mental disorders, including anxiety disorder, severe depression, bipolar disorder and oppositional defiant disorder (clinically hostile and defiant behavior). Early identification and treatment for ADHD is extremely important.

Is There Hope? Absolutely! Children and adolescents with ADHD can go on to lead very successful lives. The diagnosis of ADHD is quite new, but the biographies of many famous people, past and present, indicate they probably had the disorder. The great British leader, Winston Churchill, is one example. Mozart is another. Living examples include the athlete, Magic Johnson, and the founder of the Virgin business empire, Richard Branson.

Even if your child does not go on to become famous, a diagnosis of ADHD can be the first step towards a happier and more productive life. One mother whose child has the inattentive form of the disorder reports that, prior to diagnosis and treatment, her daughter could never find or locate things, was irritated all the time, and had difficulty paying attention in school. Now she is calmer and more focused, and benefits from her daily life being under greater control.

Effective Treatments for ADHD Children

The most effective treatments for ADHD include a combination of medication, behavior therapy, and parent support and education. Nine out of ten children respond to medication, and 50% of children who do not respond to a first medication will respond to a second. When ADHD is accompanied by other mental health disorders, a combination of drug therapies have been shown to be highly effective.

Behavior therapy is an important complement to medical treatment. Behavior therapy helps children by teaching them “survival skills” such as how to solve problems positively, communicate, and advocate for themselves. Children, especially teenagers, need to be actively included in treatment decisions. Consistency at home and school is essential. Schools can – and must, by federal law – make a variety of adaptations in classroom instruction to assist in your child’s learning. Some children may require special education services.

Most important of all is your support as a parent. Instill a
sense of self worth in your child or adolescent. Emphasize his or her talents and strengths. Remember that the side effects of untreated ADHD (such as failure, frustration, discouragement, social isolation, low self-esteem and depression) may cause more problems than the disorder itself.

Where to Go for Diagnosis Your first step should be your child’s pediatrician, who cannot only diagnose ADHD, but also do a physical exam, including vision and hearing assessment, to rule out other medical problems. Others who are qualified to diagnose the disorder are school psychologists, clinical psychologists, clinical social workers, nurse practitioners, neurologists and psychiatrists. You may wish to start by asking your child’s pediatrician or school for a recommendation.

Links

CHADD (Children and Adults with Attention/Hyperactivity Disorder) has a great link, CHADD for locating local chapters and support groups in your area. From the CHADD website you can link in turn to excellent articles and information published by their National Resource Center on ADIHD. Or you can link directly to the resource center at Resource Center For information on other mental health disorders, we suggest you go to the National Mental Health Association’s website at Mental Health