Part 13 of Our Award-Winning Series “Our Children’s Health”
By Robbie Woliver with April Jimenez
Don: “OK, Lauren, pay attention. The War of 1812 was fought by the United States against the United Kingdom and its colonies when President James Madison sent his war message to Congress. When was the war?”
Lauren: “1932?”
“No, Lauren, it was 1812. What was the name of the war?”
“The 1812 Act.”
“No. It was the War of 1812. Who sent the war message to Congress?”
“Benjamin Franklin.”
And on it goes….
Lauren, 13, is a smart girl. But it isn’t easy for her to study. She’s been on and off the honor roll for several years, one quarter barely passing, the next attaining As and Bs. But from this actual dialogue, recalled by Don, her father, it’s difficult to imagine the Lauren who struggled with studying the War of 1812 as the girl who can do so well academically.
Let’s look more closely at that study session. Don says it’s all about Lauren’s attention deficit and lack of interest in the subject at hand. During the brief discourse, Lauren would stare off into space, interrupting with unrelated statements and questions, interject an American slave spiritual she had learned in chorus, sustain a prolonged faux-coughing fit, play with her father’s hair, entangle her hand in a nearby curtain, contort her body into moves a gold medal gymnast would be proud of, doze off and execute a well-planned burping attack.
Don notes that immediately after the study session, which took approximately an hour for just one War of 1812 section, he overheard his daughter singing along to a hit novelty pop song, “Fergilicious.” She matched every nuance, every abstract syllable—all memorized down to the most subtle nonsense word.
Why she could memorize that, and not remember what year the War of 1812 began, was beyond him.
In school, it’s a bit of a different story. Lauren, who is generally well-behaved, doesn’t interrupt class with songs or burping, but she does daydream, tap her pencil, shake her leg, stare out the window, and sing “Fergilicious” to herself, in her head.
But another aspect of Lauren and her attention problems confused her parents, and that was a misperception that caused them to not initially consider a diagnosis of ADHD. Lauren can sit for hours, immersed in something that interests her, like a video game or a TV show. Nothing can distract her—no tangential thought or
conversation, no motor restlessness, no shaking the leg or tapping a pencil. Total concentration.
On the other hand, typical of Lauren’s behavior, when overwhelmed by something—whether it is studying or the pressure of a social situation—she starts losing control. She becomes hyper and silly, often inappropriate, and although she knows it is happening, and it is not acceptable behavior and that it might even be turning off her peers, she cannot control it.
When she is with friends, for example, Lauren will act in a way that even she refers to as “annoying.” She calls it that because that’s what her peer group calls it, and this behavior has had long-lasting social repercussions.
In 2006, Lauren’s attention deficit disorder was diagnosed as the “Inattentive” type. This does not seem as outwardly dramatic as the type her friend Caroline has, the “Hyperactive” type, but it is equally debilitating. When she is with Caroline, who was diagnosed with ADHD when she was 8, all is complete chaos. Caroline’s more manic behavior takes over, with loud, boisterous, overly energetic actions, and actually causes Lauren to retreat, despite Caroline being an engaging and sweet young girl. The two types of attention deficit disorders—inattentive and hyperactive—make for a volatile mixture among young friends. And although Lauren is very aware of Caroline’s inappropriate behavior, she cannot stop it in herself.
Sound familiar?
The modern concept of ADHD was introduced by English pediatrician Sir George F. Still in 1902 when he explained children’s significant behavioral problems as neurologically based, as opposed to attributing the problems to children being poorly raised, as had been conventional thinking at the time. Children who had previously been explained away as “fidgety” were discussed in a more serious light as children having neurological disabilities.
Since then, tens of thousands of specialists and studies have examined the disorder, named “minimal brain dysfunction” by doctors in the 1950s. The theory was that children with the disorder had been suffering from externally acquired brain damage. Through the years the disorder has had several names, including hyperkinetic disorder, but it wasn’t until the 1980s, when it was determined that the disorder was more complex than previously thought, that it was named ADHD, attention deficit/ hyperactivity disorder.
Considered mostly genetic in nature, ADHD is a neurobehavioral syndrome in which the patient displays impulsive, uncontrollable behaviors and has difficulty maintaining attention as well as possibly exhibiting motor restlessness. And it is estimated that up to 15 percent of American children might have this lifetime disorder.
HOW IS IT MANIFESTED?
There are three subtypes of ADHD: hyperactive, inattentive and combined.
While they have difficulty concentrating, children with the inattentive type of ADHD do have the ability to focus on things of interest to them. That causes great difficulty in school, because schoolwork is not usually one of those interests, so the children are often faced with academic underachievement. Their inability to stay organized affects them in many ways at home and school, showing up as the inability to complete homework, chores or simple tasks. These children are often viewed as “lazy,” but that is not the case.
These inattentive children also have problems in the social realm because they seem disinterested and unable to keep up with their peers. They sometimes lack the social skills appropriate to their age group. The need for stimulation can manifest itself in inappropriate behaviors and lead to further social ostracism and even discipline problems. It can also result in physical harm from the ADHD child’s attempt to show off by being inappropriately hyper, or even reckless, and when they are older, with actual stimulants such as alcohol or drugs. These children can easily become outcasts, and are often considered oddballs by schoolmates.
Jeanette Sparatino, of St. James, is the mother of 9-year-old hyperactive-type Jenna. “She’s not a bad kid at all,” says Sparatino of Jenna, who she says changes from “angelic to frenzied in a minute.” Recently, over-stimulated Jenna acted out so badly in Toys ‘R’ Us that they had to leave. “It’s not always easy [dealing with ADHD],” says Sparatino, “but your kids are God’s gifts to you, you love them no matter what wrapping paper they come in.”
Melissa Cohen at 36 years old still bears the scars of her childhood inattentive-type ADHD. A customer service representative from Medford, Cohen says she spent most of her youth feeling isolated because of the disorder, and since an ADHD diagnosis was virtually unheard of then, she was often mislabeled.
“Try being a teenager and not being able to fit into that tiny, little, perfect circle that girls are supposed to fit into,” remembers Cohen, who was labeled as “dumb” by students and teachers alike. Cohen was finally diagnosed when she was 19. By then she had missed out on crucial early intervention, says Ellenmorris Tiegerman, Ph.D., director and founder of the School for Language and Communication Development in Glen Cove.
“Most of these kids were either diagnosed as having conduct disorders, or just as bad kids. It was believed that there is this voluntary component—that the kid had control issues, not a spectrum disorder, and unfortunately they were dealt with [like kids with behavioral issues],” says Tiegerman.
“The teachers told my parents that I was unreachable, that I just couldn’t learn and that was it,” says Cohen, who would often daydream in class, or forget what she learned minutes after she wrote it down.
Dr. Larry B. Silver, M.D. author of The Misunderstood Child says those children, like Cohen, with inattentive ADD often appear out of it or detached, and have taken on the monikers of “airhead” and “space case.”
Although it is difficult for inattentive-type children to make friends because of their sometimes odd behaviors and difficulty in maintaining conversations, it is believed that they still make deeper friendships than the more hyper, social ADHD children, when they finally do make friends.
Most of us are familiar with the seemingly wild, out-of-control hyper child, but those with inattentive ADHD can fall though the cracks because of their introverted behaviors. These inattentive children often like solitary activities, and can become completely immersed in a video game or TV show. However, they might have difficulty reading and can sit with a book in front of them for an hour and never get past the first paragraph.
Hyperactive children are a whole different story. They are often regarded as the “annoying kids”—the ones who don’t stop talking, excessively babbling on, or who are excitable and in constant motion. Full of energy, they frequently attract friends; either because they are outgoing or because they behave badly—young children are often attracted to the troublemaker in class. But once they have made friends, it’s not so easy for these children to maintain friendships, due to their bouncing-off-the-wall nature. ADHD kids, with their minds constantly racing, often miss a conversation’s subtleties and details.
THE BIG QUESTION
One of the most common comments usually brought up in any discussion about ADHD is, “When is it ADHD and not just typical childhood behavior?”
Impairment is the answer: If the behaviors negatively affect the child’s academic and social life, it is considered a disorder. And there is a strict list of criteria for a diagnosis.
Although it seems as if every other child is labeled ADHD nowadays, there is a real difference between rambunctious or dreamy children and those with true ADHD.
It is important to remember that disorders are viewed as beyond the norm when the symptoms’ frequency is more prevalent or more severe than in other children at the same level of development. All disorders are judged by that standard, and it is no different for ADHD.
Aside from the specific attention problems caused by the disorder, the National Institutes of Health (NIH) points out another potential concern. These ADHD kids, with all their academic and social problems, trying to keep up with their schoolwork and social pressures, are at a much higher risk for anxiety, behavioral and mood disorders, substance abuse and delinquency. Studies and anecdotal information have shown that children with ADHD are less likely to play with other children or participate in after-school activities. Only half of parents of ADHD kids report that their children have “many good friends.” In fact, according to the NIH, ADHD children are twice as likely to be picked on at school, and have difficulty getting along with their peers.
“I’d say that half of the children diagnosed with ADHD also have a learning disability— they overlap often,” says Tiegerman, and Dr. Silver strongly agrees. It is one of the main themes of his book, which states that up to 50 percent of children with ADHD also have learning disabilities. ADHD is also often comorbid, or concurrent, with autism, and mood, behavioral, anxiety, conduct and sleep disorders, OCD, Tourette’s, bed-wetting, substance abuse and more.
ADHD children can also exhibit visual and sensory integration disturbances. And be careful when your child is tested. Since ADHD kids do not normally have lower IQs, a low test score may be a result of their poor attention span or learning disabilities, rather than an accurate assessment of the IQ itself.
In 2007, the NIH spent $116 million on ADHD research. A worldwide phenomenon, there are global studies galore on this disruptive and oft-misunderstood disorder. The numbers will likely continue to rise worldwide as more nations begin to understand and track the disorder. Parents need to use the same directive with the medical, scientific and educational establishment as they use with their children: “Pay attention!”
BY THE NUMBERS
The disorder, no matter what study you read, affects many children. The DSM-IV reports that 7 percent of American schoolchildren suffer from ADHD. The 2005 National Health Interview Survey, conducted by the Centers for Disease Control and Prevention (CDC) and National Center for Health Statistics, reported that 4.4 million American children between 3 and 17 years old—6.5 percent—have ADHD, and that boys, at 9.2 percent, were more than twice as likely as girls, at 3.8 percent, to have ADHD.
It is now commonly believed that ADHD affects boys and girls at the same rate, and that boys are simply referred to services more often than girls are.
Dr. Katya Rubia, Ph.D., a child psychiatrist at King’s College in London who specializes in ADHD, says that studies suggest that the United States statistic could be as high as 15 percent. It is a widely held belief that not all of the children who might meet the diagnostic criteria for ADHD are diagnosed.
In the United States, the highest rate, reported in the 2005 National Institute of Health Sciences study, was for multiple-race boys at 23.1 percent and multiple-race girls at 11.5 percent, for children between 10 and 17.
The CDC estimates that out of the 4.4 million youth diagnosed with ADHD by a healthcare professional nationwide, as of 2003, that 2.5 million were currently receiving medication for the disorder. In 2003, 7.8 percent of school-aged children were reported by their parent to have an ADHD diagnosis.
Genetics is a big factor with ADHD. The Attention Deficit Disorder Association reports that if a parent or close relative has ADHD, there is a 30 percent chance that a child will have it as well. Dr. Silver, the former acting director of the National Institute of Mental Health (NIMH), says it’s more like 50 percent.
WHAT IS THE CAUSE?
There are a number of theories as to what causes ADHD. They are good to know, because some might be appropriate to your child, but it is important to keep in mind that some won’t be.
It all starts in the brain. A miswired brain.
According to the NIH, researchers are concentrating on the cerebrum’s frontal lobes. This area assists with activities such as planning ahead, problem solving, motor function, spontaneity, understanding other people’s behavior, judgment, and coordinating, controlling and executing one’s behavior, especially controlling impulses. The right and left lobes communicate with each other through the corpus callosum, the nerve fibers connecting the lobes.
The body’s motor coordination is controlled by the basal ganglia, serving as the connection between the cerebrum and cerebellum. Studies show that specific areas of the brain exhibit diminished blood flow and less activity in people with ADHD. The studies also indicate that certain structures in the ADHD brain are somewhat smaller. The basal ganglia and the cerebral vermis have become popular research targets.
It is also believed that ADHD results from deficiencies in the brain’s dopamine neurotransmitter systems, which help brain cells communicate. Specifically being studied is an abnormality in the dopamine D4 receptor gene, which is associated with abnormal risk-taking behavior, hyperactivity, movement, cognition, motivation and pleasure.
NIMH scientists have also discovered a link between the ability to pay attention for a prolonged time and brain activity levels. Through positron emission tomography (PET) scans, scientists can observe the working brain. NIMH scientists measuring glucose levels (glucose supplies the brain with energy) in the areas that control attention and inhibit impulsive behavior discovered that ADHD brains used less glucose, indicating that low brain activity might cause inattention.
The brain works harder when it isn’t receiving enough neurochemicals, neurotransmitters and other brain chemicals produced by neurons, searching for ways to increase the chemicals. Children with ADHD have to find some movement, some activity to stimulate their brain—either a physical activity like running or spinning around, or other stimulation such as yelling or incessant talking, TV watching or video game playing. They crave any kind of stimulation.
It’s easy to see how closely related so many neurobiological disorders are, and how easily they mimic each other: ADHD impulsivity could easily be mistaken for OCD, the impassivity of ADD/inattentive could easily be confused with auditory processing disorder (APD) and the children with ADHD who need self-stimulation, making it difficult to differentiate between the actions of a Tourette sufferer or “stimming” (self-stimulating) activities such as the rocking or hand-flapping prevalent in autism.
Other conditions may cause ADHD and ADHD-like behaviors, such as fetal alcohol syndrome, thyroid disorders, or acquired trauma such as severe head injuries. If you suspect ADHD, a psychiatrist’s diagnosis alone might not suffice. Your child should see a medical doctor to rule out the above conditions.
Environmental factors related to ADHD, experts say, can include birth complications, lead poisoning, adverse living circumstances, and one that almost all experts agree on—genetic factors (having an ADHD mother or father is
common).
Some doctors, such as Syosset-based naturopath Pina LoGiudice, N.D., believe there are a number of underlying causes that can trigger symptoms, including digestive issues and food ingredients. Food additives are a big problem for those susceptible to ADHD.
“What’s in the food is a disaster, what we’re feeding children in the schools is a travesty—colors, dyes, hydrogenated oils—kids can’t detoxify themselves until they are about 12,” says LoGiudice, who says that lead paints in toys as well as plastics can contribute.
She also says that when TVs and video games are added “to the overload of a chemical burden, it all becomes too much stimulation for a young brain to handle.”
Environmental factors also cause ADHD. In Chernobyl, Ukraine, the site of the 1986 nuclear accident, the worst in history, the ADHD rate is a staggering 19 percent.
But there are always new theories. The most recent research reported this past November in Proceedings of the National Academy of Sciences ties the brain disorder to a developmental delay. This new data supports why some children outgrow ADHD as their brains slowly become similar to those of their peers’.
Your child should first be given a full physical exam by his or her pediatrician, to rule out other disorders. If ADHD is suspected, the child should be referred to a neurologist or mental health expert such as a child psychiatrist or psychologist.
Consistency in behavior is an important diagnostic tool. If a child displays rowdy behavior during recess, but behaves in the classroom and at home, the child might not be diagnosed with ADHD. If a child displays some ADHD symptoms, but is not impaired in schoolwork, friendships or peer relationships, they also would not necessarily be diagnosed with ADHD. The NIH says that to obtain that diagnosis, a child must exhibit “long-term, excessive and pervasive behaviors which occur more than the child’s peers.” It must be determined whether the behavior is continuous, or whether the child is acting out because of a temporary event or traumatic incident. The DSM-IV requires that there be clear evidence of clinically significant impairment in social, academic or (in teens) occupational performance, which is a key to a good diagnosis, and a strong argument that ADHD is indeed a disorder and not just a label for a bunch of misbehaviors of bad or lazy kids. But be careful with this one—a child might exhibit different symptoms in different settings.
In The Misunderstood Child, Dr. Silver addresses, head-on, the spate of misdiagnoses and lack of diagnoses so often associated with these children. He says that out of all the disorders responsible for hyperactive, impulsivity or inattentive behavior, ADHD is actually the least common—anxiety is the first, depression is the second, neurologically based disorders such as OCD, learning disabilities, sensory integration dysfunction and tactile sensitivity are third. And finally, the least common cause is ADHD. This is the main cause of the huge numbers of misdiagnoses.
Labeling our children is a problematic venture, because these disorders constantly evolve, and chances are, if your child has only one “label,” it just might not be the whole picture. So, when your doctor gives your little Jimmy a one-label diagnosis of ADHD, your first question should be, “And what else does Jimmy have?” Rest assured that something else is probably hidden behind the obvious diagnosis, and it needs to be treated with the main diagnosis.
The best advice: You, as the parent, might just know best. You see your child in his or her natural habitat—if you feel your child has ADHD, but he or she does not fit the official criteria, don’t give up.
Perhaps your child has only four, not six, of the DSM’s required symptoms. Insist on a full-spectrum, holistic view of your child. Your child with two required symptoms might actually have a more debilitating case of ADHD than a child with six symptoms. How ADHD manifests itself can change dramatically with each child.
Interpreting and misinterpreting a diagnosis because a child has impassive symptoms, or because of gender stereotyping, can lead to misdiagnosed or disregarded symptoms. Rowdy, lively boys and quiet, shy girls can easily make for many an incorrect diagnosis by a doctor who doesn’t think about the whole picture. As with other neurobiological disorders, the difference between boys and girls is becoming less and less divergent with each new study.
Visiting your child’s playgroup or classroom and finding Timmy running around wildly and Cindy sitting perfectly quiet, you might not think twice about disorders, because they are fulfilling their gender roles. If they are exhibiting other symptoms that set off alarms, don’t be fooled by stereotypical behaviors. They both could have ADHD.
Dr. Patricia Quinn, M.D., director of the National Center for Gender Issues and ADHD, says, “Girls often remain undiagnosed until mid-life when they seek treatment for themselves or their children. Often they are diagnosed as anxious, in elementary school, or depressed, in high school and beyond.”
Disruptive boys are referred for counseling much more than inattentive or even disruptive girls.
Falling through the cracks happens more than it should.
THE TREATMENT
Psychiatrists, psychologists, pediatricians, family physicians, neurologists and clinical social workers can diagnose ADHD.
Even though symptoms may be different, treatment is pretty much the same for all types of attention disorders: medication (stimulants and antidepressants), psychological counseling, special education support, and behavior modification, mostly cognitive behavioral therapy (CBT), which is a therapy that helps change bad behavior patterns and replaces them with more positive, effective ones.
Medicating the ADHD child is one of the most provocative topics in all of medicine. Some parents report that their ADHD children’s lives improved dramatically with drugs, while others say their children became listless and severely depressed. Some suicides have been attributed to ADHD drugs. How many children taking drugs like Ritalin say they feel as if a veil has been lifted from their eyes; that the world seems clearer; that they can finally concentrate; that they feel renewed, and in turn become more successful in school, at home and with their peers, boosting their performance and self-esteem? And might that not alleviate the need for drugs like Zoloft, because the comorbid anxiety disorders would then subside? On the other hand, there are many medicated ADHD children who become robotic or overly tired, or even worse, mentally unstable. There is never an easy answer for the parents of children with developmental or psychological disorders.
Many ADHD drugs such as Cylert, Concerta and the long-popular and perhaps grossly overprescribed Ritalin have the same classification as such powerful drugs as cocaine and morphine, and can affect children in the same harmful way. Cylert, for example, has such serious side effects that it is rarely the first course of action.
Amphetamines and dextroamphet-amines such as Adderall, Dexedrine, Dextrostat and Focalin are recommended for young ADHD sufferers, age 3 and older. Concerta and Ritalin LA are long-acting stimulants called methylphenidates. Metadate ER, Metadate CD and Ritalin SR are extended-release drugs prescribed for age 6 and older.
The newest drug finding favor among parents and doctors is Straterra. This non-stimulant, atomoxetine, works on the brain chemical norepinephrine, whereas stimulants concentrate on dopamine; both neurotransmitters are believed to play a role in ADHD. Studies show that Straterra has had marked improvement in symptoms.
But drugs can also have negative results, affecting the child’s mood, appetite, physical development, social interaction, sleep patterns and more. Side effects include irritability, tics, insomnia, impatience, agitation, lethargy, depression, and physical ailments such as appetite problems, digestive disturbances and headaches. Drugs that help so many children can turn other children, who had only focus and behavior difficulties, into more of a physical and emotional mess.
The Venuti family of Great Neck experienced the latter while trying to help their son Brian with his ADHD. His school administrators suggested that the then-9-year-old go on medication, telling Brian’s mother, Rita, it would help her son focus, and help the school educate him. “We wanted him to succeed, we didn’t know about these meds,” says Venuti. Brian ran the gamut with medications—he was on Concerta, Metadate, Ritalin, Adderall and Straterra. But all had adverse effects on the boy. He had terrible headaches, he wasn’t eating, and he was losing a lot of weight. “Finally we said, this is bologna, we have to do something,” Venuti recalls. Against her doctor’s orders she took her son off all of the medications and began a behavior modification program involving incentives. Since then, she says, Brian has done a complete 180.
“He’s a kid again,” says his older sister Faith. “He was like a zombie when he was on that medication, didn’t want to play, didn’t want to talk, didn’t even want to watch TV; he’d just lock himself in a room and sleep all the time.” Faith also attributes some of his attitude change to not being embarrassed or labeled as the kid who has to take a pill everyday.
Many parents who are unhappy with the results of prescription drugs turn to natural remedies such as Omega-3 and essential fatty acids, calcium and magnesium (calming minerals), GABA (gamma-aminobutyric acid) calms the body as tranquilizers do without the negative side effects, trimethylglycine, vitamin B complex (needed for brain function and digestion), extra B3 (niacin), B5 and B6, zinc, selenium, brewer’s yeast (a natural source of B vitamins), vitamin C (anti-stress vitamin) and probiotics. Also popular is valerian root, a calming herb.
Some experts believe that allergies play a great part in this disorder. The supplement Quercetin, a powerful antioxidant, has been shown to be effective for allergies and for some children with hyperactivity.
As with any medication, no vitamin, herb or supplement should be given to children without consulting a health professional first. Naturopaths might be more likely to suggest alternatives than your traditional medical provider.
And don’t forget the comorbid nature of these interconnected disorders. Remember to address the coexisting disorders such as anxiety that are often associated with ADHD. Many of these children might already be on allergy medicine, antidepressants and anti-anxiety drugs for mood or anxiety disorders, or a variety of other medications. It might be wise to consider the interactions for a child taking Ritalin while they are also on allergy medication, antibiotics for ear infections and antidepressants and anti-anxiety drugs for anxiety or mood disorders such as OCD, panic attacks or depression.
Stimulant drugs come in long- and short-term forms, making it easier to manage the child’s therapy. For example, sustained-release drugs can be taken before leaving for school, lasting so long that the child does not have to disrupt the day by going to the nurse for a new dose, as Brian Venuti did. And maybe the child doesn’t need the drug as much in school as they do at home. There are many alternatives. Again, check with your doctor, and don’t be ashamed to ask for a second or even third opinion.
It is believed that one in 10 children do not respond to these medications.
The NIMH, with its Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder, an intensive study which first published its findings in 1999, indicated that combination treatments (drugs and therapy) were the most effective.
Help doesn’t always come in a little bottle with a twist-off cap. Behavior modification techniques and various therapies are effectively utilized to target specific needs and symptoms that cause impairment in an ADHD child.
Occupational therapy can also help an ADHD child with sensory issues—heightening ability to better command their physical self, as in controlling body movements, along with developing control over their senses. Vision therapy is becoming popular for ADHD children, improving the visual skills enough, in numerous ways, to allow the child to actually pay attention and understand what they see, whether it is written language, a specific item or a physical action. Training helps them to track, fixate and focus, and to learn how to sustain their attention. And it is not just about seeing: This also helps with auditory skills.
One other aspect of your child’s behavior that should immediately be addressed by an occupational or psychological therapist is social skills. The CDC strongly suggests that parents help their ADHD child build and strengthen peer relationships.
Under the federally legislated Rehabilitation Act of 1973, Americans with Disabilities Act, and Individuals with Disabilities Education Act (IDEA), ADHD is recognized as a disability, and special education accommodations should be available. Numerous modifications can be made for your ADHD child, from seating in front of the class to best be able to see and hear the teacher, to quiet testing rooms with extended testing time.
Advocate Nancy Silva, of Westbury, has been working within the special education system for more than 15 years, and she says that children with ADHD often fall through the cracks when it comes to school, because ADHD is not one of the 13 official classifications on its own such as autism or being hearing impaired. It falls into the broader classification of other health impaired, OHI. “That ADHD child may not get as much attention, because teachers might think it’s a mild disorder and it’s not really a disability.
“It’s like saying a kid with a hearing disorder just isn’t listening—a kid with ADHD might need to walk around or tap, that doesn’t mean they are being purposefully disruptive.”
Silva suggests that parents take the time to meet with their child’s teacher and reiterate, on an index card, the symptoms the child has so that the teacher can refer to it and create a specific program of accomodations to help the child. “Let the teacher know what some of his specific issues are,” she suggests, “it will serve as a reminder that he has the most difficulty with a particular skill, or he isn’t lazy, he wants to please.
“If he’s not raising his hand, can you call on him? Give them some specific things that will allow the teacher to really know who your child is.”
“Speak up,” says Dr. Silver, who believes that parents—as the child’s most important advocate when it comes to effective school services—must fight for their kids who have what he calls often “invisible” disabilities.
THE PROGNOSIS
There is no cure for ADHD. Symptoms can be controlled, but ADHD is a chronic condition. Many children outgrow some of the symptoms, but it usually carries through to adulthood. Most ADHD children and adults learn compensatory ways to handle the attending problems, and they live full and fulfilling lives. Without treatment, studies have shown a large percentage of adults turn to substance abuse, promiscuous sex, academic failure and problems with the law. And while there are torturous years for an ADHD child trying to study, make friends, play sports, or just behave, when they get older they might find the hyperactivity of ADHD to be a benefit in activities like multitasking at work.
Whatever the case, the ADHD child needs to be attended to. They should not be written off as lazy, stupid or badly behaved. With early intervention they can be helped.
This story was adapted from the book “Alphabet Kids,” by Robbie Woliver
RESOURCES
Attention Deficit Disorder Association
www.add.org
Children and Adults with Attention Deficit
www.CHADD.org
Adders.org
www.adders.org
Addvance.com
www.addvance.com
ADHDAwareness.org
www.adhdawareness.org
National Resource Center on
AD/HD
www.help4adhd.org
AD/HD News.com
www.adhdnews.com
AD/HD.net
www.adhd.net
Oneaddplace.com
www.oneaddplace.com
Shire: ADHDsupport.com
www.adhdsupport.com
(This website is connected to the pharmaceutical industry)
The National Attention Deficit Disorder Information and Support Service
www.addiss.co.uk
AD/HD Foundation of Canada
www.adhdfoundation.ca
Attention Deficit Resource Network, Canada
www.adrn.org
The American Academy of Child and Adolescent Psychiatry
202-966-7300
www.aacap.org
American Psychological Association
800-374-2721; 800-964-2000
www.apa.org
Attention Deficit Information Network
781-455-9895
www.addinfonetwork.org
Learning Disabilities Association of America
412-341-1515
www.ldaamerica.org
Identifying ADHD
The Diagnostic and Statistical Manual of Mental Disorders-fourth edition (DSM-IV), the bible of mental health diagnoses compiled by the American Psychiatric Association, lists the specific types of attention deficit disorders and the criteria for an ADHD diagnosis:
INATTENTION:
• Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• Often has difficulty sustaining attention in tasks or play areas
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
• Often has difficulty organizing tasks and activities
• Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
• Often loses things necessary for tasks or activities (toys, school assignments, pencils, books, tools)
• Is often distracted by extraneous stimuli
• Is often forgetful in daily activities
HYPERACTIVITY-IMPULSIVITY
Hyperactivity
• Often fidgets with hands and feet and squirms in seat
• Often leaves seat in classroom or in other situations when staying seated is required
• Often runs about or climbs excessively in situations when it is inappropriate (in adolescents, this might be subjective feeling of restlessness)
• Often has difficulty playing or engaging in leisure activities quietly
• Is often on the go or often acts as if driven by a motor
• Often talks excessively
Impulsivity:
• Often blurts out answers before questions have been completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others—butts into conversations, games
COMBINED Type: Exhibiting six or more inattentive symptoms and six or more hyper-impulsive symptoms for at least six months. This type is referred to as ADHD, also used for the generic disorder.
INATTENTIVE Type: Exhibiting six or more symptoms of inattention and six or less symptoms of hyper-impulsive behavior for at least six months. Don’t be confused—the child can have inattentive type and still have hyperactive tendencies. This type is referred to as ADD.
HYPERACTIVE Type: Exhibiting six or more symptoms of hyperactive-impulsive behavior and fewer than six inattentive behaviors for at least six months. Again, although the child has the hyperactive type, they might still exhibit areas of inattention. This type is referred to as ADHD.