Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity (DEF-ih-sit hy-per-ak-TIV-ih-tee) Disorder, or ADHD, is a common developmental disorder that affects both children and adults, although it is usually diagnosed in childhood. ADHD affects a person's ability to study, learn, work, play, and even socialize with others. People with ADHD are less able to sit still, plan ahead, organize and finish tasks, and tune in fully to what is going on around them than are people without the disorder.

Kevin's Story

As a sixth-grader at a new middle school, Kevin was having a much harder time than he expected. Then again, school had never been easy for him. He often had trouble staying focused and controlling his impulse to talk out loud in class. Homework had always been a nightmare, too; he knew he had assignments to complete, but he forgot to write them down, often brought home the wrong books, and just could not sit still long enough to get anything done. Fortunately, Kevin's grade school teachers knew him well and worked with him on ways to stay focused and organized. From first through fifth grade, he always had one teacher for most of his subjects, one desk where he kept his books, and small classes. His parents and teachers were in constant communication, too. That had gotten him through most of the rough spots.

In the sixth grade, though, Kevin had a different teacher for every subject, a locker for his books and supplies, and a couple study periods during the day. He felt constantly overwhelmed and disorganized. Several of his teachers had already sent notes home expressing concern about disruptive behaviors such as calling out, walking around the room, and interrupting others. He could not keep track of his assignments and always felt like he was jumping from task to task.

After two bad report cards and many calls from concerned teachers, Kevin's parents took him to see his pediatrician. After examining Kevin and hearing about his problems in school, the pediatrician recommended that Kevin see a psychologist ^* for an evaluation. After meeting with Kevin's parents a few times, surveying his teachers and coaches, performing some special psychological tests, reading school reports, and even watching Kevin in the classroom, the psychologist confirmed what some of Kevin's teachers and his pediatrician suspected: Kevin had Attention Deficit Hyperactivity Disorder-Combined Type (or ADHD-Combined Type, meaning that he had problems with both inattention and hyperactivity). Because Kevin had learned ways to cope pretty well in grade school, the psychologist suggested that they all work together to develop new strategies that might help him deal with the more challenging environment of middle school. If those were not effective enough, then Kevin could try taking some medication that might help him stay more focused and attentive.

Just about every classroom in the United States has a student like Kevin. Experts believe that about 5 percent of students, or 1 in 20, have a form of ADHD. Boys are three to four times more likely than girls to be affected by ADHD. Of course, everyone has a hard time paying attention and staying focused now and then, but students with ADHD feel this way most of the time.

How Is Attention Deficit Hyperactivity
Disorder Diagnosed?

Diagnosing ADHD is difficult because symptoms vary and there is no simple test that can determine whether someone has ADHD. In most cases, parents notice early on that their child is much less attentive or has less control over his behavior than other children. However, the disorder usually is not diagnosed until the child enters school and is expected to follow directions, cooperate with others, and be quiet at certain times.

To make the diagnosis, a psychologist or psychiatrist ^* looks for patterns of certain behaviors that have lasted for more than six months and interfere with two or more areas of a person's life (such as school and play, school and home, or home and work). In addition to interviewing the child and family members, the specialist may need to speak with others who know the child well, such as teachers and coaches. Former teachers may be asked to fill out an evaluation. Special tests may also be administered to clarify the diagnosis.

The behaviors that experts look for fall into three categories: inattention, hyperactivity, and impulsivity. Signs of inattention in a child include:

• failure to pay close attention to details
• finding it difficult to sustain attention in work and play
• not seeming to listen when spoken to directly
• not following through on instructions and failing to finish tasks
• having difficulty organizing tasks and activities
• avoiding, disliking, or seeming reluctant to engage in tasks that require concentration
• being easily distracted by unimportant sights and sounds
• losing things
• forgetting things

Hyperactivity refers to overly active behavior. Children experiencing hyperactivity might:

• fidget with their hands or feet
• squirm while seated
  

  A mother gives her hyperactive son medication to help his behavior.

  Stock Boston

• leave their seat in the classroom and elsewhere
• run about or climb excessively
• have difficulty playing or engaging in leisure activities quietly
• seem on the go or act as if driven by a motor
• talk excessively

An impulsive child might:

• blurt out answers before questions have been completed
• interrupt or intrude on others
• have difficulty waiting his or her turn

Not everyone with ADHD has all of the above symptoms. There are three kinds of ADHD that are commonly recognized. People who have significant problems with attention but are not really hyperactive or impulsive are diagnosed with ADHD-Inattentive Type. Other children have problems mainly with hyperactivity and impulsivity. These individuals are diagnosed as having ADHD-Impulsive Hyperactive Type. Individuals with significant problems with impulsivity, hyperactivity, and attention are diagnosed with ADHD-Combined Type.

Children with ADHD may have other behavioral disorders as well. These may include oppositional defiant disorder ^* , depression ^* , anxiety ^* , and delays in learning speech and language.

What Causes ADHD?

Doctors and researchers are not sure why certain people have ADHD. There have been theories involving many possible causes, such as diet, head injuries, exposure to drugs before birth, and even family and home environment. However, none of these theories offers a satisfactory explanation for most cases of ADHD.

Researchers interested in learning about possible biological (by-uh-LOJ-ih-kul) causes of ADHD are looking at how the brains of people with ADHD might actually function differently than other people's brains. For example, using a special scanning test called a PET scan, positron emission tomography (POZ-ih-tron e-MISH-un tuh-MOG-ruh-fee), researchers can watch the brain as it works. The test lets them see how much glucose (GLOO-cose), a type of sugar, is used by the areas of the brain that inhibit impulses and control attention (glucose is the brain's main source of energy). Some studies have found that the areas of the brain that control attention use less glucose in people with ADHD; this means that these areas of the brain appear to be working less hard. Other researchers believe that ADHD has something to do with differences in the neurotransmitters ^* that deliver signals to the brain areas that control attention. Still, researchers are not sure why certain people's brains might function differently in this way. It does appear that children may inherit a tendency to develop ADHD. For example, children who have ADHD usually have at least one close relative with ADHD. In addition, if one of a pair of identical twins is diagnosed with ADHD, the other twin likely has ADHD as well.

How Is ADHD Treated?

Usually, ADHD is first treated with behavioral (be-HAY-vyor-ul) therapy. This involves working with a psychologist or psychotherapist ^* to learn ways of coping with the condition. The therapist can help people become more aware of their behavior, develop strategies for controlling it, and even help them practice how to deal with situations that caused problems in the past. A person also might find it helpful to participate in a support group with others in the same situation.

Parents and teachers are part of the treatment plan as well. Parents can learn how to establish more structure for the child, define limits more clearly, and be consistent with discipline, all of which are especially important for a child with ADHD. Teachers can provide predictable routines and structure in the classroom and try to keep the student away from distractions. Both parents and teachers can establish certain penalties and rewards to help the child make progress with behavior.

If these strategies are not effective enough in controlling the condition on their own, then a psychostimulant (SY-ko-STIM-yoo-lint) medication such as methylphenidate (meth-il-PHEN-uh-date; Ritalin, Concerta, Methylin, Metadate), dextroamphetamine (dex-tro-am-PHET-uh-meen; Dexedrine, Dextrastat), or mixed amphetamine salts (Adderall) might be prescribed. It may seem strange that an inattentive, overly active person would be treated with a stimulant (a drug that increases energy). However, these medications work by stimulating certain areas of the brain that make it possible for many people with ADHD to concentrate, behave more consistently, and take part in activities that were impossible before.

Why Is ADHD Diagnosed More Often
Than in the Past?

More children than ever before are being diagnosed with ADHD-Predominantly Impulsive Hyperactive Type or ADHD-Predominantly Inattentive Type. In addition, the use of stimulant medications increased dramatically during the 1990s; according to one estimate, production of these medications increased by 700 percent between 1990 and 1997. There is some disagreement over why this is the case. Some people think that greater awareness of the condition is leading more parents to seek help for their children. Others believe that some cases of what is simply "bad behavior" are being misdiagnosed as ADHD. Some argue that parents may find it easier to accept that their child has a mental disorder rather than learn how to deal with unruly behavior or poor school performance due to other reasons. The debate continues, but experts agree that ADHD is a real condition that can have serious consequences if it is not diagnosed and managed appropriately.

A boy with ADHD receives one-on-one instruction with his teacher. The method of teaching a child according to his or her own special way of learning is an effective way of managing ADHD.

Photo Researchers, Inc.

Living with ADHD

Living with ADHD can be difficult. Children and adults with ADHD may have a hard time keeping friends and performing well at school or work. While many individuals live well with ADHD, many may become lonely, depressed, and even use drugs or alcohol as an escape.

People with ADHD do not outgrow the condition. While they often become less hyperactive when they get older, people with ADHD may still have problems with restlessness and short attention span.

By using certain coping strategies, many people with ADHD learn to deal with the condition successfully and can achieve in school and thrive in rewarding careers. Many people are able to find the right kind of job for their strengths and abilities. For example, a person might be better suited for a position that offers variety and constant change rather than one that requires long periods at a desk.

The U.S. National Institute for Mental Health, the Federal agency for research on mental disorders, recommends the following strategies for living with ADHD:

• When necessary, ask the teacher or boss to repeat instructions instead of guessing about what was said.
• Break large assignments or job tasks into small, simple tasks. Set a deadline for each task and provide rewards for each completed task.
• Each day, make a list of what needs to be done. Plan the best order for doing each task, then make a schedule for doing them. Use a calendar or daily planner.
• Work in a quiet area. Do one thing at a time. Take short breaks.
• Write things down in a notebook with dividers. Write different kinds of information, like assignments, appointments, and phone numbers, in different sections. Keep the book on hand.
• Post reminders of things that need to be done.
• Store similar things together.
• Create a routine. Get ready for school or work at the same time, in the same way, every day.
• Exercise, eat a balanced diet, and get enough sleep.