ACEI SPEAKS

Understanding AD(H)D

Jerry Aldridge and Patricia Kuby

Mark can't seem to pay attention in school,
Billy never sits still and
Mary constantly interrupts others.
Do these children have AD(H)D?
Perhaps or perhaps not.

What Is AD(H)D?

Attention Deficit (Hyperactivity) Disorder is a broad category that can include the following subcategories: 1) inattention, 2) hyperactivity/impulsiveness, 3) both inattention and hyperactivity/impulsiveness and 4) miscellaneous. Examples of inattention are failing to pay attention to detail, failing to sustain attention, difficulty with organization, forgetting daily scheduled activities and inability to follow through with instructions or complete school work. Examples of hyperactivity include fidgeting in seat, running or climbing in inappropriate situations, difficulty engaging in leisure activities quietly and the appearance of being constantly in motion. Impulsiveness involves not waiting for turns, constantly interrupting others or spontaneously blurting out.

Even if a child has some of these characteristics, he or she may not have AD(H)D. Physicians and pediatricians diagnose AD(H)D according to these categories using the Diagnostic and Statistical Manual (4th edition) (DSM-IV) of the American Psychiatric Association. Most of the criteria used to diagnose AD(H)D refer to school-age children rather than preschoolers, but some symptoms that cause AD(H)D often appear before age 7. In order for a child to be diagnosed as having AD(H)D, he or she must have symptoms in at least two or more settings (such as home or school) and a diagnosis should be based on observations of the child over time by parents and teachers who work directly with the child.

Questions To Consider Before a Child Is Labeled with AD(H)D

Unfortunately, AD(H)D is often considered a weakness and the child's strengths are often overlooked. While children with the AD(H)D label may have excessive activity levels that adults judge negatively, they also have many positive qualities, such as multiple interests, high energy levels and sparkling personalities.

Before a child is labeled AD(H)D, certain questions should be considered over time by all individuals having ongoing contact with the child. These include:

How old is the child? Younger children are more difficult to diagnose because it is normal for them to appear overactive or inattentive in many settings. It is often difficult to tell the difference between normal and exceptional attention and activity levels.
What is happening in the child's environment? Sometimes a child may exhibit low attention or high activity levels because the environment requires too much of the child in light of his or her age or the circumstances. For example, 3-year-olds should not be asked to sit and listen for long periods of time. Many other things happen to children that could temporarily upset them and these must be considered. Is the child's family going through a divorce? Has there been a move? Was there a death in the family? Many of life's circumstances may make a child appear to have AD(H)D. Knowing what is going on in the child's life is especially important for an accurate diagnosis of AD(H)D.
Are parental or teacher expectations appropriate for the child? Some parents or teachers may believe a child has AD(H)D when, in fact, their own expectations for the child are unrealistic (when considering age and circumstances).
Does the child appear hyperactive, inattentive or impulsive in a variety of places? Children spend time in school, home, neighborhood social organizations and many other places. In determining if a child has AD(H)D, where the child is inattentive or overactive must be considered. Often, children respond very differently in various situations and contexts.
Is the child just at the "high" end of normal attention and activity levels? Every child is different from other children with regard to attention and activity. A fairly wide range of attention and activity levels is acceptable and determining what is exceptional is often difficult. Also, expectations for individual children may vary. Inattention and overactivity may be treated differently from child to child due to a number of factors, such as the child's temperament or personality.
How accurate are predictions of what a child might be like in the future? The younger the child, the less likely we will be able to predict what will happen as the child matures. Attention and activity levels may change over time. Also, we do not yet have long-term studies of the effects of many drugs, such as Ritalin. What will happen to a child who now takes Ritalin in 30 years?

What Types of Help Are Available for Children with AD(H)D?

A variety of methods may be used to help a child diagnosed as having AD(H)D. These include numerous medical, educational and family interventions. It is important to remember, however, that there are no easy answers or quick fixes for AD(H)D.

Medical Interventions (The Use of Stimulant Drugs)

The use of stimulant drugs (such as methylphenidate, or Ritalin) has been tried since the 1950s.
Positive response rates for children with AD(H)D using stimulant drugs have ranged from 60 to 90 percent (Hinshaw, 1994).
There is the possibility of side effects with any drug, including reduced appetite, disruption of sleep, stomachaches, headaches and even tics (involuntary motor activity) (Hinshaw, 1994).

Educational Interventions

Children with AD(H)D may receive help in a regular classroom under provisions of the Rehabilitation Act of 1973.
AD(H)D is not a special education category. Some children with AD(H)D, however, do receive special education services because they are classified using another disability category, such as learning disabilities, behavior disorders or other health impairments.
Behavior modification techniques are also used with children with AD(H)D. With behavior modification, a teacher or parent works with others to set up a reinforcement program specific to a particular child. Behavior modification has a fast, but often temporary, influence on behavior (Kohn, 1993).
Cognitive behavior modification is also used. With this intervention method, children are taught to check on their own behavior. From time to time, parents or teachers will stop the child, ask the child what he or she is doing, and reflect over his or her behavior.
A teacher can support a child's attention and activity level by extending attention where the child is allowed to move from activity to activity within a particular theme or strand. This is often effective.
Technology has increased the options of working with children with AD(H)D. Several technological interventions are now being tried.

Professional/Family Collaboration

Best outcomes for children occur when there is a professional/family partnership. AD(H)D is a family concern and both individual and family intervention could be beneficial in some cases.
Behavior modification has also been attempted within the family context. While some professionals have developed intervention strategies for the child alone, we now know that intervention is more effective when the family context is a primary focus.

Some Final Things To Consider
Diagnoses of AD(H)D are on the increase. In some places as many as 10 percent of the school-age population is on Ritalin. Is this the best answer? We must consider that most of the early ideas about AD(H)D focused specifically on the child and did not consider how the environment may be contributing greatly to the child's behavior. Does the environment a child is in support his or her development or would changes in the environment have a more positive influence on the child's behavior? Is a child being asked to do things that are inappropriate for his or her age or circumstances? Making expectations more appropriate might help the situation.

If you are concerned that your child has AD(H)D, consult your pediatrician, school psychologist, the special education coordinator or the local mental health facility, or refer to the references presented here.

References

Books

Fowler, M. (1992). CH.A.D.D. educators manual. Plantation, FL: CH.A.D.D.
Hannah, J. N. (1996). Parenting a child with attention deficit hyperactivity disorder. Nashville, TN: Vanderbilt Child Development Center.
Hinshaw, S. P. (1994). Attention deficits and hyperactivity in children. Thousand Oaks, CA: Sage.
Kohn, A. (1993). Punished by rewards. Boston: Houghton Mifflin. Nadeau, K. G., & Dixon, E. B. (1993). Learning to slow down and pay attention. Annandale, VA: Chesapeake Psychological Publications.
Parker, H. C. (1988). The attention deficit disorder workbook for parents, teachers and kids. Plantation, FL: Impact Publications. Rief, S. F. (1993). How to reach and teach ADD/ADHD children. West Nyack, NY: The Center for Applied Research in Education. (800-288-4745)
Taylor, J. T. (1994). Helping your hyperactive/attention deficit child. Rocklin, CA: Prima Publishing.
Weaver, C. (1994). Success at last! Helping students with AD(H)D achieve their potential. Portsmouth, NH: Heinemann.
Wender, P. H. (1987). The hyperactive child, adolescent and adult. New York: Oxford University Press.

Journals and Periodicals

Buchoff, R. (1990). Attention deficit disorder: Help for the classroom teacher. Childhood Education, 67, 86-90.
Eddowes, E. A., & Aldridge, J. (1990). Hyperactive or Òactivity hyperÓ: Helping children attend in appropriate environments. Day Care and Early Education, 17(4), 29-32.
Eddowes, E. A., & Aldridge, J., & Culpepper, S. (1994). Primary teachersÕ classroom practices and their perceptions of childrenÕs attention problems. Perceptual and Motor Skills, 79, 787-790.
Landau, S., & McAninch, C. (1993). Young children with attention deficits. Young Children, 48(4), 49-58.
Wallis, C. (1994). Life in overdrive. Time, July 18, 42-50.

On-line Sources

Wong, M. W. (1996). Attention deficit disorder (ADD) FAQ v1.2
URL: http://www. seas.upenn.edu/-mengwong/add/add.faq.html#23. ONLINE, World Wide Web, March 27, 1996.

Other Resources

A.D.D. Warehouse (printed resource catalog)
300 Northwest 70th Ave., Suite 102, Plantation, FL 33317
CH.A.D.D. (Children and Adults with ADD)
499 NW 70th Ave., Suite 109, Plantation, FL 33317

Return to ACEI home page.