DISEASES & TREATMENTS
about ATTENTION DEFICIT DISORDER:
What is attention deficit disorder?
Attention deficit disorder is a condition that
refers to an individual's inability to control their own behavior
or impulses. It can be manifest as constant movement and fidgeting.
These patients have difficulty blocking out noise or other stimuli
in order to focus on a task or what is being said. Attention deficit
disorder is a chronic problem that can be seen as early as infancy
and can extend into adulthood. It usually becomes most evident
when a child enters school and has difficulty adjusting to the
structure and demands of the classroom. Attention deficit can
have negative effects on a child's life at home, school, and in
social situations. For some individuals it can last a lifetime
and brings many challenges for patients and families.
There are two types of attention deficit disorder.
The most obvious form is Attention Deficit Hyperactive Disorder
(ADHD). The primary characteristic of this type is hyperactivity,
which is first seen before a child even enters school. The less
obvious type is Attention Deficit Disorder (ADD), where hyperactivity
is not present. The primary characteristic of this type is inattentiveness.
What are the symptoms of attention deficit
Hyperactivity is the most obvious symptom. Children
with this condition are unable to control their actions even under
the most closely monitored situations. Parents often suspect that
certain foods cause hyperactivity, but children with ADHD are
hyperactive even though these foods are not part of their diets.
Other primary symptoms include inattention, distractibility, impulsiveness,
and short attention span. There are problems with organization
and transitioning from one activity to another. The disorder can
be complicated by other kinds of learning and/or behavior problems
as well. Thought patterns may be loose and poorly organized. Children
have difficulty with memory, following directions, and completing
tasks. Learning disabilities in math, reading, or written language
may accompany the attention deficit. Late physical maturity is
often seen and can cause social problems and difficulty fitting
into peer groups. Overexaggeration of emotions is common in children
with ADD/ADHD, as is an inability to calm themselves. When these
children are excited, they can become overly excited. When they
are upset, they can become extremely upset and difficult to soothe.
Many of these children have allergies to certain food substances.
Some children may appear as quiet or passive in nature and remain
undetected. Few children with an attention deficit have just one
manifestation of their problem.
Symptoms of hyperactivity, inattentiveness,
learning difficulties, and impulsivity can occur in conditions
other than ADD/ADHD. Children suffering from emotional disturbances
and trauma can exhibit similar symptoms to those of ADD/ADHD.
Therefore, accurate diagnosis is important before treatment.
What causes attention deficit disorder?
There continues to be ongoing research into
the actual cause of ADD/ADHD. There are many theories under investigation.
The cause is likely related to abnormalities in the nervous system
(neurologic) and particularly in the way messages are sent to
and from the brain. Research has revealed that the brain in a
child with ADD may develop differently. The covering of nerve
tissues (myelin sheath) does not reach full maturity. In some
children, this covering eventually matures, and by puberty the
child becomes less inattentive and hyperactive. In other children
this sheath never matures and the child enters adulthood with
There is growing evidence to support the idea
that ADD/ADHD is hereditary and may be passed from parent to child.
It is also more prevalent in boys than in girls.
In babies that have been prenatally exposed to drugs,
including alcohol, cocaine, amphetamines, and heroin, ADD/ADHD
need to be carefully watched for. Increasing numbers of premature
infants are found to have the disorder as well.
How is attention deficit disorder diagnosed?
Children who have demonstrated persistent symptoms
for longer than six months may be at risk for ADD/ADHD. A diagnosis
is usually made by a psychiatrist, or clinical or school psychologist.
The diagnosis should only be made after ruling out other factors
related to medical, emotional, or environmental variables which
could cause similar symptoms. In order to do this, physicians,
psychologists, and educators conduct an evaluation that includes
a health and developmental history, medical evaluation, psychological
and educational assessment, behavior rating scales completed by
the parents and teacher, and possibly a speech and language evaluation.
The assessment is typically done within the school setting provided
that the school has the appropriate personnel to conduct the assessment.
Otherwise, the parent will need to consult health professionals
for an assessment. A list of organizations to contact is located
at the end of this article. Observations of the child in various
situations are made by the school psychologist or other health
professional consulted, who coordinates the assessment. The information
gathered, including all test results, is documented in a psycho-educational
report which will recommend appropriate treatment at school. The
report will be shared with the family physician in the event that
the parents and physician wish to consider treatment with medication.
How is attention deficit disorder treated?
ADD/ADHD is such a complex disorder that successful
treatment must be carefully planned and cover all aspects of the
child's life. Consistency is critical if the plan is to be effective.
At school, the teacher may implement strategies
to help the child focus on assignments and complete work with
minimal distraction. Some of these modifications may include seating
the child near the teacher or in an area clear of distraction.
Directions should be clearly understood by the child, and often
a study buddy can be provided. Worksheets and assignments may
be shortened to enhance performance and encourage success. More
time may be given for task completion or test-taking. Behavioral
contracts are frequently used to clearly define expectations and
the consequences should the child choose not to adhere to those
expectations. It is important for the teacher to maintain close
communications with the parents at all times.
Parents may want to enroll in parenting classes
or support groups to help them deal with the challenges of a child
with ADD/ADHD. They may also implement behavior contracts with
clearly stated expectations and consequences. It is crucial for
parents to maintain open communication with all the professionals
involved with their child during this process. Some families seek
counseling to address specific issues that arise. The counselor
should be advised of the modifications made at school and any
behavior contracts in progress at home and school.
It is sometimes necessary to medicate children
with severe ADD/ADHD. This is a decision made by the parents and
their physician. Many parents are reluctant to take this step,
so it is important to discuss this with the physician. The purpose
of medication for ADD/ADHD is to lengthen attention span, decrease
distraction, and provide more opportunity for effective learning.
The most commonly used medications in treating ADD/ADHD are psychostimulants.
Methylphenidate (RITALIN), dextroamphetamine (DEXEDRINE), and
pemoline (CYLERT) have been prescribed for many years with minimal
side effects. More recently, antidepressant medications such as
imipramine (TOFRANIL) and desipramine (NORPRAMIN) have also proven
to be successful in treating the disorder. Each of these medications
is believed to affect the deficiencies in the body's messages
to and from the brain which can cause ADD/ADHD. The majority of
children taking these medications show improvement. There are
some children, however, who do not react as favorably.
The physician will discuss possible side effects
and have the parent monitor the child's behavior on a calendar.
If the medication is to be taken at school, the physician will
provide the school with a prescribed amount for that student only.
The medication can only be administered by a specified health
professional or paraprofessional at the prescribed time. The medication
(with the child's name on it) is kept under lock in the school's
health office. Medication side effects such as loss of appetite,
restlessness at night, and lethargy in the classroom should be
charted and can often be controlled through dosage adjustments.
Medication alone cannot effect changes in the child. However,
in conjunction with the modifications at school and home, the
child may have a better chance for success.
Before medication is tried, many parents turn
to specific diets in an attempt to control their child's behavior.
They should seek the assistance of a physician who is prepared
to work with them in diet control for this purpose.
And what about the child's responsibility in
all of this? The child should not be allowed to use this condition
as an excuse to avoid work or behave inappropriately. The child
should be included in the treatment plan and know at all times
what his responsibilities are. The child will likely assume the
attitude of the adults around him in regard to this disorder.
It is therefore important that parents, teachers, and other involved
professionals project a united, positive attitude.
The most effective treatment of ADD/ADHD requires
full cooperation of the student, parents, teachers, and other
involved professionals such as physicians, psychologists, and
educational specialists. Consistency is critical, and it is important
to remember that changes may not happen overnight.
For more information regarding attention deficit
disorder, contact the local school district office or one of the
Bureau of Education for the Handicapped
U.S. Office of Education
Washington, DC 20202
The Association for Children with Learning Disabilities,
3739 S. Delaware Place
Tulsa, OK 74105
Council for Exceptional Children
P. O. Box 9382 Mid-City Station
Washington, DC 20005
U.S. Office of Civil Rights
Washington, DC 20402
For more information about ADD, please visit the site:
The content provided in MedicineNet by Information Network, Inc. is for information purposes only. It is intended to provide information and educational material and is not designed to diagnose or treat a specific condition or otherwise provide medical advice. Neither MedicineNet nor Information Network, Inc., is engaged in rendering professional medical or healthcare services. Information can be subject to personal interpretation and can become obsolete, and accuracy cannot be guaranteed. Please consult your own healthcare provider regarding any medical issues relating to diseases, conditions, symptoms, diagnosis, treatments and side effects.
Copyright © 1995 - 1997 Information Network, Inc.