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 disorder?

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 the disorder.

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 following:

Bureau of Education for the Handicapped
U.S. Office of Education
Washington, DC 20202

The Association for Children with Learning Disabilities, Inc.
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:

  • http://www.nimh.nih.gov/pulicat/adhd.htm
  • http://www.addmed.com/
  • http://chadd.org/
  • http://www.seas.upenn.edu/~mengwong/add/
  • http://www.famous-fixtures.com/ada3.html

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