Remember that one kid in your grade school class who could never sit still? He’d blurt out answers without raising his hand. He’d wander around the cafeteria searching for novel ways to annoy his fellow pupils. A passing car or chirping bird outside the window was always more fascinating than the math problem in front of him. In his calmer moments, he’d noisily tap his pencil or otherwise fidget relentlessly until the teacher reprimanded him yet again.He was intelligent but unable to focus on the lesson at hand or to channel his seemingly boundless energy in a positive, productive way. Like ripples on a pond, his behavior led to disappointing report cards, conflicts at home, low self-esteem and poorly honed social skills.
A generation ago this child most likely would have been labeled a troublemaker and never would have received the help he needed. Today, however, that same child would probably be diagnosed with attention-deficit/hyperactivity disorder (ADHD), which affects millions of children. His diagnosis would probably be made early, possibly before first grade. And he would be plugged into treatment and learning protocols, which, while still evolving and somewhat controversial, are effective for most cases.
According to the National Institute of Mental Health, the condition affects two to three times more in boys than girls, although recent studies suggest that girls are underdiagnosed because their symptoms are different. Every classroom houses at least one ADHD student on average. Left untreated, children with ADHD are four times more likely to drop out of school and are at increased risk for substance abuse, suicide, reduced academic achievement, accidental injuries, interpersonal problems and involvement in the juvenile justice system, according to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), a leading support and education group. ADHD continues into adulthood for many people.
The upside is that ADHD has leapt out of the closet in recent years. CHADD and other advocacy groups are raising public awareness of attention disorders, lobbying Washington on behalf of people with ADHD, and directly supporting ADHD sufferers, their loved ones and teachers. Over the past several years, Congress has amended laws guaranteeing the right of children with ADHD to a free and appropriate public education. In the laboratory, computerized imaging technology and other sophisticated diagnostic tools are revealing tantalizing clues as to why some people’s brains have a propensity toward ADHD and others do not. And with increasing financial support, researchers are toiling to pin down the cause or causes of ADHD and its possible environmental and genetic links. Scientists also are working to develop better treatments and perhaps even preventive measures.
Early diagnosis, intervention and treatment have been shown to help people with ADHD overcome their problems and achieve success in all areas of their lives.
Scientists do not know the precise cause or causes of attention-deficit/hyperactivity disorder (ADHD), but increasing evidence points to biological and genetic factors rather than dysfunctional families, too much television, poor schooling, food allergies, refined sugar, food additives or other environmental factors. Undetectable brain damage or minor head trauma, once thought to be possible causes of ADHD, also have been largely disproved.
Among theories being tested are whether exposure to cigarette smoke, crack-cocaine, alcohol or other substances while in the womb may play a role in developing the condition.
All in the family
There are reasons to believe that ADHD or the tendency toward the disorder might be passed down through the family. For instance, most children with ADHD have at last one relative with an attention disorder. At least one in three fathers who had ADHD symptoms in their youth have children with ADHD tendencies. Another study, which looked at information from 1,938 Australian families with twins and other children ages 4 to 12, found when one twin had ADHD, there was a 91 percent chance that the other identical twin would also have it. Genetic mapping studies are examining patterns of genetic inheritance in ADHD, learning disorders, and mood disorders in children.
In the brain
Scientists recently have discovered parts of the brain’s frontal lobe and basal ganglia are reduced by about 10 percent in size and activity in children with ADHD. Using positron emission tomography (PET) scanning, scientists at the National Institute of Mental Health showed a link between a person’s ability to pay continued attention and the level of activity in certain areas of the brain. In people with ADHD, the brain areas that control attention used less glucose (blood sugar), meaning that those areas were less active. Based on this research, experts believe a lower level of activity in some parts of the brain might cause inattention.
One of the first tasks in diagnosing attention-deficit/hyperactivity disorder (ADHD) is to gather information to rule out other possible causes of the child’s behavior. Another task is assessing the child’s intellectual, academic, social and emotional functioning.
Most mental health practitioners and educators are good at spotting situations such as teaching techniques that can cause a child to act as if he or she has ADHD. In some cases, a child’s inattentiveness disappears when a teacher gives more praise or simply seats that child in the front of the classroom.
Fear, loss of a loved one, divorce, child abuse, mild seizures, learning problems and a variety of mental disorders such as depression can make children seem hyperactive, impulsive or inattentive, even if they do not have ADHD. Class work that is too easy or too hard can lead to boredom, inattention or hyperactivity. Medical conditions, such as chronic middle ear infections or undiagnosed vision or hearing problems, can also look like ADHD. Sometimes a stressful and chaotic home or school environment can also lead to behavior that looks like ADHD, or the child may have a learning disability.
Sometimes parents may see signs in their toddler such as not being able to pay attention and appearing hyperactive and impulsive. The child may not be able to pay attention to a TV show or may run around completely out of control. It may be hard, however, for a parent to tell the difference between ADHD and normal behavior and personality. Some children may have more energy than others. Also children mature at different rates.
Since ADHD can affect how a child functions with other children and with class work, a teacher may be the first to suspect ADHD and may point it out to the parents that they may want to consult a health care provider. The child can be evaluated by a school psychologist, or parents can talk with the child’s pediatrician or their family doctor, who can either do the evaluation or refer the child to a child psychiatrist, child psychologist, neurologist or other specialist. You can also talk to state and local social service agencies as well as ADHD groups to find a specialist.
However, if the teacher does not notice a problem, that doesn’t always mean your child does not have ADHD. Some children with ADHD may appear cooperative and quiet, but they may not be able to pay attention.
Diagnosis of a child
To rule out situations and conditions that may be causing behavior to look like ADHD, the doctor examines school and medical records that may reveal answers.
The doctor will then gather information about the child’s behavior to compare this to symptoms that have been defined by the mental health community as ADHD. Using standardized forms, teachers past and present are asked to rate the child’s behavior in comparison to that of their child’s classmates.
The doctor will also interview teachers as well as family and anyone such as a coach who may know the child. Parents are also asked to fill out a form to rate the child’s behavior in different situations.
When looking at the results, the specialist considers how a child behaves in situations where self-control is needed and in noisy situations such as parties, or in doing tasks that require attention for periods of time, such as reading.
To make the diagnosis, a profile is then created by the doctor to answer these questions:
* Which ADHD-like behaviors does the child show? How often? In what situations? How long has the child been showing them?
* How old was the child when the problem started?
* Are the behavior problems constant or do they show up every so often?
* Are the behaviors seriously interfering with the child’s friendships, school activities or home life?
* Does the child have any other related problems?
Once a diagnosis is made, a treatment plan is developed based on defining the type of educational, medical and emotional help that may be needed.
ADHD is not necessarily something that a person can outgrow. Adults may have the condition and were never diagnosed. It may be hard to spot the problem in yourself unless you can recognize the symptoms.
Perhaps you feel frustrated most of the time because you feel you are not able to perform at your best. You may also feel restless and easily bored. Some adults with ADHD describe themselves as excitement seekers.
Your performance at home and work helps determine whether you have an attention deficit disorder. Ask your parents to rate your behavior as a child. Your doctor may have your spouse fill out a rating scale.
Changing jobs often is common among people with attention deficit disorder. According to the National Institute of Mental Health (NIMH), most adults with an attention deficit disorder (ADD) remember times throughout their lives when they were could not pay attention, acted on impulse, were overly active, or felt impatient or disorganized. According to the organization Children and Adults with Attention-Deficit/Hyperactivity Disorder, adults with ADD can do well in the workplace and in life by channeling their energy into creativity. For example, many adults with ADD become successful entrepreneurs.
Adults who believe they have ADD can talk with a psychologist, psychiatrist or neurologist. Unfortunately not all mental health specialists are skilled in identifying or treating ADD in adults. Before setting up an appointment, ask if the practitioner has specific training and experience with this problem. Or ask members of a local support group to recommend a health care provider.