According to the American Psychiatric Association, as defined in their Diagnostic and Statistical Manual IV-TR, ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) have held numerous labels over the years. There are three different types of ADHD.
Attention Deficit Hyperactivity Disorder, Primarily Inattentive Type (ADD)
This type of distractible and inattentive disorder is commonly referred as ADD or Attention Deficit Disorder.
Attention Deficit Hyperactivity Disorder, Primarily Impulsive and Hyperactive (ADHD)
Children diagnosed with this disorder often react before that think making their actions impulsive. These children also show signs of uncontrollable urges to move.
Attention Deficit Hyperactivity Disorder, Combined (ADHD)
Children in this group are distractible, inattentive and impulsive.
Common Signs and Symptoms Of ADD
ADD usually does not become problematic until a child is in third or fourth grade. The following signs and symptoms are normally present for a period of time that is no less than six months in multiple settings (home, school, activities etc.).
o Short attention span
o Forgetful
o Easily distracted
o Of has difficulty with organizational skills
o Does not appear to be listening
o Fails to follow through with school assignments, chores and activities
o Often appears to be lazy, disinterested and fails to put forth mental effort
Signs and Symptoms of ADHD
The hyperactive and impulsive child may begin to show the signs and symptoms presented below before they enter first grade. Parents who have children who can't sit still in pre-school and continually here from the teacher that their child "is much more active than the other children," usually see some of the other signs presented below while their child is at home, in stores, restaurants and other public places outside of school.
o Interrupts while others are speaking or blurts out
o Constantly getting out of seat or squirms in chair
o Has a hard time playing or completing a task quietly
o Runs, jumps and displays a lot of energy at inappropriate times
o Gets in conflict with peers
o Constantly touches people or objects without permission
o Talks excessively
o Seems to require constant supervision and direction
o Has a hard time taking turns
The ADHD child usually displays at least six of these signs and symptoms for a period no less than six months. Parents who have an ADHD child often report that their child is hard to manage and the parent is usually exhausted by the end of the day. Crying, arguing and yelling are often common character traits. Manipulation and demanding for more may also be common. Beside the parent becoming exhausted, the child is usually exhausted as well.
ADD/ADHD Is A Medical Diagnosis and Parents Decide
Diagnosing ADD/ADHD is a medical decision. Parents have a right to get a second or third opinion. Parents who get the best medical advice often report that they have had their child assessed by a trained medical doctor and nurses who specializes in this field. The medical facilities that employs educational and learning specialist who work directly with the doctors, children, schools and their families are the facilities that often make correct diagnosis when it come to this disorder. Insurance companies often cover a percentage of the cost. It's a good idea to check with your insurance company before you make a decision.
Other Common Questions Parents Have Before We Move On
What Causes ADD/ADHD?
Medical experts believe that brain structure and function play a role in causing ADD and ADHD. The brain's frontal lobe (located near our forehead) has often been the point of concentration by medical research teams. Through the use of MRI (Magnetic Resonance Imaging) these teams have found that the frontal lobes are 3 to 4 percent smaller in children who have been diagnosed with ADD/ADHD. Medical science also believes that one of the brain's main sources of energy, glucose, is used less in the areas that control attention in adults who have been diagnosed with ADD/ADHD than adult who have not been diagnosed with this condition.
Is There A Cure For ADD/ADHD?
Not yet. There is no known cure for ADD/ADHD. However, for many children and adult behavioral therapy, medications, schooling and parenting strategies that involve teaching children coping techniques have all proven to be successful interventions. Research seems to indicate that only one in three children who are diagnosed with ADD/ADHD are able to overcome the disorder by adulthood. Because there is no know cure at the present time, the primary focus has been placed on minimizing the symptoms. Once parents and educators working with children begin to accept the long-term nature of this disorder, the easier it is to manage it.
What Treatments or Interventions Work?
There are a variety of interventions that seem to lessen the severity of ADD/ADHD. Behavior modification that takes place in both the home and school has been used to help manage this disorder. Medical facilities that specialize in working with children who are ADD/ADHD can recommend a behavioral therapist who can assist the child in replacing undesirable thinking that leads to inappropriate behaviors. There are many different forms of behavioral therapy that include Rational Living Therapy, Cognitive Therapy, Dialectic Therapy and Rational Emotive Therapy. Behavioral therapy is a form of psychotherapy that is applied by a trained, licensed therapist. Parents can also be taught behavioral modification techniques that can be used at home. Some of these techniques will be provided later.
Social skills' training is another intervention that has helped children with ADD/ADHD. Children are taught how to interact with their peers and family members by practicing acceptable social behaviors. Some of medical facilities that assess ADHD also provide social skills support groups. Another option for this intervention is offered through the special education programs in numerous public schools. Check with your child's classroom teacher, school principal or special education director for availability.
The use of medication is another option that parents may want to consider after their child has been diagnosed with ADD/ADHD. There has been some controversy on the use of medication to treat children and adult who have been diagnosed with this disorder. Some of the controversy stems from the fact that some doctors over-prescribed a certain medication without first doing the proper assessments for ADD/ADHD.
The following medical and educational specialists are usually involved in the evaluation process:
o Developmental Pediatricians
o Clinical Psychologist
o Psychiatrist
o Pediatric Neurologist
o Pediatricians
What Happens During An ADD/ADHD Assessment?
Usually the assessment process includes the following process:
o Parent(s) and child meet together and separately with the professional to discuss why they are there and what they believe is happening.
o Parents often individually are asked to fill out a parent questionnaire form regarding numerous situations that they see in their child's behavioral and academic performance.
o The child's teacher (s) are asked to fill out a teacher questionnaire.
o An evaluator will administer a standardize IQ test (most commonly used test is the Wechsler test).
o A learning disorder assessment may also be given to rule out a learning disability.
o Computerized assessments may include a TOVA as well as other concentration assessments.
o The evaluator will review all assessments individually and as one prior to meeting with you to make recommendations.
What Do I Do If My Child Is Having Trouble With Homework?
Most parents of ADD/ADHD children report that homework is the most difficult part of parenting their child in relationship to school. When you think about it, there are a lot of steps that the child has to follow before a homework assignment is even turned in to be graded.
o Hear the assignment
o Understand the assignment
o Write down the assignment
o Remember to bring the assignment (and books, if necessary) home
o Remember to do the assignment
o Remember to ask for help
o Remember to take your time, focus, concentrate
o Remember to do your best
o Remember to pack the assignment
o Remember to bring the assignment to class
o Remember to turn the assignment in to the teacher
Each step may be a major challenge. So, here are some things that parents can do to help:
1. Help your child with organization. Do NOT do all the organizing yourself...just help by:
o Working with your child to organize the bedroom, backpack, school locker etc.
o Asking to see the planner notebook. (Middle and High Schools) Most schools now require them.
>Place a poster board of daily routines on the child's bedroom wall that spells out what the child must do everyday. Don't get carried away. Make it simple and precise. The same poster board routine may also be placed on the outside cover of your child's notebook for school. The poster may include:
Wake up at 7:00 a.m.
Shower at 7:10 a.m.
Eat breakfast at 7:25 a.m.
Brush teeth at 7:35 a.m.
Get backpack at 7:40 a.m.
Go to bus at 7:45 a.m.
o Some ADD/ADHD children have been successful wearing a watch that beeps to remind them to complete a task for follow directions.
o Have your child study in the same place during the same time of day whenever possible. Make sure that the décor in the room is not too busy looking or distracting to the child's eye. No music and no TV!
o Establish posted rules for your child to follow. Be consistent on a day-to-day basis. One hour of TV per day means just that! See the chapter on rules for more information.
o Be consistent in assigning your child chores and task to accomplish around the house on a day-to-day basis. Have the chores listed and placed in a place where your child can read them each day.
o Make the incentives or rewards that you provide your child for accomplishing set rules and following routines "natural rewards." Natural rewards or incentives are things that your child would naturally receive with one catch- they earn it! Such rewards may include pizza (or a favorite food) with friends, sleep over with friends, rent or order a movie or lunch with you! Make it simple and well within your budget. You don't want to teach your child that he or she needs to accomplish a task in order to get a reward. You do want to teach your child that following a routine will help them succeed.
o Part of the reward plan may include a point system. Establish a system where your child can earn points for accomplishing a task or following a routine for the day. Help the child to set a goal to reach a certain number of points for the week, month and year. Place an incentive for each point total reached. Set up a chart or a graph so that the child can see their accomplishments. Keep it positive.
Tough Questions!
What do I do when my child throws a tantrum?
If you are in a public setting, leave the setting as soon as possible with your child. Tell your child "it's time to go." Stay calm, but be deliberate. If you are at home your child should receive a "time out." "Time out" means that the child is assigned to a specific room to cool down, be safe and start over. Smaller children may be physically placed in a time out area. Bigger children can become a danger to themselves and to others, including you. For this reason, verbally direct the child to a safe "time out" place. The "time out" should only last as long as it takes for the child to cool down and get his or her behavior under control.
Nothing seems to work. Now what do I do?
Once you understand that parenting (no matter who are what your child is going through) is not a "push button" event, the quicker you will settle into becoming patient and understanding your child's needs. No parent can ever tell you (without lying) that all his or her parenting experiences were positive and fun. Keep trying. Don't give up on a plan too soon. It may take a few weeks, or even months, for a strategy to work. You can always seek outside assistance from the school counselor or psychologist. Your medical doctor may also refer to an ADD/ADHD specialist for further assessments or help. Don't quit! The plan may be working and your child is not letting you know right away by making noticeable improvements. Maybe the improvements are happening at school and your child is "just letting go" at home. That's why it's important for you to communicate with the other adults working with your child.
I don't believe in medication. Now what do I do?
Don't be harsh on yourself or on your doctor for suggesting medication for your ADD/ADHD child. Stop and think for a minute. Is there a chance that you need more information about the medicine that the doctor is recommending? Is it possible that someone, who is well meaning, provided you with information that is opposite to your doctor's advice regarding medication? If so, seek a second medical opinion. Medication is not the only answer and it's okay to use other methods, such as behavioral modification, to help your ADD/ADHD child. The American Academy of Pediatrics recommends that children with ADD/ADHD be placed on a "combined treatment: that includes behavior therapy with medication. The largest study ever done on ADHD children, the MTA Study, findings supports the AAP recommendations of combined treatment.
For the most part, medication has helped millions of children who have been diagnosed with ADD/ADHD and other disorders. However, medication will help reduce the symptoms, not cure the disorder. You are in charge! All you can do is strive to get the best medical diagnosis and options to reduce the symptoms.
Short-acting stimulants:
These stimulants are most commonly prescribed in "divided doses," given 2-3 times daily. They normally last 3-5 hours. Dexedrine, Dextrostat, Methylin, Focalin and Ritalin are all short-acting stimulants.
Intermediate-acting stimulants:
These stimulants are normally taken once or twice per day and last four to eight hours. Adderall, Metadate ER, Ritalin SR, Methylin ER and Dexedrine Spansule are all intermediate-acting stimulants.
Long-acting stimulants:
Concerta, Ritalin LA, Adderall XR and Metadate CD are all long-acting stimulants. They are normally prescribed to be taken once daily and last 8-12 hours.
The stimulants mentioned above work by increasing the chemical activity in the brain responsible for inhibiting the undesired behavior of the ADD/ADHD child while increasing attention. These chemicals in the brain are known as neurotransmitters. Two neurotransmitters, dopamine and norepinephrine, are known to have tremendous influence on our ability to focus and stay on task while decreasing our desire to become excessively active. Many children respond to stimulants within the first thirty minutes. These stimulants are given orally to children. Most school districts do not allow, as a policy, for ADD/ADHD students to carry these prescribed medications with them in class. It's important that the school nurse or school administrator is aware of the prescription medication that your child is taking while at school.
I heard that ADD/ADHD medication has bad side effects. Is that true?
Your doctor will provide you with information regarding the side effects of ADD/ADHD medication. It's important to note that any item that we ingest, including water, can have adverse side effects. You doctor should monitor the side effects of the prescribed medication that you child is place on. This means that your doctor will want to hear from you if the side effects are occurring outside the range of normalcy for most children. Some of the common side effects for these stimulants include insomnia (sleeplessness), decreased appetite, headaches, anxiety and stomachaches. These side effects, if they are present, usually decrease during the first few weeks for most children. Again, let your doctor know if your child appears to be too sleepy, anxious or unable to sleep (insomnia) for long periods of time. Your doctor may ask your child's teachers to fill out a teacher rating scale to help determine the effects of the prescribed medication during the child's school day.
It's important to note that stimulants have been prescribed to help children to cope with ADD/ADHD type behaviors since the late 1930's. Out of the millions of children treated with stimulant medications, no known research studies have found that children taking these prescribed medications have had permanent damaging effects. Likewise, the same appears true for the positive side effects. There is no known research that shows the long-term positive side effects for using stimulants alone changes or alters the child's outcome in adulthood.
Will my child have a greater chance of using drugs later in life because I allow medication to be used now?
Drug abuse research does not support the notion that children who use prescribed medications have a greater chance of abusing drugs later on in life. In fact, most research done in this area has shown just the opposite; especially for males.
Helping your child with peer relationships:
Many ADD/ADHD children are impulsive. It is often hard for them to resist blurting out or interrupting others in their social group. This impulsivity turns other children off because they do not have the patience and understanding that is often required to remain a friend.
Parents can help their child by reviewing and implementing some of the strategies listed below:
o Encourage positive conversations with your child regarding social interactions. Some comments may include:
"It looked like Tom liked some of your baseball stuff. How did you feel about sharing it with him?"
" I was nice of you to invite Tammy and Jenny over". "How did it go?" "Well, I agree, maybe next time things will go better if one friend comes over." "Maybe you can allow the friend to come up with one thing to do and then you come up with an idea."
o All children should be held accountable for their behavior, including children who have ADD/ADHD. This includes social behavior. When you become aware that your child has mistreated another person, or acted inappropriately, use this experience as a teachable moment. Teaching your child to apologize, say, "excuse me" when interrupting, pay for something that he or she has broken or admitting to an inappropriate act is something all children must learn.
Wouldn't the world be a better place if all people and children:
1. Said "Hello!" and "Good-bye!"
2. Took turns talking and using items
3. Smiled more
4. Asked others to join in
5. Listened
6. Showed that they cared for someone else
7. Said, "I'm sorry."
8. Don't make fun of others, call names, act rude
9. Give a compliment
10. Relax
Now, ask your child if they have ever acted this way toward someone who they wanted to be their friend.
o Speak with your child's teachers, school counselor and other adults that work with your child. Let them know that you are trying to help your child to be more responsible for their social behavior. Most school districts have social skill curriculums that promote these life lessons. Stay in touch and communicate with other adults in the neighborhood and ask for honest feedback when it comes to finding out how your child is interacting with your neighbor's children. Remember, your child is in the learning stages of his or her life. If you decide not to help teach these important skills, who will?
o Ask your school counselor, school psychologist or school social worker if they have support groups set up to teach, promote and have their students practice social skills. If they do, encourage your child to "try out" the group.
I'm really worried that my ADD/ADHD child is not going to "make it" in life. What can I do?
Stop worrying! Did you know that close to 90% of all diagnosed ADD/ADHD children graduate from high school. Most ADD/ADHD children do not become criminals, do not smoke or abuse drugs at a rate higher than other teens, and do not hate or love their parents any more or less than other children. Your child has been diagnosed with ADD or ADHD not terminal cancer, not a criminal offense, not terrorism, not a death sentence! So, stop it. Begin to help your child. Work with your doctor and the schools by doing the following:
o Have your child evaluated by a doctor who specializes in ADD/ADHD
o Allow your child to work with behavioral specialist that promotes behavioral change associated with this disorder.
o Encourage your child to participate in extra-curricular and co-curricular school activities that may include sports, plays and drama, speech and debate, clubs (chess, ski, math etc.) and other activities that are normally listed on your school's WebPages.
o Seek information about the available medication options from your medical doctor.
o Seek information about the family therapy and training session options from your medical doctor.
o Develop a 504 Plan with the school if necessary.
o Provide your child extra academic assistance from the school or a tutor if necessary.
Scott Wardell is a school counselor and created http://www.ScottCounseling.com to provide parents with 100's of free parenting articles to assist parents with their parenting skills.
