
commonly diagnosed childhood disorder and four times more common in boys than in girls. We have all seen the classic ADHD child. His parents are exhausted, his teachers frustrated, and his room is usually a disorganized mess. Worldwide, 3-5% of all children are diagnosed with ADHD. The ADHD child has problems paying attention, is impulsive—a risk taker—and hyperactive. The ADHD child will sometimes be described as “being driven by a motor”.
years and occur in two different settings for at least six months. There are evaluative instruments to help doctors, parents and teachers identify ADHD. Over 35 different ones were found as of the date of this writing. Conner’s Rating Scale-Revised is one of the most commonly used. ADHD is usually divided into three diagnostic categories: predominately hyperactive-impulsive; predominately inattentive; and combined hyperactive- impulsive and inattentive. The predominately hyperactive-impulsive category will include either six symptoms of hyperactivity or impulsivity (symptoms are listed below) and one to five symptoms of inattention. The category of predominately inattentive ADHD will include at least six symptoms in the inattention category and fewer than six in the hyperactivity-impulsivity category. These children are less likely to act out and may get along well with other children. However, even though they are sitting quietly, they are not able to pay attention. Diagnoses in the combined hyperactive-impulsive and inattentive category will include six or more symptoms of hyperactive-impulsivity and six or more symptoms of inattention. Most children fall into this category.
and slow to react. These children require a longer processing time for information so teachers may need to expand testing times and allow them more time to respond to questions. They are easily distracted, forget things, and miss details. They seem disorganized, miss homework assignments, and often lose things.
problems with directions, and seem to not listen when spoken to. Symptoms of hyperactivity and impulsivity in children are nonstop talking and can never wait their turn. These children squirm and fidget during school or dinner. They seem to be in constant motion, going from one activity to another and cannot seem to sit quietly. Signs of impulsivity include impatience, blurting out comments that may have no relevance, and emotional outbursts. Causes of ADHD are thought to be genetically linked, since the behaviors tend to run in families with a 75% concordance rate in twin studies. However, environmental factors may also contribute. Lead is thought to cause ADHD as well as smoking and drinking during pregnancy. Certain food additives like dyes and preservatives are suspected to make hyperactivity worse. Brain injuries are also linked to some cases of ADHD. Most research does not support the notion that refined sugar is a cause. Infections like measles, varicella, streptococcus and other bacteria in utero, at birth and early childhood are suspected to increase the risk of a child developing ADHD. Studies in 2007 and 2010 linked certain insecticides to ADHD. Two-thirds of children with ADHD are likely to be diagnosed with other conditions. Thirty-five per cent will also be diagnosed with oppositional defiant disorder and 26% will be diagnosed with conduct disorder. Symptoms of these disorders include aggression, lying, stealing, temper tantrums and stubbornness. About half of all ADHD children with oppositional defiant disorder and conduct disorder will also be diagnosed with an antisocial personality disorder in adulthood. A study was done on 120 female psychiatric patients, in which, 70% were diagnosed with both ADHD and a borderline personality disorder. Twenty-five percent of children with ADHD will also exhibit symptoms of bi-polar disorder. Other co-morbid disorders with ADHD include: obsessive-compulsive disorder, anxiety disorder, mood disorders and vigilance—which is characterized by difficulties staying awake followed by fidgeting, yawning and stretching in order to stay awake. Management of ADHD usually involves behavior modification, counseling, medication, and lifestyle modification. Behavior modification for ADHD children include: classroom management and modification; parent training; or even special education placement. Classroom management may involve a reward system for appropriate behavior, optimal seating for the ADHD student, test taking strategies and study cubicles to reduce distractions, as well as white noise or music to increase concentration. Parent training that emphasizes consistent positive reinforcement and firm guidelines for behavior as well as the modeling of appropriate behavior by the parents. Special education placement may include tutoring for specific academic areas (pull-out), or even special teacher’s aides to accompany the ADHD student during particular study times or problem classes for the ADHD student. Counseling for children of ADHD may include identifying settings or environments that increase symptoms, as well as exploring food triggers, or sleep problems that may need to be modified. There is also the problem of treating anxiety and depression with talk therapy and adjunct therapies like relaxation therapy, biofeedback, and even yoga. Lifestyle modification may also be explored separately to examine dietary concerns including food additives like dyes and preservatives, environmental concerns like temperature triggers, noise distractions, the impacts of radio, television, computers and even fluorescent lighting on the ADHD child. Prescription medication is the most controversial ADHD treatment. Psychostimulants have been used for years to treat ADHD. Psychostimulants are not used for children under the age of three years and many of them are only FDA approved only for children over the age of six years. The list of stimulants includes: Adderall, Concerta, Desoxyn, Dexedrine, Focalin, Metadate, Methylin, Ritalin and Vyvanse. Many children are unable to tolerate these medications and dosing can be difficult since many of these medications are not FDA approved for children. Close monitoring of ADHD medications is imperative. Dosage and scheduling of dosing can resolve many of the side effects of ADHD medication. Side effects of stimulants include weight loss from decreased appetite, headaches, nervousness, stomach problems, problems sleeping, and social withdrawal. Since 2003, two non-stimulant medications have been approved for the treatment of ADHD in children ages 6-17 years. Strattera and Intuniv are both thought to improve concentration and impulse control. Other medications for ADHD include anti-depressants like Pamelor, Effexor, and Wellbutrin; as well as the alpha-2-adrenoreceptor agonists (originally prescribed for blood pressure problems) Catapres and Tenex. Many cases of ADHD are symptomatically treated, since there is no one-size-fits-all therapy available. Parents may be the best judges of what symptoms need to be treated by medication and which ones may be treated behaviorally. ADHD children with sleep disorders may respond to sport therapy where the child is simply encouraged to be tired at the end of the day by involvement in activities. Using all available resources until the ADHD child is fully functioning may help parents with an ADHD child. School counselors, pediatricians, child psychologist and psychiatrists, coaches, and special education teachers may all hold a piece of the puzzle for guiding the ADHD child. One of the most important things to remember is that the hyperactive child may continue to be active as they get older. Many high- functioning elderly people were considered “over active” in their youth. So, what drives parents and teacher crazy in children, is actually a blessing as they age.
researcher Sheli Ellsworth
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