GUIDE TO ATTENTION DEFICIT HYPERACTIVITY
DISORDER (IN THE ADHD CHILD)

A Definition, Symptoms & Causes

Most parents have heard of it. Most have read reports about it. Some have even turned it into a buzzword. Though not new, recent research and advanced understanding of the disorder has put it into the spotlight, as more children have been identified as having it. “It” is ADHD, Attention Deficit Hyperactivity Disorder, or, in lay terms, ADD or Attention Deficit Disorder. The popularity of the description, even in social circles, isn’t surprising to us, given the range of behaviors it represents, which could categorize any number of disorders. This is why the diagnosis of ADHD and children must be made by a trained professional.

Brian is a bright nine-year-old in third grade. When he came to see us, he was already the target of bullies. Even the “nice” kids called him Brian the Blurter. This nickname referred to a group of behaviors that annoyed, even enraged his peers, teachers and his parents. The original “buttinsky,” Brian poked into most everything, most anytime, whenever – and however – his frisky spirit moved him. “It’s as if he was born without a censor between his brain and his mouth – or his hands,” reported Brian’s mom.

“Alicia’s our wanderer,” said the 8-year-old’s dad. “If I send her to the yard to put her bike away, she’ll return with wildflowers which were near the bike – which she still hasn’t put away!” He reported the same with homework and chores. Drifting from one thing to another is Alicia’s style, as she often forgets what she starts out to do. Even directions might land her in unknown places, off the path she started down. Sometimes her parents have actually wondered if their daughter’s head is, indeed, attached to her body.

“Where’s his OFF switch?!” Leonardo’s grandmother asked us during one consult. Leonardo, a human perpetual motion machine, seems frequently in high gear in places where “high gear” is not acceptable, for example, church. If the second-grader isn’t moving, he’s often fidgeting. The list of his moves, some out of view, is endless – and exhausting for his family and his teachers who have found themselves – more than once – pulling Leonardo back in the window, thwarting his desire to run after a ball or play with a stray dog in the schoolyard.

“But aren’t many kids impulsive little daydreamers who are all on the go?” you may ask. The answer is a resounding, yes! All children will fidget, fail to listen, act wild, and engage in some staggeringly silly experiment – some of the time, at some point in their lives, to some degree, and in some places and circumstances. But children who

a) are inattentive, wild and/or impulsive consistently and in ways that are inappropriate to their age and the situation;

b) have shown these behavior early (before age seven);

c) show them in several places, for example, both at home and at school;

d) and who are having trouble with peers or schoolwork should be considered for a work-up for ADHD by trained professional(s), who will pinpoint whether this is the correct diagnosis in a sea of other possibilities, and if there are additional accompanying problems.

The following description can help parents and teachers, often front-line in noticing difficulties, to begin to become aware of the disorder. Parents and teachers, however, should not diagnose a child on their own, either way, based upon general guidelines or lists! The consequences of misdiagnoses can create long-term problems. Again, we stress the importance of trained specialists in the diagnostic and treatment process.

Under the ADHD Umbrella : A Definition Overview

ADHD is one of the most common behavior disorders we see in young people. It’s estimated to affect as many as 5% of school-aged children, with boys three times more likely to have the disorder than girls. That translates to approximately two million children, with at least one child per classroom suffering from the disorder. ADHD is actually a group, and sometimes a combination of behaviors that starts in early childhood and may extend into adulthood. Without adequate treatment, the symptoms can cause disruptions and problems in the home, the school, and the community.

Causes: ADHD Children are Born, not “Made.”

While many details are still unknown, we do know that ADHD children come into the world with this neurobiologically_based developmental disability. Simply put, the problem is one of brain chemistry, not bad parenting or teaching. Research at this stage suggests there is a genetic component to ADHD. Children with ADHD usually have at least one close relative with the disorder. Moreover, the majority of identical twins share the trait. Though, as with any trait, an ADHD parent can certainly have children without the disorder. Outside factors, however, can increase the risk of developing problematic behavior, such as substance abuse during pregnancy, and lead exposure. While “poor” parenting doesn’t cause ADHD, family and other stressful situations, such as death, divorce, abuse, neglect, family illness and addictions, can negatively affect – even compound – the condition. The good news is, the opposite is also true. Parents, teachers and therapists can do much to help the ADHD child manage his behavior and control symptoms, which we will address in the Treatment Part of our look at ADHD.

The Primary Types of ADHD

ADHD divides into three subtypes depending upon which behaviors tend to be most prominent:

1) Inattention

2) Impulsivity

3) Hyperactivity

In any one child, symptoms may occur independently (within one group) or combine with others. Symptoms may be mild to severe and also look different at different ages. Not every ADHD child will exhibit behaviors in all three subtypes, but they may. Let’s look at each independently.

BEHAVIORS

Inattention Overview:

The most common cluster of behaviors, “inattention,” as it suggests, means the individual may have difficulty paying attention, focusing, remembering, organizing, starting and ending tasks, whether dull or challenging. While the child is generally inattentive, he may still have the ability to “hyper-focus” or get 110% “into” a private interest, spending hours playing the same video game or building Lego monuments for days.

Impulsivity Overview:

Perhaps the riskiest of the behaviors, involves “acting before thinking.” Literally leaping before looking, compromises judgement, problem-solving, can wreak havoc with family and friends – and result in dangerous or unwise consequences. These behaviors, unchecked, often continue into adulthood.

Hyperactivity Overview:

Generally more obvious in children than adults, the hyperactive child is the “mover and shaker.” Literally. But he does so inappropriately for his age or the circumstance. Hyperactive behavior includes fidgeting (squirming, hands in motion, scratching), running and non-stop talking. Contrary to popular belief, hyperactivity is not always continuous, even if this is the primary symptom, or is it present in all ADHD children. In fact, if an individual tends to be more “inattentive,” he may appear less active than normal.

What Do ADHD “Types” Look Like?

Overall, youngsters with ADHD may experience a 2 to 4_year developmental delay that may make them appear less mature and responsible than their peers. The following are examples of some specific ways in which ADHD behavior may appear by type. These are guidelines, only. Not every ADHD child will display all of the behaviors below. Each child’s behavior is individual, and must be carefully evaluated, along with other factors, by the appropriate professionals.

What Can Inattention Look Like?

– “Hello?! I’m Talking!” Even eyeball-to-eyeball, she’s not listening or hearing you.
– “Hello, where are you?” You’ve instructed, he says he understands and may have even agreed to clean up the yard or do the math project, but he never quite gets it done, or if he does, there are careless mistakes.
– “Look at the birdie.” If he says it in the park, fine. It’s not fine if he’s often distracted by sights and sounds in the middle of a piano lesson or a Scout meeting.
– The Absentminded Professor. She flies out, a poster child for disorganization. School books, homework, backpack, toys, are forgotten or lost. One child we know lost an entire saxophone – the top half – on the bus. Even routines, such as meal time, room cleaning, teeth brushing, may be forgotten.
– “Later - After.” He may be a master of the excuse to delay or avoid jobs that require concentration and focus, such as classwork or homework. And if you can get him to settle down, a simple task may seem to take forever.
– The Easy Way. Whether she takes up residence in “Toonville” or gets zonked on computer games, she’s stuck and has difficulty moving to mentally more taxing activities.

What Can Impulsivity Look Like?

– “Move it, Mister!” Whether or not he’s got places to see and people to meet, he’s seriously impatient. Waiting rooms and check-out lines feel like prison.
– The Interrupter-Intruder. More than simply excited, she’s the blurter, stepping on others’ remarks, demanding to be called on in class, offering answers in the midst of questions, butting into games and conversations, and grabbing what she wants when she wants it.

– Risky Moves. His ideas aren’t merely half-baked, they’re often unbaked – without fear or thinking through the “what if” consequences before acting. While all children will test the rules and engage in some risky behavior, the ADHD child is more apt to go with bad ideas, for example, climbing a steep hill or tree, without first considering the result. Actually the ADHD child is not necessarily a risk-taker. He gets into hot water by acting on impulse, and is often frightened, helpless, even shocked when faced with the consequences. These behaviors may become increasingly dangerous, if left unchecked, as children move into adolescence and adulthood.

– Tantrums. She may burst into a fit of rage, without clear or compelling reasons – at least to anyone else – as her frustration tolerance is low.

What Can Hyperactivity Look Like?

– Go-go-go. She may seem “motorized” and even leave her seat altogether, climb and run at inappropriate times – for example, during an English test.

– The Fidgeters, Squirmers and Touchers. Even seated he may be on the go. Indeed, some of the children we see have developed a particular movement that is less obvious, for example, finger-snapping, foot wiggle, playing with something in their desk or pockets. Others are touchers, tapping everything in reach.

– On the fly. Eating, homework, chores are often done on the fly, at once, scattered, standing, with no particular efficient organization.

– Motormouth. He talks non-stop, in, around, and over others, long after they’ve fled the room. Feedback is less important than his need to talk talk talk.

– Brown sock, black sock. He flies out untucked, uncombed and unmatched. Unless an adult supervises, he may resemble Pigpen or Bart Simpson. Ditto for his room. backpack, school desk. It’s truly possible the dog did “eat” or at least, lick, his homework, which is often smudged, wrinkled, torn or mutilated.

– What ... Quiet Time? She may have difficulty settling down to do a quiet activity or calming down once she’s revved up. Nap time may be a struggle, and she may have serious difficulty relaxing – a skill she’ll need to learn to keep her from spiraling into overload.

NOTE: Professionals link hyperactivity and impulsivity, as both involve difficulty controlling behavior.

An ADHD Child Can Exhibit One, Two, or All of the Above

Each child presents a unique human picture, and this is also true in the way each manifests ADHD. One ADHD child for example, may be primarily inattentive yet have no trouble sitting in his seat. This child’s problems will occur around issues like homework or chores. Another, may be perfectly able to focus – until she’s sabotaged by an impulsive idea or the need to get up and run. Still another, will have difficulty with all of the above in some combination of problems and degree. Once again, we stress the specific diagnosis must be made by competent professionals who are seasoned in evaluating and differentiating symptoms.

Professional diagnoses, early detection and intervention can make all the difference. As we’ve seen, ADHD presents a range of difficult challenges to these children, their families, the school and the community under the very best conditions. Without proper management, an overlay of other disturbing issues may occur, and follow throughout life. The child who is inattentive or out-of-control are likely to have problems with anger, frustration, rules, social situations, academics, low motivation and self-esteem.

Fortunately, there are now a variety of effective treatment options that can offer these children and their families new hope. Children successfully managed and treated can look forward to full and often fascinating lives!

Click on the following links to read about how Camp MakeBelieve gives you tools and techniques to help the ADD and ADHD child.

Go to the Parenting Program