Another log on the PED fire!
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Introduction
Attention-deficit/hyperactivity disorder (ADHD) is a chronic disorder that affects millions of American children, and it can persist into adulthood.
Problems generally associated with ADHD include inattention, hyperactivity and impulsive behavior. They can affect nearly every aspect of life. Children and adults with ADHD often struggle with low self-esteem, troubled personal relationships and poor performance in school or at work.
The best treatment for ADHD is a matter of debate. Currently, psychostimulant drugs are the most commonly prescribed medications for treating ADHD. But although these drugs can relieve many symptoms, they don't cure ADHD, and they can sometimes cause troubling side effects. Counseling, special accommodations in the classroom, and family and community support are other key parts of treatment.
Signs and symptoms
At various times, ADHD has been called attention-deficit disorder (ADD), hyperactivity, and even minimal brain dysfunction. But ADHD is the preferred term because it more accurately describes all aspects of the condition. Most doctors believe that a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD appear early in life and create significant problems at home and at school on an ongoing basis.
ADHD symptoms fall into two broad categories:
Inattention
Hyperactivity-impulsive behavior
In general, children are said to have ADHD if they show six or more signs or symptoms from each category for at least six months. These symptoms must significantly affect a child's ability to function in at least two areas of life — typically at home and at school. This helps ensure that the problem isn't with only a particular teacher or with only parents. Children who have problems in school but get along well at home or with friends are not considered to have ADHD. The same is true of children who are hyperactive or inattentive only at home but whose schoolwork and friendships aren't affected by their behavior.
In most children diagnosed with ADHD, signs and symptoms appear before the age of 7, although they sometimes may occur even earlier.
Inattention
Signs and symptoms of inattention may include:
Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
Often has trouble sustaining attention during tasks or play
Seems not to listen even when spoken to directly
Has difficulty following through on instructions and often fails to finish schoolwork, chores or other tasks
Often has problems organizing tasks or activities
Avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
Frequently loses needed items, such as books, pencils, toys or tools
Can be easily distracted
Forgetful often
Hyperactivity-impulsiveness
Signs and symptoms of hyperactivity-impulsive behavior may include:
Fidgets or squirms frequently
Often leaves his or her seat in the classroom or in other situations when remaining seated is expected
Often runs or climbs excessively when it's not appropriate or, if an adolescent, might constantly feel restless
Frequently has difficulty playing quietly
Always seems on the go
Talks excessively
Blurts out the answers before questions have been completely asked
Frequently has difficulty waiting for his or her turn
Often interrupts or intrudes on others' conversations or games
Most healthy children exhibit many of these behaviors at one time or another. For instance, parents may worry that a 3-year-old who can't listen to a story from beginning to end or finish a drawing may have ADHD. But preschoolers normally have a short attention span and aren't able to stick with one activity for long. This doesn't mean they're inattentive — it simply means they're normal preschoolers.
Even in older children and adolescents, attention span often depends on the level of interest in a particular activity. Most teenagers can listen to music or talk to their friends for hours but may be a lot less focused about homework.
The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're tired. And they may become even more active when they're tired, hungry, anxious or in a new environment. In addition, some children just naturally have a higher activity level than others. Every child is unique. Children should never be classified as having ADHD just because they're different from their friends or siblings.
Most children with ADHD don't have all the signs and symptoms of the disorder, and they may be different in boys and girls. Boys are more likely to be hyperactive, and girls tend to be inattentive. In addition, girls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle aimlessly. Boys also tend to be less compliant with teachers and other adults, so their behavior is often more conspicuous.
Symptoms of ADHD in adults
ADHD always begins in childhood, but it may persist into adult life. The core signs and symptoms of distractibility, hyperactivity and impulsive behavior are the same for adults as for children, but they often manifest themselves differently and far more subtly in adults. Hyperactivity, in particular, is generally less overt in adults. Children may race around madly; adults are more likely to be restless and to have trouble relaxing.
On the other hand, problems with organization and concentration often increase as people get older when their lives become more complicated and demanding. Adults diagnosed with ADHD often say that their biggest frustration is their inability to focus and to prioritize, leading not only to missed deadlines but also to forgotten meetings and social engagements.
As difficult as this is, the impulsive behavior of some adults with ADHD can be even more problematic. The inability to control impulses, which some experts say may be the defining characteristic of ADHD, can range from impatience waiting in line or driving in heavy traffic to mood swings, intense outbursts of anger, blurting out rude remarks and having troubled relationships.
One set of guidelines used to diagnose adult ADHD, called the Utah criteria, lists the following as characteristic of adults with the disorder:
A childhood history of ADHD
Hyperactivity and poor concentration
Inability to complete tasks
Mood swings
Hot temper
Inability to deal with stress
Impulsivity
Causes
Parents often blame themselves when a child has been diagnosed with ADHD, but scientists increasingly believe that structural changes in the brain, not parenting, may be a leading cause of the disorder. At the same time, certain environmental factors may contribute to or worsen a child's behavior. Although much still isn't understood about ADHD, researchers have identified several factors that may play a role:
Altered brain function and anatomy. While the exact cause of ADHD remains a mystery, researchers have discovered important differences in the brains of people with ADHD. For example, neurotransmitters — the brain's chemical messengers — aren't used properly in people with ADHD. Additionally, there appears to be less activity in the areas of the brain that control activity and attention in people with ADHD. In addition, brain scans have revealed that, on average, children with ADHD have up to 4 percent smaller brain volumes than do children without ADHD.
Heredity. ADHD tends to run in families. About one in four children with ADHD have at least one relative with the disorder.
Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke are at increased risk of having children with ADHD. And alcohol or drug abuse during pregnancy may reduce activity of the nerve cells (neurons) that produce neurotransmitters. Pregnant women who are exposed to environmental poisons, such as polychlorinated biphenyls (PCBs), also may be more likely to have children with symptoms of ADHD. PCBs are industrial chemicals that were widely used in the past.
Childhood exposure to environmental toxins. Preschool children exposed to certain environmental toxins, particularly lead and PCBs, are at increased risk of developmental and behavioral problems, many of which are similar to those found in children diagnosed with ADHD. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span. Exposure to PCBs in infancy may also increase a child's risk of developing ADHD.
When to seek medical advice
In general, if your child has trouble concentrating, sitting still or controlling his or her behavior, and these problems are creating significant difficulties at home and at school, see your pediatrician or family physician. Your doctor may later refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist or pediatric neurologist, but it's important to have a medical evaluation first to rule out other causes of your child's signs and symptoms.
Although manifestations of ADHD can sometimes appear in preschoolers, diagnosing the disorder in very young children is extremely difficult. That's because developmental problems such as language delays and adjustment difficulties can be mistaken for ADHD. For that reason, preschoolers suspected of having ADHD are more likely to need evaluation by a pediatrician, psychologist or psychiatrist, speech pathologist, or developmental pediatrician.
Children being treated with medication should see their doctors regularly — at least once during the month following diagnosis, and then at least every six months after that. Be sure to discuss how often your child should be seen for subsequent appointments with your child's doctor. You may also want to have your child retested every few years, depending on your child's grade level, age and diagnosis.
Call your physician if your child who is taking medication for ADHD experiences side effects, such as loss of appetite, trouble sleeping or increased irritability. Over time some children taking stimulant medications may also lose weight or grow more slowly, though these changes are usually temporary. This is another reason why follow-up visits are important.
Screening and diagnosis
No single test for ADHD exists, making the disorder difficult to diagnose. But a variety of exams are used to differentiate ADHD from learning disabilities and mood disorders. For this reason, make sure that the physician performing the evaluation has training in ADHD or in the diagnosis of developmental and behavioral disorders. You may want to start by talking to your child's pediatrician or your family doctor. Some pediatricians evaluate children themselves, but others may refer you to a mental health professional they know and trust.
The following chart from the National Institute of Mental Health lists the types of doctors who are qualified to diagnose and supervise treatment for ADHD, although not all may have specific training in the disorder.
Specialty Can diagnose ADHD? Can prescribe medications, if needed? Provides counseling or training?
Psychiatrists Yes Yes Yes
Psychologists Yes No Yes
Pediatricians or family physicians Yes Yes Usually no
Neurologists Yes Yes No
Diagnosing ADHD in children
Assessing a child for ADHD usually begins with complete medical, school and family histories and a medical exam to exclude other causes of your child's behavior. A number of medical conditions may cause signs and symptoms similar to those of ADHD, including learning disabilities, mood disturbances, hyperthyroidism, seizure disorders, fetal alcohol syndrome, vision or hearing problems, and Tourette syndrome — a neurological disorder characterized by compulsive body movements and vocalizations.
An evaluation for ADHD should also include checking for learning or language problems, depression, anxiety and sleep disorders. These and other coexisting conditions are found in as many as one in three children with ADHD.
Because ADHD symptoms may not be obvious in a medical office, your doctor is likely to use questionnaires and interviews to learn more about your child's behavior. You, your child's teachers and other people who know your child well, such as baby sitters and coaches, may be interviewed, and your doctor may also use ADHD-specific rating scales, such as the Vanderbilt questionnaire, the Connors' Rating Scales or the Achenbach Child Behavior Checklist (CBCL), to help collect and evaluate information about your child.
It's important to determine not just how your child behaves but whether the behavior is long-standing or temporary and when it occurs. Children diagnosed with ADHD exhibit these behaviors over a long period of time and have particular trouble in stressful, demanding situations or in activities that require sustained attention, such as reading, doing math problems or playing board games.
Gathering as much information as possible about your child is the best way to ensure an accurate diagnosis. Brain scans aren't a reliable way to diagnose the disorder, nor is a child's response to a psychostimulant medication.
Diagnosing ADHD in adults
It can be even more challenging to identify ADHD in adults than in children. The signs and symptoms in adults are often especially subtle and subjective, and no single test can confirm the diagnosis, including self-report tools such as the Copeland Symptoms Checklist for Adult ADHD or the Brown Adult Attention Deficit Disorder Scales.
What's more, adults may have a hard time remembering whether their problems date back to childhood. And yet a persistent pattern of signs and symptoms, beginning no later than age 7, is essential for a diagnosis of adult ADHD. For that reason, your doctor is likely to ask for your old school records and to gather information from teachers, parents and anyone else who knew you when you were young. If your difficulties are recent or occurred only occasionally in the past, you're not considered to have adult ADHD. In addition, your doctor will carefully assess the impact of your core symptoms on your current life — your performance at work or in school and your relationships with friends and family.
As with children, your evaluation should include a thorough physical exam to rule out other reasons for your symptoms. This means ruling out not only medical conditions that can mimic ADHD, such as hyperthyroidism and hearing loss, but also psychological problems such as bipolar disorder, which are much more common in adults than ADHD is. Substance abuse, for instance, can cause mood swings and affect memory and concentration. Severe depression can also affect attention and memory and can make it difficult to concentrate or complete tasks.
To help arrive at a diagnosis, some specialists use tests that objectively measure your cognitive ability, your short-term memory, your concentration and your problem-solving skills. Even so, many factors can affect your performance on these tests, and by themselves, they're not necessarily good indicators of the presence of adult ADHD. Combined with extensive medical and behavioral histories and school and job records, however, they can help provide a fuller and more accurate picture of how you function in the world.
Sleep disorders and ADHD
Diagnosing ADHD is further complicated because some children who are hyperactive or inattentive actually have sleep problems, not ADHD. Researchers have discovered that snoring and sleep apnea may lead to hyperactivity and inattention. Sleep apnea is a potentially serious condition in which you repeatedly stop and start breathing during sleep. If you have a child who is hyperactive and snores or who has trouble sleeping, a pediatric sleep specialist, an ear, nose and throat (ENT) doctor or both may be able to help.
Complications
ADHD can make life difficult for both children and adults. Children often struggle in the classroom, which can lead to academic failure and ridicule from both other children and adults.
Children with ADHD are also more likely to be injured than are other children. And teenagers and adults with the disorder are far more likely to be involved in car accidents. In fact, people with ADHD tend to have more accidents and injuries of all kinds than do people who don't have the disorder.
ADHD may be associated with an increased risk of alcohol and drug abuse and delinquency. And those with ADHD are more likely to have relationship problems.
In addition, although ADHD doesn't cause other psychological or developmental conditions, as many as one in three children with ADHD are affected by other disorders, including:
Oppositional defiant disorder (ODD). Generally defined as a pattern of negative, defiant and hostile behavior toward authority figures, ODD occurs in as many as half of all children with ADHD. This condition is more common in boys.
Conduct disorder. A more serious condition than ODD, conduct disorder is marked by distinctly antisocial behavior: stealing, fighting, destroying property, harming people and animals. Children with conduct disorder need immediate help.
Depression. Depression may occur in both children and adults with ADHD.
Anxiety disorders. Anxiety disorders tend to occur fairly often in children with ADHD and may cause overwhelming worry and nervousness as well as physical signs and symptoms, such as a rapid heartbeat, sweating and dizziness. Although anxiety disorders can cause severe signs and symptoms, most people can be helped with therapy or medication. Once anxiety is under control, children are better able to deal with the problems arising from ADHD.
Learning disabilities. Children with both ADHD and learning disabilities are the children most in need of special education services.
Tourette syndrome. Many children with ADHD also have Tourette syndrome, a neurological disorder characterized by compulsive muscular or vocal tics.
Treatment
Optimal treatment for ADHD is still a matter of debate. Current treatments typically involve therapy, medication or both. However, recent research indicates that a combination of therapy and medication may be the most helpful treatment.
Therapy
Children and adults with ADHD often greatly benefit from counseling or behavior therapy, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some people with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.
Counseling therapies may include:
Psychotherapy. This allows older children and adults with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms.
Behavior therapy. This type of therapy helps teachers and parents learn strategies (contingency management procedures) for dealing with children's behavior. These strategies may include token reward systems and timeouts. Behavior modification using contingency management techniques has proved especially beneficial for people with ADHD.
Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
Social skills training. This can help children learn appropriate social behaviors.
Support groups. Support groups can offer adults and children with ADHD and their parents a network of social support, information and education.
Parenting skills training. This can help parents develop ways to understand and guide their child's behavior.
The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. You can help by making every effort to work with your child's teachers and by referring them to reliable sources of information to support their efforts in the classroom.
Medications
Drugs known as psychostimulants are the most commonly prescribed medications for treating ADHD in children and adults. Commonly used psychostimulants include:
Methylphenidate (Ritalin, Concerta)
Dextroamphetamine/amphetamine (Adderall)
Dextroamphetamine (Dexedrine)
Another medication that works in a similar manner, but is not a stimulant, is atomoxetine (Strattera). Sometimes antidepressants also may be used — especially for adults and for children who don't respond to stimulants or who are depressed or have other problems.
These medications are available in short-acting and long-acting forms. The short-acting forms last about four hours, while the long-acting preparations last between six and 12 hours. With the exception of methylphenidate, these medications come only in an **** form. Methylphenidate was recently introduced in a long-acting — about nine hours — patch that can be worn on the hip. This form was approved for use in children between the ages of 6 and 12 under the brand name Daytrana.
Although scientists don't understand exactly why these drugs work, stimulants appear to boost and balance levels of the brain chemicals called neurotransmitters.
These ADHD medications help alleviate the core signs and symptoms of inattention and hyperactivity — sometimes dramatically. However, effects of the drugs wear off quickly. Additionally, the right dose varies between individuals, so it may take some time in the beginning to find the dose that's right for you or your child.
There's been some concern about using medications to treat preschoolers who have ADHD. One large-scale study found that low doses of the commonly used medications are safe and effective in young children. However, the study did find that the younger children were more susceptible to medication side effects.
Medication side effects
The most common side effects of psychostimulants in children include decreased appetite, corresponding weight loss, nervousness and problems sleeping. Some children experience irritability or increased activity as the effect of the medication tapers off. Adjustments in doses can often offset these side effects.
A small percentage of children may develop jerky muscle movements, such as grimaces or twitches (tics), but these usually disappear when the dose of medication is lowered. Stimulant medications may also be associated with a slightly reduced growth rate in children, although in most cases growth isn't permanently affected.
The nonstimulant medication Strattera has been linked to side effects that include rare liver problems. If your child is taking Strattera and develops yellow skin (jaundice), dark-colored urine or unexplained flu symptoms, contact your doctor right away. In September 2005, the Food and Drug Administration (FDA) issued a public health warning to doctors about the risk of suicidal thinking in children and adolescents being treated with Strattera. The FDA urged doctors to closely observe children being treated with Strattera for signs of suicidal thinking.
Adderall has raised concerns because of reports of sudden unexplained deaths in children taking the medication. Health officials in Canada suspended sales of Adderall XR in February 2005, but allowed the drug back on the market in August 2005 after recommending that the drug not be used in children with heart abnormalities. In the United States, the FDA also is recommending that the medication not be used in anyone with known cardiac abnormalities.
Dextroamphetamine has also raised concerns because sudden deaths in youngsters with heart abnormalities have occurred. The drug may also cause troubling psychological side effects, such as delusional thoughts or hallucinations.
Parents also are understandably concerned about psychostimulants — which are similar to amphetamines — and the risk of addiction. But dependence hasn't been reported in children who take medications orally and at the proper dosage. That's because drug levels in the brain rise too slowly to produce a "high." On the other hand, there's concern that siblings and classmates of children and teenagers with ADHD might abuse ADHD medications.
In general, psychostimulant side effects in adults are similar to those in children. But ADHD drugs are also more likely to cause certain problems specifically in adults, including mild increases in blood pressure that may be significant for people who already have hypertension, and the liver disease hepatitis. In addition, because adults usually require higher dosages of these medications than children do, the risk of abuse or addiction may be greater. Antidepressants, either alone or in combination with a psychostimulant, can help reduce mood instability and disturbances. Side effects may include dry mouth, urinary retention, weight gain, drowsiness and sexual dysfunction.
Experimental treatments
Behavior therapies and medications are the most thoroughly researched treatments for ADHD. Other approaches are being studied but are still considered to be unproved and experimental.
Biofeedback. Ordinarily, this stress-reduction technique is used to help people learn to control certain body responses, such as heart rate and muscle tension. It has also been used with the intent of teaching adults and children with ADHD to change their brain wave patterns to more normal ones.
Brain wave biofeedback. The goal of brain wave biofeedback (Neurobiofeedback) is to teach people to control their own brain wave patterns using electroencephalography (EEG) feedback, sometimes combined with a video game. EEG measures the waves of electrical activity of the brain.
Special diets and supplements. Over the years, a great deal of media attention has focused on diets for ADHD. Most diets involve eliminating additives and foods thought to increase hyperactivity, such as sugar and caffeine, and common allergens such as wheat, milk and eggs. So far, however, studies haven't found a consistent link between diet and improved symptoms of ADHD. If you think certain foods affect your child's behavior, however, try eliminating them for a time. Additionally, there's no evidence that dietary supplements, such as fatty acids, ginkgo or megadoses of vitamins, can reduce ADHD symptoms.
Self-care
Because ADHD is a complex disorder and each person with ADHD is unique, it's hard to make recommendations that are right for every child or adult. But some of the following suggestions may help:
Children at home
Show your child lots of affection. Children need to hear that they're loved and appreciated. Focusing only on the negative aspects of your child's behavior can harm your relationship with him or her and affect self-confidence and self-esteem. If your child has a hard time accepting verbal signs of affection, a smile, a pat on the shoulder or a hug can show you care.
Be patient. Try to remain patient and calm when dealing with your child, even when your child is out of control. If you're calm, your child is more likely to calm down too.
Keep things in perspective. Be realistic in your expectations for improvement — both your own and your child's.
Take time to enjoy your child. Make an effort to accept and appreciate the parts of your child's personality that aren't so difficult. One of the best ways to do this is simply to spend time together. This should be a private time when no other children or adults interfere. Try to give your child more positive than negative attention every day.
Try to keep a regular schedule for meals, naps and bedtime. Use a big calendar to mark special activities that will be coming up. Children with ADHD have a hard time accepting and adjusting to change.
Make sure your child is rested. Try to keep your child from becoming overtired, because fatigue often makes symptoms of ADHD worse.
Identify difficult situations. Try to avoid situations that are difficult for your child, such as sitting through long presentations or shopping in malls and supermarkets where the array of merchandise can be overwhelming.
Use timeouts or the loss of a privilege to discipline your child. For children with ADHD, a timeout from social stimulation can be very effective. Timeouts should be relatively brief, but long enough for your child to regain control. The idea is to interrupt and defuse out-of-control behavior. A timeout doesn't work for everything, but many parents have found that it's one of the best tools for managing the behavior of an overactive or impulsive child.
Work on organization. Help your child organize and maintain a daily assignment notebook and be sure your child has a quiet place to study.
Find ways to enhance your child's self-esteem and sense of discipline. Children with ADHD often do very well with art projects, music or dance lessons, or martial arts classes, especially karate or tae kwon do. But don't force children into activities that are beyond their abilities.
Use simple words and demonstrate when giving your child directions. Speak slowly and quietly and be very specific and concrete. Give one direction at a time. Stop and make eye contact with the child when giving directions.
Take a break yourself. If you're exhausted and stressed, you're a much less effective parent.
Children in school
Ask about school programs. Take advantage of any special programs your school may have for children with ADHD.
Talk to your child's teachers. Stay in close communication with your child's teachers, and support their efforts to help your child in the classroom. Be sure teachers closely monitor your child's work, provide positive feedback, and are flexible and patient. They should also be very clear about their instructions and expectations.
Ask about having your child use a computer in the classroom. Children with ADHD often have trouble with handwriting and can greatly benefit from using a computer or a typewriter.
Medications
Administer medications carefully to children and teenagers. They shouldn't be in charge of their own medicine.
At home, keep medication locked in a childproof container. Psychostimulant drugs are nervous system stimulants. An overdose can cause severe confusion, agitation and an accelerated heart rate and is potentially fatal. Young children are especially sensitive to drug overdoses.
Don't send supplies of medication to school with your child. Deliver any medicine yourself to the school nurse or health office.
Talk to your child about his or her medications. Make sure your children understand that it's not OK to give or sell medication to others. Ask them to tell you right away if classmates pressure or threaten them for medication.
Adults in the workplace
Choose work that uses your strengths. If you're creative, high energy and intelligent, avoid jobs that are dull or detail oriented.
Ask your boss to repeat instructions rather than guess at what is meant.
Try to work at home, at least part time.
Ask for a private office. If that's not possible, work in a quiet area and use headphones to muffle noise. Arriving before most of your co-workers also can help reduce distractions.
Work on more than one project at a time. When you get bored with one, switch to the other.
Work on boring tasks when you feel most alert.
Break up big jobs into smaller tasks.
Use deadlines for structure.
Make lists of things to do and use them to prioritize your day.
Use a day planner and to-do lists. Post notes for yourself.
Ask your secretary or office assistant to help with details.
Adult relationships
The behavior of many adults diagnosed with ADHD can be unpredictable and sometimes difficult. Forgotten appointments, missed deadlines, impulsive or irrational decisions, and angry outbursts can strain the patience of the most forgiving co-worker, friend or partner.
Therapy that focuses on these issues and helps adults better monitor their own behavior can be extremely helpful. So can classes to improve communication skills, conflict resolution and problem solving. Couples therapy and classes in which family members learn more about ADHD can sometimes significantly improve relationships.
Coping skills
Caring for a child with ADHD can be challenging for the whole family. Parents may be hurt by their child's behavior as well as by the way other people respond to it. And the stress of dealing with ADHD can sometimes lead to marital stress and even divorce. These problems may be compounded by the financial burden that ADHD can place on families.
Siblings of a child with ADHD also may have special difficulties. They can be affected by a brother or sister who is demanding or aggressive, and they may also receive less attention because the child with ADHD requires so much of a parent's time.
Resources
There are no easy answers for struggling families, but many resources are available that may help. Parents can get advice on raising a child with ADHD from a social worker or other mental health care professional or from a support group. Support groups don't appeal to everyone, but they often can provide excellent information about coping with ADHD from people who know.
There also are excellent books and guides for both parents and teachers, and Internet sites dealing exclusively with ADHD.
Techniques for coping
Many parents notice patterns in their children's behavior as well as in their own responses to that behavior. For instance, your child might throw a tantrum every night before dinner, and you might routinely give him or her a snack so that you can finish preparing the meal in peace. Although you don't mean to, you end up encouraging your child's behavior. Both you and your child need to act differently. But substituting new habits for old ones isn't easy — it takes real awareness and a lot of hard work.
You can help make change easier by ensuring that your child has the right kind of structure. For children with ADHD, structure doesn't mean rigidity or iron discipline. Instead, it means arranging things so that a child's life is as predictable, calm and organized as possible. Children with ADHD don't handle change well, and having predictable routines can make them feel safe as well as help improve behavior. Give the child a few minutes warning — with a count down — when it's necessary to change from one activity or location to another.
It's also important to have realistic expectations and not ask more of your child than is physically or mentally possible. Set small goals for both yourself and your child and don't try to make a lot of changes all at once.
How to provide positive reinforcement
One of the best ways to instill new habits is to provide firm, loving discipline that rewards good behavior and discourages destructive actions. Children with ADHD usually respond well to positive reinforcement, as long as it's genuinely earned. It's best to start by rewarding or reinforcing a new behavior every time it occurs. After a short time, this probably won't be necessary, but you need to continue to let your child know that you're serious about encouraging new habits.
Rewards can lose their effectiveness when they're overused. Instead of always offering food treats, for instance, try using a special privilege, such as staying up an extra half-hour or playing a favorite game, as a prize. Don't promise a reward and then not follow through. This defeats the purpose of rewarding good behavior and can be extremely frustrating for your child. Special activities make better rewards than tangible objects do.
Some parents object to rewards because they seem like bribery. But changing old habits is extremely hard, and rewards are simply a concrete way of recognizing your child's efforts.
Stay calm and set a good example
You also need to set a good example by acting the way you want your child to act. Try to remain patient and in control — even when your child is out of control. If you speak quietly and calmly, your child is more likely to calm down, too.
Finally, the relationship among all the family members plays a large part in managing or changing the behavior of a child with ADHD. Couples who have a strong bond often find it easier to face the challenges of parenting than do those whose bond isn't as strong. That's one reason it's important for partners to take time to nurture their own relationship.
If you're the parent of a child with ADHD, be sure to give yourself a break now and then. Don't feel guilty for spending a few hours apart from your child. You'll be a better parent if you're rested and relaxed. And don't hesitate to ask friends, grandparents and other relatives for help. Make certain baby sitters or alternative caretakers are knowledgeable about ADHD and prepared for the task.
Last updated 2/16/2007 12:00:00 AM
© 1998-2007 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.
Attention-deficit/hyperactivity disorder (ADHD) is a chronic disorder that affects millions of American children, and it can persist into adulthood.
Problems generally associated with ADHD include inattention, hyperactivity and impulsive behavior. They can affect nearly every aspect of life. Children and adults with ADHD often struggle with low self-esteem, troubled personal relationships and poor performance in school or at work.
The best treatment for ADHD is a matter of debate. Currently, psychostimulant drugs are the most commonly prescribed medications for treating ADHD. But although these drugs can relieve many symptoms, they don't cure ADHD, and they can sometimes cause troubling side effects. Counseling, special accommodations in the classroom, and family and community support are other key parts of treatment.
Signs and symptoms
At various times, ADHD has been called attention-deficit disorder (ADD), hyperactivity, and even minimal brain dysfunction. But ADHD is the preferred term because it more accurately describes all aspects of the condition. Most doctors believe that a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD appear early in life and create significant problems at home and at school on an ongoing basis.
ADHD symptoms fall into two broad categories:
Inattention
Hyperactivity-impulsive behavior
In general, children are said to have ADHD if they show six or more signs or symptoms from each category for at least six months. These symptoms must significantly affect a child's ability to function in at least two areas of life — typically at home and at school. This helps ensure that the problem isn't with only a particular teacher or with only parents. Children who have problems in school but get along well at home or with friends are not considered to have ADHD. The same is true of children who are hyperactive or inattentive only at home but whose schoolwork and friendships aren't affected by their behavior.
In most children diagnosed with ADHD, signs and symptoms appear before the age of 7, although they sometimes may occur even earlier.
Inattention
Signs and symptoms of inattention may include:
Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
Often has trouble sustaining attention during tasks or play
Seems not to listen even when spoken to directly
Has difficulty following through on instructions and often fails to finish schoolwork, chores or other tasks
Often has problems organizing tasks or activities
Avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
Frequently loses needed items, such as books, pencils, toys or tools
Can be easily distracted
Forgetful often
Hyperactivity-impulsiveness
Signs and symptoms of hyperactivity-impulsive behavior may include:
Fidgets or squirms frequently
Often leaves his or her seat in the classroom or in other situations when remaining seated is expected
Often runs or climbs excessively when it's not appropriate or, if an adolescent, might constantly feel restless
Frequently has difficulty playing quietly
Always seems on the go
Talks excessively
Blurts out the answers before questions have been completely asked
Frequently has difficulty waiting for his or her turn
Often interrupts or intrudes on others' conversations or games
Most healthy children exhibit many of these behaviors at one time or another. For instance, parents may worry that a 3-year-old who can't listen to a story from beginning to end or finish a drawing may have ADHD. But preschoolers normally have a short attention span and aren't able to stick with one activity for long. This doesn't mean they're inattentive — it simply means they're normal preschoolers.
Even in older children and adolescents, attention span often depends on the level of interest in a particular activity. Most teenagers can listen to music or talk to their friends for hours but may be a lot less focused about homework.
The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're tired. And they may become even more active when they're tired, hungry, anxious or in a new environment. In addition, some children just naturally have a higher activity level than others. Every child is unique. Children should never be classified as having ADHD just because they're different from their friends or siblings.
Most children with ADHD don't have all the signs and symptoms of the disorder, and they may be different in boys and girls. Boys are more likely to be hyperactive, and girls tend to be inattentive. In addition, girls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle aimlessly. Boys also tend to be less compliant with teachers and other adults, so their behavior is often more conspicuous.
Symptoms of ADHD in adults
ADHD always begins in childhood, but it may persist into adult life. The core signs and symptoms of distractibility, hyperactivity and impulsive behavior are the same for adults as for children, but they often manifest themselves differently and far more subtly in adults. Hyperactivity, in particular, is generally less overt in adults. Children may race around madly; adults are more likely to be restless and to have trouble relaxing.
On the other hand, problems with organization and concentration often increase as people get older when their lives become more complicated and demanding. Adults diagnosed with ADHD often say that their biggest frustration is their inability to focus and to prioritize, leading not only to missed deadlines but also to forgotten meetings and social engagements.
As difficult as this is, the impulsive behavior of some adults with ADHD can be even more problematic. The inability to control impulses, which some experts say may be the defining characteristic of ADHD, can range from impatience waiting in line or driving in heavy traffic to mood swings, intense outbursts of anger, blurting out rude remarks and having troubled relationships.
One set of guidelines used to diagnose adult ADHD, called the Utah criteria, lists the following as characteristic of adults with the disorder:
A childhood history of ADHD
Hyperactivity and poor concentration
Inability to complete tasks
Mood swings
Hot temper
Inability to deal with stress
Impulsivity
Causes
Parents often blame themselves when a child has been diagnosed with ADHD, but scientists increasingly believe that structural changes in the brain, not parenting, may be a leading cause of the disorder. At the same time, certain environmental factors may contribute to or worsen a child's behavior. Although much still isn't understood about ADHD, researchers have identified several factors that may play a role:
Altered brain function and anatomy. While the exact cause of ADHD remains a mystery, researchers have discovered important differences in the brains of people with ADHD. For example, neurotransmitters — the brain's chemical messengers — aren't used properly in people with ADHD. Additionally, there appears to be less activity in the areas of the brain that control activity and attention in people with ADHD. In addition, brain scans have revealed that, on average, children with ADHD have up to 4 percent smaller brain volumes than do children without ADHD.
Heredity. ADHD tends to run in families. About one in four children with ADHD have at least one relative with the disorder.
Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke are at increased risk of having children with ADHD. And alcohol or drug abuse during pregnancy may reduce activity of the nerve cells (neurons) that produce neurotransmitters. Pregnant women who are exposed to environmental poisons, such as polychlorinated biphenyls (PCBs), also may be more likely to have children with symptoms of ADHD. PCBs are industrial chemicals that were widely used in the past.
Childhood exposure to environmental toxins. Preschool children exposed to certain environmental toxins, particularly lead and PCBs, are at increased risk of developmental and behavioral problems, many of which are similar to those found in children diagnosed with ADHD. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span. Exposure to PCBs in infancy may also increase a child's risk of developing ADHD.
When to seek medical advice
In general, if your child has trouble concentrating, sitting still or controlling his or her behavior, and these problems are creating significant difficulties at home and at school, see your pediatrician or family physician. Your doctor may later refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist or pediatric neurologist, but it's important to have a medical evaluation first to rule out other causes of your child's signs and symptoms.
Although manifestations of ADHD can sometimes appear in preschoolers, diagnosing the disorder in very young children is extremely difficult. That's because developmental problems such as language delays and adjustment difficulties can be mistaken for ADHD. For that reason, preschoolers suspected of having ADHD are more likely to need evaluation by a pediatrician, psychologist or psychiatrist, speech pathologist, or developmental pediatrician.
Children being treated with medication should see their doctors regularly — at least once during the month following diagnosis, and then at least every six months after that. Be sure to discuss how often your child should be seen for subsequent appointments with your child's doctor. You may also want to have your child retested every few years, depending on your child's grade level, age and diagnosis.
Call your physician if your child who is taking medication for ADHD experiences side effects, such as loss of appetite, trouble sleeping or increased irritability. Over time some children taking stimulant medications may also lose weight or grow more slowly, though these changes are usually temporary. This is another reason why follow-up visits are important.
Screening and diagnosis
No single test for ADHD exists, making the disorder difficult to diagnose. But a variety of exams are used to differentiate ADHD from learning disabilities and mood disorders. For this reason, make sure that the physician performing the evaluation has training in ADHD or in the diagnosis of developmental and behavioral disorders. You may want to start by talking to your child's pediatrician or your family doctor. Some pediatricians evaluate children themselves, but others may refer you to a mental health professional they know and trust.
The following chart from the National Institute of Mental Health lists the types of doctors who are qualified to diagnose and supervise treatment for ADHD, although not all may have specific training in the disorder.
Specialty Can diagnose ADHD? Can prescribe medications, if needed? Provides counseling or training?
Psychiatrists Yes Yes Yes
Psychologists Yes No Yes
Pediatricians or family physicians Yes Yes Usually no
Neurologists Yes Yes No
Diagnosing ADHD in children
Assessing a child for ADHD usually begins with complete medical, school and family histories and a medical exam to exclude other causes of your child's behavior. A number of medical conditions may cause signs and symptoms similar to those of ADHD, including learning disabilities, mood disturbances, hyperthyroidism, seizure disorders, fetal alcohol syndrome, vision or hearing problems, and Tourette syndrome — a neurological disorder characterized by compulsive body movements and vocalizations.
An evaluation for ADHD should also include checking for learning or language problems, depression, anxiety and sleep disorders. These and other coexisting conditions are found in as many as one in three children with ADHD.
Because ADHD symptoms may not be obvious in a medical office, your doctor is likely to use questionnaires and interviews to learn more about your child's behavior. You, your child's teachers and other people who know your child well, such as baby sitters and coaches, may be interviewed, and your doctor may also use ADHD-specific rating scales, such as the Vanderbilt questionnaire, the Connors' Rating Scales or the Achenbach Child Behavior Checklist (CBCL), to help collect and evaluate information about your child.
It's important to determine not just how your child behaves but whether the behavior is long-standing or temporary and when it occurs. Children diagnosed with ADHD exhibit these behaviors over a long period of time and have particular trouble in stressful, demanding situations or in activities that require sustained attention, such as reading, doing math problems or playing board games.
Gathering as much information as possible about your child is the best way to ensure an accurate diagnosis. Brain scans aren't a reliable way to diagnose the disorder, nor is a child's response to a psychostimulant medication.
Diagnosing ADHD in adults
It can be even more challenging to identify ADHD in adults than in children. The signs and symptoms in adults are often especially subtle and subjective, and no single test can confirm the diagnosis, including self-report tools such as the Copeland Symptoms Checklist for Adult ADHD or the Brown Adult Attention Deficit Disorder Scales.
What's more, adults may have a hard time remembering whether their problems date back to childhood. And yet a persistent pattern of signs and symptoms, beginning no later than age 7, is essential for a diagnosis of adult ADHD. For that reason, your doctor is likely to ask for your old school records and to gather information from teachers, parents and anyone else who knew you when you were young. If your difficulties are recent or occurred only occasionally in the past, you're not considered to have adult ADHD. In addition, your doctor will carefully assess the impact of your core symptoms on your current life — your performance at work or in school and your relationships with friends and family.
As with children, your evaluation should include a thorough physical exam to rule out other reasons for your symptoms. This means ruling out not only medical conditions that can mimic ADHD, such as hyperthyroidism and hearing loss, but also psychological problems such as bipolar disorder, which are much more common in adults than ADHD is. Substance abuse, for instance, can cause mood swings and affect memory and concentration. Severe depression can also affect attention and memory and can make it difficult to concentrate or complete tasks.
To help arrive at a diagnosis, some specialists use tests that objectively measure your cognitive ability, your short-term memory, your concentration and your problem-solving skills. Even so, many factors can affect your performance on these tests, and by themselves, they're not necessarily good indicators of the presence of adult ADHD. Combined with extensive medical and behavioral histories and school and job records, however, they can help provide a fuller and more accurate picture of how you function in the world.
Sleep disorders and ADHD
Diagnosing ADHD is further complicated because some children who are hyperactive or inattentive actually have sleep problems, not ADHD. Researchers have discovered that snoring and sleep apnea may lead to hyperactivity and inattention. Sleep apnea is a potentially serious condition in which you repeatedly stop and start breathing during sleep. If you have a child who is hyperactive and snores or who has trouble sleeping, a pediatric sleep specialist, an ear, nose and throat (ENT) doctor or both may be able to help.
Complications
ADHD can make life difficult for both children and adults. Children often struggle in the classroom, which can lead to academic failure and ridicule from both other children and adults.
Children with ADHD are also more likely to be injured than are other children. And teenagers and adults with the disorder are far more likely to be involved in car accidents. In fact, people with ADHD tend to have more accidents and injuries of all kinds than do people who don't have the disorder.
ADHD may be associated with an increased risk of alcohol and drug abuse and delinquency. And those with ADHD are more likely to have relationship problems.
In addition, although ADHD doesn't cause other psychological or developmental conditions, as many as one in three children with ADHD are affected by other disorders, including:
Oppositional defiant disorder (ODD). Generally defined as a pattern of negative, defiant and hostile behavior toward authority figures, ODD occurs in as many as half of all children with ADHD. This condition is more common in boys.
Conduct disorder. A more serious condition than ODD, conduct disorder is marked by distinctly antisocial behavior: stealing, fighting, destroying property, harming people and animals. Children with conduct disorder need immediate help.
Depression. Depression may occur in both children and adults with ADHD.
Anxiety disorders. Anxiety disorders tend to occur fairly often in children with ADHD and may cause overwhelming worry and nervousness as well as physical signs and symptoms, such as a rapid heartbeat, sweating and dizziness. Although anxiety disorders can cause severe signs and symptoms, most people can be helped with therapy or medication. Once anxiety is under control, children are better able to deal with the problems arising from ADHD.
Learning disabilities. Children with both ADHD and learning disabilities are the children most in need of special education services.
Tourette syndrome. Many children with ADHD also have Tourette syndrome, a neurological disorder characterized by compulsive muscular or vocal tics.
Treatment
Optimal treatment for ADHD is still a matter of debate. Current treatments typically involve therapy, medication or both. However, recent research indicates that a combination of therapy and medication may be the most helpful treatment.
Therapy
Children and adults with ADHD often greatly benefit from counseling or behavior therapy, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some people with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.
Counseling therapies may include:
Psychotherapy. This allows older children and adults with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms.
Behavior therapy. This type of therapy helps teachers and parents learn strategies (contingency management procedures) for dealing with children's behavior. These strategies may include token reward systems and timeouts. Behavior modification using contingency management techniques has proved especially beneficial for people with ADHD.
Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
Social skills training. This can help children learn appropriate social behaviors.
Support groups. Support groups can offer adults and children with ADHD and their parents a network of social support, information and education.
Parenting skills training. This can help parents develop ways to understand and guide their child's behavior.
The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. You can help by making every effort to work with your child's teachers and by referring them to reliable sources of information to support their efforts in the classroom.
Medications
Drugs known as psychostimulants are the most commonly prescribed medications for treating ADHD in children and adults. Commonly used psychostimulants include:
Methylphenidate (Ritalin, Concerta)
Dextroamphetamine/amphetamine (Adderall)
Dextroamphetamine (Dexedrine)
Another medication that works in a similar manner, but is not a stimulant, is atomoxetine (Strattera). Sometimes antidepressants also may be used — especially for adults and for children who don't respond to stimulants or who are depressed or have other problems.
These medications are available in short-acting and long-acting forms. The short-acting forms last about four hours, while the long-acting preparations last between six and 12 hours. With the exception of methylphenidate, these medications come only in an **** form. Methylphenidate was recently introduced in a long-acting — about nine hours — patch that can be worn on the hip. This form was approved for use in children between the ages of 6 and 12 under the brand name Daytrana.
Although scientists don't understand exactly why these drugs work, stimulants appear to boost and balance levels of the brain chemicals called neurotransmitters.
These ADHD medications help alleviate the core signs and symptoms of inattention and hyperactivity — sometimes dramatically. However, effects of the drugs wear off quickly. Additionally, the right dose varies between individuals, so it may take some time in the beginning to find the dose that's right for you or your child.
There's been some concern about using medications to treat preschoolers who have ADHD. One large-scale study found that low doses of the commonly used medications are safe and effective in young children. However, the study did find that the younger children were more susceptible to medication side effects.
Medication side effects
The most common side effects of psychostimulants in children include decreased appetite, corresponding weight loss, nervousness and problems sleeping. Some children experience irritability or increased activity as the effect of the medication tapers off. Adjustments in doses can often offset these side effects.
A small percentage of children may develop jerky muscle movements, such as grimaces or twitches (tics), but these usually disappear when the dose of medication is lowered. Stimulant medications may also be associated with a slightly reduced growth rate in children, although in most cases growth isn't permanently affected.
The nonstimulant medication Strattera has been linked to side effects that include rare liver problems. If your child is taking Strattera and develops yellow skin (jaundice), dark-colored urine or unexplained flu symptoms, contact your doctor right away. In September 2005, the Food and Drug Administration (FDA) issued a public health warning to doctors about the risk of suicidal thinking in children and adolescents being treated with Strattera. The FDA urged doctors to closely observe children being treated with Strattera for signs of suicidal thinking.
Adderall has raised concerns because of reports of sudden unexplained deaths in children taking the medication. Health officials in Canada suspended sales of Adderall XR in February 2005, but allowed the drug back on the market in August 2005 after recommending that the drug not be used in children with heart abnormalities. In the United States, the FDA also is recommending that the medication not be used in anyone with known cardiac abnormalities.
Dextroamphetamine has also raised concerns because sudden deaths in youngsters with heart abnormalities have occurred. The drug may also cause troubling psychological side effects, such as delusional thoughts or hallucinations.
Parents also are understandably concerned about psychostimulants — which are similar to amphetamines — and the risk of addiction. But dependence hasn't been reported in children who take medications orally and at the proper dosage. That's because drug levels in the brain rise too slowly to produce a "high." On the other hand, there's concern that siblings and classmates of children and teenagers with ADHD might abuse ADHD medications.
In general, psychostimulant side effects in adults are similar to those in children. But ADHD drugs are also more likely to cause certain problems specifically in adults, including mild increases in blood pressure that may be significant for people who already have hypertension, and the liver disease hepatitis. In addition, because adults usually require higher dosages of these medications than children do, the risk of abuse or addiction may be greater. Antidepressants, either alone or in combination with a psychostimulant, can help reduce mood instability and disturbances. Side effects may include dry mouth, urinary retention, weight gain, drowsiness and sexual dysfunction.
Experimental treatments
Behavior therapies and medications are the most thoroughly researched treatments for ADHD. Other approaches are being studied but are still considered to be unproved and experimental.
Biofeedback. Ordinarily, this stress-reduction technique is used to help people learn to control certain body responses, such as heart rate and muscle tension. It has also been used with the intent of teaching adults and children with ADHD to change their brain wave patterns to more normal ones.
Brain wave biofeedback. The goal of brain wave biofeedback (Neurobiofeedback) is to teach people to control their own brain wave patterns using electroencephalography (EEG) feedback, sometimes combined with a video game. EEG measures the waves of electrical activity of the brain.
Special diets and supplements. Over the years, a great deal of media attention has focused on diets for ADHD. Most diets involve eliminating additives and foods thought to increase hyperactivity, such as sugar and caffeine, and common allergens such as wheat, milk and eggs. So far, however, studies haven't found a consistent link between diet and improved symptoms of ADHD. If you think certain foods affect your child's behavior, however, try eliminating them for a time. Additionally, there's no evidence that dietary supplements, such as fatty acids, ginkgo or megadoses of vitamins, can reduce ADHD symptoms.
Self-care
Because ADHD is a complex disorder and each person with ADHD is unique, it's hard to make recommendations that are right for every child or adult. But some of the following suggestions may help:
Children at home
Show your child lots of affection. Children need to hear that they're loved and appreciated. Focusing only on the negative aspects of your child's behavior can harm your relationship with him or her and affect self-confidence and self-esteem. If your child has a hard time accepting verbal signs of affection, a smile, a pat on the shoulder or a hug can show you care.
Be patient. Try to remain patient and calm when dealing with your child, even when your child is out of control. If you're calm, your child is more likely to calm down too.
Keep things in perspective. Be realistic in your expectations for improvement — both your own and your child's.
Take time to enjoy your child. Make an effort to accept and appreciate the parts of your child's personality that aren't so difficult. One of the best ways to do this is simply to spend time together. This should be a private time when no other children or adults interfere. Try to give your child more positive than negative attention every day.
Try to keep a regular schedule for meals, naps and bedtime. Use a big calendar to mark special activities that will be coming up. Children with ADHD have a hard time accepting and adjusting to change.
Make sure your child is rested. Try to keep your child from becoming overtired, because fatigue often makes symptoms of ADHD worse.
Identify difficult situations. Try to avoid situations that are difficult for your child, such as sitting through long presentations or shopping in malls and supermarkets where the array of merchandise can be overwhelming.
Use timeouts or the loss of a privilege to discipline your child. For children with ADHD, a timeout from social stimulation can be very effective. Timeouts should be relatively brief, but long enough for your child to regain control. The idea is to interrupt and defuse out-of-control behavior. A timeout doesn't work for everything, but many parents have found that it's one of the best tools for managing the behavior of an overactive or impulsive child.
Work on organization. Help your child organize and maintain a daily assignment notebook and be sure your child has a quiet place to study.
Find ways to enhance your child's self-esteem and sense of discipline. Children with ADHD often do very well with art projects, music or dance lessons, or martial arts classes, especially karate or tae kwon do. But don't force children into activities that are beyond their abilities.
Use simple words and demonstrate when giving your child directions. Speak slowly and quietly and be very specific and concrete. Give one direction at a time. Stop and make eye contact with the child when giving directions.
Take a break yourself. If you're exhausted and stressed, you're a much less effective parent.
Children in school
Ask about school programs. Take advantage of any special programs your school may have for children with ADHD.
Talk to your child's teachers. Stay in close communication with your child's teachers, and support their efforts to help your child in the classroom. Be sure teachers closely monitor your child's work, provide positive feedback, and are flexible and patient. They should also be very clear about their instructions and expectations.
Ask about having your child use a computer in the classroom. Children with ADHD often have trouble with handwriting and can greatly benefit from using a computer or a typewriter.
Medications
Administer medications carefully to children and teenagers. They shouldn't be in charge of their own medicine.
At home, keep medication locked in a childproof container. Psychostimulant drugs are nervous system stimulants. An overdose can cause severe confusion, agitation and an accelerated heart rate and is potentially fatal. Young children are especially sensitive to drug overdoses.
Don't send supplies of medication to school with your child. Deliver any medicine yourself to the school nurse or health office.
Talk to your child about his or her medications. Make sure your children understand that it's not OK to give or sell medication to others. Ask them to tell you right away if classmates pressure or threaten them for medication.
Adults in the workplace
Choose work that uses your strengths. If you're creative, high energy and intelligent, avoid jobs that are dull or detail oriented.
Ask your boss to repeat instructions rather than guess at what is meant.
Try to work at home, at least part time.
Ask for a private office. If that's not possible, work in a quiet area and use headphones to muffle noise. Arriving before most of your co-workers also can help reduce distractions.
Work on more than one project at a time. When you get bored with one, switch to the other.
Work on boring tasks when you feel most alert.
Break up big jobs into smaller tasks.
Use deadlines for structure.
Make lists of things to do and use them to prioritize your day.
Use a day planner and to-do lists. Post notes for yourself.
Ask your secretary or office assistant to help with details.
Adult relationships
The behavior of many adults diagnosed with ADHD can be unpredictable and sometimes difficult. Forgotten appointments, missed deadlines, impulsive or irrational decisions, and angry outbursts can strain the patience of the most forgiving co-worker, friend or partner.
Therapy that focuses on these issues and helps adults better monitor their own behavior can be extremely helpful. So can classes to improve communication skills, conflict resolution and problem solving. Couples therapy and classes in which family members learn more about ADHD can sometimes significantly improve relationships.
Coping skills
Caring for a child with ADHD can be challenging for the whole family. Parents may be hurt by their child's behavior as well as by the way other people respond to it. And the stress of dealing with ADHD can sometimes lead to marital stress and even divorce. These problems may be compounded by the financial burden that ADHD can place on families.
Siblings of a child with ADHD also may have special difficulties. They can be affected by a brother or sister who is demanding or aggressive, and they may also receive less attention because the child with ADHD requires so much of a parent's time.
Resources
There are no easy answers for struggling families, but many resources are available that may help. Parents can get advice on raising a child with ADHD from a social worker or other mental health care professional or from a support group. Support groups don't appeal to everyone, but they often can provide excellent information about coping with ADHD from people who know.
There also are excellent books and guides for both parents and teachers, and Internet sites dealing exclusively with ADHD.
Techniques for coping
Many parents notice patterns in their children's behavior as well as in their own responses to that behavior. For instance, your child might throw a tantrum every night before dinner, and you might routinely give him or her a snack so that you can finish preparing the meal in peace. Although you don't mean to, you end up encouraging your child's behavior. Both you and your child need to act differently. But substituting new habits for old ones isn't easy — it takes real awareness and a lot of hard work.
You can help make change easier by ensuring that your child has the right kind of structure. For children with ADHD, structure doesn't mean rigidity or iron discipline. Instead, it means arranging things so that a child's life is as predictable, calm and organized as possible. Children with ADHD don't handle change well, and having predictable routines can make them feel safe as well as help improve behavior. Give the child a few minutes warning — with a count down — when it's necessary to change from one activity or location to another.
It's also important to have realistic expectations and not ask more of your child than is physically or mentally possible. Set small goals for both yourself and your child and don't try to make a lot of changes all at once.
How to provide positive reinforcement
One of the best ways to instill new habits is to provide firm, loving discipline that rewards good behavior and discourages destructive actions. Children with ADHD usually respond well to positive reinforcement, as long as it's genuinely earned. It's best to start by rewarding or reinforcing a new behavior every time it occurs. After a short time, this probably won't be necessary, but you need to continue to let your child know that you're serious about encouraging new habits.
Rewards can lose their effectiveness when they're overused. Instead of always offering food treats, for instance, try using a special privilege, such as staying up an extra half-hour or playing a favorite game, as a prize. Don't promise a reward and then not follow through. This defeats the purpose of rewarding good behavior and can be extremely frustrating for your child. Special activities make better rewards than tangible objects do.
Some parents object to rewards because they seem like bribery. But changing old habits is extremely hard, and rewards are simply a concrete way of recognizing your child's efforts.
Stay calm and set a good example
You also need to set a good example by acting the way you want your child to act. Try to remain patient and in control — even when your child is out of control. If you speak quietly and calmly, your child is more likely to calm down, too.
Finally, the relationship among all the family members plays a large part in managing or changing the behavior of a child with ADHD. Couples who have a strong bond often find it easier to face the challenges of parenting than do those whose bond isn't as strong. That's one reason it's important for partners to take time to nurture their own relationship.
If you're the parent of a child with ADHD, be sure to give yourself a break now and then. Don't feel guilty for spending a few hours apart from your child. You'll be a better parent if you're rested and relaxed. And don't hesitate to ask friends, grandparents and other relatives for help. Make certain baby sitters or alternative caretakers are knowledgeable about ADHD and prepared for the task.
Last updated 2/16/2007 12:00:00 AM
© 1998-2007 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.
There's no way I could sit around long enough to read all of that. I gotta go move around.
whew! Thanks for that info EH, it took me all morning to read, well, actually I took a few breaks, but I really enjoyed those doughnuts even though the coffee was cold, and did you see ESPN this morning they were talking about the Giants management and how they deliberately covered up for Bonds, and wow what a hit that goalie took, by the way when is the NBA trading deadline? Darn I missed Idol last night and I sure miss the writers, those Leno jokes are sad... Are you kidding me? The Lobos lost to TCU? Hey alright, OJ is back in jail. Now... where did I put my car keys?
I know it was long winded but I thought if people wanted to know more about adhd they could read it.
It's not an easy disorder to diagnose.
But when they do get it right and are treated. It makes a world of differance and how that student functions and performs.
JMHO
EH
It's not an easy disorder to diagnose.
But when they do get it right and are treated. It makes a world of differance and how that student functions and performs.
JMHO
EH
Pro ball is extremely hazardous with the dwarfism and pituitary glandular deficiency plagues requiring hgh treatments, and now this rampant ADD/ADHD epidemic. Congress should insist the CDC investigate ballparks as "hot spots".
Hmmm...I should have foreseen this after that House episode when the overstretched Mom was using her kid's ADD meds as Mother's Little Helpers....
I really don't see how players can improve their games by using amphetamines. When a person is "speeding" they become hyperactive, unable to focus, racing heart etc. This would be the same effect a non ADD person whould have if they took the medication that helps a ADD person focus.
Actually, one of the effects of amphetamines can be a perseverative type of "hyper-focus". It speeds metabolism yes, but the real targets are nuerotransmitter receptors along a brain pathway that lends well to repetitive behavior rather than hyperactivity.
I've taught hundreds of college students. There are very few who have been ADD/ADHD. Maybe one in every 250 students. What's going on is baseball is a load of baloney.
I agree that if players are not ADD/ADHD and have not had a thorough testing and evaluation done by a qualified Dr.
should not be allowed to use these drugs.
Nitric_Acid, would you say that those affected with ADD/ADHD,
That you have taught.
Where they helped with being prescribed ADD/ADHD prescriptions for there disorder.
Can they function better in your class.
Are they more focused in there task.
Do they make a differance in that students life??
EH
should not be allowed to use these drugs.
Nitric_Acid, would you say that those affected with ADD/ADHD,
That you have taught.
Where they helped with being prescribed ADD/ADHD prescriptions for there disorder.
Can they function better in your class.
Are they more focused in there task.
Do they make a differance in that students life??
EH
Why is it that some MLB players need so many drugs?
It just goes to show you, where there is a will, there is a way. Those that feel they need help are getting increasinly more creative as evidenced by the post at the top of the page.
It just goes to show you, where there is a will, there is a way. Those that feel they need help are getting increasinly more creative as evidenced by the post at the top of the page.
The drugs commonly used to treat ADD/ADHD are chemically indistinguishable from cocaine as far as their effect on the brain, how they work in the neurons.
I don't deny that some children who are at the far end of the spectrum of fidgitiness will focus much better if put on these drugs. But they would if you gave them cocaine also.
I really worry about giving these powerful psychotropic drugs to kids.
I don't deny that some children who are at the far end of the spectrum of fidgitiness will focus much better if put on these drugs. But they would if you gave them cocaine also.
I really worry about giving these powerful psychotropic drugs to kids.
I dont know....I'm liking Dad04's theory of ballparks as "hotspots".
quote:Originally posted by theEH:
I agree that if players are not ADD/ADHD and have not had a thorough testing and evaluation done by a qualified Dr.
should not be allowed to use these drugs.
Nitric_Acid, would you say that those affected with ADD/ADHD,
That you have taught.
Where they helped with being prescribed ADD/ADHD prescriptions for there disorder.
Can they function better in your class.
Are they more focused in there task.
Do they make a differance in that students life??
EH
I'll be vague to keep myself out of trouble.
The short answer is yes, it does improve their ability to function in an academic environment. Their grades are better. It depends on severity. Some students go from B's to A's, some go from C's to A's. Just about everyone I know with ADHD is very bright. Students have told me directly that the medication helps them.
One of my kids has ADHD and the medication most certainly improved their quality of life. Instead of being way behind, they are now getting 90-100% on everything. They can read at grade level instead of being a year behind. Instead of being a "problem" at school, they get awards for good behavior. The medication wasn't a magic bullet; we still need to watch their diet and have structure in the house, but it was a big help.
Rob mentioned being fidgety. Someone with true ADHD is way beyond being fidgety. My son was like that. Unfocused and fidgety in class. That is not ADHD, that's being bored.
quote:Originally posted by Dad04:
Pro ball is extremely hazardous with the dwarfism and pituitary glandular deficiency plagues requiring hgh treatments, and now this rampant ADD/ADHD epidemic. Congress should insist the CDC investigate ballparks as "hot spots".
Dad04, u r too funny.
Good stuff EH.
By the way, LOTS of ADHD grown ups out there as well who have never been diagnosed. It requires a HUGE amount of evaluation for an adult to receive treatment. As indicated, symtoms are low self esteem, poor work performance, drug and alcohol abuse, inability to hold a job or function at teh job properly.
Can you just see the million dollar bb player at the doctor's office complaining he has adult ADHD?
Actually I shouldn't make fun, I know of a player who was diagnosed with ADD, supplemental first rounder a few years back. After he was diagnosed and treated, he did extremely well on the field.
I was recently offered an opportunity to go work with 5 children (elementary to middle school) all diagnosed but parents WILL not put them on medication. That's tough and I wasnot up for the challenge.
Spizzle,
Me too. Tried to read it and got distracted.
Me too. Tried to read it and got distracted.
I agree. A Ritalin prescription can be the equivilant of legalized greenies. The illegal use of Ritalin is big on college campuses for studying.quote:I've taught hundreds of college students. There are very few who have been ADD/ADHD. Maybe one in every 250 students. What's going on is baseball is a load of baloney.
Thank you Nitric_Acid for your answer's.
I Know that they work for People suffering from ADD/ADHD.
They have good result's with staying on task, and completing there assignment's on time.
They help with concentration during tests.
These drugs in NO way can they be considered in the same catagory as both Cocaine and are Meth.
Not even close.
EH
I Know that they work for People suffering from ADD/ADHD.
They have good result's with staying on task, and completing there assignment's on time.
They help with concentration during tests.
These drugs in NO way can they be considered in the same catagory as both Cocaine and are Meth.
Not even close.
EH
On the topic of ADD have you seen the interview with the Kaman kid on the Clippers basketball team?
He was diagnosed with ADD when 2 years of age, put on Ritalin at 3 years of age---now at the age of 25 it has been discovered that he was not and is not ADD---his brain races at times and disfunctions but it is not ADD---he is now off Ritalin and doing better than ever in the pros
He was diagnosed with ADD when 2 years of age, put on Ritalin at 3 years of age---now at the age of 25 it has been discovered that he was not and is not ADD---his brain races at times and disfunctions but it is not ADD---he is now off Ritalin and doing better than ever in the pros
RJM's got it. Most ADHD drugs are amphetamines. For example, I know someone diagnosed with ADHD and he currently takes Adderall XR (eXtended-Release of d-amphetamine salts).
A ballplayer getting "diagnosed" with ADHD is just looking for a quasi-legal route to secure greenies.
Hey, speed is one of the Five Tools, innit
A ballplayer getting "diagnosed" with ADHD is just looking for a quasi-legal route to secure greenies.
Hey, speed is one of the Five Tools, innit
I am not knocking anyone here or their child, but in the feminization of society, we have found a diagnoses for everything. We all knew for centuries that boys would be boys, and were more aggressive and just plain wired. But we got smarter, so we needed to call it something, and then poison our children with prescribed drugs. How about a little love, attention and discipline?
My wife says I now have OSFD. Can you belive it? I would have never thunk it.
Me with Overly Smelly Flatulance Disease!
I don't know what to take for that. Any suggestions?
My wife says I now have OSFD. Can you belive it? I would have never thunk it.
Me with Overly Smelly Flatulance Disease!
I don't know what to take for that. Any suggestions?
Beano (but that's second hand, because I've never really tried it, I just let it fly. Just call me, Nature Boy!) 
EH:
Actually, Ritalin and cocaine are very similar in how they work and what they do in the brain. They have different molecular structures, and Ritalin acts more slowly (it takes about an hour to "work" while cocaine is pretty much immediate.) The speed of the effect is one reason cocaine is more addictive.
But both drugs do the same thing. They both block the dopamine transporters in the neurons, which means that there will be more dopamine floating in the neurons, and dopamine is the "pleasure" transmitter. A study by Rush and Baker in 2001 showed the striking similarity between the two drugs in their physiological effects.
Studies have shown (Brandon, 2001) that when reaching adulthood, people who were on Ritalin as kids are more likely to become addicted to cocaine as adults.
There have been other studies that contradict these results, to be sure. But the similarity between cocaine and Ritalin in how they block the dopamine transmitters is not really at issue.
Actually, Ritalin and cocaine are very similar in how they work and what they do in the brain. They have different molecular structures, and Ritalin acts more slowly (it takes about an hour to "work" while cocaine is pretty much immediate.) The speed of the effect is one reason cocaine is more addictive.
But both drugs do the same thing. They both block the dopamine transporters in the neurons, which means that there will be more dopamine floating in the neurons, and dopamine is the "pleasure" transmitter. A study by Rush and Baker in 2001 showed the striking similarity between the two drugs in their physiological effects.
Studies have shown (Brandon, 2001) that when reaching adulthood, people who were on Ritalin as kids are more likely to become addicted to cocaine as adults.
There have been other studies that contradict these results, to be sure. But the similarity between cocaine and Ritalin in how they block the dopamine transmitters is not really at issue.
Rob,
As I understand it, the lasting effect of cocaine addiction is some sort of inability to achieve pleasure/satisfaction emotionally. Is this true, if so, can you expound on it, and would Ritalin have the same negative effect?
As I understand it, the lasting effect of cocaine addiction is some sort of inability to achieve pleasure/satisfaction emotionally. Is this true, if so, can you expound on it, and would Ritalin have the same negative effect?
Rob, Are all ADD/ADHD Prescription's the same.
And do they all effect the dopamine transmitter's.
EH
And do they all effect the dopamine transmitter's.
EH
quote:Originally posted by Coachric:
I am not knocking anyone here or their child, but in the feminization of society, we have found a diagnoses for everything. We all knew for centuries that boys would be boys, and were more aggressive and just plain wired. But we got smarter, so we needed to call it something, and then poison our children with prescribed drugs. How about a little love, attention and discipline?
My wife says I now have OSFD. Can you belive it? I would have never thunk it.
Me with Overly Smelly Flatulance Disease!
I don't know what to take for that. Any suggestions?
I have yet to see a boy with ADHD. The cases I know are girls.
In my experience as a public school teacher, it was much more common for boys to be diagnosed with ADD/ADHD. We would have to consult another source such as EH, but I believe that this gender difference in diagnosis exist nationally.
Yes it does, about 3:1 boys to girls from what I've read. Slightly more in my own experience.
I am like Sgt. Schultz of Hogans Heroes.
I KNOW NOTHING,
But what little I know is that Boy's seem to be labeled as ADHD.
Even if they don't have it.
It's not all about kids bounceing off the wall.
Thats not it.
Not all people show those outward signs of Hyper activety.
Some just have attention disorder.
It's there attention to task, And concentrating on getting that task done.
It helps with focus, and makes a world of differance in that student's ability to complete assignment's on time and achieve good grades.
JMO
EH
I KNOW NOTHING,
But what little I know is that Boy's seem to be labeled as ADHD.
Even if they don't have it.
It's not all about kids bounceing off the wall.
Thats not it.
Not all people show those outward signs of Hyper activety.
Some just have attention disorder.
It's there attention to task, And concentrating on getting that task done.
It helps with focus, and makes a world of differance in that student's ability to complete assignment's on time and achieve good grades.
JMO
EH
When chemical restraints were denied, I had good luck with chains, rope and duct tape! 
You can never have enough duck tape.
It works on unruly baseball parent's also.
LOL.
EH
It works on unruly baseball parent's also.
LOL.
EH
Before proceeding it's recognized some kids have ADDD/ADHD.quote:He was diagnosed with ADD when 2 years of age, put on Ritalin at 3 years of age---now at the age of 25 it has been discovered that he was not and is not ADD---his brain races at times and disfunctions but it is not ADD---
My brother-in-law is a clinical psychologist. He's cured 90% of the kids he's treated for ADD/ADHD. He said the cure was they didn't have it in the first place. The schools are quick to get an ADD/ADHD diagnosis because it makes the kid at-risk and gets them more funding. It also medicates the kids behavior problems.
He said many kids misdiagnosed have lack of family structure and discipline at home. I asked him if a dad has ever taken a swing at him when he told him this. He said it's happened when he gets kids sent to him from the school district from certain parts of town. Other parents take it seriously and take a look at themselves.
I once read a book written by an ADD/ADHD apologist. What he calls cures I call parenting 101.
My son was the Eveready Bunny when he was little. Several friends told us we should have him checked for ADD/ADHD. He was active in pre-school because it was boring. We were teaching him faster at home than they were in pre-school. When he started all-day kindergarten he didn't have any problems. He was then being challenged all day. As a freshman in high school, take him off the field of competition and he's one of the mellowest kids you will ever meet.quote:But what little I know is that Boy's seem to be labeled as ADHD. Even if they don't have it. It's not all about kids bounceing off the wall.
quote:Originally posted by Orlando:
A ballplayer getting "diagnosed" with ADHD is just looking for a quasi-legal route to secure greenies.
Hey, speed is one of the Five Tools, innit
A MLB player certainly doesn't fit the profile. How does a successful player get to that level with ADHD. Does he all of a sudden come down with it?
This is just outrageous, IMO.
I'd be curious to see the statistics on diagnosis of ADD/ADHD in MLB players since the banning of greenies. I'll bet there weren't a lot before the ban.quote:A ballplayer getting "diagnosed" with ADHD is just looking for a quasi-legal route to secure greenies.
quote:My brother-in-law is a clinical psychologist. He's cured 90% of the kids he's treated for ADD/ADHD. He said the cure was they didn't have it in the first place. The schools are quick to get an ADD/ADHD diagnosis because it makes the kid at-risk and gets them more funding. It also medicates the kids behavior problems.
Seriously RJM, ADD/ADHD apologist? Where do you get this stuff? From your brother-in-law? He must indeed be a very rich man, and to cure them all by simply changing their Dx. I'll have to tell all my colleagues, and the school admins too. It seems they've overlooked a major funding source.
Friends have a son diagnosed as ADD/ADHD. When he was eight I pointed out to them the kid is perfectly behaved around me because I won't put up with his ****. I'd take him home.quote:ADD/ADHD apologist? Where do you get this stuff?
It wasn't an ADD/ADHD issue. It was a behavioral issue. He knew who he could manipulate and who he couldn't. He owned his mother and his step-dad. Since I know the dad I asked him how he acts around his father. He told me he behaves because his dad would discipline him if he doesn't behave.
The mother asked me to read a book about ADD/ADHD written by a psychologist/psychiatrist I can only call an apologist. His ADD/ADHD cures were parenting 101. I can't remember the name since it was six years ago. If I cared enough I could search ADD/ADHD and recognize the name of the doctor.
My brother-in-law does do very well. He's also authored a book on ADD/ADHD that was very well received. I'll stop here before you are condescending again and make another personal attack.
I'm not talking about behaviour issue's.
And my experience is with adult's ADD/ADHD.
A person suffering with this disorder, cannot function in the classroom the same way as one not suffering from this disorder.
They suffer with comprehension, and there attention span wonders from task to task.
The medicine allows the student to focus on the task at hand.
Makes thing's clearer in there mind.
I'm not talking about drugging a hyperactive boy or girl to keep them quit.
I'm strictly talking about being able to function in a classroom the same way as other student's do without this disorder.
To blame Parents for the disorder is a cop out for uninformed people who do not understand the disorder.
Would you say that someone that suffers with siezures, was that caused by there parent's.
For those not informed and would like to know more about the disorder, Go back to my first post on this subject and READ IT.
EH
And my experience is with adult's ADD/ADHD.
A person suffering with this disorder, cannot function in the classroom the same way as one not suffering from this disorder.
They suffer with comprehension, and there attention span wonders from task to task.
The medicine allows the student to focus on the task at hand.
Makes thing's clearer in there mind.
I'm not talking about drugging a hyperactive boy or girl to keep them quit.
I'm strictly talking about being able to function in a classroom the same way as other student's do without this disorder.
To blame Parents for the disorder is a cop out for uninformed people who do not understand the disorder.
Would you say that someone that suffers with siezures, was that caused by there parent's.
For those not informed and would like to know more about the disorder, Go back to my first post on this subject and READ IT.
EH
I don't find RJM's assertion about his brother in law hard to believe in the slightest. I have researched, read and written about this issue for several years. I have spoken to and interviewed on my radio shows several national experts and authors of books on the subject.
I don't pretend I myself am an expert, but I would say that I am very informed on the subject of ADD/ADHD diagnosis, the various drug treatments for it, and how the schools deal with (and at times take advantage of) the so-called "learning disability."
I'll say right out front that there is wide variability in the rigor of diagnosis of this malady. In some cases, the diagnosis is a last resort, only after intense analysis and observation, and after many other interventions have been tried.
But way way way too often the ADD diagnosis/psychotropic drug treatment sequence is very loose and casual, often even initiated by the classroom teacher and then almost rubber stamped by the physician.
ADD/ADHD is not an illness in the sense that it is diagnosed by any chemical or physical symptoms. The diagnosis is based on observed behaviors. Take a look at the DSMIV description of behaviors that are analyzed to decide on the diagnosis.t
Any given kid will fall at some spot on the spectrum of these observed behaviors. Those who are at the far end are deemed ADD or ADHD.
I'm just very skeptical. I have seen, read and learned too much about the uncertainty in the diagnosis.
I don't pretend I myself am an expert, but I would say that I am very informed on the subject of ADD/ADHD diagnosis, the various drug treatments for it, and how the schools deal with (and at times take advantage of) the so-called "learning disability."
I'll say right out front that there is wide variability in the rigor of diagnosis of this malady. In some cases, the diagnosis is a last resort, only after intense analysis and observation, and after many other interventions have been tried.
But way way way too often the ADD diagnosis/psychotropic drug treatment sequence is very loose and casual, often even initiated by the classroom teacher and then almost rubber stamped by the physician.
ADD/ADHD is not an illness in the sense that it is diagnosed by any chemical or physical symptoms. The diagnosis is based on observed behaviors. Take a look at the DSMIV description of behaviors that are analyzed to decide on the diagnosis.t
Any given kid will fall at some spot on the spectrum of these observed behaviors. Those who are at the far end are deemed ADD or ADHD.
I'm just very skeptical. I have seen, read and learned too much about the uncertainty in the diagnosis.