Immaturity and slow psychological development
These pages provide information about Attention Deficit Hyperactivity Disorder -ADHD/ADD including diagnosis, treatment, classroom management, parent education, behavior modification, communication and family relationships. The information is updated as needed to reflect current research on attention deficit disorder. Here you will find comprehensive information, practical suggestions and useful materials for teaching and parenting children and teens with Attention Deficit Hyperactivity Disorder - ADD/ADHD.
Some children have more trouble paying attention in class and completing academic assignments than others. It is estimated that from 3 to 10 percent of the population has a condition known as Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). This disorder is said to be found present more often in boys than girls (3:1).
Not every student having trouble completing assignments or who is squirmy and disruptive to the class has Attention Deficit Disorder. This is particularly true in the lower grades where many of the students have not reached a level of maturity sufficient to meet the demands of the classroom. Some studies have found that a first grade teacher may rate as many as 50% of the boys in the class as having Attention Deficit Disorder using common clinical questionnaires. Thus, educators may mislabel behavior as being abnormal when it actually may be within the low end of normal development.
Actually, normal attention span seems to develop in three stages. First, the child’s attention is said to be overly exclusive. This is a term used by psychologists to describe attention that is focused on a single object for a long period of time while tuning out all other stimuli. An example of this would be a baby who focuses totally on a button or a pin on the clothing of the person holding him. A child whose attention becomes stuck at this stage of development might be diagnosed as having autism.
Second, a child’s attention develops to where it is overly inclusive. This refers to a very wide span of attention that is constantly and rapidly changing from one object to another such as a toddler who is running from one toy to the next never able to stay with any one toy for any period of time. A child who is stuck at the second stage of attention span development might be diagnosed as having attention deficit disorder.
Third, the child develops selective attention where he is able to shift focus at will from being inclusive to being very exclusive. This is a mature pattern of attention and concentration that is required to be successful in a classroom learning environment.
There are a variety of causes for poor attention, concentration and impulse control. A partial list would include the following:
If your child has had the symptoms of poor attention, concentration and/or poor impulse control for some time, you should have your child examined by his physician. In addition to a physical exam and appropriate lab tests, the physician may have the parents and teachers complete questionnaires about the child’s behavior. He may also refer you to a school psychologist or a mental health professional for further assessment. Depending on the outcome of the entire evaluation, one or several specific medical, educational or psychological recommendations may be given.
In the most current assessment guidelines published by the American Psychiatric Association, Diagnostic and Statistical Manual for Mental Disorders IV (DSM4), the disorder is known as Attention Deficit Disorder and has several types including: (1) predominantly inattentive; (2) predominantly impulsive or (3) combined. Individuals with this condition usually have many (but not all) of the following symptoms:
Inattention:
often fails to finish what he starts
doesn’t seem to listen
easily distracted
has difficulty concentration or paying attention
doesn’t stick with a play activity
Impulsivity:
often acts without thinking & later feels sorry
shifts excessively from one activity to another
has difficulty organizing work
needs a lot of supervision
speaks out loud in class
doesn’t wait to take turns in games or groups
Hyperactivity:
runs about or climbs on things excessively
can’t sit still and is fidgety
has difficulty staying in his seat and bothers classmates
excessive activity during sleep
always on the "go" and acts as if "driven"
Emotional Instability:
angry outbursts
social loner
blames others for problems
fights with others quickly
very sensitive to criticism
The diagnosis can be made by "ruling out" other medical or psychiatric causes for the symptoms and by then determining that the patient meets the DSM4 criteria for Attention Deficit Disorder. In some cases psychological testing is also used to help determine the diagnosis. The testing may be in the form of questionnaires such as the Conners Rating Scale or the Child Behavior Check List. Sometimes, a computerized neuropsychological test such as the TOVA, IVA or Gordon Diagnostic System may be used. These tests are known as continuous performance tests and measure a person’s ability to pay attention, tune out distractions and their impulse control while performing a repetitive task over a period of time ( 6 to 15 minutes). This type of testing can be helpful. More extensive batteries may be offered by various practitioners but are not necessary to provide the necessary data to make a diagnosis.
True Attention Deficit Disorder patients usually start showing symptoms by the time they start school. Some very impulsive children are diagnosed as early as 2 or 3 years old. Another group appears to develop more severe symptoms around the fourth grade. These children may have always had Attention Deficit Disorder but were able to compensate for the condition. As school requires more work and more organization skills, these children may reach a point where they become unable to compensate and exhibit "full blown" Attention Deficit Disorder symptoms. Some children may remain undiagnosed until they are in their teens. More recently adults have been diagnosed as having Attention Deficit Disorder. These individuals had the disorder as children but were not properly identified during their childhood.
The symptoms of Attention Deficit Disorder are caused by a neurological dysfunction within the brain. Several studies using PET scans have confirmed that there is a definite difference in brain functioning between a group of individuals diagnosed with Attention Deficit Disorder and those without it. The underlying physiological mechanism which causes Attention Deficit Disorder is still not thoroughly understood and remains under scientific study. It is presumed that brain chemistry is out of balance and that specific chemicals called neurotransmitters may be lacking in individuals with Attention Deficit Disorder. In two research studies, when the Attention Deficit Disorder subjects were given their medication and rescanned, their brain activity appeared to be much more like that of the normal group. Another interesting finding of these studies is that the areas of the brain in the Attention Deficit Disorder group where brain activity was lower than in the normal group are known to be associated with such functions as attention and concentration as well as planning and organization. These are the very functions that are impaired in persons with Attention Deficit Disorder. PET scans are considered to be very invasive because they involve the injection of radioactive material into the individual and therefore are not appropriate for diagnostic purposes. To date only two studies of Attention Deficit Disorder using PET scans have been conducted.
Attention Deficit Disorder may be either inherited or acquired. Recent research in genetics has definitely shown that Attention Deficit Disorder runs in families. The specific chromosomes that are involved have not been fully identified though more clues are being discovered as research progresses. Like many other disorders, a child may have the symptoms while his parents may not. Usually there are aunts, uncles, grandparents or cousins with the disorder.
Attention Deficit Disorder may be acquired through various conditions that cause insult (damage) to the brain. During pregnancy and delivery these include the use of drugs during pregnancy, toxemia, infectious diseases, overexposure to radiation, prematurity, complicated delivery. After birth these include meningitis, encephalitis, seizures from fever, head injury and lead toxicity. Excessive use of sweets does not cause Attention Deficit Disorder though it may make the symptoms worse for some individuals who already have the condition
Since many children with Attention Deficit Disorder appear to "outgrow" the condition it can also be looked at as a developmental disorder. Some children seem to develop the ability to pay attention and concentrate later than others just as there is a wide range to timing for developing the ability to walk, talk or be potty trained. In the past, children with Attention Deficit Disorder and other learning disabilities were labeled as "underachievers" in their younger years and then reclassified as "late bloomers" when their development in this area finally caught up with their peers.
Today, many adults look back and realize they had a learning disability or Attention Deficit Disorder as a child which they may or may not have been able to overcome. Some people with Attention Deficit Disorder become very successful. However, others continue to have significant symptoms as adults. Some were not able to adapt or compensate on their own and did not receive any help from teachers, parents or professionals. These individuals often dropped out of school and may today be social drop outs of one kind or another. It is for this last reason that children who exhibit signs of Attention Deficit Disorder or learning disabilities should receive all the help necessary and available to spare them the frustration and anguish often associated with these conditions.
Medication
Medications such as stimulants have long been employed in the treatment of Attention Deficit Disorder. These medications are presumed to improve a chemical imbalance in the brain which is causing the symptoms. The PET scan studies do show that the brain functioning of Attention Deficit Disorder patients does improve and appears to be more like the normal group after they have taken their prescribed medication.
Medications usually used to treat Attention Deficit Disorder stimulate the production of two neurotransmitters known as dopamine and norephinephrine. Specific neurotransmitters (brain chemicals) are necessary to carry a nerve impulse (message) along a neuropathway (circuit). When a neurotransmitter is under supplied, a message may be stopped short of its intended destination. When this happens, the function regulated by that circuit may not work as well as it should.
Brain circuits, like those of a computer are either on or off. When some circuits are on they make something happen such as helping a child focus on a learning situation. When other circuits are on they prevent something from happening. For instance, some circuits prevent emotional reactions to situations. If the circuit is not on or only partially on, the child may react too quickly to a minor incident which may lead to a temper tantrum.
Medications that treat Attention Deficit Disorder are not tranquilizers or sedatives. They do not slow down the nervous system. They actually stimulate various areas of the brain to be more active so that the attention and concentration functions and the self-control functions work better. The use of stimulant medications helps to keep the circuits on when they should be turned on.
Most individuals who are treated with medication take Ritalin (a psychostimulant). This drug appears to be very beneficial for many who take it. Though Ritalin has received much bad press, it is actually a very effective form of treatment and is relatively safe. When Ritalin does not work or there are contraindications for its use, other amphetamine drugs may be used. Also, antidepressants and beta blockers have proven to be effective with certain individuals. Medication is the most frequently employed treatment method for Attention Deficit Disorder. It is often employed along with psychological techniques such as behavior modification and patient/family education.
Diet and Nutrition
Scientific research does not support the use of diet and nutrition in the treatment of Attention Deficit Disorder. At one time, the Fiengold Diet was very popular and seen as an alternative to medication. However, when subjected to double blind research studies, the diet did not prove to be effective. The elimination of sweets may help some individuals to reduce the symptoms but is usually not sufficient to adequately control the symptoms. Common sense, however, would dictate that a good diet and nutrition are suggested for the well being of any individual.
One substance, L-Tyrosine, which is an amino acid (protein), has been demonstrated to be effective in some cases. This natural substance is used by the body to synthesize (produce) norepinephrine (a neurotransmitter) which is known to be elevated by the use of amphetamines. More research is needed to definitely establish the efficacy and safety of using this protein as a drug in the treatment of Attention Deficit Disorder. Many new "natural" products have been recently introduced into the market as "cures" for Attention Deficit Disorder. At the time of the publication of this manual, there have been no controlled scientific studies conducted that substantiate the claims of these products. Also, just because a substance is "natural" does not mean it is safe. Many poisons come from naturally occurring substances. Furthermore, there is no scientific basis for the claim that chiropractic adjustments can "cure" or even help Attention Deficit Disorder.
Psychological Treatment
Traditional child psychotherapy, such as play therapy or non-directive talking therapy, has not proven to be effective in the treatment of Attention Deficit Disorder nor has traditional family therapy. Providing individual psychotherapy for one or both of the parents also does not work. Research has demonstrated that modern psychological treatment methods, especially behavior modification, cognitive behavioral therapy and relaxation training can have a positive effect. In some studies, one or several of these techniques used in combination have proven to be as effective as medication in reducing Attention Deficit Disorder symptoms. Counseling is used not to provide treatment but to provide education for the child and the family to help them better understand the disorder and how to cope with it. Counseling may also be used to help build self-esteem that has been damaged as a result of having Attention Deficit Disorder.
Modern psychological treatment methods can result in actual changes in mental functioning When there are changes in mental functioning (how we think and process information) there are corresponding changes in brain function. Changes in brain function then results in changes in brain metabolism (how and where the brain is chemically active). Thus, mental functioning and brain chemistry can be altered without the use of medication. Even more important, some of the newer research indicates that changes in brain functioning with the resulting changes in brain chemistry, remain permanent over time. These studies emphasize the importance of using psychological methods in treating Attention Deficit Disorder either alone or in conjunction with medication.
Some children with Attention Deficit Disorder experience significant problems socializing with peers and cooperating with authority figures. This is because when children have difficulty maintaining attention during an interaction with an adult, they may miss important parts of the conversation. This can result in the child not being able to follow directions and so called "memory problems" due to not listening in the first place. In this case, the child is not being disobedient or "strong willed" though they may be labeled as such. When giving directions to Attention Deficit Disorder children it is important to have them repeat the directions to make sure they have correctly received them. For younger children with Attention Deficit Disorder, the directions should consist of only one or two step instructions. For older children more complicated directions should be stated in writing. For more help with discipline check out the [Parenting Skills] section of the CDI Store.
Children with poor attention and concentration often miss important aspects of social interaction with their peers. When this happens, they have a difficulty time "fitting in." They need to focus in on how other the children are playing with each other and then attempt to behave similarly. Attention Deficit Disorder kids often enter a group play situation like the proverbial "bull in the china closet" and upset the play session. As they improve their ability to attend and concentrate, Attention Deficit Disorder children can be coached on how to play appropriately with other children.
Attention Deficit Disorder children may have poor impulse control. This can result in several different problems during play time. First, they may have difficulty stopping a behavior once they have started. They may also carry the behavior to a level of intensity that is too much for the average child. This can even happen when the child is engaged in "horse play" with an adult. They often get "carried away" and don’t know when to stop. This can result in negative feelings among those playing and make the others involved not want to play with the Attention Deficit Disorder child.
Sometimes an Attention Deficit Disorder kid will complain that when he gets into trouble at school that "all the other kids were doing the same thing and I was the only one that got in trouble." When you understand how an Attention Deficit Disorder child functions it’s possible to see how that may actually be close to the truth. Imagine that the teacher has left the room for a few moments. The class decides to take advantage of the situation and "mess around." When the teacher returns, the class sees her and they immediately stop what they are doing. On the other hand the Attention Deficit Disorder child may not immediately see the teacher enter the room and when he does is not able to immediately stop the inappropriate behavior. The teacher then reprimands him for not stopping. The Attention Deficit Disorder child feels singled out and picked on by the teacher and feels he is being treated unfairly.
When properly treated through a psychological treatment program such as Focus with our without medication, children and adolescents with Attention Deficit Disorder can lead very normal and productive lives. In fact, many traits found in individuals with Attention Deficit Disorder can help them to become very successful later in life. It should be noted that a loving, supportive and consistent environment is essential for the positive growth and develop of all children and especially those with Attention Deficit Disorder or other learning disabilities. People with Attention Deficit Disorder tend to have average or above average intelligence. They are often very creative and usually have a high energy level. These individuals also are frequently very sensitive and highly affectionate.
Research shows that some children with Attention Deficit Disorder will eventually improve their ability to pay attention and concentrate whether they receive treatment or not. Their ability for self-control also improves. It is interesting that often children will require less medication as they get older. This may mean that the brain gradually is able to produce more of the needed neurotransmitters on its own without the help of medicine. However, some children seem to have increased difficulty with academic achievement around the fourth grade. This may be due to the requirement for a higher level of organization and planning skills which they do not have. Because no one can predict how a child’s Attention Deficit Disorder will progress, it is important that children who have difficulties with attention, concentration and impulse control, receive early intervention. Psychological treatment such as that provided by Focus is most important because of it’s lasting effects. Medication may also be useful in some cases.
In the last few years, it has become more likely for adults to be diagnosed with Attention Deficit Disorder and start on medication. These may be individuals who were not properly identified when they were children. In other cases, adults have learned to compensate for their disorder and become very successful individuals. In fact, some may "over compensate" and become extraordinarily successful.
Modified from http://www.cdipage.com
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