ATTENTION DEFICIT HYPERACTIVITY DISORDER

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders, occurring in approximately 3% to 5% of children. It is characterized by inattention, impulsivity, and hyperactivity. Diagnostically, ADHD is divided into either the inattentive symptoms or the hyperactivity-impulsivity constellation of symptoms. Inattention usually involves difficulty with auditory attention, difficulty sustaining attention for prolonged periods of time, failure to listen, organizational problems, distractibility, failure to follow through and complete activities, and forgetfulness. Hyperactivity symptoms typically consist of excessive behavior, restlessness, squirming, difficulty remaining seated, inappropriate noises, and difficulty waiting turns. Typically, unless caused by accident or injury, these symptoms typically are present in younger children who are developmentally identifiable between the ages of 3 and 7, although it is difficult to discern children with ADHD from other children at much younger ages given their lack the of developmental maturation. Typically, children with ADHD begin to stand out in kindergarten, first or second grade when similar age peers are increasing their control over attention and concentration abilities, impulsivity, and over activity/fidgety behavior. It is for this reason that teachers often first identify ADHD symptoms when the demands of sitting in a structured class and focusing attention on academic tasks becomes challenging or impossible for some children.

Children with ADHD often do poorly in school and they are more likely to have other difficulties, such as speech and language impairments or learning disabilities. They have increased difficulties with peer acceptance and social behavior, and they are more than likely over time to become anxious and depressed as a result of the negative feedback which their environment delivers to them in response to their behavior patterns. Additionally, children with ADHD often develop oppositional tendencies, patterns of noncompliance, and sometimes develop aggressive and antisocial behavior.

Some professionals differentiate cognitive versus behavioral ADHD, given that some children with ADHD primarily evidence symptoms in the areas of inattention which interfere with learning and academic work, while other children with impulsivity and/or hyperactivity may develop other problems such as peer difficulties, non-compliance with adults, and aggressive or anti-social behavior during adolescence.

Given the sometimes extreme nature of the difficulties that children with ADHD encounter, there is long-term potential for more serious problems developing. Research has clearly documented that there is higher than average risk amongst ADHD children of developing substance abuse problems, depression, alcoholism, legal difficulties, and longer term behavioral problems.

It is generally understood that the discontrol of behavior in ADHD results from subtle neuroanatomical abnormalities (primarily in the frontal lobes) in children, often caused by either subtle trauma (i.e. birth trauma, anoxia seizure, illness, head injury, lead ingestion) or genetic/familial transmission . Other factors, such as the presence or absence of firm parental limit setting and structure in a child's life may exacerbate or contribute to the level of discontrol the child with ADHD experiences. And while significant psychological events in a child's life (i.e. environmental stressors such as family deaths, parental divorce, or other psychologically traumatic circumstances) may contribute to exacerbating Attention Deficit Hyperactivity Disorder symptoms, these factors are generally not considered to cause such problems.

EVALUATION OF ADHD

A variety of tests and measures have been developed to evaluate ADHD, and comprehensive assessment is always needed to ensure an accurate diagnosis. Given that symptoms of anxiety, depression, lack of behavioral limit setting, family dysfunction, and other environmental stressors can contribute to behavioral patterns which appear similar to those in ADHD, it is imperative that a thorough and detailed evaluation be conducted to avoid misdiagnosis.

Although the specific instruments used to evaluate ADHD may vary, there are a variety of domains of functioning which must be evaluated using different assessment techniques. These include (1) behavioral functioning via behavior rating scales; (2) direct observation of the child at home, school, or in the office; (3) accurate reports of child behavior in school and home environments; (4) objective measures of attention and impulsivity; (5) assessment of parenting abilities and discipline; (6) and a review of early developmental history, parental history, or family history of ADHD symptoms and; (7) a thorough evaluation of current symptomatology. A list of specific measures sometimes used to evaluate each of these domains is : Achenbach Child Behavior Checklist (teacher and parent forms), Connors Symptom Checklist, Werry-Weiss-Peters Activity Rating Scale, DSM IV diagnostic criteria, Child Depression Inventory (CDI) and Children's Manifest Anxiety Scale (to rule out affective disorders), continuous performance tests, Matching Familiar Figures Test, and the Freedom From Distractibility factor on the WISC-3.

TREATMENT

Treatments for ADHD are limited to medication, behavior modification programs, parenting interventions to create structure and provide limit setting, structured interventions and environmental manipulation in the classroom, and self control training. Additionally, social skills training can be helpful in cases where peer social difficulties are a co-occurring problem.

WHO SHOULD CONDUCT EVALUATIONS

While child psychiatrists will often evaluate children for ADHD using the DSM IV during a clinical interview, psychiatrists typically do not conduct full and comprehensive evaluations using the psychological assessment instruments identified above. School systems will often initiate and conduct evaluations using behavior checklists, sometimes performing psychological and intellectual testing, and will observe children in the classroom, but will not have the resources to evaluate other factors such as developmental history, family history of ADHD, direct observation of children and parents together, or screenings for depression and anxiety. Psychologists, typically practicing in outpatient settings, are usually trained to conduct clinical interviews, psychometric testing, intellectual testing, and observational methodology to comprehensively evaluate children with Attention Deficit Hyperactivity Disorder. Psychologists will often conduct a complete evaluation, and work with local pediatricians or child psychiatrists to rule out other medical causes or contributors to attentional, impulsive, or over-active behavior patterns.

For links to other sources of information, see:

     Misc. Information on ADHD/ADD-One ADD Place

     Publications and Information on ADHD

     General ADHD Information

     Children With Attention Deficit Disorder (CHADD) Self Help Organization

     Misc. Information on ADHD/ADD-Help For ADD