ADD/ADHD

ADD /ADHD

Information by: T J Price, Psy D


GENERAL INFORMATION ABOUT A.D.D. and A.D.H.D:

Is ADD/ADHD a sickness?

Attention Deficit Disorder (ADD), with or without Hyperactivity (the H), is a condition that almost all people, who truly have ADD, have from birth.  It is not something that is “caught” from another person.  It is not something that a person can just “try harder” to overcome.  Children with ADD can make life difficult for everyone around them and themselves.  While it seems they are deliberately ignoring or flouting everyone else’s needs and wishes, a more accurate understanding is that they can’t sit still, pay attention, or follow instructions as most other people their age can.

It is a condition that professionals have been trying to fully understand for decades.  Until recently, we have not been very successful in treating the condition.  More about treatment, later.  To understand it, it may be helpful to think of the world of computers.  There are old 8086’s, 286’s, 486’s, and Pentiums.  Each has its own speed built into it.  True ADD is a “hardware” type of condition, not a type of software.  Changing the software, or the information input, does not affect how fast the computer works, or what its limits are.

I have heard it said, jokingly, that a more appropriate name for ADD would be Intentional Deficit Disorder.  There is some truth to that; it often seems as if everything out there in the world catches the person’s attention and it is those voluntary, intentional tasks that suffer the most.  Another way to understand this; we all have 100% of the attention we have. But, some people lack the neural ability to harness that attention to what really matters at the moment (an Executive Function of the brain).

Is ADD/ADHD New?

Let’s discuss what ADD actually is.  To begin with, as you may or may not know, the name of this disorder has changed over the years as our understanding of the condition has increased.  ADD/ADHD in children is by no means a new disorder.  The constellation of symptoms:   INATTENTIVENESS, IMPULSIVITY, and HYPERACTIVITY were first recognized in the beginning of this century.  The name changes seem to reflect what research understood at those times as to what was believed to be the predominant feature of the disorder.  For example, in the first part of the century, the disorder was referred to as Minimal Brain Damage, and then Minimal Brain Dysfunction.  Later, terms such as “Brain Injured Child Syndrome” and “Hyperkinetic Reaction of Childhood” were used to reflect the belief that these symptoms were related to brain functioning and specific patterns of maladaptive behavior.  Later research uncovered that brain damage was not the significant feature or even necessarily the cause of ADD symptoms. Then over-activity and inattentiveness became the core focus.  In the latest edition of the DSM-IV  (which is a manual used by medical and mental health professionals to identify psychiatric, learning and emotional disorders), the term “ADHD” or “ADD” has been adapted to refer to Attention Deficit Disorders with or without Hyperactivity (the “H”).  I present this information because quite often, as parents gather information about Attention Deficit Disorder, it can be confusing to encounter the many names that have been used to describe the disorder.  It sometimes helps to point out that these terms are all referring to the same problem.  Based on the term used, it helps us know approximately when the material was written.

How Common is ADD/ADHD?

Approximately 3 to 10% of school age children have an attention-related disorder, which is 2 million children, or more.  ADD/ADHD affects children from virtually all cultural, socio-economic and racial backgrounds and has been diagnosed on children of all levels of intelligence.  The disorder seems to occur more in males than females, with a ratio of about 4:1 males to females in the general population, and 9:1 ratio in clinical populations.  Girls with attention related disorders may actually be under diagnosed, as their problems tend to be more related to inattention (which does not grab the attention of adults) whereas boys tend to show more symptoms of hyperactivity.  Recent research indicates that the disorder is increasingly diagnosed in girls.  In addition,  ADD/ ADHD symptoms tend to persist into adolescence, with 66% to 80% of individuals who were diagnosed with ADD showing some signs of the disorder in adolescence.  Generally, in 1/3 of the cases, symptoms persist into adulthood.  Also, research suggests that the disorder is more common in first-degree relatives of individuals with ADD/ADHD, suggesting that there may be a hereditary link.  The latest research suggests that it is not a disorder of attention, per se.  Rather, it appears to be more accurate to view the disorder as a developmental failure in the brain circuitry that underlies inhibition and self-control.  This difficulty with self-control impairs other important brain functions crucial for maintaining attention (including the ability to delay gratification to allow for later, greater benefits).

A Developmental Disability

Therefore, ADD/ADHD is a developmental disability characterized by symptoms of inattentiveness, impulsivity, and hyperactivity which are considered to be maladaptive and inappropriate for the child’s age or stage of development.  While not all children with ADD/ADHD show all of the symptoms, these children do exhibit some characteristic behavior patterns that lead to a diagnosis of the disorder.  The essential feature is a persistent pattern of inattentiveness/hyperactivity and/or impulsivity that is more frequent and severe than is typically observed in children of the same age (developmental level).  Children who have ADD/ADHD are easily distracted and have trouble maintaining their attention on what they are doing.  Completing tasks, whether schoolwork or household chores, are proven areas of difficulty and, as a parent, this can be an area of constant battling.  ADD/ADHD children also have difficulty waiting their turn in activities, following directions, and tend to talk excessively while not seeming to listen when others are talking to them.  In addition, they can become easily frustrated when they cannot complete a task, especially homework or tedious chores.

Behavioral Progression of ADD/ADHD

These symptoms of inattention, hyperactivity and impulsivity change over time as the child develops.  It is usually during the preschool years that parents and teachers tend to first notice that the behavior is not typical.  During this time, the child’s excessive activity and noisiness tend to exceed that of classmates, sometimes to a great degree.  As the child gets older, fidgeting while sitting and talkativeness seem to be more apparent.  As ADD/ADHD children advance through the elementary school years, they seem to demand more attention, both at home and at school.  Sometimes, noncompliant behavior becomes a problem.  By adolescence, large motor activity is seen less often and restlessness and talking out of turn become more prevalent.  In addition, adolescents with ADD/ADHD may have difficulties at school, problems with peers, and many parents become concerned about the child’s self-control and judgment when away from home.  We can use the word “HID” to remind us of the order of the sets of symptoms people tend to outgrow.  The H stands for the gross Hyper-activity which is usually outgrown first.  The I stands for Impulsivity which many develop out of next.  Finally, the D is for Distractibility, which tends to be the last constellation of symptoms out of which people develop.

Problems at School

ADD/ADHD creates obstacles that interfere with a child’s ability to succeed in school – both academically and socially.  In fact, it is the emergence of school-related problems that usually prompts parents to have their child evaluated, often at the suggestion of the child’s teacher.  Because a child is faced with more demands and tasks that require persistence at school, than at home, his or her inattention, impulsivity and hyperactivity may be more readily apparent in a school setting.  Numerous activities encountered routinely in school pose problems for a child with ADD/ADHD.  Some of these include: starting and successfully completing tasks, being able to transition smoothly from one task to another, interacting with other children, following directions, performing at a consistent level and organizing tasks which require several steps.  Therefore, children with an attention related disorder frequently experience academic difficulties.

Other Problems Associated with ADD/ADHD

Children with ADD/ADHD very often have additional, or secondary, problems.  ADD/ADHD children often experience problems with their peers, as their behavior tends to be intrusive, uncooperative or aggressive.  They may have Learning Disabilities, mood disturbances (such as depression or anxiety), or behavior disorders, like Oppositional Defiant Disorder.  For example, about 60% of children with a learning disability also have ADD/ADHD and over 50% of ADD/ADHD children also meet the diagnostic criteria for Oppositional Defiant Disorder.  Moreover, the combination of poor school performance in addition to social problems can lead to the development of low self-esteem.

Treatment

There is no known “cure” for ADD/ADHD, but while it may not be easy to “cure” the condition, there is a lot of good news.  Of those people who show enough symptoms to have the diagnosis of ADD in early childhood, about 1/3 “mature” out of the condition by adolescence and another 1/3 of people “mature” out of it by early adulthood.  I use the term “mature”, which includes brain development and maturing, learning of self-management skills and sometimes finding or setting up an environment that is more conducive to success for people with ADD.
There are several medications that help reduce symptoms – while the person is regularly taking them.  Parents and teachers can do many things to increase socially acceptable performance.  There are specific self-management skills that people with ADD/ADHD can learn.  The bulk of the research indicates that a multi-modal treatment approach works the best.  That entails education, working with parents and teachers, changing the person’s environment, changing how family members act and react with the person, engaging the person in self-management training, social skills training, possibly group interventions, and often, use of effective medication.

And, don’t forget, laws in the U.S. state that it is a child’s right to be supplied the education that he or she needs, in the manner he or she needs it.  School personnel, by law, need to cooperate with parents and assess and provide an educational experience that matches the needs and abilities of each child.

Above adapted from a compilation of work by
John Taylor, Russell A. Barkley, Paul H. Wender, and Cindi Hays.

A recent development:  a “State of the Art” neuro-feedback coaching/training system called PlayAttention is now available, and is found to help a person improve his/her ability to pay attention, better ignore distractions, and complete a task. This is accomplished by training the Central Nervous System and strengthening the neural networks involved in paying focused attention on a task.

Revised 5-11-15,  T J Price, Psy D