by Steve York

A recent conversation in my mind:

It's time for the next newsletter. How about an article on Attention Deficit Disorder? We've got plenty of information about it here at the MARE office, so it shouldn't be a problem.

 

I've read some of the materials and now it's time to start writing. (Very long pause) How long will I stare at this blank page? I'm easily distracted by paperwork and other projects.

 

Write the article.

 

My desk could use a good cleaning. How about catching up on some reading?

 

Write the article.

 

I could reorganize some files and clean up the hard drive on my computer.

Write the article.

What could really be described as a recent bout of "writer's block" gave me a very small inkling of what people who cope with Attention Deficit Disorder must feel on a regular basis. Unfocused, easily distracted, and agitated, the irony of trying to write about Attention Deficit Disorder was not lost on me as I attempted to put my thoughts on paper.

Attention Deficit Disorder, with or without hyperactivity (AD/HD), is characterized by various problems which impair a child's ability to regulate his or her behavior. These children generally have problems in a few key areas. One such area is inattention, or difficulty focusing on activities for the amount of time needed to complete them. AD/HD children may also exhibit distractibility and impulsivity. They do not seem to think before they act or consider the consequences of their actions. They can have difficulty following rules and instructions, and may appear to be over aroused, overactive, and unable to sit still for more than short periods of time.

AD/HD affects three to five percent of children in the U.S. with boys outnumbering girls by at least a three to one margin. A large number of children with AD/HD perform below their academic potential, while 20 to 30 percent may have learning disorders in addition to AD/HD. Children with AD/HD may also be at risk for other disorders. Nearly 25 percent of children and adolescents with AD/HD display antisocial behaviors and Conduct Disorders.

Three specific subtypes of AD/HD are defined by the Diagnostic and Statistics Manual published by the American Psychiatric Association. The predominantly inattentive type defines those who are primarily inattentive, though not hyperactive and impulsive. These children have displayed six or more symptoms of inattention which have persisted for at least six months. The predominantly hyperactive-impulsive type defines those children who are primarily hyperactive and impulsive, though not inattentive. Six or more symptoms of hyperactivity-impulsivity have persisted for at least six months. The combined type defines children who are both hyperactive-impulsive and inattentive. It is the combined type that make up the majority of AD/HD cases in children.

It is possible to distinguish AD/HD in children, even toddlers. The AD/HD child may be more difficult to contain and may display excessive movements. These symptoms may intensify by the time the child reaches elementary school. The child may exhibit bossiness, stubbornness, and temper outbursts. The inattentive child may have difficulty staying focused in the classroom and perform poorly in school. The impulsive AD/HD child may become a negative focus on the family and other relationships.

Hyperactivity and impulsivity are the behaviors that parents and clinicians try hardest to modify and alleviate. These two temperaments generally appear simultaneously in children of AD/HD, combined type, or AD/HD, predominantly hyperactive-impulsive type.

There is no standard psychological test which will accurately determine whether a child is hyperactive or not. While there are specific behaviors to look for in making a determination of hyperactivity, it is not clear what is considered as differing from the norm. Hyperactivity tends to be present during situations in which concentration, attention, and delaying impulses are necessary, often in public places.

Impulsive children have more difficulty than other children in delaying and controlling their behaviors. They generally respond quickly but inaccurately to the tasks and social situations in their lives. Impulsive behavior stems from acting before thinking. It does not necessarily mean that a child does not know how to behave; it is just that the child acts too quickly without thinking about prior learning.

The following symptoms can be used as indicators of hyperactivity and impulsivity in children:

• unfocused behavior or behavior that is not goal-oriented
• increasing areas of movement; not being able to keep activities to a confined area
• unlimited energy
• acting without drawing upon previous experience
• tics and/or excessive involuntary motor activity
• difficulty with peer interactions
• difficulty inhibiting responses

Assessing AD/HD

Parents and/or teacher who suspect that a child is exhibiting AD/HD symptoms should initiate an assessment process in order to make an acurate diagnosis. Assessment of hyperactivity and AD/HD is multidimensional and takes place in the home, school, and therapist's office. Four types of assessment procedures should be involved:

• Interviews - can provide a great deal of information about the child's behavior in his/her environment. Interviews naturally make the parents and teachers part of the treatment team by involving them early in the process.
• Rating scales - present additional opportunities to glean information from parents, teachers, and children and can help arrive at a diagnosis. Rating scales take relatively little time to administer and score and can be used in the ongoing evaluation of the child as treatment progresses.
• Behavioral observations - can help gather information to create and implement behavior modification programs at home and in school.
• Standardized psychological testing - can also play an important role in the diagnosis of AD/HD. This kind of testing provides information about the child's learning abilities and allows for the evaluation of neurologically based difficulties which may be present along with AD/HD.