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AD/HD, or Attention Deficit/Hyperactivity Disorder, is a neurobiological condition affecting children and adults that is characterized by problems with inattentiveness, impulsivity, and hyperactivity. Research suggests that AD/HD is one of the most common disorders found in children, totaling 30% to 50% of child referrals to mental health services. AD/HD is the current diagnostic label for a condition with long history of research and study. The nomenclature AD/HD as an identifiable diagnostic category came about in the late 1960’s. Prior to that time, AD/HD has been known by several other names, such as “super-active,” "brain damaged syndrome," "minimal brain dysfunction," "hyperkinetic impulsive disorder," and "attention deficit disorder (ADD)."
For many people, however, AD/HD is not a disorder, but a trait, a way of being in the world. If it impairs one’s life, it can be a disorder; if one learns take of advantage of its benefits, it can be a gift. A good analogy is that having AD/HD is like having a turbocharged car in your brain. If you manage it by taking certain specific steps, you can take advantage of the benefits while avoiding the disasters it has the potential to create.back to top |
There are no definitive answers; however, research has demonstrated that AD/HD has a very strong neurobiological basis; and, as such, it is classified as a neurobiological disorder since it is caused by problems in the dopamine neurotransmitter in the brain.
Contrary to the popularly held views, research does not support the fact that AD/HD arises from poor parenting, drugs, excessive sugar intake, food additives, excessive viewing of television, allergies, or social and environmental factors such as poverty or family chaos.
Most AD/HD cases are genetically influenced (not determined). Although precise causes have not yet been identified, there is little question that heredity makes the largest contribution to the expression of the disorder in the population.
In instances where heredity does not seem to be a factor, difficulties during pregnancy such as a lack of oxygen, prenatal exposure to alcohol and tobacco, premature delivery, significantly low birth weight, excessively high body lead levels, and postnatal injury to the prefrontal regions of the brain have all been found to contribute to the risk for AD/HD to varying degrees.back to top |
The National Institute of Mental Health (NIMH) estimates that AD/HD affects 3% to 5% of school age children. NIMH also stated that AD/HD occurs three times more often in boys than in girls. It is also believed that between 2% to 4% of adults are affected by AD/HD. According to the Center for Disease Control and Prevention, nearly 7% of elementary-aged children in the United States have been diagnosed with AD/HD. If these estimates are accurate, it means, in every classroom with thirty children or more, there is at least one child, and as many as two, affected by this symptom. back to top |
When the person’s brain is not receiving adequate neuro-chemicals, it tries to find other ways to increase their release. The most common ways that people with AD/HD stimulate their brains is through movements, namely, physical activity, doing things that cause stimulation, or focusing on things that are stimulating in themselves. This is the reason why children with AD/HD can be disruptive in the school classrooms, when in fact they are only trying to stimulate their brains to feel their sense of existence. Given this, it is not unusual to find people with AD/HD to engage in reckless or dangerous activities for stimulation with potential for physical and legal consequences.
In general, when discussing difficulties associated with AD/HD, many of them usually are related to “executive functions” of the brain. The deficit in inhibition, which is the core problem of AD/HD, impairs the development of executive functions, which are important in overall management of the brain enabling people to perform both routine and creative work, as well as to maintain control and accomplish goal-directed behaviors. Apparently, in children with AD/HD, some of these executive functions are developmentally delayed compared to other children without AD/HD of the same age. This is why children with AD/HD tend to focus only on items that interest them, and disregard all other less interesting items -- reasons why these children with AD/HD often run into additional problems such as academic underachievement, lack of social relationship, etc. back to top |
AD/HD diagnosis is based not upon the presence of AD/HD-like symptoms, which most people display from time to time, but upon the “intensity” and “duration” of the symptoms, as compared to a group of child’s peers. So if your child is intensely distractible, and has been for long time, a professionally conducted diagnosis will be helpful.
Another benefit of diagnosis is learning about AD/HD, which is crucial and highly therapeutic, as it allows everyone involved to reframe the problem in a medical, rather than moral or judgmental, context. This also facilitates the hard work of learning structures and strategies to cope with AD/HD to begin in honest with everyone’s support. back to top |
It depends on whose point of view. In some places, it seems children who display normal children-like symptoms (being highly active) get diagnosed with AD/HD. At the same time, there are places where doctors refuse to make the diagnosis because they don’t believe in AD/HD. What is important is to keep an open mind to this issue for greater understanding, so that both over-diagnosis and under-diagnosis can be resolved. back to top |
Unfortunately, there is no simple test (like a blood test or a short counseling session) to determine whether your child has AD/HD. Accurate diagnosis is made only by a trained clinician after an extensive evaluation. This evaluation should include ruling out other possible causes for the symptoms involved, a thorough physical examination, and a series of interviews with the individual (child or adult) and other key persons in the individual's life (for example, parents, spouse, teachers, and others). back to top |
Many books have a list of AD/HD symptoms and criteria for AD/HD determination. You must be VERY CAREFUL. Those checklists determine only if you have the symptoms, and do not determine what the cause of the symptoms is. To find out if you or your child has AD/HD, you will need a diagnosis from a knowledgeable professional who is trained in differentiating between the causes of the AD/HD symptoms, such as pediatrician, neurologist, psychiatrist, psychologist or other properly licensed mental health provider who has experience evaluating and treating individuals with AD/HD. This is VERY IMPORTANT. back to top |
This can be confusing. Tersely put, this is just a matter of “nosology,” the classification of disorders. Today, we refer ADD as a subset of AD/HD. Regardless of whether one has ADD or AD/HD, it is a long-recognized condition that has not always been called the same thing (read, “What is AD/HD?” in FAQ). In the past, different labels have been used for what we now call attention-deficit/hyperactivity disorder (AD/HD).
So, what happened, and how is ADD connected to AD/HD?
The American Psychiatric Association publishes the official guidelines for naming and diagnosing mental disorders. This guideline, called "Diagnostic and Statistical Manual of Mental Disorders" or DSM-IV, is regularly updated as researchers and scientists make additional discoveries. Researches made in the 1970s through 1980s showed there are different types of attention deficit conditions. Although these had major differences, the researches showed they were more alike than different, and were all part of the same major condition. As a result, in 1994, the DSM changed the name ADD (attention deficit disorder) to AD/HD, and further defined the symptom in three types:
(a) inattentive,
(b) hyperactive/impulsive, and
(c) combined.
Given this, many healthcare professionals still use the term ADD, and if that is the diagnosis your child has received, it means s/he has the inattentive type of AD/HD. The inattentive AD/HD type is who seems to be easily distracted, daydreaming, forgetful and disorganized. It simply means that your child has ADHD without symptoms of H. ADHD without hyperactivity ore impulsivity is more common among girls.
On the other hand, the hyperactive/impulsive child, the one who is overly energetic and can’t sit still, may have ADHD with symptoms of “H.” back to top
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Teachers and other school personnel without medical training are not qualified either to diagnose a medical condition or suggest specific treatments for addressing that medical condition. In general, only a physician (M.D. or D.O.) who is properly licensed may prescribe medications used to treat AD/HD. Because AD/HD is a medical condition, it should be diagnosed by a pediatrician, neurologist, psychiatrist, psychologist, clinical social worker, or other properly licensed mental health provider who has experience evaluating and treating individuals with AD/HD. Further, some symptoms of AD/HD may be symptoms of other conditions, as such it is essential that you consult a trained professional and obtain a thorough evaluation and formal diagnosis for your child. back to top |
First of all, it is reported that as many as 90% of children with AD/HD diagnosis receive medication at some time, mostly psycho-stimulant medication. The reason is that many scientific studies have shown that certain psycho-stimulants such as methylphenidate (Ritalin), amphetamine compounds (Dexedrine, Adderall), and pemoline (Cylert) are effective in helping children with AD/HD in the short-term.
The most commonly used medications are the stimulants such as Ritalin and Adderall, or their long-acting equivalents, such as Concerta, Ritalin LA or Adderall XR.
The non-stimulant amantadin, bupropion (Wellbutrin), and *Strattera have been used to in treating AD/HD.
The studies have shown that for about two-thirds to three-quarters of medicated AD/HD children, stimulants improve their classroom behavior and performance, such as reduced class disruption, improved peer relationship, increased compliances, in addition to improved academic productivity.
Bottom line: You should never take medication until you understand the facts and only if you feel comfortable doing so. In addition, it is very important to consult with a medical doctor who has experience prescribing them, as subtle adjustments can make a big difference. back to top |
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When a child is positive responder to stimulants, the improvements in the classroom are generally quiet large and immediate. The beneficial effects may even extend beyond the classroom, including the home setting (increased compliance of parent requests) and recreational setting (improvement in behavior).
It is important to note, however, there are very large individual differences in the degree of responsiveness that children with AD/HD show to stimulant drugs such as Ritalin, Adderall, Dexedrine, and Cylert. Some children show substantial improvements, while some improve little or not at all. For this reason, it is critical that medication effects be carefully measured by the medical professionals to make certain that each child receives the appropriate type and dose of medication.
It is documented that approximately one-quarter to one-third of AD/HD children do not show positive responses to stimulants. These children either have no response or have adverse responses to medication.
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This issue basically should be determined by you, the parents of AD/HD child, with advice of medical professional. Based on reports from “Center for Children and Families” at SUNY-Buffalo, there are no proven long-term benefits of psycho-stimulant drugs as the sole treatment for AD/HD. For example, studies have shown that if medication is the only treatment a child receives, he or she will not show any more improvement in daily-functioning skills as a teenager or young adult than a child who never received treatment. Given this, the current prevailing professional belief is that medication should be given along with behavioral treatments for more effectiveness. back to top |
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This is where you must consult medical professionals, given there are large differences in the way individuals respond to stimulant drugs.
Most common side effects which are documented are: Appetite suppression and insomnia. Other reported reactions that can occur include: nausea, stomach-aches, headaches, elevated blood pressure, skin rashes, anxiety, drowsiness, lip smacking, irritability, dizziness, nail or cheek biting, muscle twitches/tics, and social withdrawal. Hallucinations have been reported, but rarely, and only at very high doses. It has been also reported that the stimulants can cause zombie-like problems with thinking process in some children which may decrease academic performance.
Many of these symptoms either disappear within a few days or can be managed by reducing the dosage. In some cases, stopping the medication altogether causes the symptoms to disappear. Simply put, each individual responds differently.
It is worth noting that a reduction in normal height and/or weight gain has been reported in some children with long-term application of stimulants. Among professionals, there is a disagreement concerning the overall long-term effects, as some reports have shown that children have a period of catch-up growth once the medication use is discontinued. The current practice of using relatively low dosage and minimizing the medication (e.g., only for school hours and severely reduced dosage on vacations or weekends), is intended to reduce this type of problem. back to top
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According to the Info Sheet for AD/HD medication produced by University of Buffalo, “some media claims about negative effects of these [stimulant] medications are untrue…stimulants do not cause children to become suicidal or homicidal…children…do not become psychologically reliant upon their medication or physically addicted to it, and it does not appear to cause long-term problems with drug use. However, stimulants are potentially abusive drugs” and therefore require professional’s guidance. back to top |
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Currently, there are no medications approved by the FDA besides the *stimulant medications to treat ADHD. It is reported that “other” medications used by some people (e.g., various antidepressants and clonidine) produce considerably less beneficial effects on AD/HD symptoms, without reciprocating reduction in risks and side effects, compared to the stimulant drugs. Further, combinations of these “other” drugs with stimulants are not approved, given that the safe use of combination approaches has not been demonstrated. For this reason, medical professionals recommend that AD/HD child be tried on all forms of stimulant medication before being treated with any other class of drugs.
If your child fails to respond or has prohibitive side effects to all stimulants, “other’ medication maybe considered, but the risks associated with those drugs must be carefully evaluated against the benefits obtained under the full auspice of the medical professionals.
* Non-stimulant medication Strattera is approved for use in adults. Dr. Edward M. Hallowell, the author of “Driven to Distraction” and “Delivered from Distraction,” states that Strattera is not as effective as hoped given the length of time to reach a high enough dose, and the fact that it fails to effectively relive symptoms, as well as burdensome side effects. Dr. Hallowell has found atypical antidepressant Wellbutrin to be a more useful non-stimulant medication. He also feels Amantadine may work very well for AD/HD. It is absolutely important that one obtains medical professional’s advice on any of these medications. back to top
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Remember, AD/HD is a medical condition and the school staff is most likely not trained or qualified to diagnose AD/HD. Yet, it is important to recognize the fact that school maybe communicating the impact of certain AD/HD symptoms on your child’s behaviors which confront them on daily basis. As such, if you or other adults in your child's life believe likewise, you should consult with your family doctor or other licensed medical/mental health professional who is trained in the diagnosis and treatment of AD/HD. It is also important to know that teachers and other school personnel’s evaluation of your child's learning ability or deficit is an important part of the comprehensive evaluation done by the medical/mental health professional. back to top |
No. Intelligence and AD/HD are two separate matters. It is possible to be intellectually gifted and have AD/HD, and vice versa. What is important to recognize is that AD/HD impacts academic performance, regardless of your child’s intelligence. back to top |
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In addition, there are other sites that dedicate their resources on AD/HD:
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It depends. One size does not fit all and if the treatment doesn’t seem to work, change it.
The best approach is individualized and comprehensive specifically designed for one’s particular situation and needs. Generally speaking, a good comprehensive plan should include diagnosis, identification of strengths, life-style change (reduce TV), education on AD/HD, structure, counseling such as coaching or psychotherapy, physical exercise, medication, and other therapies that can augment (or even replace) the medication such as stimulation of the cerebellum, nutritional interventions, etc.
Most professionals believe that combination approach of using both strong psychosocial (non-medical) component and medication is most effective. The scientific literatures on treatment for AD/HD from National Institute of Mental Health and among others state that both psychosocial treatments (another way of saying behavioral modification) and stimulant medication have a solid base of evidence for short term effectiveness. In fact, behavior modification is the only non-medical treatment for AD/HD with a large scientific evidence base (Center for Children and Families at University of Buffalo, SUNY). back to top |
The problems faced by AD/HD children go beyond their known symptoms: Inattentiveness, hyperactivity, and impulsivity. Most children with AD/HD have problems in daily life functioning that most people take for granted such as academic performance, social relationships, family relationships, etc. How well children with AD/HD perform in these areas predict how well those children will do in adulthood. As such, the behavioral treatments focus on these life-related problems rather than the core AD/HD symptoms.
In addition, unlike medication, behavioral treatments teach skills which are useful for children’s lifetime in overcoming their impairments, given that AD/HD is a chronic condition.
Lastly, the medication treatment alone has not been shown to improve long-term outcomes for children with AD/HD, further evidencing the importance of behavioral treatments. Studies have shown that if medication is the only treatment a child receives, he or she will not show any more improvement as a teenager or young adult than a child who has never received treatment. back to top |
Most professionals believe that treatments should be started when the child is as young as possible. There is a consensus that starting early is better than staring later. back to top |
Behavioral treatment is where children are taught skills (in our case by our Smart Coach) to employ certain skills in their daily functioning in key areas such as how to on social relationship, classroom behaviors, etc. The children with AD/HD employ these skills in their interaction with other children who are in the SmartCoach class. back to top |
Traditional individual therapy where a child spends time with a therapist with focus on discussing problems is not behavior modification. A family therapy with therapist discussing family dynamics also does not qualify as behavior modification. Behavior modification’s primary goal is to teach certain skills. The therapies do not. back to top |