ADHD

Attention Deficit-Hyperactivity Disorder (ADHD)

Children, adolescents, and adults can be distractible, impulsive, or hyperactive for several reasons. Some of these reasons are

anxiety
depression
illness
developmental and learning problems, or
ADHD

ADHD is generally understood as a long-standing constitutional problem, that is, a problem the person was born with. Problems associated with ADHD begin to be noticed in early childhood. These behaviors can be noticed, but not at a level that creates significant problems for the child or others. Depending on the severity of the problem, they may not seriously impair a child's life until he or she faces greater demands on attention and self-control in elementary school or even later. A key feature of ADHD is a very significant degree of impairment of the person's life. Many children have mild or intermittent problems in this area, but do not receive or deserve the ADHD diagnosis. ADHD, when severe, can be a major handicap.

Some children have problems with attention which are not associated with hyperactivity or impulsive behavior. Such problems are often associated with slower cognitive processing, and a "dreamy" or "spacey" appearance. This has been called different names over the years, including "Attention Deficit Disorder without Hyperactivity," "Undifferentiated ADD," and, most recently, "ADHD - predominantly inattentive type." This type of ADD is thought to be a separate, distinct disorder from the ADHD with impulsive and/or hyperactive behavior. More research on the "inattentive ADD" without Hyperactivity is underway.

ADHD is diagnosed using a combination of procedures and data from more than one part of a child's life. It is important that it be carefully investigated. The diagnosis of ADHD requires a developmental history of the person's behavior at each developmental stage. A diagnostic interview is essential. Standardized behavior questionnaires completed by parents and teacher(s) are also necessary. I use several questionnaires developed through research on ADHD children, adolescents, and adults. There is no definitive "laboratory test" for ADHD; however, there are standardized tests of attention which aid in diagnosis. I use one of these, the Connors Continuous Performance Test, when appropriate. It can be hard to interpret the data from history, testing, behavior questionnaires, interviewing, and conversations with teachers, parents, and other data sources. One must be careful about the situational nature of children's behavior, and about which circumstances evoke the ADHD symptoms. Does the child show these symptoms in the classroom, at home, with peers? Some children behave consistently in different situations, but many do not.

ADHD can exist alone, but is often seen in combination with learning disabilities or emotional problems. It can contribute to oppositional, defiant behavior. Frequently, the experience of having ADHD can cause a person to have emotional problems, especially lowered self-esteem. I also like to help parents and children understand ADHD, educate themselves about it, and develop recommendations for treatment and behavior management. If a child needs medication treatment for ADHD, I can work with a referring physician, or make a referral to an experienced pediatrician or child psychiatrist.

Treatment of ADHD has been the subject of much research, speculation, and controversy. A balanced and comprehensive discussion of ADHD treatment that I have found is the book, Running on Ritalin, by Lawrence Diller, M.D.