Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition that involves problems with inattention and hyperactivity-impulsivity that are developmentally inconsistent with the age of the child.

ADHD is not a disorder of attention; rather, it is a function of developmental failure in the brain circuitry that monitors inhibition and self-control. This loss of self-regulation impairs other important brain functions crucial for maintaining attention, including the ability to defer immediate rewards for later gain.

Behavior of children with ADHD can also include excessive motor activity. The high energy level and subsequent behavior are often misperceived as purposeful noncompliance when, in fact, they may be a manifestation of the disorder and require specific interventions. Children with ADHD exhibit a range of symptoms and levels of severity. In addition, many children with ADHD often are of at least average intelligence and have a range of personality characteristics and individual strengths.

Children with ADHD typically exhibit behavior that is classified into:

• Combined type (inattentive/hyperactive/impulsive). Children with this type of ADHD show all three symptoms. This is the most common form of ADHD.
• Hyperactive/impulsive type. Children show both hyperactive and impulsive behavior, but for the most part, they are able to pay attention.
• Inattentive type. Formerly called attention deficit disorder (ADD). These children are not overly active. They do not disrupt the classroom or other activities, so their symptoms might not be noticed

A child expressing hyperactivity commonly will appear fidgety, have difficulty staying seated or playing quietly, and act as if driven by a motor. Children displaying impulsivity often have difficulty participating in tasks that require taking turns.

Other common behaviors may include blurting out answers to questions instead of waiting to be called and flitting from one task to another without finishing.

The inattention component of ADHD affects the educational experience of these children because ADHD causes them to have difficulty in attending to detail in directions, sustaining attention for the duration of the task, and misplacing needed items. These children often fail to give close attention to details, make careless mistakes, and avoid or dislike tasks requiring sustained mental effort.

Although these behaviors are not in themselves a learning disability, almost one-third of all children with ADHD have learning disabilities. Children with ADHD may also experience difficulty in reading, math, and written communication

Furthermore, ADHD commonly occurs with other conditions. Although any disability can coexist with ADHD, certain disabilities seem to be more common than others. These include disruptive behavior disorders, mood disorders, anxiety disorders, tics and Tourettes Syndrome, and learning disabilities.

In addition, ADHD affects children differently at different ages. In some cases, children initially identified as having hyperactive-impulsive subtype are subsequently identified as having the combined subtype as their attention problems surface.

When many people think of attention deficit disorder, they picture an out-of-control kid in constant motion, bouncing off the walls and disrupting everyone around. But this is not the only possible picture.
Some children with ADD/ADHD are hyperactive, while others sit quietly—with their attention miles away. Some put too much focus on a task and have trouble shifting it to something else. Others are only mildly inattentive, but overly impulsive.

Children with ADD/ADHD may be:

• Inattentive, but not hyperactive or impulsive.
• Hyperactive and impulsive, but able to pay attention.
• Inattentive, hyperactive, and impulsive (the most common form of ADD/ADHD).

Children who only have inattentive symptoms of ADD/ADHD are often overlooked, since they’re not disruptive. However, the symptoms of inattention have consequences: getting in hot water with parents and teachers for not following directions; underperforming in school; or clashing with other kids over not playing by the rules.

These characteristics affect not only the academic lives of students with ADHD, they may affect their social lives as well. Children with ADHD of the predominantly hyperactive-impulsive type may show aggressive behaviors, while children of the predominantly inattentive type may be more withdrawn. Also, because they are less disruptive than children with ADHD who are hyperactive or impulsive, many children who have the inattentive type of ADHD go unrecognized and unassisted.

Both types of children with ADHD may be less cooperative with others and less willing to wait their turn or play by the rules. Their inability to control their own behavior may lead to social isolation. Consequently, the children’s self-esteem may suffer.

Causes of ADHD

ADHD has traditionally been viewed as a problem related to attention, stemming from an inability of the brain to filter competing sensory inputs such as sight and sound. Recent research, however, has shown that children with ADHD do not have difficulty in that area. Instead, researchers now believe that children with ADHD are unable to inhibit their impulsive motor responses to such input.

It is still unclear what the direct and immediate causes of ADHD are, although scientific and technological advances in the field of neurological imaging techniques and genetics promise to clarify this issue in the near future. Most researchers suspect that the cause of ADHD is genetic or biological, although they acknowledge that the Childs environment helps determine specific behaviors.

Imaging studies conducted during the past decade have indicated which brain regions may malfunction in patients with ADHD, and thus account for symptoms of the condition. Researchers have suggested mutations in several genes that are active in the prefrontal cortex and basal ganglia may play a significant role In addition, some non genetic factors have been linked to ADHD including premature birth, maternal alcohol and tobacco use, high levels of exposure to lead, and prenatal neurological damage. Although some people claim that food additives, sugar, yeast, or poor child rearing methods lead to ADHD, there is no conclusive evidence to support these beliefs.

Identifying ADHD

Although toddlers and preschoolers, on occasion, may show characteristics of ADHD, some of these behaviors may be normal for their age or developmental stage. These behaviors must be exhibited to an abnormal degree to warrant identification as ADHD. Even with older children, other factors (including environmental influences) can produce behaviors resembling ADHD.

The criteria set forth by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are used as the standardized clinical definition to determine the presence of ADHD . A person must exhibit several characteristics to be clinically diagnosed as having ADHD:

• The behavior in question must occur more frequently in the child than in other children at the same developmental stage.
• Early onset. At least some of the symptoms must have been present prior to age 7.
• The symptoms must also have been present for at least 6 months prior to the evaluation.

Show signs of inattention, hyperactivity, and/or impulsivity in specific ways. These children:

• Are in constant motion
• Squirm and fidget
• Do not seem to listen
• Have trouble playing quietly
• Often talk excessively
• Interrupt or intrude on others
• Are easily distracted

Symptoms of inattention in children:

• Doesn’t pay attention to details
• Makes careless mistakes
• Has trouble staying focused; is easily distracted
• Appears not to listen when spoken to
• Has difficulty remembering things and following instructions
• Has trouble staying organized, planning ahead, and finishing projects
• Gets bored with a task before it’s completed
• Frequently loses or misplaces homework, books, toys, or other item

 Symptoms of hyperactivity in children:

• Constantly fidgets and squirms
• Often leaves his or her seat in situations where sitting quietly is expected
• Moves around constantly, often runs or climbs inappropriately
• Talks excessively
• Has difficulty playing quietly or relaxing
• Is always “on the go,” as if driven by a motor
• May have a quick temper or a “short fuse”

 Symptoms of impulsivity in children:

• Acts without thinking
• Blurts out answers in class without waiting to be called on or hear the whole question
• Can’t wait for his or her turn in line or in games
• Says the wrong thing at the wrong time
• Often interrupts others
• Intrudes on other people’s conversations or games
• Inability to keep powerful emotions in check, resulting in angry outbursts or temper tantrums
• Guesses, rather than taking time to solve a problem