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February 1999 - Volume 2 - Issue 2

Understanding ADD and using a team approach to overcome it
By Howard C. Bean Jr., M.D., M.Ed.,
Ladson Berry, B.A. , M.Ed., and June Bond, B.A., M.Ed.

This is the third article in our Feature Series: Learning about ADD/ADHD. Presidio does not specifically support any one way of researching, diagnosing or treating ADHD/ADD.

For some children and their families, the start of a new school year means more than just the usual adjustment or readjustment to the rules, routines, and structure of the classroom. An estimated 1 in 3 adopted children has attention deficit disorder (ADD), and because the school setting requires the very skills that are difficult for children with ADD, the disorder is most often diagnosed during the early primary grades.

Although some parents are relieved to have a name for the problems and behaviors they've been dealing with for years, others refuse to accept that their child has ADD. For these parents, a diagnosis of ADD is like a death sentence for their child.

Parents must keep in mind, though, that ADD is simply a trait, not a disease or illness. Although children with ADD are at risk for school failure and emotional difficulties, with early identification and treatment, they can succeed.

To help their children achieve success, parents first need a solid understanding of the disorder and how it manifests in daily activities - at home, in the classroom, and in social situations.

Understanding ADD

ADD is a neurological disorder that interferes with a person's ability to sustain attention or focus on a task and to delay impulsive behavior. It was first recognized in 1902. Since that time, the disorder has been given a number of names, including Minimal Brain Dysfunction and the Hyper kinetic Reaction of Childhood. The diagnosis of Attention Deficit Disorder was formally recognized in 1980 in the Diagnostic and Statistical Manual (3rd edition), the official diagnostic manual of the American Psychiatric Association.

Although the cause of ADD is unknown, evidence suggests a dysfunction in the frontal lobes of the brain, where behavior is regulated. In people who have the disorder, less metabolic activity than usual occurs there, or brain chemicals called neurotransmitters may be deficient. ADD is considered genetic; 30-40 percent of adults in whom ADD is diagnosed have children who exhibit the disorder.

Diagnostic Features

Children who have ADD exhibit a persistent pattern of inattention of hyperactivity/impulsivity that is more frequent and severe than is typically observed in children at a comparable level of development. Children who have ADD may fail to give close attention to details or make careless mistakes in schoolwork or other tasks. Their work is often messy and carelessly performed. They have difficulty finishing tasks in an allotted time period and shifting from one activity or academic subject to another. Losing pens, pencils, assignments, and even homework completed the day before is not uncommon. Children who have ADD often appear as if their mind is elsewhere or they did not hear what was just said to them. They may have trouble screening our extraneous stimuli. Noises like the hum of the air conditioner, the fish tank, and a bird chirping in the tree become the dominant noise rather than the background noise.

Hyperactivity may manifest in the inability to sit still. Children who have ADD drum their fingers incessantly on anything near them, constantly shuffle or wiggle their feet, and have difficulty remaining seated for an extended activity. This includes desk work as well as sitting on the floor during group activities in the earlier grades. They get up from the table during meals, while watching TV, or while doing homework. They talk excessively and make excessive noise even during quiet activities.

Impulsivity may manifest itself as impatience and difficulty with taking turns at tasks or games. This often results in social behavior that is unacceptable to peers. In the classroom, children may blurt out answers before the teacher has completely asked the question.

Treating ADD in children requires a multimodal approach, including appropriate medication, parent training in behavior management, and appropriate modifications at school.

Medical Management

The use of medication in the treatment of children with ADD has been common practice since the 1960's. Drugs such as Ritalin and Dexedrine have been used most frequently, but there are many others. These drugs stimulate the frontal lobes of the brain where inadequate amounts of neurotransmitters are present. This stimulation decreases hyperactivity, impulsivity, and aggression. Drug therapy has also helped to increase concentration and academic productivity. Side effects such as increased appetite, headaches, and sleep disturbances have been reported.

Drug therapy is most effective when there is cooperation and communication among parents, school staff, and the physician. Each child is different and his or her reaction to a given medication of dosage will be different. It is critical that parents and teachers note any changes in the child that might be related to his or her medication. It is also important to understand the basic effect of the medicine being used and to note how the medication and dosage interact to provide the best results. The dosage that worked during the past school year may not be right for this school year. Like wise, the child's schedule may be dramatically different than it was the preceding year. Parents need to work with the physician to determine when maximum concentration is needed for core academic subjects. Puberty, weight gain, and an increase in physical activity may also alter the effectiveness of the medication. Just because one medication did not work does not mean another will fail to provide benefit. Likewise, medication that has worked for a period of time may not be as effective as the child grows older. Your doctor needs input from you and your child's teacher to determine how best to prescribe medication.

The Educational Component

Academic success is perhaps the biggest challenge and most important factor affecting your child's future self esteem and success as an adult. Students with ADD may be eligible for services under two different federal laws: Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973.

IDEA details a special education plan that may include resource classes and special education classes for the child who has a disability. Under IDEA, a child receives an Individualized Education Program specifically designed to meet his or her unique needs. A common example of this is the child who attends special classes for a learning disability. Students with ADD may be classified as "other health impaired" when the disorder significantly affects their educational performances.

If a child does not qualify for special education under IDEA, he or she may still qualify for reasonable modifications under the Section 504 legislation, which addresses the ways a teacher can alter delivery style and curriculum in the regular classroom. Common modifications include tailoring home work assignments, increasing communication between home and school, providing a more structured learning environment, reducing distractions, simplifying instructions, modifying test delivery, adjusting medication for maximum results, allowing the use of tape recorders, computer aided instruction, reducing copying tasks, and allowing more time for completion of tasks.

Both federal laws require a multi-disciplinary team to evaluate the child to determine which service may be appropriate. Parents are critical players on the team. They must sign the plan outlined for their child, and the plan should be reviewed at least once a year.

Structure at Home

Children with ADD benefit greatly by strategies incorporated into daily life at home. Consistent discipline using rules that bear immediate consequences is critical. Rules should be phrased positively, emphasizing what children should do rather than should not do. Children should be praised for small steps toward good behavior and impulse control.

Because children with ADD respond better to a structured environment that rewards good behavior, parents may want to try a behavior modification program where the child earns points for desired behaviors rather than is punished for unacceptable behaviors. Parents should carefully pick a few behaviors to work on at one time. Focusing on the positive rather than the negative contributes to self esteem. Parents need to help their child develop person strengths.

Structure at home can also contribute to success at school. Providing a study area away from distractions in important, as is establishing firm routines for homework, bedtime, and medication times. Students with ADD need more external cues -- checklists, planners, long-range calendars -- to develop routines. These external cues provide a sense of structure and organization.

Children with ADD will need more help traversing the road to successful adulthood, but with help from school, medical community, and parents, ADD can add up to success.

Reprinted from FosterCare Magazine, April 1997. Dr. Bean specializes in the treatment of children, adolescents, and adults with ADD. Ladson Berry, a school psychologist, is the recipient of the S.S. Excellence on School Psychology Award. June Bond is a certified adoption investigator and teacher/counselor who works with families touched by ADD.

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