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January 1999 - Volume 2 Issue 1

Acting up or ADD?
By Alice Lesch Kelly, from PARENTS magazine , October 1998


Why is ADHD (attention-deficit hyperactivity disorder; also known as ADD, attention deficit disorder) a conundrum to professionals and to virtually every parent whose child seems a little more active or less attentive than the other kids on the playground? Because taken individually, the behaviors associated with ADHD are perfectly normal. After all, what young child hasn't climbed around like a monkey, ignored instructions, and gotten so wound up that he could light a small city with all his energy? But for the roughly 5 million American children diagnosed with ADHD, these behaviors are so constant, so disruptive, and so unmanageable that parents can't keep control, teachers can't teach, and the kids themselves can't learn or socialize well

Usually, an ADHD diagnosis comes after a child stars school; occasionally, it's spotted earlier. ADHD tends to run in families. For 30 to 60 percent of the children affected by it, the symptoms continue into adulthood. In early childhood, boys are 4 to 5 times more likely than girls to be diagnosed with it

By adulthood, however, equal numbers of males and females have ADHD. The causes are still unknown. But the best way to treat this disorder has never been clearer.

Behavior skills reduce the need for drugs

Children with ADHD are hyperactive and inattentive because their brains are under-stimulated, not overstimulated. To compensate, their minds - and often their bodies - wander in search of more input, explains Mark B. Goor, Ph.D., Assistant Dean of the Graduate School of Education at George Mason University, in Fairfax, Virginia. According to the NIH (National institutes of Health), an ADHD diagnosis applies to children who consistently display one or more of the following behaviors over a period of time:

  • Inattention: Difficulty focusing on one thing at a time unless it's a favorite activity, such as playing video games.
  • Hyperactivity: Constant moving, roaming, squirming, talking, tapping feet. Doing several things at once.
  • Impulsivity: Difficulty thinking before acting. Kids may dash out into the street, grab toys from or hit other children, or blurt out inappropriate comments.

Even if these behaviors exist, making an accurate diagnosis can still be tricky. There is no laboratory test for ADHD; professionals base their assessments solely on what they observe. Before they conclude that a child has ADHD, however, other conditions should be ruled out.

"Lots of kids display ADHD-like symptoms, but that doesn't mean they have ADHD," says Steve Zecker, Ph.D., associate professor of learning disabilities in the Department of Communication Sciences and Disorders Program at Northwestern University, in Evanston, Illinois. " I have heard other professionals claim that maybe a quarter of even a third of all cases are mis-diagnosed. I wouldn't disagree with this at all."

Ritalin and other stimulant drugs, such as Dexedrine, Cylert, and Adderall, bring about "dramatic improvements" in behavior, says Howard Abikoff, Ph.D., professor of clinical psychiatry and director of research at the Child Study Center, New York University School of Medicine, In Manhattan. They allow children to calm down, focus, be less aggressive, curb their impulsiveness, and reduce the number of conflicts they have with others. Some children do experience side effects, such as headaches and stomachaches, decreased appetite, and difficulty sleeping, but these are usually offset by changing the amount and time of the dosage.

Though drugs may offer immediate help, behavior therapy holds the best hope for a long-term solution. In therapy, ADHD kids can learn to verbalize emotions such as anger, frustration, boredom, and impatience rather than act them out.

Parents must learn new strategies too

Behavior modification isn't limited to children, however - both parents and teachers need to learn new ways to think about kids who have problems paying attention and focusing. There are many reasons a child loses focus and many ways to strengthen those weaknesses: to-do lists, keeping track of what gets done and what doesn't , moving a child's desk closer to the teacher's and creating small steps toward solving problems so that a child feels mastery. Activities such as karate classes, team sports, dance and music lessons may also help a child develop focus.

At home, behavior modification revolves around rules, rewards, and punishments, says Robert Schleser, Ph.D., professor of psychology at the Illinois Institute of Technology. And all three "have to be as clear and predictable as sunrise," he says. Most important, parents should be supportive, not punitive, in their discipline.

To help a child learn to focus Maria Nahmias, Ph.D., adjunct assistant professor at the University of Arizona Department of Special Education and Rehabilitation, in Tucson, suggest the following:

  • Maintain a schedule and set rules: Be sure your child knows what is expected of her and when. Post rules in a convenient location.
  • Set realistic goals: And provide plenty of opportunities for success. Let older children help choose goals.
  • Use clear , brief directions: Get the point across before your child's attention strays.
  • Provide organizational help: Keep work areas neat and have older children use a notebook to record important information.
  • Provide consistent rewards: such as notes and charts with stickers, as well as positive feedback.
  • Encourage self rewarding: Help your child learn to reward and praise himself for accomplished goals.
  • Don't give an instruction or ask a question unless you have the child's full attention.
  • Be very direct and specific in your requests. Say, "Read your book on the sofa until I'm done doing the dishes," not " Sit down until I'm done."
  • Be consistent in your expectations and requirements, as well as in your discipline and praise. React to the child's actions immediately, the same way each time.

1998 Gruner + Jahr USA Publishing. Excerpts reprinted from PARENTS magazine by permission (October 1998 Issue).

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