c

 

 

ADHD is a common behavioral disorder that affects an estimated 8% to 10% of school-age children. Boys are about
three times more likely than girls to be diagnosed with it, though it's not yet understood why.Kids with ADHD act
without thinking, are hyperactive, and have trouble focusing. They may understand what's expected of them but have
trouble following through because they can't sit still, pay attention, or attend to details.Of course, all kids (especially
younger ones) act this way at times, particularly when they're anxious or excited. But the difference with ADHD is that
symptoms are present over a longer period of time and occur in different settings. They impair a child's ability to
function socially, academically, and at home.

The good news is that with proper treatment, kids with ADHD can learn to successfully live with and manage their
symptoms.

Y


ADHD used to be known as  
 


, or . In 1994, it was renamed ADHD and broken down
into three subtypes, each with its own pattern of behaviors:
 
 
 , with signs that include:
 inability to pay attention to details or a tendency to make careless errors in schoolwork or other activities
 difficulty with sustained attention in tasks or play activities
 apparent listening problems
 difficulty following instructions
 problems with organization
 avoidance or dislike of tasks that require mental effort
 tendency to lose things like toys, notebooks, or homework
 distractibility
 forgetfulness in daily activities
Ñ  



 , with signs that include:
 fidgeting or squirming
 difficulty remaining seated
 excessive running or climbing
 difficulty playing quietly
 always seeming to be "on the go"
 excessive talking
 blurting out answers before hearing the full question
 difficulty waiting for a turn or in line
 problems with interrupting or intruding
ÿ 

 , which involves a combination of the other two types and is the most common

Although it can be challenging to raise kids with ADHD, it's important to remember they aren't "bad," "acting out," or
being difficult on purpose. And they have difficulty controlling their behavior without medication or behavioral therapy.


 


Because there's no test that can determine the presence of ADHD, a diagnosis depends on a complete evaluation.
Many children and adolescents diagnosed with ADHD are evaluated and treated by primary care doctors including
pediatricians and family practitioners, but your child may also be referred to one of several different specialists
(psychiatrists, psychologists, neurologists) especially when the diagnosis is in doubt, or if there are other concerns,
such as Tourette syndrome, a learning disability, anxiety, or depression.

To be considered for a diagnosis of ADHD:

a child must display behaviors from one of the three subtypes before age 7
 these behaviors must be more severe than in other kids the same age
 the behaviors must last for at least 6 months
 the behaviors must occur in and negatively affect at least two areas of a child's life (such as school, home, day-
care settings, or friendships)
The behaviors must also not only be linked to stress at home. Kids who have experienced a divorce, a move, an
illness, a change in school, or other significant life event may suddenly begin to act out or become forgetful. To avoid
a misdiagnosis, it's important to consider whether these factors played a role in the onset of symptoms

First, your child's doctor will take a medical history by performing a physical examination and asking you about any
concerns and symptoms, your child's past health, your family's health, any medications your child is taking, any
allergies your child may have, and other issues.

The doctor may also check hearing and vision so other medical conditions can be ruled out. Because some emotional
conditions, such as extreme stress, depression, and anxiety, can also look like ADHD, you'll fill out questionnaires to
help rule them out.

You'll be asked many questions about your child's development and behaviors at home, school, and among friends.
Other adults who see your child regularly (like teachers, who are often the first to notice ADHD symptoms) probably
will be consulted, too. An educational evaluation, which usually includes a school psychologist, may also be done. It's
important for everyone involved to be as honest and thorough as possible about your child's strengths and
weaknesses.

‰
ADHD is  caused by poor parenting, too much sugar, or vaccines.

ADHD has biological origins that aren't yet clearly understood. No single cause has been identified, but researchers
are exploring a number of possible genetic and environmental links. Studies have shown that many kids with ADHD
have a close relative who also has the disorder.

Although experts are unsure whether this is a cause of the disorder, they have found that certain areas of the brain
are about 5% to 10% smaller in size and activity in kids with ADHD. Chemical changes in the brain also have been
found.

Recent research also links smoking during pregnancy to later ADHD in a child. Other risk factors may
include premature delivery, very low birth weight, and injuries to the brain at birth.
Some studies have even suggested a link between excessive early television watching and future attention problems.
Parents should follow the American Academy of Pediatrics' (AAP) guidelines, which say that children under 2 years old
should not have any "screen time" (TV, DVDs or videotapes, computers, or video games) and that kids 2 years and
older should be limited to 1 to 2 hours per day, or less, of quality television programming.




One of the difficulties in diagnosing ADHD is that it's often found in conjunction with other problems. These are called
coexisting conditions, and about two thirds of kids with ADHD have one. The most common coexisting conditions are:

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)

At least 35% of kids with ADHD also have oppositional defiant disorder, which is characterized by stubbornness,
outbursts of temper, and acts of defiance and rule breaking. Conduct disorder is similar but features more severe
hostility and aggression. Kids who have conduct disorder are more likely to get in trouble with authority figures and,
later, possibly with the law. Oppositional defiant disorder and conduct disorder are seen most commonly with the
hyperactive and combined subtypes of ADHD.


 

About 18% of kids with ADHD, particularly the inattentive subtype, also experience depression. They may feel
inadequate, isolated, frustrated by school failures and social problems, and have lowself-esteem.


 

Anxiety disorders affect about 25% of kids with ADHD. Symptoms include excessive worry, fear, or panic, which can
also lead to physical symptoms such as a racing heart, sweating, stomach pains, and diarrhea. Other forms of anxiety
that can accompany ADHD are obsessive-compulsive disorder and Tourette syndrome, as well as motor or vocal tics
(movements or sounds that are repeated over and over). A child who has symptoms of these other conditions should
be evaluated by a specialist.
A    
About half of all kids with ADHD also have a specific learning disability. The most common learning problems are with
reading (dyslexia) and handwriting. Although ADHD isn't categorized as a learning disability, its interference with
concentration and attention can make it even more difficult for a child to perform well in school.

If your child has ADHD and a coexisting condition, the doctor will carefully consider that when developing a treatment
plan. Some treatments are better than others at addressing specific combinations of symptoms.

Ê

ADHD can't be cured, but it á
be successfully managed. Your child's doctor will work with you to develop an
individualized, long-term plan. The goal is to help a child learn to control his or her own behavior and to help families
create an atmosphere in which this is most likely to happen.

In most cases, ADHD is best treated with a combination of medication and behavior therapy. Any good treatment plan
will require close follow-up and monitoring, and your doctor may make adjustments along the way. Because it's
important for parents to actively participate in their child's treatment plan, parent education is also considered an
important part of ADHD management.



 

Several different types of medications may be used to treat ADHD:

 Y

  are the best-known treatments ² they've been used for more than 50 years in the treatment of
ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. Possible side
effects include decreased appetite, stomachache, irritability, and insomnia. There's currently no evidence of long-
term side effects.
   

  were approved for treating ADHD in 2003. These appear to have fewer side effects than
stimulants and can last up to 24 hours.
  
  are sometimes a treatment option; however, in 2004 the U.S. Food and Drug Administration
(FDA) issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. If an
antidepressant is recommended for your child, be sure to discuss these risks with your doctor.

Medications can affect kids differently, and a child may respond well to one but not another. When determining the
correct treatment, the doctor might try various medications in various doses, especially if your child is being treated
for ADHD along with another disorder.


Ê 

Research has shown that medications used to help curb impulsive behavior and attention difficulties are more
effective when combined with behavioral therapy.

Behavioral therapy attempts to change behavior patterns by:

 reorganizing a child's home and school environment

 giving clear directions and commands
 setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate
ones

Here are examples of behavioral strategies that may help a child with ADHD:

 ‰
 Try to follow the same schedule every day, from wake-up time to bedtime. Post the schedule in
a prominent place, so your child can see what's expected throughout the day and when it's time for homework,
play, and chores.
 ´organized Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to
lose them.
 

 
  Turn off the TV, radio, and computer games, especially when your child is doing homework.
 A


 
 Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn't
overwhelmed and overstimulated.
 ‰  
 
  
  
 Instead of long-winded explanations and cajoling, use clear, brief
directions to remind your child of responsibilities.
   Use a chart to list goals and track positive behaviors, then reward your child's efforts.
Be sure the goals are realistic (think baby steps rather than overnight success).
 


 
  Instead of yelling or spanking, use timeouts or removal of privileges as consequences for
inappropriate behavior. Younger kids may simply need to be distracted or ignored until they display better
behavior.
   
 
     All kids need to experience success to feel good about themselves. Finding
out what your child does well ² whether it's sports, art, or music ² can boost social skills and self-esteem.

 
Ê
 
Currently, the only ADHD therapies that have been proven effective in scientific studies are medications and
behavioral therapy. But your doctor may recommend additional treatments and interventions depending on your
child's symptoms and needs. Some kids with ADHD, for example, may also need special educational interventions
such as tutoring, occupational therapy, etc. Every child's needs are different.
A number of other alternative therapies are promoted and tried by parents including: megavitamins, body treatments,
diet manipulation, allergy treatment, chiropractic treatment, attention training, visual training, and traditional one-on-
one "talking" psychotherapy. However, scientific research has  found them to be effective, and most have not
been studied carefully, if at all.
Parents should always be wary of
 therapy that promises an ADHD "cure." If you're interested in trying something
new, speak with your doctor first.

 Ê



Parenting a child with ADHD often brings special challenges. Kids with ADHD may not respond well to typical parenting
practices. Also, because ADHD tends to run in families, parents may also have some problems with organization and
consistency themselves and need active coaching to help learn these skills.

Experts recommend parent education and support groups to help family members accept the diagnosis and to teach
them how to help kids organize their environment, develop problem-solving skills, and cope with frustrations. Training
can also teach parents to respond appropriately to a child's most trying behaviors with calm disciplining techniques.
Individual or family counseling can also be helpful.


‰


As your child's most important advocate, you should become familiar with your child's medical, legal, and educational
rights.

Kids with ADHD are eligible for special services or accommodations at school under the Individuals with Disabilities in
Education Act (IDEA) and an anti-discrimination law known as Section 504. Keep in touch with teachers and school
officials to monitor your child's progress.

In addition to using routines and a clear system of rewards, here are some other tips to share with teachers for
classroom success:

  
 
 
  Lessening distractions might be as simple as seating your child near the teacher
instead of near the window.
   
      



 The teacher can include assignments and
progress notes, and you can check to make sure all work is completed on time.
    

 . Keep instructions clear and brief, breaking down larger tasks into smaller, more
manageable pieces.
 ´
 

 
 
  Always be on the lookout for positive behaviors. Ask the teacher to offer praise
when your child stays seated, doesn't call out, or waits his or her turn instead of criticizing when he or she doesn't.
 Ê     
 Underlining, note taking, and reading out loud can help your child stay focused and
retain information.
 Y
 Check that your child goes and comes from school with the correct books and materials. Sometimes
kids are paired with a buddy to can help them stay on track.
   

  

 Ask the teacher to provide feedback to your child in private, and avoid
asking your child to perform a task in public that might be too difficult.
 |         
 He or she can help design behavioral programs to address
specific problems in the classroom.


 ‰


You're a stronger advocate for your child when you foster good partnerships with everyone involved in your child's
treatment ² that includes teachers, doctors, therapists, and even other family members. Take advantage of all the
support and education that's available, and you'll help your child navigate toward success.

Reviewed by: Richard S. Kingsley, MD

Date reviewed: September 2008
Originally reviewed by: W. Douglas Tynan, PhD











































 
 
 !"#" " 
p

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists
into adulthood. Problems associated with ADHD include inattention and hyperactive, impulsive behavior. Children with
ADHD may struggle with low self-esteem, troubled relationships and poor performance in school.

While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves psychological
counseling, medications or both.

A diagnosis of ADHD can be scary, and symptoms can be a challenge for parents and children alike. However,
treatment can make a big difference, and the majority of children with ADHD grow up to be vibrant, active and
successful adults.

Y



ADHD has been called attention-deficit disorder (ADD) and hyperactivity. But ADHD is the preferred term because it
describes both primary aspects of the condition: inattention and hyperactive-impulsive behavior.

While many children who have ADHD tend more toward one category than the other, most children have some
combination of inattention and hyperactive-impulsive behavior. Signs and symptoms of ADHD become more apparent
during activities that require focused mental effort.

In most children diagnosed with ADHD, signs and symptoms appear before the age of 7. In some children, signs of
ADHD are noticeable as early as infancy.

Y
  


 
 
 
!

V Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities

V Often has trouble sustaining attention during tasks or play

V Seems not to listen even when spoken to directly

V Has difficulty following through on instructions and often fails to finish schoolwork, chores or other tasks

V Often has problems organizing tasks or activities

V Avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework

V Frequently loses needed items, such as books, pencils, toys or tools

V Can be easily distracted

V Often forgetful

Y
  

  
 




 
!

V Fidgets or squirms frequently

V Often leaves his or her seat in the classroom or in other situations when remaining seated is expected

V Often runs or climbs excessively when it's not appropriate or, if an adolescent, might constantly feel restless

V Frequently has difficulty playing quietly

V Always seems on the go

V Talks excessively

V Blurts out the answers before questions have been completely asked

V Frequently has difficulty waiting for his or her turn

V Often interrupts or intrudes on others' conversations or games

ADHD behaviors can be different in boys and girls.

V Boys are more likely to be hyperactive, whereas girls tend to be inattentive.

V ´irls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle
aimlessly.

V Boys tend to be less compliant with teachers and other adults, so their behavior is often more conspicuous.


    

"

   if you notice consistently inattentive or hyperactive,
impulsive behavior that:

V Lasts more than six months

V Occurs in more than just one setting (typically at home and at school)

V Regularly disrupts school, play and other daily activities

V Causes problems in relationships with adults and other children

 
 
  
Most healthy children are inattentive, hyperactive or impulsive at one time or another. For instance, parents may
worry that a 3-year-old who can't listen to a story from beginning to end may have ADHD. But preschoolers normally
have a short attention span and aren't able to stick with one activity for long. Even in older children and adolescents,
attention span often depends on the level of interest. Most teenagers can listen to music or talk to their friends for
hours but may be a lot less focused about homework.

The same is true of hyperactivity. Young children are naturally energetic ² they often wear their parents out long
before they're tired. And they may become even more active when they're tired, hungry, anxious or in a new
environment. In addition, some children just naturally have a higher activity level than do others. Children should
never be classified as having ADHD just because they're different from their friends or siblings.

Children who have problems in school but get along well at home or with friends are not considered to have ADHD.
The same is true of children who are hyperactive or inattentive only at home but whose schoolwork and friendships
aren't affected by their behavior.

#      

If your child has disruptive behaviors you think may be signs of ADHD, such as trouble concentrating, sitting still or
controlling his or her behavior, see your pediatrician or family doctor. Your doctor may refer you to a specialist, but
it's important to have a medical evaluation first to check for likely causes of your child's signs and symptoms.

If your child is already being treated for ADHD, he or she should see the doctor regularly ² at least once during the
month following diagnosis, and then at least every six months after that. Be sure to discuss how often your child
should be seen for appointments with his or her doctor. Call the doctor if your child has any medication side effects,
such as loss of appetite, trouble sleeping or increased irritability. Over time some children taking stimulant
medications may also lose weight or grow more slowly, although these changes are usually temporary.

‰
 
Parents may blame themselves when a child is diagnosed with ADHD, but researchers increasingly believe that causes
have more to do with inherited traits than parenting choices. At the same time, certain environmental factors may
 contribute to or worsen a child's behavior. Although there's still a lot that isn't known about ADHD, researchers have
identified several factors that may play a role:

V 
 
   
 While the exact cause of ADHD remains a mystery, brain scans have revealed
important differences in the structure and brain activity of people with ADHD. For example, there appears to be less
activity in the areas of the brain that control activity and attention.

V 
  ADHD tends to run in families. About one in four children with ADHD have at least one relative with the
disorder.

V  

$ %%
Pregnant women who smoke are at increased risk of having
children with ADHD. And alcohol or drug abuse during pregnancy may reduce activity of the nerve cells (neurons) that
produce neurotransmitters. Pregnant women who are exposed to environmental poisons, such as polychlorinated
biphenyls (PCBs), also may be more likely to have children with symptoms of ADHD. PCBs are industrial chemicals
that were widely used up until the 1970s.

V ‰
% 

 %
 Preschool children exposed to certain toxins are at increased risk of
developmental and behavioral problems. Exposure to lead, which is found mainly in paint and pipes in older buildings,
has been linked to disruptive and even violent behavior and to a short attention span. Exposure to PCBs in infancy
also may increase a child's risk of developing ADHD.

Î

Risk factors for ADHD include:

V Maternal exposure to toxins

V Smoking, drinking alcohol or using drugs during pregnancy

V A family history of ADHD or certain other behavioral and mood disorders

V Premature birth

ADHD frequently occurs along with certain other conditions, including:

V Hyperthyroidism

V Having a learning disability or being a gifted learner

V Oppositional defiant disorder

‰
 
ADHD can make life difficult for children. Children with ADHD:

V Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults

V Tend to have more accidents and injuries of all kinds than do children who don't have the disorder

V Are more likely to have trouble interacting with peers and adults

V Are at increased risk of alcohol and drug abuse and other delinquent behavior

‰%

  

 
ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely
than other children to also have conditions such as:

V þ

  
  
 &þ' ´enerally defined as a pattern of negative, defiant and hostile behavior
toward authority figures, ODD occurs in as many as half of all children with ADHD. This condition is more common in
boys than it is in girls.
V ‰   
 A more serious condition than ODD, conduct disorder is marked by antisocial behavior such as
stealing, fighting, destroying property and harming people or animals. This condition is much less prevalent than
ODD.

V 
  Depression frequently occurs in children with ADHD.

V  %
 
 Anxiety disorders tend to occur fairly often in children with ADHD and may cause overwhelming
worry and nervousness and other symptoms. Once anxiety is treated and is under control, children are better able to
deal with ADHD.

V A
 



 Learning disabilities are common in children with ADHD. However, gifted learners also get
ADHD more often than do other children. Children with both ADHD and learning disabilities may need extra attention
in the classroom or special education services.

V Ê 
 Many children with ADHD also have Tourette syndrome, a neurological disorder characterized
by compulsive muscular or vocal tics.

ü  
 
 


You're likely to start by first taking your child to a family doctor or a pediatrician. Depending on the results of the
initial evaluation, your doctor may refer you to a specialist, such as a developmental-behavioral pediatrician,
psychologist, psychiatrist or pediatric neurologist.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well
prepared for your child's appointment. Here's some information to help you get ready for your appointment, and what
to expect from your doctor.

#   

V #
  

  

 $ including any that may seem unrelated to the
reason for which you scheduled the appointment.

V #
   


 $ including any major stresses or recent life changes.

V 



 $ as well as any vitamins or supplements, that your child is taking.

V #
 (
  your child's doctor.

Your time with the doctor is limited, so preparing a list of questions will help you make the most of your time
together. List your questions from most important to least important in case time runs out. For ADHD, some basic
questions to ask your doctor include:

V Other than the most likely cause, what are other possible causes for my child's symptoms or condition?

V What kinds of tests does my child need?

V What is the best course of action?

V What are the alternatives to the primary approach that you're suggesting?

V My child has these other health conditions. How can I best manage them together?

V Should my child see a specialist?

V Is there a generic alternative to the medicine you're prescribing for my child?

V Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend
visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your
appointment at any time that you don't understand something.
 #  %  
   
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any
points you want to spend more time on. Your doctor may ask:

V When did you first notice your child's behavior issues or other symptoms?

V Have your child's symptoms been continuous, or occasional?

V How severe are your child's symptoms?

V What, if anything, appears to worsen your child's symptoms?

V What, if anything, seems to improve your child's symptoms?

V In what settings have you noticed the symptoms: at home, at school or in other situations?

V Does your child consume caffeine?

V What are your child's sleep hours and patterns?

V How is your child's current and past academic performance?

V Does your child read at home? Does he or she have trouble reading?

V What discipline methods have you used at home?

V Describe who lives at home and a typical daily routine.

Ê     
No single test for ADHD exists, which can make the disorder difficult to diagnose. ´athering as much information as
possible about your child is the best way to get an accurate diagnosis and rule out other possible causes of your
child's symptoms.

An appointment to check for ADHD usually begins with a complete medical exam and a number of questions about
your child's health, medical problems, symptoms, and issues that occur at school and at home.

Children diagnosed with ADHD exhibit symptoms over a long period of time and have particular trouble in stressful,
demanding situations or in activities that require sustained attention, such as reading, doing math problems or playing
board games.

Most doctors believe that a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD start early
in life and create significant problems at home and at school on an ongoing basis.


 
 

   
 

)  

  

To be diagnosed with ADHD, your child must meet the criteria spelled out in the Diagnostic and Statistical Manual of
Mental Disorders (DSM). This manual is published by the American Psychiatric Association. For a diagnosis of ADHD, a
child must have six or more signs and symptoms from one of the two categories below (or, six or more signs and
symptoms from each of the two categories).

|  


V Often fails to give close attention to details or makes careless mistakes in schoolwork other activities

V Often has difficulty sustaining attention in tasks or play activities

V Often does not seem to listen when spoken to directly

V Often does not follow through on instructions and fails to finish schoolwork or chores (not due to oppositional behavior
or failure to understand instructions)
V Often has difficulty organizing tasks and activities

V Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort(such as schoolwork or
homework)

V Often loses things necessary for tasks or activities (for example, toys, school assignments, pencils, books)

V Is often easily distracted

V Is often forgetful in daily activities

  

  





V Often fidgets with hands or feet or squirms in seat

V Often leaves seat in classroom or in other situations in which remaining seated is expected

V Often runs about or climbs excessively in situations in which it is inappropriate

V Often has difficulty playing or engaging in leisure activities quietly

V Is often "on the go" or often acts as if "driven by a motor"

V Often talks excessively

V Often blurts out answers before questions have been completed

V Often has difficulty awaiting turn

V Often interrupts or intrudes on others (for example, butts into conversations or games)

In addition to having at least six symptoms from one of the two categories, a child with ADHD:

V Has inattentive or hyperactive-impulsive signs and symptoms that caused impairment and were present before age 7

V Has behaviors that aren't normal for children the same age who don't have ADHD

V Has symptoms for at least six months

V Has symptoms that impair school, home life or relationships in more than one setting (such as at home and at school)

A child diagnosed with ADHD is often given a more specific diagnosis, such as:

V 

  
 
   $ a child has at least six signs and symptoms from the first list, above
("inattention").

V 

     



  $ a childhas at least six signs and symptoms from the second
list, above ("hyperactivity and impulsivity").

V ‰

 $ a child has six or more signs and symptoms from each of the two lists above.

þ  

   
 
Your child's doctor will want to check for all possible causes of your child's behavior. A number of medical conditions
may cause signs and symptoms similar to those of ADHD, including:

V Learning or language problems

V Mood disorders (such as anxiety or depression)

V Hyperthyroidism

V Seizure disorders
V Fetal alcohol syndrome

V Vision or hearing problems

V Tourette syndrome

V Sleep disorders

V Asperger's disorder

V Autism

Not only can some of these conditions cause symptoms that mimic ADHD, these and other coexisting conditions are
found in as many as one in three children with ADHD.


 
 
   
 
Although signs of ADHD can sometimes appear in preschoolers or children even younger, diagnosing the disorder in
very young children is difficult. That's because developmental problems such as language delays can be mistaken for
ADHD. For that reason, children preschool age or younger suspected of having ADHD are more likely to need
evaluation by a specialist such as a psychologist or psychiatrist, speech pathologist or developmental pediatrician.

*
 
  


Because ADHD symptoms may not be obvious in a medical office, the doctor is likely to use questionnaires and
interviews to learn more about your child's behavior. Your child's doctor may want to interview your child's teachers
or other people who know your child well, such as baby sitters and coaches. Your child's doctor may also use ADHD
rating scales to help collect and evaluate information about your child.

Y

  
     
The following chart from the National Institute of Mental Health lists the types of doctors who are qualified to diagnose
and supervise treatment for ADHD, although not all may have specific training in the disorder.


 



 

  
  



Y
 

 
 







 !"        
 !"       
"#   $ !        
%! "# 
&       


Ê 
   

Standard treatments for ADHD in children include medications and counseling. Other treatments to ease ADHD
symptoms include special accommodations in the classroom, and family and community support.



 
Currently, stimulant drugs (psychostimulants) and the nonstimulant medication atomoxetine (Strattera) are the most
commonly prescribed medications for treating ADHD.

Y

 


  for ADHD include:

V Methylphenidate (Ritalin, Concerta, Daytrana)

V Dextroamphetamine-amphetamine (Adderall)

V Dextroamphetamine (Dexedrine)

Although scientists don't understand exactly why these drugs work, stimulants appear to boost and balance levels of
the brain chemicals called neurotransmitters. These ADHD medications help improve the core signs and symptoms of
inattention, impulsivity and hyperactivity ² sometimes dramatically. However, effects of the drugs wear off quickly.
Additionally, the right dose varies from child to child, so it may take some time in the beginning to find the correct
dose.

Stimulant drugs are available in short-acting and long-acting forms.

V The short-acting forms last about four hours, while the long-acting preparations last between six and 12 hours.

V Methylphenidate is available in a long-acting patch that can be worn on the hip (Daytrana). It delivers medication for
about nine hours and is approved for use in children between the ages of 6 and 12. While the long-lasting effects
mean your child won't need to take medication as often, it can take up to three hours to start working. For it to work
in the morning, the patch needs to be put in place early while your child is still asleep.

Y

 


  
  
The most common side effects of stimulant medications in children include:

V Decreased appetite

V Weight loss

V Problems sleeping

V Irritability as the effect of the medication tapers off

A few children may develop jerky muscle movements, such as grimaces or twitches (tics), but these usually disappear
when the dose of medication is lowered. Stimulant medications may also be associated with a slightly reduced growth
rate in children, although in most cases growth isn't permanently affected. There's been some concern about using
stimulants to treat preschoolers who have ADHD.




     

Although a rare occurrence, several heart-related deaths have occurred in children and adolescents taking stimulant
medications. Your child's doctor will want to be sure your child doesn't have any signs of a heart condition before
prescribing a stimulant. Experts disagree about whether children need an extensive evaluation before taking these
medications. The American Heart Association has said that every child should have a heart test called an
electrocardiogram (EC´) before getting stimulant medications for ADHD, while other organizations such as the
American Academy of Pediatrics say that a thorough history and physical exam is enough to screen for heart
problems.

  

 


 
Atomoxetine (Strattera) is generally given to children with ADHD when stimulant medications aren't effective or cause
side effects. In addition to reducing ADHD symptoms, atomoxetine may also reduce anxiety. ´iven one or two times a
day, atomoxetine side effects can include nausea and sedation. It can also cause reduced appetite and weight loss.

Atomoxetine has been linked to rare side effects that include liver problems. If your child is taking atomoxetine and
develops yellow skin (jaundice), dark-colored urine or unexplained flu symptoms, contact the doctor right away.

There's been some concern that children and adolescents taking atomoxetine have an increased risk of suicidal
thinking. Although atomoxetine has never been linked to an actual suicide, contact your child's doctor if you notice
any signs of suicidal thinking or other signs of depression.

þ


  used to treat ADHD include:
V Antidepressants. These medications are generally used in children who don't respond to stimulants or atomoxetine or
have a mood disorder as well as ADHD.

V Clonidine (Catapres) and guanfacine (Tenex). These are high blood pressure drugs shown to help with ADHD
symptoms. They may be prescribed to reduce tics or insomnia caused by other ADHD medications, or to treat
aggression caused by ADHD.

´




   
Making sure your child takes the right amount of the prescribed medication is very important. Parents are
understandably concerned about stimulants ² which are similar to amphetamines ² and the risk of abuse and
addiction. But dependence hasn't been reported in children who take medications at the proper dose. That's because
drug levels in the brain rise too slowly to produce a "high." On the other hand, there's concern that siblings and
classmates of children and teenagers with ADHD might abuse ADHD medications. To keep your child's medications
safe and to make sure your child is getting the right dose of medication at the right time:

V 





    Children and teens shouldn't be in charge of their own ADHD medication.

V  
$ 



   
  
  
An overdose of stimulant drugs is serious and
potentially fatal. Young children are especially sensitive to drug overdoses.

V  " 



  
  
Deliver any medicine yourself to the school nurse or
health office.

  
   
Children with ADHD often benefit from counseling or behavior therapy, which may be provided by a psychiatrist,
psychologist, social worker or other mental health care professional. Some children with ADHD may also have other
conditions such as anxiety disorder or depression. In these cases, counseling can help both ADHD and the coexisting
problem.

Counseling types include:

V    This allows older children with ADHD to talk about issues that bother them, explore negative
behavioral patterns and learn ways to deal with their symptoms.

V 
  Teachers and parents can learn behavior-changing strategies for dealing with difficult situations.
These strategies may include token reward systems and timeouts.

V [

    Family therapy can help parents and siblings deal with the stress of living with someone who has
ADHD.

V Y



 This can help children learn appropriate social behaviors.

V Y  Support groups can offer children with ADHD and their parents a network of social support,
information and education.

V  



 This can help parents develop ways to understand and guide their child's behavior.

The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians
working together. You can help by making every effort to work with your child's teachers and by referring them to
reliable sources of information to support their efforts in the classroom.

A
    


 
Because ADHD is a complex disorder and each person with ADHD is unique, it's hard to make recommendations that
are right for every child. But some of the following suggestions may help:

‰
 


V Y  
 
  Children need to hear that they're loved and appreciated. Focusing only on the
negative aspects of your child's behavior can harm your relationship with him or her and affect self-confidence and
 self-esteem. If your child has a hard time accepting verbal signs of affection, a smile, a pat on the shoulder or a hug
can show you care. Look for behaviors for which you can compliment your child regularly.

V 
  Try to remain patient and calm when dealing with your child, even when your child is out of control. If
you're calm, your child is more likely to calm down too.

V 

 
 Be realistic in your expectations for improvement ² both your own and your child's.

V Ê 

   +   
 Make an effort to accept and appreciate the parts of your child's personality that
aren't so difficult. One of the best ways to do this is simply to spend time together. This should be a private time
when no other children or adults interfere. Try to give your child more positive than negative attention every day.

V Ê  
$  

Use a big calendar to mark special activities that
will be coming up. Children with ADHD have a hard time accepting and adjusting to change. Avoid sudden transitions
from one activity to another.

V    


  Try to keep your child from becoming overtired, because fatigue often makes
symptoms of ADHD worse.

V | 
  

 

  Try to avoid situations that are difficult for your child, such as sitting through long
presentations or shopping in malls and supermarkets where the array of merchandise can be overwhelming.

V 






  
 For children with ADHD, a timeout from social
stimulation can be very effective. Timeouts should be relatively brief, but long enough for your child to regain control.
The idea is to interrupt and defuse out-of-control behavior. A timeout doesn't work for everything, but many parents
have found that it's one of the best tools for managing the behavior of an overactive or impulsive child.

V # 
,
  Help your child organize and maintain a daily assignment notebook and be sure your child
has a quiet place to study. ´roup objects in the child's room and store in clearly marked spaces.

V [
 

  
"
  


 Children with ADHD often do very well
with art projects, music or dance lessons, or martial arts classes, especially karate or tae kwon do. But don't force
children into activities that are beyond their abilities.

V  

   
   

  

 
  Speak slowly and quietly and be very
specific and concrete. ´ive one direction at a time. Stop and make eye contact with the child when giving directions.

V Ê  If you're exhausted and stressed, you're a much less effective parent.

‰
 
 

V     
 Take advantage of any special programs your school may have for children with
ADHD. As with other disabilities, schools are required by law to have a program in place to make sure children who
have a disability that interferes with learning are getting the support they need. Your child may be eligible for
additional services offered under the federal laws Section 504 or the Individuals With Disabilities Education Act
(IDEA). These can include curriculum adjustments, changes in classroom setup, modified teaching techniques, study
skills instruction, and increased collaboration between parents and teachers.

V Ê  
"  Stay in close communication with your child's teachers, and support their efforts to
help your child in the classroom. Be sure teachers closely monitor your child's work, provide positive feedback, and
are flexible and patient. Ask that they be very clear about their instructions and expectations.

V   

  
   

  
 Children with ADHD often have trouble with
handwriting and can greatly benefit from using a computer or a typewriter.

   
 
There's little research that indicates that alternative medicine treatments can significantly reduce ADHD symptoms,
although some do appear to help. These include:

V  There's growing evidence yoga may help alleviate symptoms of ADHD.
V Y
 
 Most diets for ADHD involve eliminating foods thought to increase hyperactivity, such as sugar and
caffeine, and common allergens such as wheat, milk and eggs. Some diets recommend eliminating artificial food
colorings and additives. So far, studies haven't found a consistent link between diet and improved symptoms of
ADHD, though a limited number of studies suggest diet changes might make a difference.

V 


 

 
  While certain vitamins and minerals are necessary for good health, there's no
evidence that supplemental vitamins or minerals can reduce symptoms of ADHD. "Megadoses" of vitamins ² doses
that far exceed the Recommended Dietary Allowance (RDA) ² can be harmful.

V  
  The verdict is still out on whether taking hypericum, ginseng, ginkgo, traditional Chinese
medicine formulas or other herbal remedies may help with ADHD.

V Ë 
   
 These fats, which include omega-3 oils, are necessary for the brain to function properly.
Researchers are still investigating whether these they may improve ADHD symptoms.

V ´  
  The term "glyconutrients" refers to eight specific sugars that theoretically reduce symptoms by
helping form important compounds called glycoproteins. While sugars are necessary for brain function, it isn't clear
whether glyconutrient supplements have any effect on ADHD.

V    

 Also called electroencephalographic biofeedback, this treatment involves regular sessions
in which a child focuses on certain tasks while using a machine that shows brain wave patterns. Theoretically, a child
can learn to keep brain wave patterns active in the front of the brain ² improving symptoms of ADHD. More research
is needed to see whether this treatment works.

‰  

Caring for a child with ADHD can be challenging for the whole family. Parents may be hurt by their child's behavior as
well as by the way other people respond to it. And the stress of dealing with ADHD can lead to marital stress. These
problems may be compounded by the financial burden that ADHD can place on families.

Siblings of a child with ADHD also may have special difficulties. They can be affected by a brother or sister who is
demanding or aggressive, and they may also receive less attention because the child with ADHD requires so much of a
parent's time.

 
There are no easy answers for struggling families, but many resources are available that may help. Parents can get
advice on raising a child with ADHD from a social worker or other mental health care professional or from a support
group. Support groups don't appeal to everyone, but they often can provide excellent information about coping with
ADHD from people who know.

There also are excellent books and guides for both parents and teachers, and Internet sites dealing exclusively with
ADHD.

Ê 
(  

Many parents notice patterns in their child's behavior as well as in their own responses to that behavior. For instance,
your child might throw a tantrum every night before dinner, and you might routinely give him or her a snack so that
you can finish preparing the meal in peace. Although you don't mean to, you end up encouraging your child's
behavior. Both you and your child need to act differently. But substituting new habits for old ones isn't easy ² it takes
real awareness and a lot of hard work. It's important to have realistic expectations and not ask more of your child
than is physically or mentally possible. Set small goals for both yourself and your child and don't try to make a lot of
changes all at once.

Here are a few things that can help you and your child manage ADHD:

V Y   

" 
 You can help make change easier by ensuring that your child has the right kind of
structure. For children with ADHD, structure doesn't mean rigidity or iron discipline. Instead, it means arranging
things so that a child's life is as predictable, calm and organized as possible. Children with ADHD don't handle change
well, and having predictable routines can make them feel safe as well as help improve behavior. ´ive your child a few
minutes warning ² with a countdown ² when it's necessary to change from one activity or location to another.
V 
 

 


 One of the best ways to instill new habits is to provide firm, loving discipline that
rewards good behavior and discourages destructive actions. Children with ADHD usually respond well to positive
reinforcement, as long as it's genuinely earned. It's best to start by rewarding or reinforcing a new behavior every
time it occurs. After a short time, this probably won't be necessary, but you need to continue to let your child know
that you're serious about encouraging new habits. Some parents object to rewards because they seem like bribery.
But changing old habits is extremely hard, and rewards are simply a concrete way of recognizing your child's efforts.

V Y  
 %
 You also need to set a good example by acting the way you want your child to
act. Try to remain patient and in control ² even when your child is out of control. If you speak quietly and calmly,
your child is more likely to calm down, too.

V Y
 

 
 
 Finally, the relationship among all the family members plays a large part in
managing or changing the behavior of a child with ADHD. Couples who have a strong bond often find it easier to face
the challenges of parenting than do those whose bond isn't as strong. That's one reason it's important for partners to
take time to nurture their own relationship.

V ´
    If you're the parent of a child with ADHD, be sure to give yourself a break now and then.
Don't feel guilty for spending a few hours apart from your child. You'll be a better parent if you're rested and relaxed.
And don't hesitate to ask friends, grandparents and other relatives for help. Make certain baby sitters or alternative
caretakers are knowledgeable about ADHD and mature enough to be prepared for the task.

ü  
There's no way to prevent ADHD from occurring. However, there are a few steps that could help prevent problems
caused by ADHD and assure your child is as physically, mentally and emotionally healthy as possible:

V During pregnancy, avoid anything that could harm fetal development. Don't drink alcohol, smoke cigarettes or use
drugs.

V Protect your child from exposure to pollutants and toxins, including cigarette smoke, agricultural or industrial
chemicals, and lead paint (found in some old buildings).

V Be consistent, set limits and have clear consequences for your child's behavior.

V Put together a daily routine for your child with clear expectations that include such things as bedtime, morning time,
mealtime, simple chores, and television.

V Avoid multitasking yourself when talking with your child, make eye contact when giving instructions, and set aside a
few minutes every day to praise your child.

V Work with teachers and caregivers to identify problems early. If your child does have ADHD or another condition that
interferes with learning or social interaction, early treatment can reduce the impact of the condition.



















‘ 
p‘p
By Mawi Fojas de Ocampo
Philippine Daily Inquirer
First Posted 00:34:00 11/19/2008

Filed Under: Lifestyle & Leisure, Health, People

ADHD OR ATTENTION DEFICIT Hyperactivity Disorder is a neurodevelopmental disability that affects children
and adults alike. In the US, the incidence can range from four to eight percent of the population. Data from a 2006
study in the Philippines indicate a four-percent incidence (that¶s more than three million!) assuming at that time the
population was at 84 million.

Proclamation 472 has declared October each year as ³National Attention Deficit/Hyperactivity Disorder Awareness
Week.´

What is the cause of ADHD?

Doctors do not know what causes it. However, researchers who study the brain are coming closer to
understanding what may cause it. They believe that some people with ADHD do not have enough chemicals called
neurotransmitters in their brain. These chemicals help the brain control behavior.

It is important to note that parents and teachers do not cause ADHD. However, there are many things that both
parents and teachers can do to help the child cope with ADHD.

What is the difference between ADHD and ADD?

Ria Vecin, founding partner for the Tomatis Center in the Philippines (Tomatis has been used as treatment for
people with ADHD) says: ³ADD or Attention Deficit Disorder is an older term used to describe children and adults
with attention issues. However this term is no longer used. Normally ADHD is the term used to diagnose those with
attention issues.´

Anna C. de Ocampo, MD, FAAP, Developmental & Behavioral Pediatrician practicing at the Melmed Center in
Scottsdale, Arizona, USA clarifies:

³In reality, there is no ADD in the books (Diagnostic and Statistical Manual IV); but people have coined the term
ADD for children and adults who do not have the hyperactivity component and are mainly inattentive and
distracted.´

According to De Ocampo, there are three classifications of ADHD based on the DSM-IV (this is like the bible of
psychiatry) as follows below:

ADHD-Inattentive Type:

This is characterized by no hyperactivity or impulsivity or just minimal hyperactivity or impulsivity. Predominant

symptoms include:

Inattention, distractibility, daydreaming

Inability to finish work, reluctance to engage in tasks requiring sustained mental effort

Disorganization or executive function deficits (meaning not being able to prioritize tasks, having trouble getting
started on a task, losing things, forgetfulness)

Making careless errors or mistakes

ADHD-HI Type-Hyperactive-Impulsive Type:

Kids with this type have normal attention span. The hyperactivity characteristics, however, include:
Fidgetiness or squirming in seat, out of seat, fidgeting with hands and feet and things

Inability to play quietly

Always on the go, as if driven by a motor, bouncing off the walls

Loud, excessively talkative and usually disruptive in class

Imparts an air or impression that they do not hear what is being told to them

Engaging in physically dangerous activities without thinking of the consequences

Often losing things necessary for tasks or activities at school

Does not follow instructions

Monopolizing conversations due to excessive talking

The impulsivity characteristics include:

Acting without thinking

Rushing through work

Blurting out answers before being called

Interrupting

Inability to wait for their turn

ADHD-Combined Type:

This is the most common in both girls and boys. Combined type means they are hyperactive, impulsive and
inattentive (They have it all!). They are usually disruptive in class because of their symptoms. About 50% have
ODD (Oppositional Defiant Disorder). Kids with ODD are defiant, quick to anger, argumentative, quick to get
annoyed, and very oppositional.

De Ocampo explains: ³So, to answer the question, ADD is the inattentive type of ADHD while ADHD is the
combined type or hyperactive/impulsive type of ADHD.´

How can you know for sure that your child has ADHD?

If your child exhibits the signs mentioned above, it is best to consult with a developmental pediatrician. De Ocampo
says that a diagnostic evaluation and treatment can be done by the following specialists:

Developmental and behavioral pediatricians

Child and adolescent psychiatrists

Neurologists

Clinical psychologists (who can diagnose but cannot prescribe medications)

General pediatricians and family practitioners (those mainly geared for seeing children) may also be able to
diagnose and treat ADHD.

A
 

What is the treatment for it?

Vecin says, ³There are varied treatments for ADHD. The most common goal of treatment is to manage the
symptoms. Treatments vary from nutritional or dietary (though the GFCF diet² Gluten-Free Casein-Free Diet) to
occupational therapy and alternative therapies, as well as changing teaching styles in schools.´

De Ocampo adds: ³A multi-disciplinary approach is best for a child with ADHD, which includes family involvement,
teacher support and the help of a doctor (a psychologist or developmental pediatrician).´

Dr. Lourdes Sumpaico-Tanchanco of Medical City (tel. 6356788) says: ³The best evidence points to a multi-modal
treatment²that means employing different approaches depending on the needs of the child. This may include the
use of medications, behavioral therapy, occupational therapy, speech therapy and educational intervention. Again,
all of these depend on the needs of the child.´

Can children with ADHD outgrow it?

Only about 40% will outgrow the symptoms or may have mild impairment as adults, De Ocampo says. About 60%
carry symptoms through adulthood. ³Although they may outgrow the hyperactivity, they may still be impulsive (i.e.
poor judgement/jumps from one job to another/may have driving accidents; and most likely still inattentive, being
unable to finish tasks and are forgetful),´ she adds

Will a child ever have a normal life given this condition?

³Yes, there are many modes of intervention nowadays that can help manage symptoms of ADHD and can greatly
diminish their occurrence,´ Vecin says.

Are there special schools that cater to kids with ADHD?

³The problem in the Philippines are the big class sizes (about more than 40 in each class) which is less than ideal
for a child with ADHD,´ De Ocampo says. ³They do benefit from small class sizes because there is less distraction,
of course.´

³Most of the time, even in the US, children with ADHD are just mainstreamed in the regular classroom and given
accommodations by the teacher to help them succeed academically. If the child has a severe case of ADHD, he
may go to a Special Ed classroom for emotionally disabled children.´

According to De Ocampo, the trend in the US is just getting most of these kids mainstreamed unless they are so
bad that they will end up being sent to behavior school (aka boot camp!).

Vecin says many schools in the Philippines are integrating inclusion programs for children with ADHD.

Check out these helpful websites:

ADHDsociety.org (ADHD Society of the Philippines)

This website offers support groups, meetings, seminars and other resources.

OCHADD.ORG (Childen and Adults with Attention Deficit Disorder)

This is a US based website and support group with lots of good information. They also conduct yearly meetings.
 c       
  


     

ADHD refers to a chronic biobehavioral disorder that initially manifests in childhood and is characterized byhyperactivity, impulsivity,
and/or inattention. Not all of those affected by ADHD manifest all three behavioral categories. These symptoms can lead to difficulty in
academic, emotional, and social functioning. The diagnosis is established by satisfying specific criteria and may be associated with
other neurological, significant behavioral, and/or developmental/learning disabilities. Therapy may consider the use of medication,
behavioral therapy, and adjustments in day-to-day lifestyle activities.
Studies in the United States indicates approximately 8%-10% of childrensatisfy diagnostic criteria for ADHD. ADHD is, therefore, one of
the most common disorders of childhood. ADHD occurs two to four times more commonly in boys than girls (male to female ratio 4:1 for
the predominantly hyperactive type vs. 2:1 for the predominantly inattentive type). Three subtypes of ADHD are described: (1)
predominantly inattentive, (2) predominantly hyperactive and impulsive, and (3) combined. While previously believed to be "outgrown"
by adulthood, current opinion indicates that many children will continue throughout life with symptoms that may affect both occupational
and social functioning. Some medical researchers note that approximately 40%-50% of ADHD-hyperactive children will have (typically
non-hyperactive) symptoms persist into adulthood.

c   


The cause of ADHD has not been fully defined. One theory springs from observations in functional brain imagining studies between
those with and without symptoms. However, other authorities point out that similar variations have been shown in studies of the
structure of the brain of affected and non-affected individuals. Animal studies have demonstrated differences in the chemistry of brain
transmitters involved with judgment, impulse control, alertness, planning, and mental flexibility.
A genetic predisposition has been demonstrated in (identical) twin and sibling studies. If one identical twin is diagnosed with ADHD,
there is at 92% probability of diagnosis with the twin sibling. When comparing nonidentical twin sibling subjects, the probability falls to
33%. (Overall population incidence is 8%-10% in the U.S., as described above.)

c 
 

The diagnostic criteria for ADHD are outlined in the p
 
 


  
 

 
 
,   . (p
-). All of the
symptoms of inattention, hyperactivity, and impulsivity must have persisted for at least six months to a degree that is maladaptive and
inconsistent with the developmental level of the child.
Inattention:

 The child often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
 The child often has difficulty sustaining attention in tasks or play activities.
 The child often does not seem to listen when spoken to directly.
 The child often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions).
 The child often has difficulty organizing tasks and activities.
 The child often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or
homework).
 The child often loses things necessary for tasks or activities (toys, school assignments, pencils, books, or tools).
 The child is often easily distracted by extraneous stimuli.
 The child is often forgetful in daily activities.

Hyperactivity:

 The child often fidgets with his/her hands or feet or squirms in his/her seat
 The child often leaves his/her seat in the classroom or in other situations in which remaining seated is expected.
 The child often runs about or climbs excessively in situations in which it is inappropriate.
 The child often has difficulty playing or engaging in leisure activities quietly
 The child often talks excessively.

Impulsivity:

 The child often blurts out answers before questions have been completed.
 The child often has difficulty awaiting his/her turn
 The child often interrupts or intrudes on others (for example, butts into conversations or games).
p
 criteria for diagnosis of ADHD requires that some hyperactive, impulsive, or inattention symptoms that cause present difficulties
were present before 7 years of age and are present in two or more settings (at school [or work] or at home). Similarly, there must be
clear evidence of significant impairment in social, academic, or occupational functioning. In addition, symptoms may not entirely be
caused by another severe physical disorder (for example, severe illness associated with chronic pain) or mental disorder (for
example, schizophrenia, other psychotic disorders, severe disabling mood disorders, etc.).
Inattention symptoms are most likely to manifest about at 8 to 9 years of age and commonly are lifelong. The "delay" in onset of
inattentive symptoms may reflect its more subtle nature (vs. hyperactivity) and/or variability in the maturation of cognitive development.
Hyperactivity symptoms are usually obvious by 5 years of age and peak in severity between 7 to 8 years of age. With maturation, these
behaviors progressively decline and often have been "outgrown" by adolescence. Impulsive behaviors are commonly linked to
hyperactivity and also peak about 7 to 8 years of age; however, unlike their hyperactive counterpart, impulsivity issues remain well into
adulthood. Impulsive adolescents are more likely to experiment with high-risk behaviors (drugs, sexual activity, driving, etc.). Impulsive
adults have a higher rate of financial mismanagement (impulse buying, gambling, etc.).

 
  

The evaluation of a child suspected of having ADHD involves various disciplines to provide comprehensive medical, developmental,
educational, and psychosocial evaluations. Interviewing parents and the child along with contact with the child's teacher(s) is crucial.
Investigation regarding the family history for behavioral and/or social problems is imperative.
While direct person-to-person contact is considered vital at the outset of an investigation, follow-up studies may be guided by
comparing standardized questionnaires (parental and teacher) completed prior to intervention and subsequent to therapeutic trials of
medication, behavioral therapy, or other approaches. While there is no unique finding on physical exam in patients with ADHD, unusual
physical features should prompt consideration of consultation with a geneticist due to the high association with ADHD behavioral
patterns and well-recognized congenital syndromes (for example, fetal alcohol syndrome).

  

       



Physicians and parents should be aware that schools are federally mandated to perform an appropriate evaluation if a child is
suspected of having a disability that impairs academic functioning. This policy was recently strengthened by regulations implementing
the 1997 reauthorization of the Individuals With Disabilities Act (IDEA), which guarantees appropriate services and a public education to
children with disabilities from ages 3 to 21. If the assessment performed by the school is inadequate or inappropriate, parents may
request that an independent evaluation be conducted at the school's expense. Furthermore, some children with ADHD qualify for
special-education services within the public schools, under the category of "Other Health Impaired." In these cases, the special-
education teacher, school psychologist, school administrators, classroom teachers, along with parents, must assess the child's
strengths and weaknesses and design an Individualized Education Program (IEP). These special-education services for children with
ADHD are available though IDEA.
Despite this "federal mandate," the reality is that many school districts, because of inadequate funding or understaffing, are unable to
perform "an appropriate evaluation" for all children suspected of having ADHD. The districts have the latitude to define the degree of
"impairment of academic functioning" necessary to approve "appropriate evaluation." This usually means the children who are failing or
near failing in their academic performance. A very large segment of the ADHD-affected children will be "getting by" (not failing)
academically (at least for their early years of school), but they are usually achieving well below their potential and will fall further behind
each year on the academic prerequisite skills necessary for later school success. Thereafter, further educational testing may be
requested from the school district. Unfortunately, some families will have to assume the financial burden of an independent educational
evaluation. These evaluations are commonly done by an educational psychologist and may involve approximately eight to 10 hours of
testing and observation spread out over several sessions. A primary goal of an educational evaluation is to exclude/include the
possibility of learning disorders (such as dyslexia, language disorders, etc.).


    

Research has shown that ADHD does seem to cluster in families. Several investigations have demonstrated that children who have
ADHD usually have at least one close relative (child or adult) who also has ADHD. At least one-third of all fathers who have ADHD will
produce a child with ADHD. With the newer realization that adults may also experience ADHD symptoms, it is not unheard of to have a
parent's "problem at my job" be credited toADHD -- often at the same time their child's diagnosis is being established! Lastly, several
studies have demonstrated a number of genes that may reflect a role in altered brain neurochemistry that provide a physiologic basis
for this disorder and inheritance pattern.


    

No one knows for sure whether the prevalence of ADHD per se has risen, but it is very clear that the number of children identified with
the disorder and who obtain treatment has risen over the past decade. Some of this increased identification and increased treatment
seeking is due in part to greater media interest, heightened consumer awareness, and the availability of effective treatments. Teachers
are better trained to recognize the condition and suggest that the family seek help, especially in the more mild to moderate cases. In
addition, the diagnostic criteria for ADHD are now more specifically and concisely defined.
The diagnosis of ADHD is less of a social stigma than in the past. This more enlightened perspective reflects the understanding that
ADHD is a biochemical disorder and not merely an "out of control child." As such, more parents are receptive to medical therapy for the
condition rather than resorting to less effective home/school discipline techniques. Interestingly, the increase in prevalence of ADHD is
not solely an American phenomenon but has been noted also in other countries. Whether the number of patients with ADHD has truly
increased or rather better recognition and acceptance of ADHD as a diagnosis has "increased" remains to be further defined.

‰
          

Neuroimaging research has shown that the brains of children with ADHD differ fairly consistently from those of children without the
disorder in that several brain regions and structures tend to be smaller. There is also a lack of expected symmetry between the right
and left hemispheres. Overall, brain size is generally 5% smaller in affected children than children without ADHD. While this average
difference is observed consistently, it is too small to be useful in making the diagnosis of ADHD in a particular individual. In addition,
there appears to be a link between a person's ability to pay continued attention and measures that reflect brain activity. In people with
ADHD, the brain areas that control attention appear to be less active, suggesting that a lower level of activity in some parts of the brain
may be related to difficulties sustaining attention. It is important to reiterate that these laboratory observations are not yet sufficiently
sensitive or specific enough to use to establish or confirm the diagnosis of ADHD or to monitor the effectiveness of treatment.
‰       


The diagnosis of ADHD in the preschool-aged (under 5 years old) child is possible, but it can be difficult and should be made cautiously
by experts well trained in childhood neurobehavioral disorders. A variety of physical problems, emotional problems, developmental
problems (especially language delays), and adjustment problems can sometimes imitate ADHD in this age group. It is certainly not
mandatory that the preschool-aged child showing ADHD-suggestive symptoms be placed in a preschool. The first line of therapy for
children of this age showing ADHD-like symptoms is not stimulant medication therapy but rather environmental or behavioral therapy.
This type of therapy can certainly be carried out in the home with appropriate training supplied to the parents. If the child is to be placed
in a preschool, the caretakers must be equally trained in the techniques of behavioral therapy. Stimulant therapy can reduce
oppositional behavior and improve mother-child interaction, but it's usually reserved for severe cases or when a child does not respond
to environmental or behavioral interventions.
c   
     

Life can be hard for children with ADHD. They are often in trouble at school, can't finish a game, and have trouble making friends. They
may spend agonizing hours each night struggling to keep their mind on their homework, only to forget to bring it to school. Family
conflict can increase, placing added stress on exhausted parents and frustrated children. Adolescents are at increased risk for poor
self-esteem, motor-vehicle accidents, tobaccoand other drug use, early pregnancy, and lower educational attainment. School programs
to help children with problems often connected to ADHD (social skills and behavior training) are not available in many schools. In
addition, not all children with ADHD qualify for special-education services. To overcome these barriers, parents may want to look for
school-based programs that have a team approach involving parents, teachers, school psychologists, other mental-health specialists,
and physicians. In addition there arebehavioral treatments and parenting strategies for parents of children with ADHD.

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CAM (complementary and alternative medicine) therapies are considered and/or tried in over half of patients with ADHD. Many times,
these modalities are used covertly and it is important for the treating physician to inquire about CAM to encourage open communication
and review risks vs. benefits of such an approach. CAM treatment modalities incorporating vision training, special diets and
megavitamin therapy, herbal and mineral supplements, EEG biofeedback, and applied kinesiology have all been advocated. The
benefits of these approaches, however, have not been confirmed in double-blind controlled research studies. Families should be aware
that such programs might require a long-term financial commitment that may not have insurance reimbursement as an option. Recent
research on the benefits of specific polyunsaturated fatty acid (EPA and DHA) supplementation has demonstrated a therapeutic benefit
in several well-designed studies. Further research in this area will hopefully shed light on how these supplements work.

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In 2001, the American Academy of Pediatrics (AAP), in their Clinical Practice Guideline, suggested that when treating target ADHD
symptoms, "clinicians should recommend stimulant medication and/or behavior therapy, as appropriate." Several forms of behavioral
intervention have been found to show little or no effectiveness in treating ADHD patients. These included individual or play therapy,
long-term psychotherapy, psychoanalysis, sensory-integration training, and cognitive behavioral therapy. However, one form of a non-
medication approach, behavioral therapy, has been demonstrated to be somewhat effective with ADHD children. The therapy sessions
are conducted by a mental-health professional (for example, a psychologist or social worker) and consist of parent and teacher training
in child behavior management. The parents and teachers are taught to consider their child's behavior as a function of the disorder,
rather than "bad behavior" or the result of failed parenting/teaching skills. The sessions then go on to teach the adults to pay attention
to appropriate behavior, ignore minor inappropriate behavior, to give clear and concise directions, and to establish effective incentive
programs, such as token or point reward systems. The adults manage misbehavior by applying immediate, specific, and consistent
consequences (removal of privileges). Basically, the three principles of behavior therapy are
 1. set specific goals,

2. provide rewards and consequences,

3. and keep using the rewards and consequences for a long time.
Parents can help their child's behavior with specific goals such as: (1) maintaining a daily schedule, (2) keeping distractions to a
minimum, (3) setting small and reasonable goals, (4) rewarding positive behavior, (5) using charts and checklists to keep a child "on
task," and (6) finding activities in which the child will succeed (sports, hobbies).
Many feel that behavior therapy can be an appropriate first-level treatment in several scenarios:
1. the milder ADHD patient,

2. for the preschool-aged child with ADHD-suspicious symptoms,

3. and when the family prefers this approach vs. medication.

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Children with ADHD may require adjustments in the structure of their educational experience, including tutorial assistance and the use
of a resource room. Many children function well throughout the entire school day with their peers. However, some patients with ADHD
will benefit from a "pull out session" to complete tasks, review specific homework assignments, and develop "management" skills
necessary for higher education. Extended time for class work/tests may be necessary as well as assignments written on the board and
preferential seating near the teacher. An IEP (individualized educational program) should be developed and reviewed periodically with
the parents. ADHD is considered a disability falling under U.S. Public Law 101-476 (Individuals With Disabilities Education Act, "IDEA").
As such, individuals with ADHD may qualify for "appropriate accommodations within the regular classroom" within the public-school
system. In addition, the Americans With Disabilities Act ("ADA") indicates that secular private schools may be required to provide
similar "appropriate accommodations" in their institutions.

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Psychostimulant medications, includingmethylphenidate (Ritalin, Metadate, andConcerta), amphetamine (Dexedrine, Vyvanse,

and Adderall), and atomoxetine (Strattera, marketed as a "non-stimulant," although its mechanism of action and potential side effects
are essentially equivalent to the "psychostimulant" medications), are the most widely researched and commonly prescribed treatments
for ADHD. Numerous short-term studies have established the safety and effectiveness of stimulants and psychosocial (behavioral
therapy) treatments for not only alleviating the symptoms of ADHD but also improving the child's ability to follow rules and improve
relationships with peers and parents. National Institute of Mental Health (NIMH) research has indicated that the two most effective
treatment modalities for elementary-school children with ADHD are a closely monitored medication treatment or a program that
combines medication with intensive behavioral interventions (behavior therapy). In the NIMH Multimodal Treatment Study for Children
With ADHD (MTA), which included nearly 600 elementary-school children across multiple sites, nine out of 10 children improved
substantially on one of these treatment programs.
Recently the Federal Drug Administration (FDA) has licensed the use of guanfacine as a non-stimulant medication effective in treating
ADHD. Both a short-term preparation (Tenex) and a long-term preparation (Intuniv) are available. Unfortunately, 18% of Intuniv users
discontinued use of their medication due to side effects, including drowsiness (35%), headache (25%), and fatigue (14%).
Two types of antidepressant medications, the "tricyclic antidepressants" (TCA) (imipramine, desipramine, and nortriptyline)
and bupropion (Wellbutrin), have also been shown to have a positive effect on all three of the major components of ADHD: inattention,
impulsivity, and hyperactivity. They tend, though, to be considered as second options for the children who have shown inadequate
response to stimulant medication or who experience unacceptable side effects from stimulant medication such as tics (uncontrolled
movement disorders) or insomnia. The antidepressants, however, have a greater potential for side effects of their own, such as heart-
rate and rhythm changes, dry mouth, headaches, and drowsiness, to name a few. If higher doses are required, bupropion may bring
on seizures. The antidepressants, therefore, require more careful monitoring.
For the child who has a combination of ADHD and comorbid conditions such asdepression, anxiety disorders, or mood disorders,
stimulant medications can be combined with an antidepressant medication very successfully.
      
   
For most children, stimulant medications are very safe and extremely effective. Research has shown that up to 80% of ADHD children
show very good to excellent response to these medications. Improvements in the delivery systems for these medications in the last few
years that have allowed the child to frequently only require one dose per day, alleviating the embarrassing "trip to the nurse's office" for
a midday dose at school. Recently, a skin patch (Daytrana, a methylphenidate transdermal system) that, when applied daily, delivers
the medication at a carefully controlled rate. The doctor will work with the child and his family to find the best medication, dosage,
schedule, and delivery system. This requires careful individualization, since some children respond to one type of stimulant much better
than another and each child's daily needs and schedules are so variable.

     

   
The expected duration of treatment has lengthened during this past decade as evidence has accumulated that benefits extend into
adolescence and adulthood. Medication usage during the teen years can become problematic. The natural rebellion and desire for
independence can make the adolescent protest against taking a medication. The need for a medication may reinforce anxiety that is
common during the teen years in that it reinforces the notion of "I am different" to an age range that craves "fitting in." As such, parents
and physicians must empower the teen to become a partner rather than a mere participant in his/her health. In some circumstances, it
may even be necessary to allow the teenager to suffer the effects (academic and social) should he refuse to take medication. It is
frequently the case that medication will be required into adulthood, and these years are critically important ones for the adolescent to
begin to learn self-management of medication and other issues related to ADHD.

          ! 


While it is certainly true that the prescribing of stimulant medication has increased sharply in the last 15 years, the statistics indicate that
this increase coincides with the number of legitimately diagnosed cases of ADHD worldwide. Physicians, and the population in general,
have achieved a much greater degree of awareness of and acceptance of the biological nature of ADHD, as well as the dramatic
effectiveness of treatment protocols.
             
There are significant differences in access to mental-health services between children of different racial groups, and consequently,
there are differences in medication use. In particular, African-American children are much less likely than Caucasian children to receive
psychotropic medications, including stimulants, for treatment of mental disorders.
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Recall that the three key components in ADHD are inattention, impulsiveness, and hyperactivity. While the exact nature of the disorder
at the brain-cell level is not completely understood, it is felt that the medications work by stimulating the brain cells to make more of the
chemicals (neurotransmitters) available that send messages from one brain cell to another. This improved message-sending system
enhances the brains ability to pay attention, control behavior and impulses, plan actions, and follow through on schedules.
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Stimulant medications have been successfully used to treat patients with ADHD for more than 50 years. This class of medication, when
used under proper medical supervision, has an excellent safety record. In general, the side effects of the stimulant class of medications
are mild, often temporary, and potentially reversible with adjustment in dosage amount or interval of administration. The incidence of
side effects is highest when administered to preschool-aged children. Common side effects include appetite
suppression, sleep disturbances, and weight loss. Less common side effects include an increase in heart rate/blood pressure,
headache, and emotional changes (social withdrawal, nervousness, and moodiness). Patients treated with the methylphenidate patch
(Daytrana) may develop a skin sensitization at the site of application. Approximately 15%-30% of children treated with stimulant
medication develop minor motor tics (involuntary rapid twitching of facial and/or neck and shoulder muscles). These are almost always
short lived and resolve without stopping the use of medication.
A recent investigation studied the possibility of stimulant medication used to treat ADHD and cardiovascular side effects. Concern
focused on a possible association with heart attack, heart-rate and rhythm disturbances, and stroke. At the time of the writing of this
article, there is no certainty as to the relationship to these event (including sudden death) when medication is used in a pediatric
population screened for prior cardiovascular symptoms or structural pathology. A positive family history for certain conditions (such as
unusual heart-rhythm patterns) may be considered a risk factor. The current position of the American Academy of Pediatrics is that a
screening EKG is not indicated before initiation of stimulant medication in a patient without risk factors.
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Although an increased risk of drug abuse and cigarette smoking is associated with childhood ADHD, this risk appears due to the ADHD
condition itself, rather than its treatment. In a study jointly funded by the NIMH and the National Institute on Drug Abuse, boys with
ADHD who were treated with stimulants were significantly less likely to abuse drugs and alcohol when they got older. Caution is
warranted, nonetheless, as the overall evidence suggests that people with ADHD (particularly untreated ADHD) are indeed at greater
risk for later alcohol or substance abuse. Because some studies have come to conflicting conclusions, more research is needed to
understand these phenomena. Regardless, in view of the substantial, well-established findings of the harmful effects of inadequate
treatment or no treatment for a child with ADHD, parents should not be dissuaded from seeking effective treatments because of
misconstrued or exaggerated claims about substance-abuse risks.
"Diversion" is the transfer of medication from the patient for whom it was prescribed to another individual. Several large studies have
indicated that 5%-9% of grade-school and high-school students and 5%-35% of college-age individuals reported use of non-prescribed
stimulant medication. Approximately 16%-29% of students for whom stimulant medications were prescribed reported being approached
to give, trade, or sell their medication. Misuse was more frequently seen in whites, members of fraternities and sororities, and students
with a lower GPA. Diversion was more likely with the short-acting preparations. The most common reasons cited for use on non-
prescribed stimulants were they "helped with studying," improved alertness, drug experimentation, and "getting high."

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         !   
      

While the recognition and understanding of ADHD has advanced greatly, it is still frequently under-recognized by most laypeople and
many physicians that coexisting conditions affect as many as 50%-60% of all children with ADHD. Many of these coexisting conditions
have many of the same symptoms of ADHD, and these symptoms are often the first signs of problems in youngsters under 5 years of
age. At the time of the initial evaluation and diagnosis of ADHD, as well as throughout the lifetime of the ADHD patient, these other
conditions must be looked for. They include the following.

 
   (in up to 35% of children with ADHD) include oppositional defiant disorder (ODD) and conduct disorder
(CD). The behaviors in these areas go well beyond the usual "limit testing" of childhood and adolescence. Patients with ODD
repeatedly demonstrate major defiance and hostility toward authority figures, refusal to follow rules, frequent loss of temper, deliberate
annoyance of others, and generally angry, vindictive, and resentful behavior. Conduct disorder is more extreme and is defined as "a
repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate social rules are violated." CD
extends into serious acts of violence against people and/or animals, school truancy, running away, vandalism, stealing, and so on. The
person with CD is often labeled as "a delinquent" and has the potential for serious legal problems. It has been shown that early
introduction of stimulant medication improves not only the basic ADHD symptoms but also the ODD or CD symptoms as well.
Frequently, additional measures are also needed, especially in the CD category. These may include therapy from professional
behavior-therapist intervention to special classrooms set up for more intensive behavior management to residential school placement
with psychiatric involvement.
#    (in up to 15%-20% of children with ADHD) such as depression andbipolar disorder are often more difficult to
recognize than the disruptive behavior disorders. Many children with ADHD alone are noted to be irritable, moody, easily frustrated, or
immature emotionally. When these symptoms become severe enough to dominate the child's life, mood disorders must be considered.
Children with combined ADHD/mood disorders (especially the more severe bipolar disorder) are at greater risk for drug abuse
and suicide. Children in this category often require referral to a developmental/behavioral specialist or a psychiatrist, as there are a
variety of behavioral/psychotherapeutic methods along with additional medications that can be very helpful.
!    (in up to 25% of children with ADHD) often involve symptoms that are largely internal and, again, more difficult to
immediately recognize. These symptoms may be extreme fear, worry, and feelings of panic associated with physical findings like racing
heart rates, muscle tension, nausea, vomiting, or extreme sweating. These bouts of anxiety are severe, ongoing, and frequent (at least
three to five times per week and lasting for more than one hour). The use of stimulant medication alone may help both the ADHD
symptoms and anxiety symptoms as well. If not, behavioral therapy and/or additional medication in the tricyclic antidepressant family or
the selective serotonin reuptake inhibitor (SSRI) family (Celexa, Zoloft, Lexapro, and Prozac, etc.) can be very helpful.
A     are conditions that can interfere with the child's mastery of specific skills like mathematics or reading. They can
include auditory perceptual problems, visual perceptual problems, and so on. The school should be approached to carry out testing for
these specific learning disorders. Depending on the type of learning disorder detected, altering teaching techniques can help the
student bypass areas of weakness and utilize other pathways of learning that may actually be quite strong.

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Research supports the clinical observation that as many as 50% of children with ADHD will have symptoms persist into adulthood. One
caveat needs to be mentioned -- manystudies previously conducted focused on a patient population of males who were evaluated or
treated by psychiatrists/psychologists or in clinics specially developed for such a patient population. Generalizing these results as
applicable to the entire patient population with ADHD may not be appropriate. Fortunately, new studies are being conducted to address
this issue. The following are current areas of concern.

1. Education: Follow-up studies of children with ADHD growing into adolescence showed impairment of academic success. A few
studies into adulthood have demonstrated persistence of these findings. Completion of expected schooling, lower achievement
scores, and failure of courses are areas of concern.
2. Employment: The rate of adult employment of those with and without a diagnosis of ADHD did not vary; however, those with
ADHD did have occupations with a lower "job status."
3. Socialization issues: As noted above, a significant subset of children with ADHD has an accompanying disruptive behavior
disorder (ODD and CD). In studies that followed children with ADHD into adulthood, between 12%-23% have socialization
problems (vs. 2%-3% of the general population).
4. Substance abuse: The medical literature investigating whether those with ADHD have a higher likelihood for such high-risk
behaviors is controversial. The largest study to date supports other smaller studies that indicate ADHD patients who
consistently take their medication have twice the likelihood not to utilize drugs or excessive alcohol.
5. Driving: Teens with ADHD are two to four times more likely to have motor-vehicle accidents or have their license suspended
than peers without such a diagnosis. Impulsivity and inattention again seem to be limited when at-risk teens consistently take
their recommended medication.

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ADHD has assumed many aliases over time from hyperkinesis (the Latin derivative for 
 ) to hyperactivity in the early 1970s.
In the 1980s, p
- dubbed the syndrome attention deficit disorder (or ADD), which could be diagnosed with or without hyperactivity.
This definition was created to underline the importance of the inattentiveness or attention deficit that is often but not always
accompanied by hyperactivity. The revised edition of p
-, the p
-, published in 1987, returned the emphasis back to the
inclusion of hyperactivity within the diagnosis, with the official name of ADHD. With the publication of p
, the name ADHD still
stands, but there are varying types within this classification to include symptoms of both inattention and hyperactivity-impulsivity,
signifying that there are some individuals in whom one or another pattern is predominant (for at least the past six months). In the
 International Classification of Diseases (used predominantly in other Western countries), the term      is used, but the
criteria are the same as for ADHD/combined type.

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1. The current criteria for the diagnosis of ADHD are taken from the p
 
 

  





p  ,  . (p
-) published in 1994. Much has been revealed about ADHD since then. The next edition (p
 expected
May 2012) will need to reflect our broader understanding of ADHD. In addition, there is currently just one set of diagnostic criteria
used for the diagnosis of ADHD for all age groups. Clearly, we must establish different diagnostic criteria for childhood, adolescent,
and adult ADHD.

2. We need more data regarding the long-term effects of the methods of treatment (medication, behavioral therapy, etc.) that have
now been used for several decades, as well as the long-term outcome of children with ADHD who have not been treated.

3. The development of psychotropic medications in non-ADHD areas has expanded dramatically in the past few years. We must
continue to look for even safer and more effective medications for ADHD alone and (perhaps even more importantly) for the patients
with combined ADHD/comorbid conditions.

4. The societal impact of ADHD needs to be investigated. Studies in this regard include: strategies for implementing effective
medication management or combination therapies in different schools and pediatric health-care systems; the nature and severity of
the impact on adults with ADHD beyond the age of 20, as well as their families; and determination of the use of mental-health
services related to diagnosis and care of people with ADHD.

5. Additional studies are needed to improve communication across educational and health-care settings to ensure more
systematized treatment strategies.

6. Studies should be done in the areas of prevention/early intervention strategies that target known risk factors that may lead to later
ADHD.

7. Further evaluation is necessary for the rapidly evolving technology of brain-imaging techniques as a possible tool in the diagnosis
and subsequent management of ADHD.

Attention Deficit Hyperactivity Disorder (ADHD) At A Glance

 ADHD refers to a chronic disorder that initially manifests in childhood and is characterized by hyperactivity, impulsivity, and/or
inattention.
 The cause of ADHD has not been fully defined and may involve brain-chemical and genetic factors.
 The diagnosis of ADHD involves many disciplines to include comprehensive medical, developmental, educational, and psychosocial
evaluations.
 ADHD can cluster in families.
 Children with ADHD may require adjustments in the structure of their educational experience including tutorial assistance and the
use of a resource room.
 Medications are available to treat ADHD and can improve overall function.

For more information regarding attention deficit disorder, contact the local school-district office or one of the following:
Bureau of Education for the Handicapped
U.S. Office of Education
Washington, DC 20202
The Association for Children With Learning Disabilities, Inc.
3739 S. Delaware Place
Tulsa, OK 74105
Council for Exceptional Children
PO Box 9382 Mid-City Station
Washington, DC 20005
U.S. Office of Civil Rights
Washington, DC 20402
For more information about ADHD, please visit C.H.A.D.D. (Children and Adults With Attention-Deficit/Hyperactivity
Disorder (http://www.chadd.org).
SOURCE: Portions of the above information were provided with the kind permission of the National Institute of Mental Health (http://www.nimh.nih.gov).

A
 
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By HENRY S. TENEDORO
September 1, 2010, 7:44pm
It is estimated that three to five percent of school-age students are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Individuals usually do not outgrow the condition; therefore, adolescents and adults experience the symptoms.

The Diagnostic and Statistical Manual, Fourth Edition (1994) lists the criteria for three types of ADHD.

They are:

‡ DHD ± Predominantly inattentive type

‡ ADHD ± Predominantly hyperactive-impulsive type
‡ ADHD ± Combined type.

A student must be at least seven years old and exhibit at least six criteria under each type.

The three main categories of symptoms include inattentiveness, restlessness or hyperactivity, and impulsivity.

Other symptoms that are frequently reported by individuals include poor memory, slow at completing tasks, and poor management of
time and tasks.

The usual and customary treatment for ADHD has been medication. Perhaps this is the case due to the lack of knowledge of how to
address the problem non-medically.

Empirical and clinical treatment of the condition indicates that the condition can be treated or addressed symptomatically whether an
individual is on medication or not.

However, there are various ways and means applying learning styles approaches and methods that can help minimize the impact of
this behavior. The following are some of the procedures on how to handle ADD or ADHD.

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Symptoms of inattentiveness can be addressed by some of the following procedures:

 Use seating arrangements or cubicles that are not near others for individual work
 Allow studying in quiet environment for those distracted by noiseUse background music to drown out extraneous noises in the
environment
 Practice attention and concentration exercises in the midst of extraneous sounds
 Allow frequent breaks or distributed practice
 Give short assignments (10 problems rather than 25 on a page)
 Plan variety of activities
 Use multisensory materials

Symptoms of hyperactivity can be addressed by some of the following procedures:

 Teach or address the problem with kinesthetic and tactual tasks

 Require learning tasks which require movement
 Allow students to use dance, drama, and pantomime to illustrate learning
 Require students to walk to the board to write or illustrate learning
 Allow frequent breaks
 Use the student as an assistant to the teaches

Symptoms of impulsivity can be addressed by some of the following procedures:

 Require the individual to think of more than one answer or response to a question before giving the final answer
 At the beginning of a period or at the beginning of the day, plan for it
 Reinforce student for raising his or her hand rather than blurting a response
 Require and reinforce student for checking their own work before handing it in
 Teach students to say, ³let me think about it,´ or count to 10 before responding
Memory problems can be addressed by some of the following procedures:

 Write the schedule or deadlines on the board daily

 Allow students to write a schedule or plan for the day and deadlines and tape in different places such as in the cover of
notebook, on the door of the locker, etc.
 Paste a calendar on the notebook
 Teach students how to use watches, stop clocks, and other tools as reminders to end a task, to set a watch 5-10 minutes fast
to prevent being late

Problems of disorganization can be addressed by some of the following procedures:

 Give students time to clean out their desk periodically

 Give students time to arrange and label materials in their desks, notebooks, and lockers
 Teach students to put materials where they belong immediately
 Show students how to match the color of Math notebook with the color of the Math book and do the same for other subjects

The procedures are not meant to be exhaustive, rather to provide examples of what can be done to address various symptoms of
ADHD which are frequently reported by teachers and parents and which interfere with performance.

For effectiveness it is recommended that teachers and parents work together so that the same procedures and routines are carried out
at home and school. If these procedures are done on a consistent basis a habit will be formed. Adolescents and adults in the work
place can also take advantage of these procedures.

Isn¶t this the beauty of learning styles? Its application can be so enormous - in the family, at school and the community at large!

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