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- What is ADHD?
- Diagnosing ADHD in Children
- What Causes ADHD in Children?
- Help for Children with ADHD
- More Information on ADHD in Children
What is Attention Deficit Hyperactivity Disorder (ADHD)?
Attention Deficit Hyperactivity Disorder in children, commonly referred to as ADHD, is characterized by poor concentration, hyperactivity, distractibility, and impulsiveness that are inappropriate for the child's age.
ADHD child symptoms include becoming easily distracted by sights and sounds in their environment, inability to concentrate for long periods of time, restlessness and impulsiveness, a tendency to daydream, and slowness in completing tasks.
Attention deficit hyperactive disorder in children is becoming increasingly common. For these children, their world can be like living inside a continuous fireworks display, where sounds, images, and thoughts are constantly exploding and distracting them, making it impossible for them to stay focused.
These children often find it impossible to fit in. As a result, they live in their own chaotic world. In order for these children to achieve their full potential, they should receive help, guidance, and understanding from parents, guidance counselors, and the public education system.
ADHD child symptoms often continues into adolescence and adulthood, and can cause a lifetime of frustrated dreams and emotional pain. Read more about adults with ADHD.
The Difference Between ADD and ADHD
Attention Deficit Disorder (ADD) is the umbrella disorder, encompassing three sub-groups. These three groups are defined as follows:
- ADD Inattentive Type
A main characteristic of inattentive behavior is the inability to concentrate and focus. This lack of attention may only be noticed when a child enters the challenging environment of school. This is not classified as ADHD, as hyperactivity is not present.
- ADD Hyperactive/Impulsive Type
A child with hyperactive and impulsive behavior is commonly ‘all over the place’ and very active (both mentally and physically), making hasty decisions at any moment. This is classified as ADHD, as hyperactivity is present.
- ADD Combined Type
ADD child symptoms of inattentive type are combined with the symptoms of hyperactive/impulsive type. This is the most common form of ADD. A child with more than six ADD combined type symptoms should have a comprehensive evaluation. This is classified as ADHD, as hyperactivity is present.
How does ADHD Manifest in Children?
To their family, classmates, or teachers, children with ADHD seem difficult and hard to manage. However, children who have attention deficit hyperactivity disorder are not bad, lazy, or stupid.
These children have a disorder that can make it difficult for them to follow instructions or participate in activities. Parents are naturally concerned when their child's disruptive behavior, as it can cause numerous meetings with the school faculty.
Even though the child with ADHD often wants to be a good student, the erratic behavior can be very troublesome - so much so that it interferes with their ability to live normal lives.
Although attention deficit hyperactive disorder in children is a relatively new phrase, the disorder was first described by Dr. Heinrich Hoffman in 1845. "The Story of Fidgety Philip" was an accurate description of a little boy who had ADHD. Since then, several thousand scientific papers on the disorder have been published.
ADHD is not itself considered a learning disability, but the ADHD child symptoms can lead to problems with learning, thus creating obstacles in a child's academic development. It is important to have a child thoroughly evaluated to determine if learning disabilities are present.
Learning disabilities are common in children with ADHD, but not all children with learning disorders have ADHD. ADHD does not affect intelligence, as children with the disorder span the same IQ range as the general population.
Diagnosing ADHD in Children
Many of the techniques and principles used to diagnose attention deficit hyperactivity disorder in children are the same as those used to diagnose adults with ADHD, including teens.
Alternative Testing Methods
There are no objective means (i.e. blood tests) of diagnosing ADHD at this time, although your health care professional/ psychologist may see other signs or symptoms in your child that warrant blood tests, brain imaging studies or an EEG.
Steps in Making the ADHD Diagnosis
A diagnosis of ADHD is only applied to children who consistently display certain characteristic behaviors over a period of time. Above all, the behaviors must severely compromise at least two areas of your child's life, such as school, home, or social settings.
For example, a child who constantly misbehaves at home but whose schoolwork or friendships are not impaired by these behaviors would not be diagnosed with ADHD. Similarly, a child who seems overly active at school but functions well elsewhere would not be diagnosed with ADHD.
Sometimes the problem can lie with the environment (school or home) rather than with the child. Children often become little barometers of problems existing in their family or school environments. In such instances, it would be incorrect to diagnose the child with a psychiatric disorder.
Because children mature at different rates and are very different in personality, temperament, and energy levels, it is useful to get an expert's opinion of whether the behavior is appropriate for your child's age.
Symptoms of ADHD must be inappropriate for age and not caused by any other environmental, psychological or physical factors. This means that a child with a primary diagnosis of anxiety disorder or depression, for example, should not be diagnosed with ADHD as well.
After the symptoms of the primary diagnosis are resolved, a further assessment can be carried out to determine if a diagnosis of ADHD is appropriate. Unfortunately, the practice of multiple diagnoses is common, often leading to unnecessary and excessive use of prescription drugs.
The process of diagnosing ADHD must be therefore be very comprehensive. It requires several steps and it involves evaluating information from multiple sources.
NOTE: Under no circumstances should ADHD be diagnosed in any children who have been diagnosed with emotional disorders, such as such as anxiety or depression.
During an assessment, specialists consider several critical questions:
- Are these behaviors excessive, long-term, pervasive, and affecting life tasks?
- Do they occur more often than in other people the same age?
- Are they a continuous problem, not just a response to a temporary situation?
- Do the behaviors occur in several settings or only in one specific place like the playground or at home?
Those who should be involved in assessing your child's behavior include:
- You, your partner, and your child
- Your child's school, teachers, and principal
- Your child's caregivers, nanny, or babysitter
- Your child's psychologist
- Anyone who can provide insight and contribute to the bigger picture.
Your health care professional/psychologist might investigate the following areas:
- Pregnancy history (any problems during pregnancy or during delivery)
- Early childhood development
- Family history (for any occurrence of ADHD)
- Family functioning
- Child's medical problems (physical problems, particularly allergies)
- School history and school reports (looking for specific problems beginning as early as possible that may have been encountered during the child's development)
- Sibling relationships
- Eating habits and sleeping patterns
Your health professional or psychologist will want to know how you handle different situations and may want to observe you interacting with your child. You may need to fill in checklists or rating scales about your child's behavior. If your child is home- schooled, it is especially important to assess his behavior in settings outside of the home.
Your health care professional/psychologist will also talk to your child about how he/she acts and feels. In addition to looking at your child's behavior, a physical examination may be necessary.
Psychologists will apply a battery of psychometric tests to assess your child's intellectual and emotional functioning in a variety of areas. These tests are very helpful in pinpointing areas of weakness and strength, and can also help to identify other problems such as learning or perceptual disorders that may be contributing towards your child's problems.
What are the Symptoms of ADHD?
ADHD does not have clear physical signs that can be seen in an x-ray or show up on a lab test. Symptoms are only identified by looking for associated behaviors, and these behaviors vary from child to child. Symptoms typically occur in early childhood (before age seven) and are present consistently for a period of six months.
Symptoms of ADHD include:
- Can be aggressive
- Fidgets or squirms
- Talks excessively, blurts out answers, or interrupts others often
- Has difficulty staying seated, standing in line, or waiting his or her turn
- Is impatient and often "on the go"
- Difficulty delaying responses
- Has difficulty playing quietly - often running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected
True ADHD symptoms appear on a regular basis and can interfere with learning. That is why a teacher sometimes is the first to notice inattention, hyperactivity and/or impulsivity and bring these symptoms to the parents' attention.
What Causes ADHD in Children?
One of the first questions a parent will ask is "Why is this affecting my child? What went wrong?" or even "Did I do something to cause this?"
When correctly diagnosed, there is little evidence that ADHD arises purely from social factors or child-rearing methods. Experts in the field are finding more and more evidence that legitimate ADHD does not stem from the home environment, but from biological causes.
Knowing this can remove a huge burden of guilt from parents who might blame themselves for their child's behavior.
Other possible causes of ADHD type symptoms are food intolerance, hypoglycemia (low blood sugar), allergies, low muscle tone, perceptual difficulties, nutritional problems, candida, hyperthyroidism, Tourette's Syndrome, brain dysfunction, family and emotional problems, poor discipline, depression, and other conditions.
Each of these problems would require different treatment and may even be exacerbated by Ritalin or other prescription medication for ADHD, making correct diagnosis and evaluation even more important.
Researchers suspect that there are several factors that may contribute to the condition, including:
- Heredity and genetics: The fact that ADHD tends to run in families suggests that children may inherit a genetic tendency to develop an attention-deficit disorder from their parents.
- Chemical imbalance: Children who have ADHD do not make enough chemicals in key areas of the brain that are responsible for organizing thought or suppressing hyperactivity and impulsiveness.
- Brain changes: Areas of the brain that control attention are less active in children with ADHD than in children without the disorder.
The Myths Surrounding the Causes of ADHD
Although the following factors may present symptoms similar to those of ADHD, research has shown that there is no evidence that ADHD is caused by the following:
- Too much TV
- Poor home life
- Poor schools or colleges
- Bad parenting
- Aspartame (or sugar substitutes)
- Lack of vitamins
- Fluorescent lights
- Video games
However, in some cases, the above factors could certainly cause symptoms similar to those seen in ADD in certain individuals, and it is worth investigating their impact if a link is suspected.
Are Certain Children More Likely to Develop ADHD?
A child might have a greater chance of developing ADHD if one of their relatives already has ADHD or another type of behavioral disorder. Two to three times more boys than girls suffer with ADHD, though the disorder is being identified increasingly in girls.
ADHD is the most commonly diagnosed mental disorder of children. It most often is discovered during the early school years, when a child begins to have problems paying attention.
Help for Children with ADHD
ADHD is often treated using conventional prescription medications.
While there is a place for prescription medication in certain cases of ADHD, careful consideration should be taken regarding possible side effects and cautions.
There are options available for treating attention deficit hyperactivity disorder. Making simple changes in diet, sleep, exercise and routine can help. Even trying more involved approaches like incorporating relaxation therapies such as guided imagery, meditation techniques or yoga can be beneficial.
More Information on ADHD in Children
Managing ADHD in Children
Bringing up an ADHD child, like bringing up any child, is a process. No single point is ever reached where the parent can sit back and say, "That's it. My child is now OK, and I don't have to do anything more." As a parent, you need to be proactive and take the initiative in finding the best possible way to help your child.
It is important for you to manage your child in ways that will be kind, firm, and effective. If parents are consistent with some of these suggestions and interventions, you may even find that your child's 'symptoms' disappear or become much less severe.
The first thing to look at is your child's diet. Not all children respond, but there are definitely some children who do - and quite dramatically! Things to avoid are soda pops and 'fizzy' cold drinks, anything with caffeine (again, cola drinks, coffee, Ceylon tea and chocolate), food with high sugar content, as well as anything containing tartrazine (an artificial food coloring), MSG, or artificial preservatives.
One must make allowances for the occasional treat, but educate your child and be firm about what he may and may not eat, especially on school days.
Here is a brief summary regarding diet:
- Avoid foods and drinks high in sugar - e.g. candies - during school days, and limit over weekends.
- Avoid foods and drinks containing stimulants like caffeine - found in coffee, tea, chocolate and colas, as well as in many energy drinks.
- Avoid foods and drinks with artificial flavors and colors, especially tartrazine and MSG.
- Try to keep junk foods down to a minimum.
- See what happens if you eliminate wheat and refined carbohydrate from the diet for a few weeks. Many children have a wheat intolerance which can cause hyperactivity. Instead use oats, brown rice, and rye bread.
- Have your child eat lots of fresh fruit, salads, and veggies. Include fish in the diet as much as possible.
- Give your child a supplement containing flaxseed oil or evening primrose oil.
You may also try to limit the hours spent watching television and playing computer games, especially those with a high violence content. Television and computer games in excess have been shown to affect the child's ability to concentrate at school and can also cause reading problems in sensitive children. It is recommended that there be:
- No television on school nights
- Two hours in total during the weekend
- No television before school
While there is no single activity that guarantees kids with ADHD instant success, certain types of activities tend to reap more positive results.
- Look for activities with a singular focus such as sports that focus (e.g. karate, judo)
- Consider activities that involve movement, providing an appropriate and controlled physical outlet
- Learning a musical instrument
- Seek activities that offer individualized instruction
- Explore activities that result in tangible rewards
Avoid activities that:
- Involve a lot of down time
- Require too much divided attention
- Require fine motor skills
An ADHD Management Checklist
- Use frequent eye contact when speaking to your child or giving instructions
- Keep directions simple and set simple house rules
- Avoid major or frequent changes
- Be consistent in your discipline
- Provide a structured outlet for hyperactivity
- Teach using as many of the senses as possible and make learning interactive
- Review your expectations for your child
- Reward positive behavior immediately
- Anticipate situations
- Make sure your child is supervised all the time
- Learn and understand the symptoms of ADHD
- Keep a fairly consistent schedule, if possible
- Organize needed everyday items
- Use homework and notebook organizers
- Set a homework routine
- Focus and reward on effort, not grades
- Speak often to your child's teachers
- Play games that promote concentration, listening skills, and memory
- Make a special effort to highlight positives in your child
It is important to try not to:
- Use physical punishment
- Put too many expectations on your child
- Focus too much on the areas your child is struggling with
Controversial Treatments for Children with ADHD
No comprehensive discussion of ADHD is possible without considering the benefits and disadvantages of prescription drugs - a subject fraught with controversy.
ADHD stimulant medications have sparked a great deal of controversy. Often seen as an easy 'quick fix', they are prescribed to treat symptoms but not the underlying cause of ADHD.
Often parents feel that by researching alternatives to prescribed drugs, they are in some way neglecting their child and endangering their health. Ironically, side effects of these prescription drugs can seriously endanger a child's health.
Educating yourself on each of the prescription drugs used to treat ADHD is a necessity if you want to provide the safest treatment for your child.
ADHD represents a growing market for pharmaceutical companies. Although psycho-stimulants may be helpful for many families, no one should underestimate the influence of the economic issues involved.
Furthermore, the long-term affects of prescription drugs for the treatment of ADHD has not been determined, especially in the case of children. For this reason, treatment of ADHD with prescription drugs or stimulant drugs should be regarded as a last resort when all other avenues have been exhausted.
Prescription Medications & Their Side Effects
While there is a place for prescription medication in certain cases of ADHD, careful consideration should be taken regarding possible side effects and cautions.
Use of these stimulant medications in children under age 6 is not recommended. Discuss with your doctor the risks and benefits of giving these medications to your child.
It is strongly advised that the following criteria are fully investigated with regards to any prescription drugs for ADHD: common uses, cautions, possible side effects, overdose, additional information, and major drug interactions.
The Food and Drug Administration (FDA) are still investigating certain side effects of certain prescription ADHD drugs, and it is advisable that parents do their own research into these medications so that they are fully aware of the potential risks.
Research into the long-term effects of drugs prescribed for ADD is still in its early stages. More research is needed.
Discuss with your doctor the risks and benefits of using these medications or treating your teen with these medications.
The Food and Drug Administration (FDA) are still investigating certain side effects of certain prescription ADHD drugs, and it is advisable that individuals do their own research into these medications so that they are fully aware of the potential risks.
Physicians still have a difficult time predicting which prescription medications will produce beneficial results, so treatment is individualized and performed on a trial and error basis. This 'hit and miss' technique requires close observation and cooperation between all participants and is understandably not ideal. If an initial regimen doesn't work, doctors often change the dosage, switch to a different drug or even add another medication.
Some doctors even recommend trying a second psycho-stimulant if a first one fails. If the child still doesn't respond, antidepressants or other second-line drugs may be prescribed. Before long a child may be taking a cocktail of drugs to treat the side effects of the initial medication, thus creating a domino effect.
Medications don't cure ADHD, they only control the symptoms on the day they are taken.
Although the medications may help the child pay better attention and complete school work, they can't increase knowledge or improve academic skills. The medications can only help the child to use those skills he or she already possesses - but this may just as easily be obtained through behavioral therapy and other proactive techniques - such as 'out of the box' creative teaching methods. It is vital that you educate yourself on all aspects of ADD/ADHD before making a decision.
The best chances of minimizing side effects, is to use a remedy that is free of side-effects completely. Contrary to what some doctors believe, these do exist.
Other Treatment Options for ADHD in Children
With ADHD, no single treatment is the answer for every child. A child may have undesirable side effects to a medication, making a particular treatment unacceptable. Each child's needs and personal history must be carefully considered. It is important to work with a health care professional/psychologist to determine the safest treatment.
If all other options and avenues have been investigated, and prescription drugs are chosen for treatment, frequent follow-up visits should be scheduled to assess the response and to detect possible side effects. Children on medications should have regular checkups. Parents should also talk regularly with the child's teachers, psychologist, and health care professional about how the child is doing.
Stimulants are not a cure-all, and families should be informed of healthy choices with regards to food, exercise, healthy hobbies, and friends. The best chances of minimizing side effects, is to use a plan that is free of side effects completely.
- Dietary Approaches. A number of diets have been suggested for people with ADHD. Various studies have reported behavioral improvement with diets that restrict possible allergens in the diet.
Parents may want to discuss with their health care professional, homeopath, or naturopath regarding implementing an elimination diet of certain foods or adding supplements that might help. This is a very individualized approach and would differ from child to child. Always consult a nutritional expert before restricting the diet of any child.
- Feedback approaches. A technique that uses auditory (sound) feedback may prove to be an effective tool for increasing children's attention.
- Neurofeedback. This technique uses electronic devices to help the child control their own brain wave activity.
- Interactive metronome and musical therapy. Feedback from sound is used to improve attention, motor control, and certain academic skills.
- Massage and relaxation techniques. Massage therapy can help ADHD children to feel more relaxed, fidget less, be less hyperactive, and focus on tasks. Other methods include reflexology, relaxation training, meditation, and music therapy.
For parents worried about over-medicating children who have attention problems, behavioral therapy may be a welcome addition to treatment. This type of therapy, carried out under the supervision of a psychologist, helps someone with ADHD alter their behavior and thought patterns to learn how to relate to others and succeed.
Other forms of treatment that may benefit the child with ADHD include:
- Social skills training. This can help a child with ADHD learn behaviors that will help them develop and maintain social relationships.
- Support groups and parenting skills training. Education and support for the parents can be an integral part of treating ADHD in children.
Conditions often Accompanying ADHD in Children
One of the difficulties in diagnosing ADHD is that it is often accompanied by other problems.
A number of disorders may mimic or accompany ADHD. Many experts believe the term ADHD should be used to describe a collective group of symptoms and behavioral problems. However, many of these problems require other methods of treatment and should be diagnosed separately, even if they accompany ADHD.
Because emotional disorders and attention disorders so often go hand-in-hand, every child who has ADHD should be checked for accompanying anxiety and depression. Remember, a diagnosis of ADHD cannot be made if the child suffers with anxiety or depression as a primary diagnosis. Anxiety and depression are serious disorders in children, and should be treated as soon as possible.
Many children with ADHD symptoms suffer from hypoglaecemia or are hypoglaecemic due to incorrect diet. This means that their blood sugar levels will fluctuate a lot, leading to mood swings, irritability, restlessness, as well as lack of concentration. Deficiencies in these elements will cause problems in concentration, memory, and mood.
Conditions Commonly Coexisting with ADHD
ADHD may coexist with one or more disorders. The most common disorders to occur with ADHD are:
- Learning Disabilities
- Tourette's Syndrome
- Oppositional defiant disorder (ODD)
- Conduct disorder (CD)
- Sleep disorders
Of course, not all children with ADHD have an additional disorder. Nor do all people with learning disabilities, Tourette's syndrome, oppositional defiant disorder and conduct disorder have ADHD. But when they do occur together, the combination of problems can seriously complicate a person's life. For this reason, it's important to watch for other disorders in children who have ADHD.
The diagnosis of ODD along with ADHD is seen as controversial by some. It is important to note that any child suffering from legitimate ADHD will feel frustrated and misunderstood. Behavior could therefore easily be seen as defiant, confrontational, and disrespectful. This then could easily be seen as ODD. Similarly, asserting his or her personality and will is a normal stage in any child's development - which can often be misdiagnosed as ODD. Once again, correct evaluation of the child is essential.
Conduct disorder (CD) is sometimes seen as a more serious pattern of antisocial behavior. Similarly, as with ODD, it is important to note that any child suffering from ADHD will 'act out' and unruly behavior could escalate. This could easily be seen as CD, but correct diagnosis and evaluation of the child is essential. Similarly, a child developing normally but who has emotional problems may destroy property, steal, and lie - all of which can be misdiagnosed as CD.
Any child with a principle diagnosis of an anxiety disorder, mood disorder, bipolar disorder, depression, or any other emotional disorder may not be diagnosed with ADHD. Emotional disorders must be treated separately, and as the only disorder affecting the child. Once these disorders have been treated, the initial symptoms of ADHD can be re-assessed.
Sleep disorders or disturbances are very common with ADHD children, which can lead to the age old 'chicken or the egg' question... "Is my child struggling to sleep because of the ADHD or is he or she suffering with ADHD symptoms due to lack of sleep?" Ironically, many stimulant drugs used to treat ADHD list sleep problems in children as a possible side effect to the prescribed medication.