Birth To Success, LLC
| Birth To Success, LLC |
| Understanding ADHD (a fair and balanced discussion) |
| ADHD is real... BUT it is not a "disease"... it is not an "illness". |
| All rights reserved. |
| dedicated to helping all children live healthier, happier, and more successful lives |
Birth To Success, LLC
| Birth To Success, LLC |
| Birth To Success, LLC |
| Birth To Success, LLC |
The term Attention Deficit Hyperactivity Disorder or ADHD describes a condition in which an individual
experiences difficulties characterized by:
However, not everyone who has these symptoms has ADHD. In fact, it is important to remember that we can create
these same symptoms in children at any time should we elect to do so. For example:
Suppose we send a child into a classroom to listen to the teacher give a lecture... but before the child enters the
room we put ear plugs in his ears and place a headset playing soft music over his ears... this child will quickly lose
interest in what the teacher is saying because he cannot hear her. He will begin doodling, looking for something to
play with in his desk, or asking to go to the bathroom... not because he has ADHD, but because he cannot hear
what is going on.
Suppose we send a student to the library to read after smearing her glasses with hand cream. Within a few minutes
of sitting down with her book she will begin to get restless, lean over to talk with her friend, or ask if she can get a
drink of water... not because she has ADHD, but because she cannot see the words on the page.
Now, imagine you are an individual who is having hallucinations... you are seeing bugs moving on the walls and
hearing voices talking to you. The classroom instructor repeatedly calls your name and asks you to pay attention to
her, but within moments you will be looking around at the bugs and listening to the imaginary voices. From the
teacher's viewpoint you are displaying many of the classic symptoms of ADHD... ongoing inattention, distractibility,
restlessness... but you do not have ADHD, you are dealing with a different mental health disorder that is presenting
with many of the same symptoms as ADHD.
So--
When physicians or other mental health professionals assess a child for ADHD, they need to make two important
decisions:
1) Does the child meet the formal criteria for Attention Deficit Hyperactivity Disorder, and
2) If the child meets the criteria for ADHD, is there anything other than ADHD that can account for the symptoms.
Making the diagnosis of ADHD
Unfortunately, there currently are no lab tests or x-ray studies that can adequately measure attention levels in the
brain.
There are software programs that some individuals employ to measure how inattentive or impulsive a child is while
watching a computer screen waiting for a specific target to appear. There are also specialized diagnostic imaging
systems, such as SPECT scans, and brain wave monitoring systems that some professionals believe can reliably
identify ADHD.
However, there is significant disagreement among professionals within various specialties regarding the specificity of
these types of diagnostic tools -- that is, whether the findings that are obtained are truly specific for ADHD.
When one stops to consider that children will often look like they have ADHD in one setting but not in another, then
it is hard to understand how a single test performed at one point in time within a quiet office setting can determine
for certain whether a child experiences symptoms of ADHD after spending six hours in a noisy classroom.
In the future, perhaps research will help us to come up with better ways to identify ADHD. Until then the diagnosis of
attention deficit hyperactivity disorder will continue to be based on a carefully obtained history.
The DSM-IV.
Assessment for ADHD revolves around a patient meeting the diagnostic criteria for ADHD as published in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association). The history asks
nine questions relating to the presence of symptoms often found in children who struggle with inattention,
distractibility, and forgetfulness, and nine questions relating to restlessness, hyperactivity, and impulsiveness. A
score of 6 or more traits in either category is consistent with the presence of ADHD. Six or more traits relating to the
inattention group only will be termed ADHD of the predominantly inattentive type (formerly ADD). Six or more traits
relating to the hyperactivity-impulsiveness group will be recorded as ADHD of the predominantly
hyperactive-impulsive type. If a child meets six or more criteria in both categories a diagnosis of ADHD of the
combined type will likely be made.
It is not uncommon for younger children to normally display many of the behaviors commonly associated with ADHD,
so it is important to differentiate between ADHD and normal developmental variation. When trying to determine
whether a child truly has ADHD it is important to assess not only whether these traits exist, but whether these issues
have an adverse effect on the child's life. That is, do these characteristics cause the child to struggle in life,
struggle with family relationships at home, or struggle with chronic academic failure in school. In general there
should be evidence of problems prior to seven years of age. In addition, the adults who are rating the child's
difficulties need to feel certain that the youngster being assessed has problems that are greater than those seen in
most of the other children his or her age.
Unfortunately, despite the use of standardized rating scales that ask parents and teachers to rate the relative
severity of a child's problems, the results may often be influenced significantly by a parent's or teacher's own
childhood experiences or their current levels of emotional stress.
For example: Suppose a child's mother was raised as an only child who typically spent her weekends with her
parents peacefully reading and discussing books or working as a team to put together picture puzzles. Dad, on the
other hand, was one of five brothers who spent much of their days together running through the house, wrestling
around on the floor accidentally knocking over lamps or breaking family heirlooms, and making tripos to the ER for a
variety of resulting injuries. When these individuals now have a child who likes to bounce up and down on the
furniture, Mom may perceive the recurring behavior to be unacceptable while Dad laughs and says "That's nothing
compared to what my brothers and I used to do; he is just being a normal boy." Whether the child's jumping on the
couch is perceived as "hyperactive" or "normal" suddenly becomes as much a reflection of the parents' tolerance as
it does the child's behavior.
Similarly the role of family stress (moving, job loss, divorce, introduction of a new step-parent, alcohol-related
stresses, parental depression or anger control issues) or teacher stress (personal or family issues, illness,
ever-increasing instructional demands, classroom overcrowding, professional burnout) can have a significant impact
on an adult's ability to tolerate a child's lack of compliance with expectations. As adult tolerance wanes, children are
perceived as being "uncooperative" or "lazy". Unfortunately, the children in question are often as much a victim of
the difficulties being encountered as the parents and teachers are.
Making the diagnosis of ADHD based purely on the responses to ADHD questionnaires is easy and can be
accomplished within a matter of minutes. However such rating scale assessments only serve to confirm the
presence of symptoms, they do not necessarily determine why these symptoms are present. Those who assess
ADHD need to be prepared to go beyond the "six out of nine ADHD traits" mind set and consider the possibility that
other problems may account for the symptoms being attributed to ADHD. As noted at the beginning of this section,
visual problems, hearing problems, and mental health disorders may all present with a clinical picture that could be
mistaken for ADHD.
experiences difficulties characterized by:
However, not everyone who has these symptoms has ADHD. In fact, it is important to remember that we can create
these same symptoms in children at any time should we elect to do so. For example:
Suppose we send a child into a classroom to listen to the teacher give a lecture... but before the child enters the
room we put ear plugs in his ears and place a headset playing soft music over his ears... this child will quickly lose
interest in what the teacher is saying because he cannot hear her. He will begin doodling, looking for something to
play with in his desk, or asking to go to the bathroom... not because he has ADHD, but because he cannot hear
what is going on.
Suppose we send a student to the library to read after smearing her glasses with hand cream. Within a few minutes
of sitting down with her book she will begin to get restless, lean over to talk with her friend, or ask if she can get a
drink of water... not because she has ADHD, but because she cannot see the words on the page.
Now, imagine you are an individual who is having hallucinations... you are seeing bugs moving on the walls and
hearing voices talking to you. The classroom instructor repeatedly calls your name and asks you to pay attention to
her, but within moments you will be looking around at the bugs and listening to the imaginary voices. From the
teacher's viewpoint you are displaying many of the classic symptoms of ADHD... ongoing inattention, distractibility,
restlessness... but you do not have ADHD, you are dealing with a different mental health disorder that is presenting
with many of the same symptoms as ADHD.
So--
When physicians or other mental health professionals assess a child for ADHD, they need to make two important
decisions:
1) Does the child meet the formal criteria for Attention Deficit Hyperactivity Disorder, and
2) If the child meets the criteria for ADHD, is there anything other than ADHD that can account for the symptoms.
Making the diagnosis of ADHD
Unfortunately, there currently are no lab tests or x-ray studies that can adequately measure attention levels in the
brain.
There are software programs that some individuals employ to measure how inattentive or impulsive a child is while
watching a computer screen waiting for a specific target to appear. There are also specialized diagnostic imaging
systems, such as SPECT scans, and brain wave monitoring systems that some professionals believe can reliably
identify ADHD.
However, there is significant disagreement among professionals within various specialties regarding the specificity of
these types of diagnostic tools -- that is, whether the findings that are obtained are truly specific for ADHD.
When one stops to consider that children will often look like they have ADHD in one setting but not in another, then
it is hard to understand how a single test performed at one point in time within a quiet office setting can determine
for certain whether a child experiences symptoms of ADHD after spending six hours in a noisy classroom.
In the future, perhaps research will help us to come up with better ways to identify ADHD. Until then the diagnosis of
attention deficit hyperactivity disorder will continue to be based on a carefully obtained history.
The DSM-IV.
Assessment for ADHD revolves around a patient meeting the diagnostic criteria for ADHD as published in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association). The history asks
nine questions relating to the presence of symptoms often found in children who struggle with inattention,
distractibility, and forgetfulness, and nine questions relating to restlessness, hyperactivity, and impulsiveness. A
score of 6 or more traits in either category is consistent with the presence of ADHD. Six or more traits relating to the
inattention group only will be termed ADHD of the predominantly inattentive type (formerly ADD). Six or more traits
relating to the hyperactivity-impulsiveness group will be recorded as ADHD of the predominantly
hyperactive-impulsive type. If a child meets six or more criteria in both categories a diagnosis of ADHD of the
combined type will likely be made.
It is not uncommon for younger children to normally display many of the behaviors commonly associated with ADHD,
so it is important to differentiate between ADHD and normal developmental variation. When trying to determine
whether a child truly has ADHD it is important to assess not only whether these traits exist, but whether these issues
have an adverse effect on the child's life. That is, do these characteristics cause the child to struggle in life,
struggle with family relationships at home, or struggle with chronic academic failure in school. In general there
should be evidence of problems prior to seven years of age. In addition, the adults who are rating the child's
difficulties need to feel certain that the youngster being assessed has problems that are greater than those seen in
most of the other children his or her age.
Unfortunately, despite the use of standardized rating scales that ask parents and teachers to rate the relative
severity of a child's problems, the results may often be influenced significantly by a parent's or teacher's own
childhood experiences or their current levels of emotional stress.
For example: Suppose a child's mother was raised as an only child who typically spent her weekends with her
parents peacefully reading and discussing books or working as a team to put together picture puzzles. Dad, on the
other hand, was one of five brothers who spent much of their days together running through the house, wrestling
around on the floor accidentally knocking over lamps or breaking family heirlooms, and making tripos to the ER for a
variety of resulting injuries. When these individuals now have a child who likes to bounce up and down on the
furniture, Mom may perceive the recurring behavior to be unacceptable while Dad laughs and says "That's nothing
compared to what my brothers and I used to do; he is just being a normal boy." Whether the child's jumping on the
couch is perceived as "hyperactive" or "normal" suddenly becomes as much a reflection of the parents' tolerance as
it does the child's behavior.
Similarly the role of family stress (moving, job loss, divorce, introduction of a new step-parent, alcohol-related
stresses, parental depression or anger control issues) or teacher stress (personal or family issues, illness,
ever-increasing instructional demands, classroom overcrowding, professional burnout) can have a significant impact
on an adult's ability to tolerate a child's lack of compliance with expectations. As adult tolerance wanes, children are
perceived as being "uncooperative" or "lazy". Unfortunately, the children in question are often as much a victim of
the difficulties being encountered as the parents and teachers are.
Making the diagnosis of ADHD based purely on the responses to ADHD questionnaires is easy and can be
accomplished within a matter of minutes. However such rating scale assessments only serve to confirm the
presence of symptoms, they do not necessarily determine why these symptoms are present. Those who assess
ADHD need to be prepared to go beyond the "six out of nine ADHD traits" mind set and consider the possibility that
other problems may account for the symptoms being attributed to ADHD. As noted at the beginning of this section,
visual problems, hearing problems, and mental health disorders may all present with a clinical picture that could be
mistaken for ADHD.
inattention, distractibility, and forgetfulness and / or hyperactivity, restlessness, impulsiveness. |
 |  |