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Does my child have ADHD?
Chances are you picked up this pamphlet because you or someone you know has a child that has been labeled “ADHD”. Perhaps a teacher told you to see a doctor because of this problem, or you saw a television news program about ADHD and during the show, felt like you were watching a video of your own child. For whatever reason you are interested in ADHD, this pamphlet will provide you with important information about a problem that impacts a large number of children and families in the United States.

What is ADHD?
ADHD, or Attention Deficit Hyperactivity Disorder is simply a label given to children (and adults) who exhibit certain kinds of behaviors more often than the general population. During childhood, most of these behaviors are considered problematic because of difficulty fitting in at home, at school and with friends. The most common of these behaviors are inattention, impulsivity and hyperactivity.

Inattention
Children with this problem have a very difficult time focusing long enough to organize and complete tasks, particularly if the task is dull, boring, repetitive and takes more than a few minutes (as in homework and chores). The book that mental health professionals use to help them in diagnosing ADHD (DSM IV) lists the following symptoms of inattention:

• Often fails to give close attention to details or making careless mistakes in school work, work or other activities;
• Often has difficulty sustaining attention in tasks or play activities;
• Often does not seem to listen when spoken to directly;
• 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);
• Often has difficulty organizing tasks and activities;
• Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework);
• Often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books or tools);
• Is often easily distracted by extraneous stimuli; and/or
• Is often forgetful in daily activities.

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Impulsivity
Children with this problem respond quickly without waiting for instructions to be completed or without allowing themselves enough time to figure out what is the “right thing” to do in a given situation. Symptoms of impulsivity are:

• Often blurts out answers before questions have been completed;
• Often has difficulty waiting his or her turn; and/or
• Often interrupts or intrudes on others (e.g., butts into conversations or games).

Hyperactivity
Children with this problem are often in motion. Much of their movement may seem to have no purpose, such as fidgeting. They may talk almost constantly, perhaps in the form of a running commentary on the action around them. Symptoms of hyperactivity include:

• Often fidgets with hands or feet or squirms in seat;
• Often leaves seat in classroom or in in other situations in which it is inappropriate;
• Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subject feelings of restlessness);
• Often has difficulty playing or engaging in leisure activities quietly;
• Is often “on the go” or acts as if “driven by a motor”; and/or
• Often talks excessively.

Not all children with ADHD exhibit all of these behaviors. Even if a child does exhibit a particular behavior, it may only be noticeable or bothersome under certain conditions (such as in the classroom or when the child is tired). One of the hallmarks of ADHD is that children who have this problem are extremely variable across situations: They can behave quite nicely at times and at other times, theirproblematic behavior may seem unmanageable.

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How do I know if my child has ADHD?
Your child may have ADHD if they:

• Have more difficulty than other children their age with a variety of inattentive, impulsive and hyperactive behaviors;
• Have exhibited these behaviors continuously since early in life (before age 7); and
• Have significant problems because of these behaviors in more than one area of life (such as at home and at school).

A variety of mental professionals are trained in how to formally diagnose ADHD, including school psychologists, social workers, clinical psychologists and psychiatrists. Prior to making a diagnosis, these professionals should ask you, your child and your child’s teacher a variety of questions about your child’s current and past behaviors, as well as their general adjustment at home, in school and with friends. This is usually done through a combination of interviews and questionnaires. It is highly unlikely that a professional will accurately diagnose ADHD by simply observing your child during an office visit and by talking with you for just a few minutes.

How many children have ADHD?
Somewhere between 3-5% of children in the United States are thought to have ADHD. ADHD is approximately three times more common in boys than girls. ADHD is one of the most common reasons that parents bring their children to a mental health clinic.

What causes ADHD?
Accordingly to Russell Barkley, PhD, author of 14 books, manuals and co-edited texts and more than 150 book chapters on ADHD, neuroimaging and other recently developed technologies are enabling physicians and researchers to measure brain activity and see the neurology behind the disorder.

Researchers are finding that in individuals with ADHD, there is a 8-15% less brain volume. Three structures in the brain seem to show up in ADHD. These three regions are functionally interconnected and inhibit motor responses, affecting an individuals inhibitions and preparation to act. The smaller regions seem to appear more in the right hemisphere of the brain than the left.

Over the last 10 years, scientists have also made great strides in proving that ADHD is hereditary. Twelve research teams are currently attempting to identify an ADHD gene. They have found two in the past four years. “It is a complex disorder with multiple traits,” says Barkley, “and because complex traits are due to multiple genes, there will be more discovered in the future.” The genes should be identified within the next 5-6 years.

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What other major kinds of problems do ADHD children have?
Most children with ADHD have difficulty in school, but only about 25-35% actually have a learning disability. Besides the problems that inattentive, impulsive and hyperactive behaviors pose in a school setting, another reason that schoolwork can be difficult is that approximately 30-65% of children with ADHD also have problems with defiant and oppositional behavior with teachers. Many of these same children also have trouble with obeying parents, as well as with fighting, stealing and other more serious behaviors.

A significant number of children with ADHD (up to 30%) have difficulties with feelings of anxiety or depression. These feelings may arise from repeated failures in the home or school setting, as well as repeated failures with peers. Many (up to 50%) have major difficulties in social situations and are viewed as either socially immature or socially inept. Approximately 30-60% of children with ADHD have immature motor coordination abilities and thus successful engagement with same age peers in some of the common activities of childhood such as sports may be difficult and frustrating.

Could my child have trouble with inattention, impulsivity and hyperactivity and not have ADHD?
Yes, a variety of conditions, situations and events are related to children behaving as if they have ADHD. For example, many preschoolers and teenagers can appear to have ADHD, but in reality they are going through a normal stage of development.

There are a variety of specific problems that do mimic ADHD. Children who have gone through a traumatic situation such as a major accident or injury, the loss of a parent or spending a period of time in an abusive home may exhibit symptoms of ADHD. Children who have certain physical problems, such as chronic middle ear infections, may seem like they have ADHD. Children who are different from their same age peers in terms of academic skills may also behave as if they have ADHD. While some children in these various circumstances may legitimately have ADHD, many probably do not, but are simply responding to adversity in a way that looks like ADHD.

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Do children outgrow ADHD?
In the past, many people believed that children with ADHD symptoms would eventually grow out of their problems. However, various studies now indicate that most children with ADHD (70-80%) continue to exhibit significant ADHD symptoms during adolescence. Many (50-65%) continue to have ADHD during adulthood. Some children with ADHD (20-30%) have very serious problems in later life, including substance abuse and criminal behavior.
Some of the more common misconceptions, according to Russell Barkley about ADHD are:

• People will eventually outgrow it.
• It stems from a lack of will or effort at self-control.
• It is the result of a moral failing or the way parents are raising their children.
• It is the result of too much television or too many video games.
• It is related to diet.
• It is a result of our fast paced, stressful culture.

If my child has ADHD, can anything be done to help?
YES!! There are several widely available treatments that are helpful for many children, but there is no cure for ADHD. Partly because ADHD is such a common problem, treating ADHD has become big business and there are many widely available treatments that simply do not work.

The best treatment approach for ADHD:

• Help the child manage their behavior in multiple areas of life.
  
• Continue treatment programs throughout childhood and adolescence. The most reasonable way to meet these goals is to teach parents and teachers how to develop and maintain treatment programs without the continuous assistance of a mental health professional.

The three most effective treatments for ADHD, at least over the short run are:

• Medication
• Parent education and skills training
• Teacher education and skills training

While medication is, be far the most common treatment, it helps control ADHD symptoms only while the medication is active inside the child’s brain. For the most common ADHD drugs, this may be only a few hours after the child takes a pill. In contrast, parents, teachers and day care can provide the child with helpful experiences on a relatively continuous basis. Most experts believe that some combination of each of these treatments continued throughout childhood is the most effective way to help children with ADHD.

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Medication
The most common medications for ADHD are called “stimulants” and include Ritalin, Adderall, Dexedrine and Cylert. In many children with ADHD (approximately 70%), at least one of these drugs can help with some ADHD symptoms. Unfortunately, exactly how each drug affects a specific child is difficult to predict and may change from day to day. For some children, a stimulant drug can help increase attention span, for others it may decrease impulsivity or fidgeting and for others it may help with all of these problems. Some children may even be more cooperative when they take a stimulant.

Like most medications, the stimulants do cause undesired effects in some children. The most common of these are:

• Difficulty sleeping
• Decreased appetite
• Headaches
• Stomachaches

If one of the stimulants is not helpful or if there are certain complicating factors, antidepressant medications, such as Welbutrin or Prozac or antihypertensive medications, such as Clonidine, may be helpful instead of a stimulant.

Parent Education and Skills Training
Teaching parents how to effectively manage their child’s ADHD symptoms is considered the foundation of a good treatment program. During parent training, mental health professionals help parents to take a step back, evaluate and change some of the difficult patterns that is so easy to get stuck in with ADHD children. Parents learn how to focus on the positive aspects of their child and how to take advantage of the numerous opportunities for teaching that they have each day with their child. Parents learn how to create structure in daily life, how to choose which battles to deal with and which to ignore and what types of discipline work best in the long run. Parents also learn how to work as advocates for their children in the school and mental health service settings.

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Teacher Education and Skills Training
Most teachers deal with at least one child with ADHD everyday. Some teachers are quite skilled at adapting their classroom structure and teaching techniques for children with ADHD. Other teachers know what needs to be done, but because of the many other demands they face every day, they have difficulty dealing effectively with such a child.

Teacher training provides educators with skills to help children with ADHD succeed in the classroom, such as:

• How to modify a child’s workload to match their attentional abilities;
• How to alter teaching style and curriculum to make it more interesting and engaging; and
• How to create and enforce classroom rules that are helpful, both for the child with ADHD and his or her peers.

During the training period, a mental health professional also works with a teacher to develop specific programs useful for a specific child. The professional then provides support and consultation as the programs are initially implemented. Usually, programs are developed that link home and school in some way, such as having parents provide children a reward at home for appropriate behavior at school.What types of treatment are not effective?

The most common type of treatment that is not effective for ADHD is one-to-one therapy (for example, play therapy). If a mental health professional is working alone with your child in his/her office and not also working with you and your child’s school, it is unlikely that much will change in your child’s life. Another common type of treatment that has not proven to be effective is group therapy for children or adolescents. It is unlikely that your child’s behavior will change if he or she is only attending a social skills training or self control training group in a clinic once a week. Each of these types of therapies might be helpful for children with ADHD in certain circumstances, but only if in combination with other types of treatments that are conducted at the same time.

Besides these traditional therapies, there are many treatments that are clearly not effective for most children with ADHD:

• Megavitamins
• Special or Restricted Diets
• Allergy Treatments
• Anti-oxidant Treatments
• Relaxation Training (EMG Biofeedback)
• Neurofeedback (EEG Biofeedback)
• Sensory Integration Therapy
• Chiropractic Manipulation
• Balance, Perceptual, Motor or Eye Training
• Treatment for a Yeast Infection

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How can I find a good mental health professional?
Before you look for a mental health professional to assist you, find out more about the current best practices for treating ADHD. Reading one of the books listed below is a good start. Alternatively, contact a local parent advocacy group in your area such as Ch.A.D.D. (Child and Adults with Attention Deficit Disorder or UPLIFT (a non-profit organization that offers help for families with challenging children) for further information.

Once you know something about what you are looking for, seek out licensed mental health professionals who have specific training in the diagnosis and treatment of children with ADHD. Choosing a professional licensed by your state provides you with some degree of protection against improper or ineffective treatments. You can obtain the names of licensed professionals in your community by calling your state licensing boards.

Alternatively, you could ask a health professional that you respect (for example, your family physician), a parent of a child with ADHD who has been doing their homework longer than you or a member of a local advocacy organization such as Ch.A.D.D. or UPLIFT for their ideas. Since ADHD is such a common problem, it is likely that the individual you talk with has had to make referrals for ADHD before and they may have done some checking within your community already about the best mental health professionals for certain kinds of problems.

Once you have several names of licensed professionals within your community, ask each for an interview. Often such interviews are free. Find out how they diagnose and treat children with ADHD and ask for written materials about their practice and clinic. After meeting with at least 2 or 3 professionals, choose the person that seems to be the most up to date in terms of treatment techniques for ADHD and with whom you feel the most comfortable.Where can I get more information?General Information: World Wide Web

If you surf the Web, you will find an amazing amount of information available about ADHD. Beware of the quality of this information: it may be up to date and scientific or it may be completely unfounded. Triple check any promising information you find with other sources! A good place to start on the web is the UPLIFT web site at http://www.uplift-wyoming.com This site contains UPLIFT educational series, quarterly newsletters, upcoming UPLIFT events, links to other informational sites, as well as access to UPLIFT through email.

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The following sites are available through links on the UPLIFT homepage links and references:

Federation of Families for Children’s Mental Health http://www.ffcmh.org
Ch.A.D.D. http://www.chadd.org
Learning Disabilities Association http://www.ldanatl.org
National Attention Deficit Disorder Association http://www.add.org

General Information: Books
Much has been written about ADHD. One of the best and most scientifically up to date writers about the diagnosis and treatment of ADHD is child clinical psychologist, Dr. Russell A. Barkley.

Barkley, R.A. (1995). Taking Charge of ADHD: The Complete, Authoritative Guide for Parents. New York: Guilford Press

Barkley, R.A. (1997). ADHD, Self Control and Time. New York: Guilford Press.

Barkley, R.A. (1990). Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York: Guilford Press.

These books, as well as many other useful resources for ADHD, can be ordered from your local bookstore or the ADD Warehouse at (800) 233-9273 or loaned through the UPLIFT library. UPLIFT has a well stocked library available to the public. New books, videos and audios are added to the library regularly.
The book that mental health professionals refer to when diagnosing ADHD is available in most university libraries and many major bookstores (for example, Barnes and Noble):American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders; Fourth Edition. Washington, D.C.: American Psychiatric Association
 
The educational series is intended for informational purposes only and
not to replace professional evaluationand treatment.

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