It seems Attention Deficit Hyperactivity Disorder (ADHD or ADD, the acronym for Attention Deficit Disorder) has become the catch-phrase for any child who wiggles or squirms, enthusiastically blurts out answers in the classroom, or exhibits endless energy (which parents often wish they had in reserve!) The truth is, ADHD is a complicated, often misunderstood neurological condition. Most school-aged children will have attention-related and behavior issues at some point along the way, but that doesn’t necessarily mean ADHD is the culprit. An accurate diagnosis will help a child get the help that is needed. But an improper diagnosis can make the situation worse. Being informed makes all the difference.
What is Attention Deficit Hyperactive Disorder?
Attention Deficit Hyperactive Disorder, often referred to as both ADHD and ADD, has increasingly become one of the most common childhood disorders diagnosed for school-aged children nationally. Although many people consider ADHD a type of learning disability, it has a distinct set of symptoms and criteria, which differ from specific learning issues. The main symptoms often recognized first are a combination of difficulty sustaining attention, impulsivity, poor concentration, and hyperactive behavior. Children with ADHD may have emotional difficulties as well because of the challenges associated with attention deficits and impulsivity. Early diagnosis and effective treatment can make a huge difference for improved school performance and increased sense of well being.
Attention Deficit Hyperactivity Disorder has three subtypes. Although no diagnosis neatly fits into exact categorizations, the differences between the three are important to understand. The classifications are based on the severity of symptoms in each subtype. People often use ADD as shorthand for ADHD, but that is not entirely accurate. A child with ADD is considered to have ADHD, but without the hyperactive component. Most children have some degree of both types. The three sub-types are:
Inattentive Type: This child has great difficulty organizing, planning, finishing tasks, or following instructions. The child may have tremendous trouble remembering things, focusing for sustained periods of time, or may lose things regularly. Daily routines are disrupted by an inability to follow through on tasks in multiple areas. These are often the children people refer to as ADD.
Hyperactive-Impulsive Type:
Teachers often identify these children as being excessively fidgety, speaking out of turn, and disrupting classmates. Younger children may run around the classroom without permission and display an inability to stop the behavior on their own. There can be excessive climbing, jumping, and real difficulty with impulse control.
Combined Type: Most children fall under this category, with symptoms from both previous types described above.
Signs and Symptoms
The main indicators of ADHD are inattention, hyperactivity, and impulsivity. While is perfectly normal for children to display these behaviors at different times in childhood, it is the severity and the chronic nature of the behavior that would suggest a diagnosis of ADHD. The symptoms of ADHD must be present for a period of at least six months and be much more prominent than what is observed in other children of the same age for the diagnosis to be made.
Symptoms for Children with ADHD (Inattentive Type)
Very easily distracted
Extreme difficulty focusing
Easily bored after a very short time, unless an activity is something they choose
Poor organization and planning skills
Often described as daydreamers and poor listeners
Difficulty following instructions, even when offered multiple times
Trouble handing in homework assignments
Loses things easily and often
Symptoms for Children with ADHD (Hyperactive-Impulsive Type)
Lots of squirming and fidgeting, beyond their control
Excessive talking, unable to stop, even when asked
Often described as jumping, running around, climbing on furniture at school
Interrupts others often
Can be extremely impatient
Blurts out comments without regard for consequences
Symptoms for Children with ADHD (Combined Type)
Combinations of behaviors listed previously. These children might display a different set of symptoms and behaviors under different circumstances and situations.
Diagnosis
Diagnosing ADHD can be tricky, so it’s important to make sure you are working with the right professionals to make a correct diagnosis. It’s also important to remember that there are many steps involved in assessing ADHD, which should include a complete physical exam. Some ADHD symptoms may actually be related to a different condition, and should be appropriately evaluated to rule out any medical issues. Before you do anything, check in with your pediatrician.
There is no single test that is used to diagnose a child with ADHD. The evaluation process may involve multiple professionals, including, but not limited to teachers, neurologists, neuropsychologists, psychiatrists, and pediatricians. The evaluating process really involves identifying the cluster of symptoms involved, several of which must be present to meet the criteria for an ADHD diagnosis. Because diagnosis can be complicated, it is important to rely on professionals who specialize in this particular area of study and practice. Pediatric neuropsychologists are often the best professionals to do an evaluation, because they can also assess for learning issues, which often co-exist with ADHD. School reports, report cards, standardized test results, and behavioral checklists are also extremely important tools for obtaining an accurate diagnosis. Parent questionnaires are very helpful as well. If a child is old enough, self-report checklists are extremely useful.
During the evaluation process, it’s important to work collectively with all professionals involved. This is often referred to as a multidisciplinary approach, and is highly effective. It takes time and patience, but it is better than rushing to inaccurate conclusions.
As a parent, you want to make sure a detailed history about your child’s development, school and home experiences, and social relationships are well examined. It is important to examine problems and challenges across a broad range of activities. And it’s very important to be honest about all the information provided, no matter how difficult or painful. Remember, you are not trying to find out what is wrong with your child, but looking to discover ways to help your child.
Online Resources
Jamie Kay, Ph.D., received her doctoral degree in clinical psychology from The Derner Institute at Adelphi University. She was the Director of the Center for Attention and Learning at Lenox Hill Hospital for seven years, securing and maintaining six Robin Hood Foundation grants. She has held senior positions at behavioral health centers and hospitals throughout the greater metropolitan area. Dr. Kay developed a series of groups and workshops at the esteemed 92nd Street Y Parenting Center on the Upper East Side of New York and maintained a private practice in Manhattan for over 20 years. Currently, Dr. Kay works exclusively with parents of children with learning disabilities, through Learning Solutions NYC (www.LearningSolutionsNYC.com)
