Attention deficit hyperactivity disorder, or ADHD, which affects almost two million children, has existed for generations and is grossly misdiagnosed. But until this November we were no closer to being able to objectively diagnose those who really have it than we were a half century ago. Included: Strategies for teaching students with ADHD, and resources for additional information.
Doctors still do not know the best way to diagnose or treat attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) although it affects approximately 3 to 5 percent of all American schoolchildren. According to the journal Pediatrics, currently about 1.5 million children ages 5 through 18 take drugs like the amphetamine Ritalin for relief from attention and hyperactivity disorders. But do all of those children really have attention deficit hyperactivity disorder? Do all of those children really benefit from taking drugs?
"My sixteen-year-old identical twin brothers were identified as having attention deficit disorder," says thirteen-year-old Jenny W. "They were diagnosed at a young age and put on Ritalin. However, this just worsened the problem. The medicine made them talk, move, and think slowly. The other kids made fun of them because of that."
"They stayed on [Ritalin] a few years," adds Jenny. "In pictures you could see they look drugged. They're better now. They're off the drugs and have learned other ways to adapt. They look and act more normal now, but that experience messed up their self-confidence."
"There is a real danger in misdiagnosing children," Carolee Malen, a therapist at a residential treatment center in Milwaukee, told the Milwaukee Sentinel. (See Is ADHD Being Overdiagnosed?) If a child is impulsive, talkative, irritable, has poor academic performance, cognitive impairment, low-self esteem, and difficulty with peer relationships; he is frequently assumed to have ADHD. But a child who is depressed, has bi-polar disorder, a form of autism called Asperger's syndrome, post traumatic stress, lead poisoning, or even chronic ear infections can act out in much the same way.
"My cousin has ADHD," says eleven-year-old Harry J. "He takes Ritalin, but he seems the same to me even when he forgets to take it."
"Last year this person on my football team had ADHD, and he took Ritalin," adds Harry. "When he was at practice, he'd tell the coaches to 'shut-up' and stuff like that. Later one of the coaches talked to him and found out he was depressed."
Both of those boys might not have needed Ritalin at all. According to an article in the Journal of the American Medical Association, use of drugs like Ritalin has risen 250% since 1990.
Steve Levine, a school psychologist in the Milwaukee public schools, has seen "an extreme over-diagnosis of ADHD especially during the past ten years." What is scary, Levine said in the Sentinel article, "is that therapy for children, say with depression, varies greatly from that offered to children with ADHD."
Attention deficit hyperactivity disorder has existed for generations. First identified in 1923 by Dr. Ebaugh, it was initially called epidemic encephalitis. In the 30's and 40's it was called overactivity, organic behavior syndrome, and distractibility. In the 50's and 60's the terms for it were minimal brain damage, Strauss Syndrome, hyperkinetic impulse disorder, minimal brain dysfunction, and hyperkinetic reaction of childhood. In the 70's and 80's it was identified as hyperkinesis and hyperactivity, and attention deficit disorder and attention deficit disorder with hyperactivity. Finally, in 1986 scientists called it yet another name, attention deficit hyperactivity disorder (ADHD), the term we use today.
ADHD affects almost two million schoolchildren, has existed for generations, and is grossly misdiagnosed, but until this November we were no closer to being able to objectively diagnose those who really have it than we were a half century ago.
This November a Stanford Department of Psychology research group announced in the Proceedings of the National Academy of Sciences that they had taken a first step toward developing an objective test to identify children who truly have attention deficit hyperactivity disorder. They used an MRI to scan the brains of 16 boys between the ages of 8 and 13 while playing a simple mental game. Ten of the boys had a diagnosis of attention deficit hyperactivity disorder, and the others were considered normal. The MRI detected different brain activity between the two groups.
"As the boys watched letters of the alphabet flash individually on a screen," explained the researchers, "they were to push a button for every letter except X. When X flashed, they were to do nothing. Since impulse control and poor concentration are a hallmark of attention deficit hyperactivity disorder, those with it do much worse than the others."
The boys were again tested after they took Ritalin. When the new brain scans were compared, researchers found that the boys with the disorder had more activity in the basal ganglia, a brain structure, than they had before taking Ritalin. In contrast, the boys without the disorder had less activity in that part of the brain. The test thus can give a "brain signature" that biologically identifies those with the illness and may become a way to objectively identify ADHD children. It may be comforting for children to know there is biological proof why they act a certain way, and that they are not just "bad kids."
Thirteen-year-old Ashley W. says, "Though never identified, I think my dad has attention deficit hyperactivity disorder, and it makes him very angry with himself. All through his childhood I think he had it without knowing it. He would always try his hardest to do well in school, but he never could pay attention. He has to read and reread sentences to comprehend them, and he has a problem with writing and remembering spelling, too. It frustrated him very much and kept him from excelling. Now he continuously has to remind himself to stay focused. Although he can't always do it, he's gotten better."
"When he was younger, he didn't know what was wrong," Ashley adds. "He was never diagnosed. If he had gotten help earlier, his future might have been different."
Currently there are several intervention and remediation strategies that might have helped those like Ashley's dad. Some with ADHD mitigate their symptoms through use of vitamin supplements, herbs, anti-motion sickness medication, anti-fungal medication, biofeedback, and/or by eliminating foods such as additives and sugar from their diets. Some find success by using family intervention or parent training, group relaxation techniques, bodily manipulation, or hypnotherapy. Some have even found that using magnetic mattress pads produced wonderful results for them.
ADHD children frequently require special accommodations in the classroom in order to meet success. Teachers with ADHD children might help them if they keep their directions simple, break learning tasks down into small manageable components, seat the children away from distractions and near the teacher, have a structured environment with clear expectations, and liberally and frequently use praise. It also might help to allow those with ADHD to be the ones who pass out books or assignments, or to move around the room as long as they do not disturb others.
In addition to using many of the same techniques as teachers, parents of ADHD children could try to have those with the condition study with a friend who is a good student; they might be able to improve study techniques that way. Parents might also try to find extra-curricular activities in which their ADHD child could excel and build up self-esteem. Helping their children get organized and keep track of assignments by using planners they sign daily sometimes helps, too. And then there is drug therapy. Stimulants such as Cylert and Ritalin are frequently effective in the short term, especially when combined with behavior-modification training, but many in the field suggest that other methods be explored first because no studies have examined the drugs' effects on children who take them for more than 14 months; no one knows yet the effects of using the drugs over a long period of time.
Thirteen-year-old Adam R. has ADHD. "Having ADHD is hard," he says. "You can't concentrate on sports or schoolwork I started taking a type of Ritalin when I was in sixth grade last year, and it has helped me. I used to take two pills of 4 mg twice a day. Now I take one pill of 5 mg once a day. I know of only two people who take pills to calm them down because of ADHD. I know what they are going through. It's better to know I'm not alone."
"When I was in first grade, I was diagnosed with ADHD," says seventh grader Chris M. "Since then I have taken Ritalin in the morning. When I don't take it, I am very fidgety and hyper. When I forget to take it, I often get into trouble at school."
"Many people say Ritalin slows your thinking down, but for me it just makes me calm, and I can concentrate better," says Chris. "Being ADHD is not a shameful thing for me. I know that one day I will adapt."
"My dad told me that when he was a child, he could not pay attention in class either," adds Chris. "He never took medication, but he wishes he did because he would have done a lot better in school. Being ADHD must be hereditary in my family, and I wonder if my son will have it."
Currently, attention deficit hyperactivity disorder is frequently misunderstood, misinterpreted, and misdiagnosed. But perhaps through the efforts of researchers like those at Stanford, we will eventually be able to develop reliable methods to diagnose and then safe methods to help those with ADHD. The future of nearly two million children like Chris and Adam depends on it.
Article by Glori Chaika
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