ADHD: What Is It?

Education World examines the personal experiences of children with ADHD, describes the disorder's symptoms, and explains the three types of the disorder. Included: Recommended guidelines for diagnosing ADHD.

The whispers and quiet chatter in Lori's classroom combined with the sounds of the pencil sharpener, the lawn mower outside, and a group of students passing in the hall. Those ambient sounds blurred into echoes so distracting that Lori couldn't concentrate. That was how 11-year-old Lori (not her real name) described what it was like in a classroom before taking stimulant medication.

Lori's pediatrician diagnosed attention deficit hyperactivity disorder (ADHD). The medication he prescribed helps Lori isolate all those sounds that blur together, Lori tells her mother. It allows her to focus, which helps her also deal with diagnosed learning disabilities.

Like Lori, Chris Kaplanek, now 18, also was diagnosed with ADHD when he was in elementary school. He has a different type of ADHD. His disorder pertains to excessive hyperactivity in combination with inattention. He also has been diagnosed with a learning disability; that, in combination with his ADHD, contributes to his low tolerance for frustration.

Without help in school and at home, Chris tells his mother, "I would be a loser ... nowhere." His mother, Beth Kaplanek, is the volunteer president of the board of directors of Children and Adults With Attention-Deficit/Hyperactivity Disorder (CHADD).

THREE TYPES OF ADHD

Lori and Chris have different types of ADHD. Experts have identified three subsets of the disorder: inattention, hyperactivity, and inattention with hyperactivity. Regardless of the type, many children with ADHD commonly report that images, sounds, and thoughts churn constantly in their minds, distracting them. Those distractions make staying fixed on any one task or activity nearly impossible. Some children with ADHD don't even hear people speak because they are so distracted, according to the American Academy of Child & Adolescent Psychiatry (AACAP).

Others find that all those images create such frenzy for them that they are unable to sit still, to pay attention to what is going on, or to plan ahead. The core problem of ADHD, say experts, is that it affects all thought-processing tasks.

"Chris is so scattered in his thoughts that he needs someone to coach him through school," explained Beth Kaplanek. Although he has an IQ of 130, which is well above average, the combination of his disorders interferes with his ability to learn in school, Kaplanek said. "Chris is not happy he has it. He cries sometimes, and he doesn't understand why he has to have it. But he says he tries to go inside himself and think about others who have it tougher."

Many children with ADHD also suffer from learning disabilities, and they find succeeding in school a struggle.

AACAP estimates that every teacher has at least one child with ADHD; about 3 to 5 percent of children are affected with ADHD. However, the www.aap.org American Academy of Pediatrics places that figure higher, between 4 and 12 percent of all school-age children, making ADHD the most common childhood neurobehavioral disorder.

TEACHERS IN THE MIDDLE

Teachers are often the first persons to identify a child who may have ADHD. "It's crazy we are asking teachers to diagnose that," said Jonathan Michaelis, a clinical neuropsychologist and a clinical director of three ADD Centers in Connecticut.

"Physicians must depend on what the teacher told a parent in order to render a diagnosis," Michaelis told Education World. "The poor physician has about 10 to 12 minutes to see a patient. That's all the time the insurance company will give." A ten-minute evaluation doesn't cut it when a comprehensive evaluation is needed, he said.

Because pediatricians and family physicians are more likely than psychiatrists to make the diagnosis, the AAP issued Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Guidelines last May. The AAP designed the guidelines to provide a standard for diagnosing ADHD in children six to 12 years old.

The AAP guidelines recommend the following:

• A child must exhibit at least six of nine symptoms of the criteria defined by the American Psychiatric Association.
• The child should demonstrate those symptoms in at least two settings.
• Those symptoms must be harmful to the child's academic or social functioning for at least six months.
• The assessment requires evidence directly obtained from the classroom teacher (or another school professional).
• An additional assessment should also be conducted for associated (coexisting) conditions, such as learning disabilities and other mental health or behavioral disorders.

If children don't display ADHD symptoms at home, then they don't have ADHD, advises David B. Pruitt, past president of the American Academy of Child and Adolescent Psychiatry, in Your Child: What Every Parent Needs to Know: What's Normal, What's Not, and When to Seek Help. The problem may be that the children are bored, discouraged, restless, and unable to follow instructions at school because they don't find the structure or challenge in school appropriate for them, according to Pruitt. He recommends that careful evaluation of children with school problems should include assessments of possible learning disabilities or other emotional or neurological disorders, such as depression or Tourette's syndrome.

ADHD SYMPTOMS

Pruitt summarizes the symptoms of ADHD. He says the least common type of ADHD is the hyperactivity subset. Children with hyperactivity tend to blurt out answers in the classroom but are able to concentrate on their tasks. They also may have difficulty sitting through a structured activity. Hyperactive children are predominantly fidgety. Some are impulsive to the point of being dangers to themselves. Others can be aggressive with their classmates.

Children with the inattention subset are easily distracted in class and are disorganized, but not hyperactive. They daydream, forget or lose things, procrastinate with their assignments, and fail to complete their work. Some have difficulty paying attention for more than a few minutes.

The third type is the most severe. These children have both the hyperactivity and inattention components.

CAUSES OF ADHD MAY BE BRAIN ADNORMALITIES

Research supports biological, genetic, and neuropsychological underpinnings of ADHD, but no one is absolutely certain exactly what causes it, according to the studies funded by the National Institute of Mental Health (NIMH).

Studies have found a genetic component because ADHD runs in families. About half of parents who had ADHD as a child will have a child with the disorder.

In addition to the genetic element, imaging technology by NIMH researcher F. Xavier Castellanos, found that children with ADHD have subtle brain circuit abnormalities on the right side of the brain in the frontal lobe just behind the forehead.

Castellanos also discovered that both sides of the brains of children with ADHD are symmetrical. In children who do not have ADHD, the left and right sides of their brains are not the same size and are not symmetrical; the right side is larger than the left side in most people.

Many experts put forth a brain chemical imbalance theory that supports a physiological basis for ADHD. This "dopamine theory" has gained a wide following, according to the Mental Health: A Report of the Surgeon General. The theory explains that the reason stimulant medication is effective in children who have ADHD is because stimulants increase the availability of the neurotransmitter dopamine.

Although researchers have found brain abnormalities in children who have ADHD, they have not found a clear reason. Some researchers have found a correlation between children with ADHD and histories of prenatal and birth complications. That correlation is leading researchers to speculate that events in the womb and at birth may affect the normal development of brain symmetry that may underlie ADHD.

Diane Weaver Dunne
Education World®
Copyright © 2005 Education World

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