Much attention has been given to the problem of inattention in our nation’s children during the past few years. National magazines, several books and public radio have all discussed the topic, most commonly talked about as ADD, or Attention Deficit Disorder. So what exactly is ADD? Why does it seem so common nowadays? How “treatable” is it? Here is some basic information on ADD.
Attention Deficit Disorder can be divided into two, distinct subtypes. The better-known type is the neurologically-based Attention Deficit Hyperactivity Disorder(ADHD). ADHD is a diagnosis applied to children and adults who consistently display certain characteristic behaviors over a sustained amount of time. The most common behavior traits are distractibility, impulsivity, and hyperactivity. Most children diagnosed with ADHD display overactive behavior. These children jump from one task to another, showing both physical over-activity and poorly sustained focus. It is estimated that approximately four to six percent of the US population has ADHD.
The other, less commonly addressed type of Attention Deficit Disorder is ADD without the hyperactivity. Although less prevalent than ADHD, ADD still afflicts somewhere between four to twelve percent of children in the United States. These children are poorly attentive as well, but not nearly as physically active (or disruptive). Boys outnumber girls in the overall diagnosis (by a ratio of three to one); however, a higher percentage of girls fall into the non-hyper category. These girls appear quieter and better behaved than their male counterparts, but their attention deficits are just as severe.
The common denominator of the two subtypes is a lack of sustained attention towards tasks necessary for achievement. There are now strict and standardized criteria that medical personnel can use to fairly apply this diagnosis, outlined in a manual containing all psychiatric and related diagnoses.
ADD usually isn’t diagnosed before 5 to 7 years of age, when entrance into school, which demands attentiveness, obedience and periods of inactivity, begins to highlight the children who cannot meet those demands. Whereas other 6 year olds are settling, children with ADD begin to fall out of the norm. Though to meet the criteria for ADD, symptoms must have been present before the age of 7, those “symptoms’ may not have been seen as problem behaviors. Diagnosing the disorder in preschoolers is much more problematic and, according to the American Academy of Pediatrics, unreliable. Not only are high-energy and a short-attention span part of normal toddler and preschool behavior, but differences in temperament and pace of development affect behavior as well.
What ADD describes is a constellation of behaviors including impulsivity, hyperactivity, distractibility, frustration, and sometimes aggression. A diagnosis requires that some, but not all, of these behaviors be present. They must be consistent over time and across different social situations. A child who is hyperactive at home but perfectly behaved at school, or vice versa, has a situational problem -- not ADD. Symptoms must also be present for at least six months before ADD is diagnosed. There is no blood test, no brain scan, and no medical test that proves ADD. The diagnosis is clinical, based upon observations of the child, usually assessed in a behavioral questionnaire completed by caretakers and educators. A neurologist, psychiatrist, primary care pediatrician, or family doctor can make the diagnosis. The behaviors assessed by the questionnaires are rated and scored. If the score is high enough to make ADD likely, a trial of medication can be given and the effect measured by a second set of questionnaires. While taking a few weeks to accomplish, this important exercise allows for a more accurate diagnosis and provides some evidence that medicines can have a positive effect. When considering a clinical diagnosis like ADD, it is very important to exclude other serious causes of ADD-type behavior such as depression, post-traumatic stress disorder, abuse, hearing or vision problems, or learning disorders. In fact, 25 percent of children with ADD will also have some type of learning disorder, making it worthwhile to screen all such children with a comprehensive developmental assessment.
Treatment options include more than just medication -- a fact often overlooked when ADD is debated in the popular press. An educational setting more conducive to learning is as important as medical treatment. This usually involves more structure and occasionally special education and a smaller classroom. Parents must be brought into the treatment equation by structuring home-life differently and educating themselves and their families about ADD. Sometimes formal counseling is also beneficial. For many children, structure and behavioral interventions are sufficient, making medications unnecessary. No child should be on medicines alone without these other interventions.