The first step in successful treatment is to realize that ADD or ADHD has very real physical causes which may be made worse by social and environmental factors, especially stress, lack of sleep and inadequate exercise. About 5% of school age children have ADD or ADHD. Other disorders in children have similar features to ADD/ADHD such as bipolar disorder, post traumatic stress disorder, generalized anxiety disorder and oppositional defiant disorder. To make things even more confusing, many of the above symptoms are also exhibited by gifted children, and ADD/ADHD and giftedness also sometimes occur together. This is why it is so important that the child have a comprehensive assessment by a licensed professional to diagnose and/or rule-out any other problems.
ADD/ADHD symptoms look slightly different for each individual, and can be affected by family interactions, school expectations and environments, and other demands placed on the individual child, and tend to worsen when the child is under stress and/or exposed to new situations. Since children do not have the coping skills to effectively deal with stress, most children become agitated/irritable/”bounce off the walls” and will have some ADD/ADHD-like symptoms when they are under stress.
SYMPTOMS AND DIAGNOSIS
Diagnosis in children and adults is usually made by history, self-report and observation from caregivers, teachers and the child him or herself. Additionally, the clinician will probably also use a diagnostic test or checklist such as the SNAP-IV Parent-Teacher Rating Scale to assist in making a concrete diagnosis. Some important features the clinician will look for are: inattention, impulsivity, and hyperactivity.
If a diagnosis of ADD/ADHD is made, I often recommend working with a physician or psychiatrist to begin a short-term medication regimen to address the presenting symptoms. Getting the symptoms under control gives the child and family some relief, hope, encouragement and the ability to focus on any other issues that may be causing or worsening the symptoms. If the symptoms are caused by stress and the child actually does not have ADD/ADHD, then medication is no help.
TREATMENT OPTIONS
Effective treatment includes some or all of the following: medication , individual and family therapy, behavioral interventions, additional structure for the child and family, education about the disorder, parenting and communication skills for parents with high-needs children and a reduction of overt stressors (such as parents fighting at home, or being “put on the spot” at school). Parents and teachers are active participants in successful treatment efforts by providing structure and helping children learn to provide structure for themselves. Structure and self-awareness are at the core of successful interventions.
Stimulants are the most commonly used medications, with some use of anti-depressants and antianxiety medications for other conditions of depression and anxiety. Stimulants have a paradoxical (opposite) effect on persons with true ADD or ADHD. Instead of “hyping them up” they actually help the person focus. (Note: This does not mean you should try to “self-medicate” your child with caffeine. There are very specific medications that act in very specific ways on the brain.)
INTERVENTIONS: COUNSELING, CONSULTATION, AND SUPPORT
Lack of consistency, structure and predictability causes stress in children. When children are “stressed” they become more symptomatic. It is also important to note that most children are especially sensitive to stress in their parents. Even if it appears your child has no reason to be stressed, evaluate your own stress. Young children have poor emotional boundaries, and often take on the emotions of those around them.
It is important that interventions are be consistent at home, school and anywhere else the child spends significant time. Additionally, it is helpful if the people with whom the child spends time are not overly stressed, depressed or anxious. This creates a “safe zone” the majority of the time. The child knows what the rules are and what to expect which typically helps reduce “acting out.” In addition to basic behavioral interventions, coping skills, social skills, and self-monitoring skills are important tools that can be taught in counseling, at home and in the classroom.
Parents can often benefit from local or online support groups, such as CHADD (a support group for children and adults with attention deficit disorder). This does not mean you are a bad parent, it means that most people do not know how to deal with this issue. Call your local United Way Information and Referral line or ask your child’s pediatrician or school counselor for referrals to local services. ADD cannot effectively be treated online, but online support groups for parents and adults with ADD can be helpful.
Typical challenges for students with ADD or ADHD include: 1) organizational problems; 2) problems with transitions between activities or settings (i.e. school to home); 3) acting as if rules don't apply to them; 4) adopting a negative attitude out of frustration in academic tasks, social interactions, or as a defense against low self esteem; 5) isolation from or rejection by peers; 6) poor grades; 7) impulsive behavior; 8) difficulty sustaining attention or completing tasks; 9) different learning styles; or 10) distractibility, 11) inability to self-monitor.
Motivation around academic tasks or conforming to rules can be a challenge for these students. One intervention that has proven successful is “chunking” or organizing assignments into smaller sections. This makes successful completion a more likely outcome. Try to reward completion of “chunks” with some sort of activity that allows the student to get up and move around a bit. Even such a small amount of movement can help discharge energy that is so critical for these students. When my son was in school, after students completed an assignment, they were to put their head down on their desk and be quiet. You might as well just have told him he was never going to have recess. That was nearly an impossible task for him.
Other very helpful interventions include things to increase self-awareness of feelings such as behavior/feeling checklists or worksheets, providing verbal cues such as asking the person to “Stop and check – where is your mind?” or physical monitoring cues such as a simple tap on the shoulder to help the person remember to self-monitor. These cues can be made general enough in the classroom so the child does not feel singled out.
PROGNOSIS
Most people may have symptoms of ADD that continue throughout adulthood, but with the right coping skills and new medications, they can be as happy and productive as anyone else.
RESOURCES
Continuing Education for Professionals http://www.allceus.com
Children and Adults with Attention Deficit Disorder (CHADD) CHADD website: http://www.chadd.org/ CHADD National Call Center 1-800-233-4050
Attention Deficit Disorder Association Website: http://www.add.org
American Academy of Child & Adolescent Psychiatry Website: http://www.aacap.org/