ATTENTION DEFICIT HYPERACTIVITY DISORDER DECADE OF THE BRAIN
ATTENTION DEFICIT HYPERACTIVITY DISORDER DECADE OF THE BRAIN
Imagine living in a fast-moving kaleidoscope, where sounds,
images, and thoughts are constantly shifting. Feeling easily bored,
yet helpless to keep your mind on tasks you need to complete.
Distracted by unimportant sights and sounds, your mind drives you
from one thought or activity to the next. Perhaps you are so wrapped
up in a collage of thoughts and images that you don't notice when
someone speaks to you.
- For many people, this is what it's like to have Attention
Deficit Hyperactivity Disorder, or ADHD. They may be unable to sit
still, plan ahead, finish tasks, or be fully aware of what's going
on around them. To their family, classmates or coworkers, they seem
to exist in a whirlwind of disorganized or frenzied activity.
Unexpectedly--on some days and in some situations--they seem fine,
often leading others to think the person with ADHD can actually
control these behaviors. As a result, the disorder can mar the
person's relationships with others in addition to disrupting their
daily life, consuming energy, and diminishing self-esteem.
- ADHD, once called hyperkinesis or minimal brain dysfunction, is
one of the most common mental disorders among children. It affects
3 to 5 percent of all children, perhaps as many as 2 million
American children. Two to three times more boys than girls are
affected. On the average, at least one child in every classroom in
the United States needs help for the disorder. ADHD often continues
into adolescence and adulthood, and can cause a lifetime of
frustrated dreams and emotional pain.
- But there is help...and hope. In the last decade, scientists
have learned much about the course of the disorder and are now able
to identify and treat children, adolescents, and adults who have
it. A variety of medications, behavior-changing therapies, and
educational options are already available to help people with ADHD
focus their attention, build self-esteem, and function in new ways.
- In addition, new avenues of research promise to further improve
diagnosis and treatment. With so many American children diagnosed
as having attention disorder, research on ADHD has become a
national priority. During the 1990s--which the President and
Congress have declared the "Decade of the Brain"--it is
possible that scientists will pinpoint the biological basis of ADHD
and learn how to prevent or treat it even more effectively.
- This booklet is provided by the National Institute of Mental
Health (NIMH), the Federal agency that supports research nationwide
on the brain, mental illnesses, and mental health. Scientists
supported by NIMH are dedicated to understanding the workings and
interrelationships of the various regions of the brain, and to
developing preventive measures and new treatments to overcome brain
disorders that handicap people in school, work, and play.
- The booklet offers up-to-date information on attention deficit
disorders and the role of NIMH-sponsored research in discovering
underlying causes and effective treatments. It describes treatment
options, strategies for coping, and sources of information and
support. You'll find out what it's like to have ADHD from the
stories of Mark, Lisa, and Henry. You'll see their early
frustrations, their steps toward getting help, and their hopes for
the future.
- The individuals referred to in this brochure are not real,
but their stories are representative of people who show symptoms of
ADHD.
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Mark
Mark, age 14, has more energy than most boys his age. But then,
he's always been overly active. Starting at age 3, he was a human
tornado, dashing around and disrupting everything in his path. At
home, he darted from one activity to the next, leaving a trail of
toys behind him. At meals, he upset dishes and chattered nonstop. He
was reckless and impulsive, running into the street with oncoming
cars, no matter how many times his mother explained the danger or
scolded him. On the playground, he seemed no wilder than the other
kids. But his tendency to overreact--like socking playmates simply
for bumping into him--had already gotten him into trouble several
times. His parents didn't know what to do. Mark's doting grandparents
reassured them, "Boys will be boys. Don't worry, he'll grow out
of it." But he didn't.
Lisa
At age 17, Lisa still struggles to pay attention and act
appropriately. But this has always been hard for her. She still gets
embarrassed thinking about that night her parents took her to a
restaurant to celebrate her 10th birthday. She had gotten so
distracted by the waitress' bright red hair that her father called
her name three times before she remembered to order. Then before she
could stop herself, she blurted, "Your hair dye looks awful!"
- In elementary and junior high school, Lisa was quiet and
cooperative but often seemed to be daydreaming. She was smart, yet
couldn't improve her grades no matter how hard she tried. Several
times, she failed exams. Even though she knew most of the answers,
she couldn't keep her mind on the test. Her parents responded to
her low grades by taking away privileges and scolding, "You're
just lazy. You could get better grades if you only tried." One
day, after Lisa had failed yet another exam, the teacher found her
sobbing, "What's wrong with me?"
Henry
Although he loves puttering around in his shop, for years Henry
has had dozens of unfinished carpentry projects and ideas for new
ones he knew he would never complete. His garage was piled so high
with wood, he and his wife joked about holding a fire sale.
- Every day Henry faced the real frustration of not being able to
concentrate long enough to complete a task. He was fired from his
job as stock clerk because he lost inventory and carelessly filled
out forms. Over the years, afraid that he might be losing his mind,
he had seen psychotherapists and tried several medications, but
none ever helped him concentrate. He saw the same lack of focus in
his young son and worried.
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The three people you've just met, Mark, Lisa, and Henry, all have
a form of ADHD--Attention Deficit Hyperactivity Disorder. ADHD is not
like a broken arm, or strep throat. Unlike these two disorders, ADHD
does not have clear physical signs that can be seen in an x-ray or a
lab test. ADHD can only be identified by looking for certain
characteristic behaviors, and as with Mark, Lisa, and Henry, these
behaviors vary from person to person. Scientists have not yet
identified a single cause behind all the different patterns of
behavior--and they may never find just one. Rather, someday
scientists may find that ADHD is actually an umbrella term for
several slightly different disorders.
- At present, ADHD is a diagnosis applied to children and adults
who consistently display certain characteristic behaviors over a
period of time. The most common behaviors fall into three
categories: inattention, hyperactivity, and impulsivity.
Inattention. People who are inattentive have a hard
time keeping their mind on any one thing and may get bored with a
task after only a few minutes. They may give effortless,
automatic attention to activities and things they enjoy. But
focusing deliberate, conscious attention to organizing and
completing a task or learning something new is difficult.
- For example, Lisa found it agonizing to do homework. Often, she
forgot to plan ahead by writing down the assignment or bringing
home the right books. And when trying to work, every few minutes
she found her mind drifting to something else. As a result, she
rarely finished and her work was full of errors.
Hyperactivity. People who are hyperactive always seem
to be in motion. They can't sit still. Like Mark, they may dash
around or talk incessantly. Sitting still through a lesson can be
an impossible task. Hyperactive children squirm in their seat or
roam around the room. Or they might wiggle their feet, touch
everything, or noisily tap their pencil. Hyperactive teens and
adults may feel intensely restless. They may be fidgety or, like
Henry, they may try to do several things at once, bouncing around
from one activity to the next.
Impulsivity. People who are overly impulsive seem
unable to curb their immediate reactions or think before they
act. As a result, like Lisa, they may blurt out inappropriate
comments. Or like Mark, they may run into the street without
looking. Their impulsivity may make it hard for them to wait for
things they want or to take their turn in games. They may grab a
toy from another child or hit when they're upset.
- Not everyone who is overly hyperactive, inattentive, or
impulsive has an attention disorder. Since most people sometimes
blurt out things they didn't mean to say, bounce from one task to
another, or become disorganized and forgetful, how can specialists
tell if the problem is ADHD?
- To assess whether a person has ADHD, specialists consider
several critical questions: Are these behaviors excessive,
long-term, and pervasive? That is, do they occur more often than in
other people the same age? Are they a continuous problem, not just
a response to a temporary situation? Do the behaviors occur in
several settings or only in one specific place like the playground
or the office? The person's pattern of behavior is compared against
a set of criteria and characteristics of the disorder. These
criteria appear in a diagnostic reference book called the DSM
(short for the Diagnostic and Statistical Manual of Mental
Disorders).
- According to the diagnostic manual, there are three patterns of
behavior that indicate ADHD. People with ADHD may show several
signs of being consistently inattentive. They may have a pattern of
being hyperactive and impulsive. Or they may show all three types
of behavior.
- Because everyone shows some of these behaviors at times, the DSM
contains very specific guidelines for determining when they
indicate ADHD. The behaviors must appear early in life, before age
7, and continue for at least 6 months. In children, they must be
more frequent or severe than in others the same age. Above all, the
behaviors must create a real handicap in at least two areas of a
person's life, such as school, home, work, or social settings. So
someone whose work or friendships are not impaired by these
behaviors would not be diagnosed with ADHD. Nor would a child who
seems overly active at school but functions well elsewhere.
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The fact is, many things can produce these behaviors. Anything
from chronic fear to mild seizures can make a child seem overactive,
quarrelsome, impulsive, or inattentive. For example, a formerly
cooperative child who becomes overactive and easily distracted after
a parent's death is dealing with an emotional problem, not ADHD. A
chronic middle ear infection can also make a child seem distracted
and uncooperative. So can living with family members who are
physically abusive or addicted to drugs or alcohol. Can you imagine a
child trying to focus on a math lesson when his or her safety and
well-being are in danger each day? Such children are showing the
effects of other problems, not ADHD.
- In other children, ADHD-like behaviors may be their response to
a defeating classroom situation. Perhaps the child has a learning
disability and is not developmentally ready to learn to read and
write at the time these are taught. Or maybe the work is too hard
or too easy, leaving the child frustrated or bored.
- Tyrone and Mimi are two examples of how classroom conditions can
elicit behaviors that look like ADHD. For months, Tyrone shouted
answers out in class, then became disruptive when the teacher
ignored him. He certainly seemed hyperactive and impulsive.
Finally, after observing Tyrone in other situations, his teacher
realized he just wanted approval for knowing the right answer. She
began to seek opportunities to call on him and praise him.
Gradually, Tyrone became calmer and more cooperative.
- Mimi, a fourth grader, made loud noises during reading group
that constantly disrupted the class. One day the teacher realized
that the book was too hard for Mimi. Mimi's disruptions stopped
when she was placed in a reading group where the books were easier
and she could successfully participate in the lesson.
- Like Tyrone and Mimi, some children's attention and class
participation improve when the class structure and lessons are
adjusted a bit to meet their emotional needs, instructional level,
or learning style. Although such children need a little help to get
on track at school, they probably donþt have ADHD.
- It's also important to realize that during certain stages of
development, the majority of children that age tend to be
inattentive, hyperactive, or impulsive--but do not have ADHD.
Preschoolers have lots of energy and run everywhere they go, but
this doesn't mean they are hyperactive. And many teenagers go
through a phase when they are messy, disorganized, and reject
authority. It doesn't mean they will have a lifelong problem
controlling their impulses.
- ADHD is a serious diagnosis that may require long-term treatment
with counseling and medication. So it's important that a doctor
first look for and treat any other causes for these behaviors.
What Can Look Like ADHD?
- Underachievement at school due to a learning disability
- Attention lapses caused by petit mal seizures
- A middle ear infection that causes an intermittent hearing
problem
- Disruptive or unresponsive behavior due to anxiety or depression
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One of the difficulties in diagnosing ADHD is that it is often
accompanied by other problems. For example, many children with ADHD
also have a specific learning disability (LD), which means they have
trouble mastering language or certain academic skills, typically
reading and math. ADHD is not in itself a specific learning
disability. But because it can interfere with concentration and
attention, ADHD can make it doubly hard for a child with LD to do
well in school.
- A very small proportion of people with ADHD have a rare disorder
called Tourette's syndrome. People with Tourette's have tics and
other movements like eye blinks or facial twitches that they cannot
control. Others may grimace, shrug, sniff, or bark out words.
Fortunately, these behaviors can be controlled with medication.
Researchers at NIMH and elsewhere are involved in evaluating the
safety and effectiveness of treatment for people who have both
Tourette's syndrome and ADHD.
- More serious, nearly half of all children with ADHD--mostly
boys--tend to have another condition, called oppositional defiant
disorder. Like Mark, who punched playmates for jostling him, these
children may overreact or lash out when they feel bad about
themselves. They may be stubborn, have outbursts of temper, or act
belligerent or defiant. Sometimes this progresses to more serious
conduct disorders. Children with this combination of problems are
at risk of getting in trouble at school, and even with the police.
They may take unsafe risks and break laws--they may steal, set
fires, destroy property, and drive recklessly. It's important that
children with these conditions receive help before the behaviors
lead to more serious problems.
- At some point, many children with ADHD--mostly younger children
and boys--experience other emotional disorders. About one-fourth
feel anxious. They feel tremendous worry, tension, or uneasiness,
even when there's nothing to fear. Because the feelings are
scarier, stronger, and more frequent than normal fears, they can
affect the child's thinking and behavior. Others experience
depression. Depression goes beyond ordinary sadness--people may
feel so "down" that they feel hopeless and unable
to deal with everyday tasks. Depression can disrupt sleep,
appetite, and the ability to think.
- Because emotional disorders and attention disorders so often go
hand in hand, every child who has ADHD should be checked for
accompanying anxiety and depression. Anxiety and depression can be
treated, and helping children handle such strong, painful feelings
will help them cope with and overcome the effects of ADHD.
(Graphic Omitted: Diagram showing the overlapping of other
disorders with ADHD.)
- Of course, not all children with ADHD have an additional
disorder. Nor do all people with learning disabilities, Tourette's
syndrome, oppositional defiant disorder, conduct disorder, anxiety,
or depression have ADHD. But when they do occur together, the
combination of problems can seriously complicate a person's life.
For this reason, it's important to watch for other disorders in
children who have ADHD.
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Understandably, one of the first questions parents ask when they
learn their child has an attention disorder is "Why? What
went wrong?"
- Health professionals stress that since no one knows what causes
ADHD, it doesn't help parents to look backward to search for
possible reasons. There are too many possibilities to pin down the
cause with certainty. It is far more important for the family to
move forward in finding ways to get the right help.
- Scientists, however, do need to study causes in an effort to
identify better ways to treat, and perhaps some day, prevent ADHD.
They are finding more and more evidence that ADHD does not stem
from home environment, but from biological causes. When you think
about it, there is no clear relationship between home life and
ADHD. Not all children from unstable or dysfunctional homes have
ADHD. And not all children with ADHD come from dysfunctional
families. Knowing this can remove a huge burden of guilt from
parents who might blame themselves for their child's behavior.
- Over the last decades, scientists have come up with possible
theories about what causes ADHD. Some of these theories have led to
dead ends, some to exciting new avenues of investigation.
- One disappointing theory was that all attention disorders and
learning disabilities were caused by minor head injuries or
undetectable damage to the brain, perhaps from early infection or
complications at birth. Based on this theory, for many years both
disorders were called "minimal brain damage" or
"minimal brain dysfunction." Although certain
types of head injury can explain some cases of attention disorder,
the theory was rejected because it could explain only a very small
number of cases. Not everyone with ADHD or LD has a history of head
trauma or birth complications.
- Another theory was that refined sugar and food additives make
children hyperactive and inattentive. As a result, parents were
encouraged to stop serving children foods containing artificial
flavorings, preservatives, and sugars. However, this theory, too,
came under question. In 1982, the National Institutes of Health
(NIH), the Federal agency responsible for biomedical research, held
a major scientific conference to discuss the issue. After studying
the data, the scientists concluded that the restricted diet only
seemed to help about 5 percent of children with ADHD, mostly either
young children or children with food allergies.
ADHD Is Not Usually Caused by:
- too much TV
- food allergies
- excess sugar
- poor home life
- poor schools
- In recent years, as new tools and techniques for studying the
brain have been developed, scientists have been able to test more
theories about what causes ADHD.
- Using one such technique, NIMH scientists demonstrated a link
between a person's ability to pay continued attention and the level
of activity in the brain. Adult subjects were asked to learn a list
of words. As they did, scientists used a PET (positron emission
tomography) scanner to observe the brain at work. The researchers
measured the level of glucose used by the areas of the brain that
inhibit impulses and control attention. Glucose is the brain's main
source of energy, so measuring how much is used is a good
indicator of the brain's activity level. The investigators found
important differences between people who have ADHD and those who
don't. In people with ADHD, the brain areas that control attention
used less glucose, indicating that they were less active. It
appears from this research that a lower level of activity in some
parts of the brain may cause inattention.
![[ Brain Scan Images ]](http://www.pueblo.gsa.gov/cic_text/health/attendef/adhd01.jpg) |
Brain scan images produced by positron emision tomography
(PET) show differences between an adult with Attention deficit
Hyperactivity Disorder (right) and an adult free of the disease
(left). |
- The next step will be to research WHY there is less activity in
these areas of the brain. Scientists at NIMH hope to compare the
use of glucose and the activity level in mild and severe cases of
ADHD. They will also try to discover why some medications used to
treat ADHD work better than others, and if the more effective
medications increase activity in certain parts of the brain.
- Researchers are also searching for other differences between
those who have and do not have ADHD. Research on how the brain
normally develops in the fetus offers some clues about what may
disrupt the process. Throughout pregnancy and continuing into the
first year of life, the brain is constantly developing. It begins
its growth from a few all-purpose cells and evolves into a complex
organ made of billions of specialized, interconnected nerve cells.
By studying brain development in animals and humans, scientists are
gaining a better understanding of how the brain works when the
nerve cells are connected correctly and incorrectly. Scientists at
NIMH and other research institutions are tracking clues to
determine what might prevent nerve cells from forming the proper
connections. Some of the factors they are studying include drug use
during pregnancy, toxins, and genetics.
- Research shows that a mother's use of cigarettes, alcohol, or
other drugs during pregnancy may have damaging effects on the
unborn child. These substances may be dangerous to the fetus's
developing brain. It appears that alcohol and the nicotine in
cigarettes may distort developing nerve cells. For example, heavy
alcohol use during pregnancy has been linked to fetal alcohol
syndrome (FAS), a condition that can lead to low birth weight,
intellectual impairment, and certain physical defects. Many
children born with FAS show much the same hyperactivity,
inattention, and impulsivity as children with ADHD.
- Drugs such as cocaine--including the smokable form known as
crack--seem to affect the normal development of brain receptors.
These brain cell parts help to transmit incoming signals from our
skin, eyes, and ears, and help control our responses to the
environment. Current research suggests that drug abuse may harm
these receptors. Some scientists believe that such damage may lead
to ADHD.
- Toxins in the environment may also disrupt brain development or
brain processes, which may lead to ADHD. Lead is one such possible
toxin. It is found in dust, soil, and flaking paint in areas where
leaded gasoline and paint were once used. It is also present in
some water pipes. Some animal studies suggest that children exposed
to lead may develop symptoms associated with ADHD, but only a few
cases have actually been found.
- Other research shows that attention disorders tend to run in
families, so there are likely to be genetic influences. Children
who have ADHD usually have at least one close relative who also has
ADHD. And at least one-third of all fathers who had ADHD in their
youth bear children who have ADHD. Even more convincing: the
majority of identical twins share the trait. At the National
Institutes of Health, researchers are also on the trail of a gene
that may be involved in transmitting ADHD in a small number of
families with a genetic thyroid disorder.
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Mark
In third grade, Mark's teacher threw up her hands and said, "Enough!"
In one morning, Mark had jumped out of his seat to sharpen his pencil
six times, each time accidentally charging into other children's
desks and toppling books and papers. He was finally sent to the
principal's office when he began kicking a desk he had overturned. In
sheer frustration, his teacher called a meeting with his parents and
the school psychologist.
- But even after they developed a plan for managing Mark's
behavior in class, Mark showed little improvement. Finally, after
an extensive assessment, they found that Mark had an attention
deficit that included hyperactivity. He was put on a medication
called Ritalin to control the hyperactivity during school hours.
Although Ritalin failed to help, another drug called Dexedrine did.
With a psychologist's help, his parents learned to reward desirable
behaviors, and to have Mark take "time out" when he
became too disruptive. Soon Mark was able to sit still and focus on
learning.
Lisa
Because Lisa wasn't disruptive in class, it took a long time for
teachers to notice her problem. Lisa was first referred to the school
evaluation team when her teacher realized that she was a bright girl
with failing grades. The team ruled out a learning disability but
determined that she had an attention deficit, ADHD without
hyperactivity. The school psychologist recognized that Lisa was also
dealing with depression.
- Lisa's teachers and the school psychologist developed a
treatment plan that included participation in a program to increase
her attention span and develop her social skills. They also
recommended that Lisa receive counseling to help her recognize her
strengths and overcome her depression.
Henry
When Henry's son entered kindergarten, it was clear that he was
going to have problems sitting quietly and concentrating. After
several disruptive incidents, the school called and suggested that
his son be evaluated for ADHD. As the boy was assessed, Henry
realized that he had grown up with the same symptoms that specialists
were now finding in his son. Fortunately, the psychologist knew that
ADHD can persist in adults. She suggested that Henry be evaluated by
a professional who worked with adults. For the first time, Henry was
correctly diagnosed and given Ritalin to aid his concentration. What
a relief! All the years that he had been unable to concentrate were
due to a disorder that could be identified, and above all, treated.
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Many parents see signs of an attention deficit in toddlers long
before the child enters school. For example, as a 3-year-old, Henry's
son already displayed some signs of hyperactivity. He seemed to lose
interest and dart off even during his favorite TV shows or while
playing games. Once, during a game of "catch," he left the
game before the ball even reached him!
- Like Henry's son, a child may be unable to focus long enough to
play a simple game. Or, like Mark, the child may be tearing around
out of control. But because children mature at different rates, and
are very different in personality, temperament, and energy level,
it's useful to get an expert's opinion of whether the behaviors are
appropriate for the child's age. Parents can ask their
pediatrician, or a child psychologist or psychiatrist to assess
whether their toddler has an attention disorder or is just
immature, has hyperactivity or is just exuberant.
- Seeing a child as "a chip off the old block" or "just
like his dad" can blind parents to the need for help. Parents
may find it hard to see their child's behavior as a problem when it
so closely resembles their own. In fact, like Henry, many parents
first recognize their own disorder only when their children are
diagnosed.
- In many cases, the teacher is the first to recognize that a
child is hyperactive or inattentive and may consult with the school
psychologist. Because teachers work with many children, they come
to know how "average" children behave in learning
situations that require attention and self control. However,
teachers sometimes fail to notice the needs of children like Lisa
who are quiet and cooperative.
Types of Professionals Who Make the Diagnosis
School-age and preschool children are often evaluated by a school
psychologist or a team made up of the school psychologist and other
specialists. But if the school doesn't believe the student has a
problem, or if the family wants another opinion, a family may need to
see a specialist in private practice. In such cases, who can the
family turn to? What kinds of specialists do they need?
- The family can start by talking with the child's pediatrician or
their family doctor. Some pediatricians may do the assessment
themselves, but more often they refer the family to an appropriate
specialist they know and trust. In addition, state and local
agencies that serve families and children, as well as some of the
volunteer organizations listed in the back of this booklet, can
help identify an appropriate specialist.
- Knowing the differences in qualifications and services can help
the family choose someone who can best meet their needs. Besides
school psychologists, there are several types of specialists
qualified to diagnose and treat ADHD. Child psychiatrists are
doctors who specialize in diagnosing and treating childhood mental
and behavioral disorders. A psychiatrist can provide therapy and
prescribe any needed medications. Child psychologists are also
qualified to diagnose and treat ADHD. They can provide therapy for
the child and help the family develop ways to deal with the
disorder. But psychologists are not medical doctors and must rely
on the child's physician to do medical exams and prescribe
medication. Neurologists, doctors who work with disorders of the
brain and nervous system, can also diagnose ADHD and prescribe
medicines. But unlike psychiatrists and psychologists, neurologists
usually do not provide therapy for the emotional aspects of the
disorder. Adults who think they may have ADHD can also seek a
psychologist, psychiatrist, or neurologist. But at present, not all
specialists are skilled in identifying or treating ADHD in adults.
- Within each specialty, individual doctors and mental health
professionals differ in their experience with ADHD. So in selecting
a specialist, it's important to find someone with specific training
and experience in diagnosing and treating the disorder.
Steps In Making a Diagnosis
Whatever the specialist's expertise, his or her first task is to
gather information that will rule out other possible reasons for the
child's behavior. In ruling out other causes, the specialist checks
the child's school and medical records. The specialist tries to sense
whether the home and classroom environments are stressful or chaotic,
and how the child's parents and teachers deal with the child. They
may have a doctor look for such problems as emotional disorders,
undetectable (petit mal) seizures, and poor vision or hearing. Most
schools automatically screen for vision and hearing, so this
information is often already on record. A doctor may also look for
allergies or nutrition problems like chronic "caffeine highs"
that might make the child seem overly active.
- Next the specialist gathers information on the child's ongoing
behavior in order to compare these behaviors to the symptoms and
diagnostic criteria listed in the DSM (Diagnostic and
Statistical Manual of Mental Disorders). This involves talking
with the child and if possible, observing the child in class and in
other settings.
- The child's teachers, past and present, are asked to rate their
observations of the child's behavior on standardized evaluation
forms to compare the childþs behaviors to those of other
children the same age. Of course, rating scales are
subjective--they only capture the teacher's personal perception of
the child. Even so, because teachers get to know so many children,
their judgment of how a child compares to others is usually
accurate.
- The specialist interviews the child's teachers, parents, and
other people who know the child well, such as school staff and
baby-sitters. Parents are asked to describe their child's behavior
in a variety of situations. They may also fill out a rating scale
to indicate how severe and frequent the behaviors seem to be.
- In some cases, the child may be checked for social adjustment
and mental health. Tests of intelligence and learning achievement
may be given to see if the child has a learning disability and
whether the disabilities are in all or only certain parts of the
school curriculum.
- In looking at the data, the specialist pays special attention to
the child's behavior during noisy or unstructured situations, like
parties, or during tasks that require sustained attention, like
reading, working math problems, or playing a board game. Behavior
during free play or while getting individual attention is given
less importance in the evaluation. In such situations, most
children with ADHD are able to control their behavior and perform
well.
- The specialist then pieces together a profile of the child's
behavior. Which ADHD-like behaviors listed in the DSM does the
child show? How often? In what situations? How long has the child
been doing them? How old was the child when the problem started?
Are the behaviors seriously interfering with the child's
friendships, school activities, or home life? Does the child have
any other related problems? The answers to these questions help
identify whether the child's hyperactivity, impulsivity, and
inattention are significant and long-standing. If so, the child may
be diagnosed with ADHD.
- Adults are diagnosed for ADHD based on their performance at home
and at work. When possible, their parents are asked to rate the
person's behavior as a child. A spouse or roommate can help rate
and evaluate current behaviors. But for the most part, adults are
asked to describe their own experiences. One symptom is a sense of
frustration. Since people with ADHD are often bright and creative,
they often report feeling frustrated that they're not living up to
their potential. Many also feel restless and are easily bored. Some
say they need to seek novelty and excitement to help channel the
whirlwind in their minds. Although it may be impossible to document
when these behaviors first started, most adults with ADHD can give
examples of being inattentive, impulsive, overly active, impatient,
and disorganized most of their lives.
- Until recent years, adults were not thought to have ADHD, so
many adults with ongoing symptoms have never been diagnosed. People
like Henry go for decades knowing that something is wrong, but not
knowing what it is. Psychotherapy and medication for anxiety,
depression, or manic-depression fail to help much, simply because
the ADHD itself is not being addressed. Yet half the children with
ADHD continue to have symptoms through adulthood. The recent
awareness of adult ADHD means that many people can finally be
correctly diagnosed and treated.
- A correct diagnosis lets people move forward in their lives.
Once the disorder is known, they can begin to receive whatever
combination of educational, medical, and emotional help they need.
- An effective treatment plan helps people with ADHD and their
families at many levels. For adults with ADHD, the treatment plan
may include medication, along with practical and emotional support.
For children and adolescents, it may include providing an
appropriate classroom setting, the right medication, and helping
parents to manage their child's behavior.
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Children with ADHD have a variety of needs. Some children are too
hyperactive or inattentive to function in a regular classroom, even
with medication and a behavior management plan. Such children may be
placed in a special education class for all or part of the day. In
some schools, the special education teacher teams with the classroom
teacher to meet each child's unique needs. However, most children are
able to stay in the regular classroom. Whenever possible, educators
prefer to not to segregate children, but to let them learn along with
their peers.
- Children with ADHD often need some special accommodations to
help them learn. For example, the teacher may seat the child in an
area with few distractions, provide an area where the child can
move around and release excess energy, or establish a clearly
posted system of rules and reward appropriate behavior. Sometimes
just keeping a card or a picture on the desk can serve as a visual
reminder to use the right school behavior, like raising a hand
instead of shouting out, or staying in a seat instead of wandering
around the room. Giving a child like Lisa extra time on tests can
make the difference between passing and failing, and gives her a
fairer chance to show what she's learned. Reviewing instructions or
writing assignments on the board, and even listing the books and
materials they will need for the task, may make it possible for
disorganized, inattentive children to complete the work.
- Many of the strategies of special education are simply good
teaching methods. Telling students in advance what they will learn,
providing visual aids, and giving written as well as oral
instructions are all ways to help students focus and remember the
key parts of the lesson.
- Students with ADHD often need to learn techniques for monitoring
and controlling their own attention and behavior. For example,
Mark's teacher taught him several alternatives for when he loses
track of what he's supposed to do. He can look for instructions on
the blackboard, raise his hand, wait to see if he remembers, or
quietly ask another child. The process of finding alternatives to
interrupting the teacher has made him more self-sufficient and
cooperative. And because he now interrupts less, he is beginning to
get more praise than reprimands.
- In Lisa's class, the teacher frequently stops to ask students to
notice whether they are paying attention to the lesson or if they
are thinking about something else. The students record their answer
on a chart. As students become more consciously aware of their
attention, they begin to see progress and feel good about staying
better focused. The process helped make Lisa aware of when she was
drifting off, so she could return her attention to the lesson
faster. As a result, she became more productive and the quality of
her work improved.
- Because schools demand that children sit still, wait for a turn,
pay attention, and stick with a task, it's no surprise that many
children with ADHD have problems in class. Their minds are fully
capable of learning, but their hyperactivity and inattention make
learning difficult. As a result, many students with ADHD repeat a
grade or drop out of school early. Fortunately, with the right
combination of appropriate educational practices, medication, and
counseling, these outcomes can be avoided.
Right to a Free Public Education
Although parents have the option of taking their child to a
private practitioner for evaluation and educational services, most
children with ADHD qualify for free services within the public
schools. Steps are taken to ensure that each child with ADHD receives
an education that meets his or her unique needs. For example, the
special education teacher, working with parents, the school
psychologist, school administrators, and the classroom teacher, must
assess the child's strengths and weaknesses and design an
Individualized Educational Program (IEP). The IEP outlines the
specific skills the child needs to develop as well as appropriate
learning activities that build on the child's strengths. Parents play
an important role in the process. They must be included in meetings
and given an opportunity to review and approve their child's IEP.
- Many children with ADHD or other disabilities are able to
receive such special education services under the Individuals with
Disabilities Education Act (IDEA). The Act guarantees appropriate
services and a public education to children with disabilities from
ages 3 to 21. Children who do not qualify for services under IDEA
can receive help under an earlier law, the National Rehabilitation
Act, Section 504, which defines disabilities more broadly.
Qualifying for services under the National Rehabilitation Act is
often called "504 eligibility."
Because ADHD is a disability that affects children's ability
to learn and interact with others, it can certainly be a
disabling condition. Under one law or another, most children can
receive the services they need.
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For decades, medications have been used to treat the symptoms of
ADHD. Three medications in the class of drugs known as stimulants
seem to be the most effective in both children and adults. These are
methylphenidate (Ritalin), dextroamphetamine (Dexedrine or
Dextrostat), and pemoline (Cylert). For many people, these medicines
dramatically reduce their hyperactivity and improve their ability to
focus, work, and learn. The medications may also improve physical
coordination, such as handwriting and ability in sports. Recent
research by NIMH suggests that these medicines may also help children
with an accompanying conduct disorder to control their impulsive,
destructive behaviors.
- Ritalin helped Henry focus on and complete tasks for the first
time. Dexedrine helped Mark to sit quietly, focus his attention,
and participate in class so he could learn. He also became less
impulsive and aggressive. Along with these changes in his behavior,
Mark began to make and keep friends.
- Unfortunately, when people see such immediate improvement, they
often think medication is all that's needed. But these medicines
don't cure the disorder, they only temporarily control the
symptoms. Although the drugs help people pay better attention and
complete their work, they can't increase knowledge or improve
academic skills. The drugs alone can't help people feel better
about themselves or cope with problems. These require other kinds
of treatment and support.
- For lasting improvement, numerous clinicians recommend that
medications should be used along with treatments that aid in these
other areas. There are no quick cures. Many experts believe that
the most significant, long-lasting gains appear when medication is
combined with behavioral therapy, emotional counseling, and
practical support. Some studies suggest that the combination of
medicine and therapy may be more effective than drugs alone. NIMH
is conducting a large study to check this.
Use of Stimulant Drugs
Stimulant drugs, such as Ritalin, Cylert, and Dexedrine, when used
with medical supervision, are usually considered quite safe. Although
they can be addictive to teenagers and adults if misused, these
medications are not addictive in children. They seldom make children
"high" or jittery. Nor do they sedate the child.
Rather, the stimulants help children control their hyperactivity,
inattention, and other behaviors.
- Different doctors use the medications in slightly different
ways. Cylert is available in one form, which naturally lasts 5 to
10 hours. Ritalin and Dexedrine come in short-term tablets that
last about 3 hours, as well as longer-term preparations that last
through the school day. The short-term dose is often more practical
for children who need medication only during the school day or for
special situations, like attending church or a prom, or studying
for an important exam. The sustained-release dosage frees the child
from the inconvenience or embarrassment of going to the office or
school nurse every day for a pill. The doctor can help decide which
preparation to use, and whether a child needs to take the medicine
during school hours only or in the evenings and on weekends, too.
- Nine out of 10 children improve on one of the three stimulant
drugs. So if one doesn't help, the others should be tried. Usually
a medication should be tried for a week to see if it helps. If
necessary, however, the doctor will also try adjusting the dosage
before switching to a different drug.
- Other types of medication may be used if stimulants don't work
or if the ADHD occurs with another disorder. Antidepressants and
other medications may be used to help control accompanying
depression or anxiety. In some cases, antihistamines may be tried.
Clonidine, a drug normally used to treat hypertension, may be
helpful in people with both ADHD and Tourette's syndrome. Although
stimulants tend to be more effective, clonidine may be tried when
stimulants don't work or can't be used. Clonidine can be
administered either by pill or by skin patch and has different side
effects than stimulants. The doctor works closely with each patient
to find the most appropriate medication.
- Sometimes, a child's ADHD symptoms seem to worsen, leading
parents to wonder why. They can be assured that a drug that helps
rarely stops working. However, they should work with the doctor to
check that the child is getting the right dosage. Parents should
also make sure that the child is actually getting the prescribed
daily dosage at home or at school--it's easy to forget. They also
need to know that new or exaggerated behaviors may also crop up
when a child is under stress. The challenges that all children
face, like changing schools or entering puberty, may be even more
stressful for a child with ADHD.
- Some doctors recommend that children be taken off a medication
now and then to see if the child still needs it. They recommend
temporarily stopping the drug during school breaks and summer
vacations, when focused attention and calm behavior are usually not
as crucial. These "drug holidays" work well if the child
can still participate at camp or other activities without
medication.
- Children on medications should have regular checkups. Parents
should also talk regularly with the child's teachers and doctor
about how the child is doing. This is especially important when a
medication is first started, re-started, or when the dosage is
changed.
The Medication Debate
As useful as these drugs are, Ritalin and the other stimulants
have sparked a great deal of controversy. Most doctors feel the
potential side effects should be carefully weighed against the
benefits before prescribing the drugs. While on these medications,
some children may lose weight, have less appetite, and temporarily
grow more slowly. Others may have problems falling asleep. Some
doctors believe that stimulants may also make the symptoms of
Tourette's syndrome worse, although recent research suggests this may
not be true. Other doctors say if they carefully watch the child's
height, weight, and overall development, the benefits of medication
far outweigh the potential side effects. Side effects that do occur
can often be handled by reducing the dosage.
- It's natural for parents to be concerned about whether taking a
medicine is in their child's best interests. Parents need to be
clear about the benefits and potential risks of using these drugs.
The child's pediatrician or psychiatrist can provide advice and
answer questions.
- Another debate is whether Ritalin and other stimulant drugs are
prescribed unnecessarily for too many children. Remember that many
things, including anxiety, depression, allergies, seizures, or
problems with the home or school environment can make children seem
overactive, impulsive, or inattentive. Critics argue that many
children who do not have a true attention disorder are medicated as
a way to control their disruptive behaviors.
Medication and Self-Esteem
When a child's schoolwork and behavior improve soon after starting
medication, the child, parents, and teachers tend to applaud the drug
for causing the sudden change. But these changes are actually the
child's own strengths and natural abilities coming out from behind a
cloud. Giving credit to the medication can make the child feel
incompetent. The medication only makes these changes possible. The
child must supply the effort and ability. To help children feel good
about themselves, parents and teachers need to praise the child, not
the drug.
- It's also important to help children and teenagers feel
comfortable about a medication they must take every day. They may
feel that because they take medicine they are different from their
classmates or that thereþs something seriously wrong with
them. CH.A.D.D. (which stands for Children and Adults with
Attention Deficit Disorders), a leading organization for people
with attention disorders, suggests several ways that parents and
teachers can help children view the medication in a positive way:
- Compare the pills to eyeglasses, braces, and allergy
medications used by other children in their class. Explain that
their medicine is simply a tool to help them focus and pay
attention.
- Point out that they're lucky their problem can be helped.
Encourage them to identify ways the medicine makes it easier to
do things that are important to them, like make friends,
succeed at school, and play.
Myths About Stimulant Medication
Myth:
Stimulants can lead to drug addiction later in life.
Fact:
Stimulants help many children focus and be more successful at
school, home, and play. Avoiding negative experiences now may
actually help prevent addictions and other emotional problems later.
Myth:
Responding well to a stimulant drug proves a person has ADHD.
Fact:
Stimulants allow many people to focus and pay better attention,
whether or not they have ADHD. The improvement is just more
noticeable in people with ADHD.
Myth:
Medication should be stopped when the child reaches adolescence.
Fact:
Not so! About 80 percent of those who needed medication as children
still need it as teenagers. Fifty percent need medication as adults.
Treatments To Help People With ADHD and Their Families Learn To
Cope
Life can be hard for children with ADHD. They're the ones who are
so often in trouble at school, can't finish a game, and lose friends.
They may spend agonizing hours each night struggling to keep their
mind on their homework, then forget to bring it to school.
- It's not easy coping with these frustrations day after day. Some
children release their frustration by acting contrary, starting
fights, or destroying property. Some turn the frustration into body
ailments, like the child who gets a stomachache each day before
school. Others hold their needs and fears inside, so that no one
sees how badly they feel.
- It's also difficult having a sister, brother, or classmate who
gets angry, grabs your toys, and loses your things. Children who
live with or share a classroom with a child who has ADHD get
frustrated, too. They may feel neglected as their parents or
teachers try to cope with the hyperactive child. They may resent
their brother or sister never finishing chores, or being pushed
around by a classmate. They want to love their sibling and get
along with their classmate, but sometimes it's so hard!
- It's especially hard being the parent of a child who is full of
uncontrolled activity, leaves messes, throws tantrums, and doesn't
listen or follow instructions. Parents often feel powerless and at
a loss. The usual methods of discipline, like reasoning and
scolding, don't work with this child, because the child doesn't
really choose to act in these ways. It's just that their
self-control comes and goes. Out of sheer frustration, parents
sometimes find themselves spanking, ridiculing, or screaming at the
child, even though they know it's not appropriate. Their response
leaves everyone more upset than before. Then they blame themselves
for not being better parents. Once children are diagnosed and
receiving treatment, some of the emotional upset within the family
may fade.
Medication can help to control some of the behavior problems
that may have lead to family turmoil. But more often, there are
other aspects of the problem that medication can't touch. Even
though ADHD primarily affects a person's behavior, having the
disorder has broad emotional repercussions. For some children,
being scolded is the only attention they ever get. They have few
experiences that build their sense of worth and competence. If
they're hyperactive, they're often told they're bad and punished
for being disruptive. If they are too disorganized and unfocused
to complete tasks, others may call them lazy. If they impulsively
grab toys, butt in, or shove classmates, they may lose friends.
And if they have a related conduct disorder, they may get in
trouble at school or with the law. Facing the daily frustrations
that can come with having ADHD can make people fear that they are
strange, abnormal, or stupid.
Often, the cycle of frustration, blame, and anger has gone on
so long that it will take some time to undo. Both parents and
their children may need special help to develop techniques for
managing the patterns of behavior. In such cases, mental health
professionals can counsel the child and the family, helping them
to develop new skills, attitudes, and ways of relating to each
other. In individual counseling, the therapist helps children or
adults with ADHD learn to feel better about themselves. They
learn to recognize that having a disability does not reflect who
they are as a person. The therapist can also help people with
ADHD identify and build on their strengths, cope with daily
problems, and control their attention and aggression. In group
counseling, people learn that they are not alone in their
frustration and that others want to help. Sometimes only the
individual with ADHD needs counseling support. But in many cases,
because the problem affects the family as well as the person with
ADHD, the entire family may need help. The therapist assists the
family in finding better ways to handle the disruptive behaviors
and promote change. If the child is young, most of the
therapist's work is with the parents, teaching them techniques
for coping with and improving their child's behavior.
Several intervention approaches are available and different
therapists tend to prefer one approach or another. Knowing
something about the various types of interventions makes it
easier for families to choose a therapist that is right for their
needs.
Psychotherapy works to help people with ADHD
to like and accept themselves despite their disorder. In
psychotherapy, patients talk with the therapist about upsetting
thoughts and feelings, explore self-defeating patterns of
behavior, and learn alternative ways to handle their emotions. As
they talk, the therapist tries to help them understand how they
can change. However, people dealing with ADHD usually want to
gain control of their symptomatic behaviors more directly. If so,
more direct kinds of intervention are needed.
Cognitive-behavioral therapy helps people work
on immediate issues. Rather than helping people understand their
feelings and actions, it supports them directly in changing their
behavior. The support might be practical assistance, like helping
Henry learn to think through tasks and organize his work. Or the
support might be to encourage new behaviors by giving praise or
rewards each time the person acts in the desired way. A
cognitive-behavioral therapist might use such techniques to help
a belligerent child like Mark learn to control his fighting, or
an impulsive teenager like Lisa to think before she speaks.
Social skills training can also help children
learn new behaviors. In social skills training, the therapist
discusses and models appropriate behaviors like waiting for a
turn, sharing toys, asking for help, or responding to teasing,
then gives children a chance to practice. For example, a child
might learn to "read" other people's facial expression
and tone of voice, in order to respond more appropriately. Social
skills training helped Lisa learn to join in group activities,
make appropriate comments, and ask for help. A child like Mark
might learn to see how his behavior affects others and develop
new ways to respond when angry or pushed.
Support groups connect people who have common
concerns. Many adults with ADHD and parents of children with ADHD
find it useful to join a local or national support group. Many
groups deal with issues of children's disorders, and even ADHD
specifically. The national associations listed at the back of
this booklet can explain how to contact a local chapter. Members
of support groups share frustrations and successes, referrals to
qualified specialists, and information about what works, as well
as their hopes for themselves and their children. There is
strength in numbers--and sharing experiences with others who have
similar problems helps people know that they aren't alone.
Parenting skills training, >offered by
therapists or in special classes, gives parents tools and
techniques for managing their child's behavior. One such
technique is the use of "time out" when the child
becomes too unruly or out of control. During time outs, the child
is removed from the agitating situation and sits alone quietly
for a short time to calm down. Parents may also be taught to give
the child "quality time" each day, in which they share
a pleasurable or relaxed activity. During this time together, the
parent looks for opportunities to notice and point out what the
child does well, and praise his or her strengths and abilities.
- An effective way to modify a child's behavior is through a
system of rewards and penalties. The parents (or teacher) identify
a few desirable behaviors that they want to encourage in the
child--such as asking for a toy instead of grabbing it, or
completing a simple task. The child is told exactly what is
expected in order to earn the reward. The child receives the reward
when he performs the desired behavior and a mild penalty when he
doesn't. A reward can be small, perhaps a token that can be
exchanged for special privileges, but it should be something the
child wants and is eager to earn. The penalty might be removal of a
token or a brief "time out." The goal, over time, is to
help children learn to control their own behavior and to choose the
more desired behavior. The technique works well with all children,
although children with ADHD may need more frequent rewards.
- In addition, parents may learn to structure situations in ways
that will allow their child to succeed. This may include allowing
only one or two playmates at a time, so that their child doesn't
get overstimulated. Or if their child has trouble completing tasks,
they may learn to help the child divide a large task into small
steps, then praise the child as each step is completed.
- Parents may also learn to use stress management methods, such as
meditation, relaxation techniques, and exercise to increase their
own tolerance for frustration, so that they can respond more calmly
to their child's behavior.
Controversial Treatments
Understandably, parents who are eager to help their children want
to explore every possible option. Many newly touted treatments sound
reasonable. Many even come with glowing reports. A few are pure
quackery. Some are even developed by reputable doctors or
specialists--but when tested scientifically, cannot be proven to
help.
- Here are a few types of treatment that have not been
scientifically shown to be effective in treating the majority of
children or adults with ADHD:
- biofeedback
- restricted diets
- allergy treatments
- medicines to correct problems in the inner ear
- megavitamins
- chiropractic adjustment and bone re-alignment
- treatment for yeast infection
- eye training
- special colored glasses
- A few success stories can't substitute for scientific evidence.
Until sound, scientific testing shows a treatment to be effective,
families risk spending time, money, and hope on fads and false
promises.
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Mark
Today, at age 14, Mark is doing much better in school. He channels
his energy into sports and is a star player on the intramural
football team. Although he still gets into fights now and then, a
child psychologist is helping him learn to control his tantrums and
frustration, and he is able to make and keep friends. His
grandparents point to him with pride and say, "We knew he'd turn
out just fine!"
Lisa
Lisa is about to graduate from high school. She's better able to
focus her attention and concentrate on her work, so that now her
grades are quite good. Overcoming her depression and learning to like
herself have also given her more confidence to develop friendships
and try new things.
- Lately, she has been working with the school guidance counselor
to identify the right kind of job to look for after graduation. She
hopes to find a career that will bypass her attention problems and
make the best use of her assets and skills. She is more alert and
focused and is considering trying college in a year or two. Her
counselor reminds her that she's certainly smart enough.
Henry
These days, Henry is successful and happy in his job as a shoe
salesman. The work allows him to move around throughout the day, and
the appearance of new customers provides the variety he needs to help
him stay focused. He recently completed a course in time management,
and now keeps lists, organizes his work, and schedules his day. Now
that he has harnessed his energy, his ability to think about several
things at once allows him to be creative and productive.
- He is proud that he and his wife have developed important
parenting skills for working with their son, so that he, too, is
doing better at home and at school. Henry is also pleased with his
new ability to follow through on projects. In fact, he just
finished making his son a beautiful wooden toy chest for his
birthday.
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Even though most people don't outgrow ADHD, people do learn to
adapt and live fulfilling lives. Mark, Lisa, and Henry are making
good lives for themselves--not by being cured, but by developing
their personal strengths. With effective combinations of medicine,
new skills, and emotional support, people with ADHD can develop ways
to control their attention and minimize their disruptive behaviors.
Like Henry, they may find that by structuring tasks and controlling
their environment, they can achieve personal goals. Like Mark, they
may learn to channel their excess energy into sports and other high
energy activities. And like Lisa, they can identify career options
that build on their strengths and abilities.
- As they grow up, with appropriate help from parents and
clinicians, children with ADHD become better able to suppress their
hyperactivity and to channel it into more socially acceptable
behaviors, like physical exercise or fidgeting. And although we
know that half of all children with ADHD will still show signs of
the problem into adulthood, we also know that the medications and
therapy that help children also work for adults.
- All people with ADHD have natural talents and abilities that
they can draw on to create fine lives and careers for themselves.
In fact, many people with ADHD even feel that their patterns of
behavior give them unique, often unrecognized, advantages. People
with ADHD tend to be outgoing and ready for action. Because of
their drive for excitement and stimulation, many become successful
in business, sports, construction, and public speaking. Because of
their ability to think about many things at once, many have won
acclaim as artists and inventors. Many choose work that gives them
freedom to move around and release excess energy. But some find
ways to be effective in quieter, more sedentary careers. Sally, a
computer programmer, found that she thinks best when she wears
headphones to reduce distracting noises. Like Henry, some people
strive to increase their organizational skills. Others who own
their own business find it useful to hire support staff to provide
day-to-day management.
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Although no immediate cure is in sight, a new understanding of
ADHD may be just over the horizon. Using a variety of research tools
and methods, scientists are beginning to uncover new information on
the role of the brain in ADHD and effective treatments for the
disorder Such research will ultimately result in improving the
personal fulfillment and productivity of people with ADHD.
- For example, the use of new techniques like brain imaging to
observe how the brain actually works is already providing new
insights into the causes of ADHD. Other research is seeking to
identify conditions of pregnancy and early childhood that may cause
or contribute to these differences in the brain. As the body of
knowledge grows, scientists may someday learn how to prevent these
differences or at least how to treat them.
- NIMH and the U.S. Department of Education are cosponsoring a
large national study--the first of its kind--to see which
combinations of ADHD treatment work best for different types of
children. During this 5-year study, scientists at research clinics
across the country will work together in gathering data to answer
such questions as: Is combining stimulant medication with behavior
modification more effective than either alone? Do boys and girls
respond differently to treatment? How do family stresses, income,
and environment affect the severity of ADHD and long-term outcomes?
How does needing medicine affect children's sense of competence,
self-control, and self-esteem? As a result of such research,
doctors and mental health specialists may someday know who benefits
most from different types of treatment and be able to intervene
more effectively.
- NIMH grantees are also trying to determine if there are
different varieties of attention deficit. With further study,
researchers may find that ADHD actually covers a number of
different disorders, each with its own cluster of symptoms and
treatment requirements. For example, scientists are exploring
whether there are any critical differences between children with
ADHD who also have anxiety, depression, or conduct disorders and
those who do not. Other researchers are studying slight physical
differences that might distinguish one type of ADHD from another.
If clusters of differences can be found, scientists can begin to
distinguish the treatment each type needs.
- Other NIMH-sponsored research is examining the long-term outcome
of ADHD. How do children with ADHD turn out, compared to brothers
and sisters without the disorder? As adults, how do they handle
their own children? Still other studies seek to better understand
ADHD in adults. Such studies give insights into what types of
treatment or services make a difference in helping an ADHD child
grow into a caring parent and a well-functioning adult.
- Animal studies are also adding to our knowledge of ADHD in
humans. Animal subjects make it possible to study some of the
possible causes of ADHD in ways that can't be studied in people. In
addition, animal research allows the safety and effectiveness of
experimental new drugs to be tested long before they can be given
to humans. One NIH-sponsored team of scientists is studying dogs to
learn how new stimulant drugs that are similar to Ritalin act on
the brain.
- Piece by piece, through studies of humans and animals,
scientists are beginning to understand the biological nature of
attention disorders. New research is allowing us to better
understand the inner workings of the brain as we continue to
develop new medications and assess new forms of treatment.
- As we learn more about what actually happens inside the brain,
we approach a future where we can prevent certain brain and mental
disorders, make valid diagnoses, and treat each effectively. This
is the hope, mission, and vision of the National Institute of
Mental Health.
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Several publications, organizations, and support groups exist to
help individuals, teachers, and families to understand and cope with
attention disorders. The following resources provide a good starting
point for gaining insight, practical solutions, and support. Other
resources are outpatient clinics of childrenþs hospitals,
university medical centers, and community mental health centers.
Additional printed information can be found at libraries and book
stores.
Books for Children and Teens:
Galvin, M. Otto Learns about his Medication. New York:
Magination Press, 1988. (for young children)
Gehret, J. Learning Disabilities and the Don't Give Up Kid.
Fairport, New York: Verbal Images Press, 1990. (for classmates and
children with learning disabilities and attention difficulties, ages
7-12)
Gordon, M. Jumpin' Johnny, Get Back to Work! A Child's Guide
to ADHD/Hyperactivity. DeWitt, New York: GSI Publications, 1991.
(for ages 7-12)
Meyer, D.; Vadasy, P.; and Fewell, R. Living with a Brother or
Sister with Special Needs: A Book for Sibs. Seattle: University
of Washington Press, 1985.
Moss, D. Shelly the Hyperactive Turtle. Rockville, MD:
Woodbine House, 1989. (for young children)
Nadeau, K., and Dixon, E. Learning to Slow Down and Pay
Attention. Annandale, VA: Chesapeake Psychological Publications,
1993.
Parker, R. Making the Grade: An Adolescent's Struggle with
ADD. Plantation, FL: Impact Publications, 1992.
Quinn, P., and Stern, J. Putting on the Brakes: Young People's
Guide to Understanding Attention Deficit Hyperactivity Disorder.
New York: Magination Press, 1991. (for ages 8-12)
Thompson, M. My Brother Matthew. Rockville, MD: Woodbine
House, 1992.
Books for Adults With Attention Disorders:
Adelman, P., and Wren, C. Learning Disabilities, Graduate
School, and Careers: The Student's Perspective. Lake Forest, IL:
Learning Opportunities Program, Barat College, 1990.
Hallowell, E., and Ratey, J. Driven to Distraction. New
York: Pantheon Books, 1994.
Hartmann, T. Attention Deficit Disorder: A New Perception.
Lancaster, PA: Underwood-Miller, 1993.
Kelly, K., and Ramundo, P. You Mean I'm Not Lazy, Stupid, or
Crazy?! Cincinnati, OH: Tyrell and Jeremy Press, 1993.
Weiss, G., and Hechtman, L. (eds). Hyperactive Children Grown
Up. 2d ed. New York: Guilford Press, 1992.
Weiss, L. Attention Deficit Disorder in Adults. Dallas,
TX: Taylor Pub. Co., 1992.
Wender, P. The Hyperactive Child, Adolescence, and Adult:
Attention Deficit Disorder Through the Lifespan. New York: Oxford
University Press, 1987.
Books for Parents:
Anderson, W.; Chitwood, S.; and Hayden, D. Negotiating the
Special Education Maze: A Guide for Parents and Teachers. 2d ed.
Rockville, MD: Woodbine House, 1990.
Bain, L. A Parent's Guide to Attention Deficit Disorders.
New York: Dell Publishing, 1991.
Barkley, R. Defiant Children. New York: Guilford Press,
1987.
Child Psychopharmacy Center, University of Wisconsin. Stimulants
and Hyperactive Children. Madison: 1990. (Order by calling (608)
263-6171.)
Copeland, E., and Love, V. Attention, Please!: A Comprehensive
Guide for Successfully Parenting Children with Attention Disorders
and Hyperactivity. Atlanta, GA: SPI Press, 1991.
Fowler, M. Maybe You Know My Kid: A Parent's Guide to
Identifying, Understanding, and Helping your Child with ADHD. New
York: Birch Lane Press, 1990.
Goldstein, S., and Goldstein, M. Hyperactivity: Why Won't My
Child Pay Attention? New York: J. Wiley, 1992.
Greenberg, G.; Horn, S.; and Wade F. Attention Deficit
Hyperactivity Disorder: Questions & Answers for Parents.
Champaign, IL: Research Press, 1991.
Ingersoll, B., and Goldstein, S. Attention Deficit Disorder
and Learning Disabilities: Realities, Myths, and Controversial
Treatments. New York: Doubleday, 1993.
Kennedy, P.; Terdal, L.; and Fusetti, L. The Hyperactive Child
Book. New York: St. Martrin's Press, 1993.
Moss, R., and Dunlap, H. Why Johnny Can't Concentrate: Coping
with Attention Deficit Problems. New York: Bantam Books, 1990.
Silver, L. Dr. Silver's Advice to Parents on Attention-Deficit
Hyperactivity Disorder. Washington, DC: American Psychiatric
Press, 1993.
Vail, P. Smart Kids with School Problems. New York: EP
Dutton, 1987.
Wilson, N. Optimizing Special Education: How Parents Can Make
a Difference. New York: Insight Books, 1992.
Windell, J. Discipline: A Sourcebook of 50 Failsafe Techniques
for Parents. New York: Collier Books, 1991.
Other Resources:
For individuals with a computer and modem, there are on-line
bulletin boards where parents, adults with ADHD, and medical
professionals share experiences, offer emotional support, and ask and
respond to questions.
Two such on-line services include CompuServe [(800) 848-8990] and
America Online [(800) 827-6364]. You may also wish to check with
other national and local on-line communications companies to see if
they offer similar services.
Resources for Teachers and Specialists:
Barkley, R. Attention Deficit Hyperactivity Disorder (four
40-minute videocassettes in VHS format). New York: Guilford
Publications, 1990.
Copeland, E., and Love, V. Attention Without Tension: A
Teacher's Handbook on Attention Disorders. Atlanta, GA: 3 C's of
Childhood, 1992.
Harris, K., and Graham, S. Helping Young Writers Master the
Craft. Cambridge, MA: Brookline Books, 1992.
Johnson, D. I Can't Sit Still-Educating and Affirming
Inattentive and Hyperactive Children: Suggestions for Parents,
Teachers, and Other Care Providers of Children to Age 10. Santa
Cruz, CA: ETR Associates, 1992.
Parker, H. The ADD Hyperactivity Handbook for Schools.
Plantation, FL: Impact Publications, 1992.
Related Materials Available from NIH:
Attention Deficit Disorder Information Packet and "Know Your
Brain Fact Sheet." Both are available from NIH Neurological
Institute, P.O. Box 5801; Bethesda, MD 20824 (800) 352-9424. Learning
Disabilities (NIH Pub. No. 93-3611) and "Plain Talk about
Depression' (NIH Pub. No. 93-3561). These are available by
contacting: NIMH, 6001 Executive Boulevard, Rm. 8184, MSC 9663
Bethesda, MD 20892-9663.
Support Groups and Organizations
Attention Deficit Information Network (Ad-IN)
475 Hillside
Avenue
Needham, MA 02194
(781) 455-9895
Provides up-to-date information on current research, regional
meetings. Offers aid in finding solutions to practical problems faced
by adults and children with an attention disorder.
ADD Warehouse
300 NW 70th Avenue
Plantation, FL 33317
(800) 233-9273
Distributes books, tapes, videos, assessment on attention
deficit hyperactivity disorders. A central location for ordering many
of the books listed above. Call for catalog.
Center for Mental Health Services
Office of Consumer, Family,
and Public Information
5600 Fishers Lane, Room 15-105
Rockville, MD 20857
(301) 443-2792
This national center, a component of the U.S. Public Health
Service, provides a range of information on mental health, treatment,
and support services.
Children and Adults with Attention Deficit Disorders
(CH.A.D.D.)
499 NW 70th Avenue, Suite 101
Plantation, FL
33317
(800) 233-4050
A major advocate and key information source for people dealing
with attention disorders. Sponsors support groups and publishes two
newsletters concerning attention disorders for parents and
professionals.
Council for Exceptional Children
11920 Association Drive
Reston, VA 22091
(703) 620-3660
Provides publications for educators. Can also provide referral
to ERIC (Educational Resource Information Center) Clearinghouse for
Handicapped and Gifted Children.
Federation of Families for Children's Mental Health
1021
Prince Street
Alexandria, VA 22314
(703) 684-7710
Provides information, support, and referrals through
federation chapters throughout the country. This national parent-run
organization focuses on the needs of children with broad mental
health problems.
HEATH Resource Center
American Council on Education
1
Dupont Circle, Suite 800
Washington, DC 20036
(800)
544-3284
A national clearinghouse on post-high school education for
people with disabilities.
Learning Disabilities Association of America
4156 Library
Road
Pittsburgh, PA 15234
(412) 341-8077
Provides information and referral to state chapters, parent
resources, and local support groups. Publishes news briefs and a
professional journal.
National Association of Private Schools
for Exceptional
Children
1522 K Street, NW, Suite 1032
Washington, DC 20005
(202) 408-3338
Provides referrals to private special education programs.
National Center for Learning Disabilities
99 Park Avenue, 6th
Floor
New York, NY 10016
(212) 687-7211
Provides referrals and resources. Publishes Their World
magazine describing true stories on ways children and adults cope
with LD.
National Clearinghouse for Alcohol and Drug Information
P.O.
Box 2345
Rockville, MD 20847
(800) 729-6686
Provides information on the risks of alcohol during pregnancy,
and fetal alcohol syndrome.
National Information Center for Children
and Youth with
Disabilities (NICHCY)
P.O. Box 1492
Washington, DC 20013
(800) 695-0285
Publishes free, fact-filled newsletters. Arranges workshops.
Advises parents on the laws entitling children with disabilities to
special education and other services.
Sibling Information Network
A.J. Pappanikou Center
1776
Ellington Road
South Windsor, CT 06074
(203) 648-1205
Publishes a newsletter for and about siblings of children with
special needs.
Tourette Syndrome Association
42-40 Bell Boulevard
Bayside, NY 11361
(718) 224-2999
State and local chapters provide national information,
advocacy, research, and support.
MESSAGE FROM THE NATIONAL INSTITUTE OF MENTAL HEALTH
Research conducted and supported by the National Institute of
Mental Health brings hope to millions of people who suffer from
mental illness and to their families and friends. In many years of
work with animal as well as human subjects, researchers have advanced
our understanding of the brain and vastly expanded the capability of
mental health professionals to diagnose, treat, and prevent mental
and brain disorders.
Now, in the 1990s, which the President and Congress have declared
the "Decade of the Brain," we stand at the threshold of a
new era in brain and behavioral sciences. Through research, we will
learn even more about mental and brain disorders such as depression,
bipolar disorder, schizophrenia, panic disorder, obsessive-compulsive
disorder, and attention deficit hyperactivity disorder. And we will
be able to use this knowledge to develop new therapies that can help
more people overcome mental illness.
The National Institute of Mental Health is part of the National
Institutes of Health (NIH), the Federal Government's primary agency
for biomedical and behavioral research. NIH is a component of the
U.S. Department of Health and Human Services.
All material in this publication is free of copyright restrictions
and may be copied, reproduced, or duplicated without permission from
NIMH; citation of the source is appreciated.
Credits
This booklet was written by Sharyn Neuwirth, M.Ed., an education
writer and instructional designer in Silver Spring, MD. Scientific
information and review was provided by NIMH staff members L. Eugene
Arnold, M.D.; F. Xavier Castellanos, M.D.; and Alan J. Zametkin, M.D.
Also providing review and assistance were Russell A. Barkley, Ph.D.,
University of Massachusetts Medical School; Eileen Weiner-Dwyer,
Ph.D., and Kevin Dwyer, M.A., N.C.S.P., of the Montgomery County
(Maryland) Schools; JoAnne Evans, R.N., Children and Adults with
Attention Deficit Disorders; Jane Hauser, U.S. Department of
Education; Reid Lyon, Ph.D., National Institute of Child Health and
Human Development; Harvey C. Parker, Ph.D., A.D.D. Warehouse; Larry
B. Silver, M.D., Georgetown University. Editorial direction was
provided by Lynn J. Cave, NIMH.
U.S. Department of Health and Human Services
Public Health
Service
National Institutes of Health
National Institute of Mental
Health
NIH Publication No. 96-3572
Printed 1994, Reprinted 1996
Bulk sales (Stock No. 017-024-01543-1) by the U.S. Government
Printing Office, Superintendent of Documents, Mail Stop: SSOP,
Washington, DC 20402-9328.
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