Attention-Deficit/Hyperactivity Disorder

by Mary Fowler

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Every year the National Information Center for Children and Youth with Disabilities (NICHCY) receives thousands of requests for information about the education and special needs of children and youth with Attention Deficit Disorder (ADD). Over the past several years, ADD has received a tremendous amount of attention from parents, professionals, and policymakers across the country; so much so, in fact, that nearly everyone has now heard about ADD.

While helpful to those challenged by this disability, such widespread recognition creates the possibility of improper diagnostic practice and inappropriate treatment. Now, more than ever, parents who suspect their child might have ADD and parents of children diagnosed with the disorder need to evaluate information, products, and practitioners carefully.

This NICHCY Briefing Paper is intended to serve as a guide to help parents and educators know what ADD is, what to look for, and what to do. While acknowledging that adults, too, can have ADD, this paper focuses on the disorder as it relates to children and youth.

Is ADD Something New?

References to ADD-type symptoms have been found in the medical literature for almost 100 years. In fact, this syndrome is one of the most widely researched of all childhood disorders. Scientific experts have long understood ADD as a disability that can and does cause serious lifelong problems, particularly when nothing is done to manage the difficulties associated with the disorder.

Throughout all these years of research, the children with ADD have not changed. The characteristics of ADD evident 40 years ago are still the same seen today. It is our understanding of ADD that has evolved. The knowledge we have gained through research has, in fact, led to a change in the disorder's name and in

What is Attention Deficit Disorder?

ADD is officially called Attention Deficit/Hyperactivity Disorder, or AD/HD (American Psychiatric Association, 1994), although most lay people, and even some professionals, still call it ADD (the name given in 1980). The disorder's name has changed as a result of scientific advances and the findings of careful field trials; researchers now have strong evidence to support the position that AD/HD (as we will refer to the disorder throughout the remainder of this Briefing Paper) is not one specific c disorder with different variations. In keeping with this evidence, AD/HD is now divided into three subtypes, according to the main features associated with the disorder: inattentiveness, impulsivity, and hyperactivity. The three subtypes are:

• AD/HD Predominantly Combined Type,
  
  
• AD/HD Predominantly Inattentive Type, and
  
  
• AD/HD Predominantly Hyperactive-Impulsive Type. These subtypes take into account that some children with AD/ HD have little or no trouble sitting still or inhibiting behavior, but may be predominantly inattentive and, as a result, have great difficulty getting or staying focused on a task or activity. Others with AD/HD may be able to pay attention to a task but lose focus because they may be predominantly hyperactive-impulsive and, thus, have trouble controlling impulse and activity. The most prevalent subtype is the Combined Type. These children will have significant symptoms of all three characteristics.
  
  

"Maybe you know my kid. He's the ore who says the first thing that comes to mind. He's the youngster who can't remember a simple request. When he scrapes his knee, he screams so load and long that the neighbors think I am beating him. He's the kid in school with arts in his parts who could do the work if he really tried. Or so his parents have been told over and over again."

From Mary Fowler's (1993), Maybe you know my kid: A parent's guide to identifying, understanding, and helping your child with ADHD (2nd ed.) Used with permission.

Defining Attention Deficit/Hyperactivity Disorder*

Instead of a single list of 14 possible symptoms as listed in the prior edition of the DSM (the DSM-III-R), the DSM -IV categorically sorts the symptoms into three subtypes of the disorder:

• Combined Type: multiple symptoms of inattention, impulsivity, and hyperactivity;
  
  
• Predominantly Inattentive Type: multiple symptoms of inattention with few, if any, of hyperactivity-impulsivity;
  
  
• Predominantly Hyperactive:Impulsive Type/multiple symptoms of hyperactivity/impulsivity with few, if any, of inattention.
  
  

Other essential diagnostic features of AD/HD include:

• Symptoms of inattention, hyperactivity, or impulsivity must persist for at least six months and be maladaptive and inconsistent with developmental levels;
  
  
• Some of the symptoms causing impairment must he present before age 7 years;
  
  
• Some impairment from the symptoms is present in two or more settings (e.g., at school/work, and at home);
  
  
• Evidence of clinically significant impairment is present in social, academic, or occupational functioning;
  
  
• Symptoms do not occur exclusively during the course of Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety disorder, Dissociative Disorder, or Personality Disorder).
  
  

Don't All Children Show These Signs Occasionally?

From time to time, all children will be inattentive, impulsive, and overly active. In the case of AD/ HD, these behaviors are the rule. not the exception. When a child exhibits the behaviors listed above as symptomatic of AD/HD, even if he or she does so consistently, do not draw the conclusion that the child has the disorder. Until a proper evaluation is completed, you can only assume that the child might have AD/HD.

Conversely, people have been known to read symptom lists and, finding one or two exceptions, rule out the possibility of the disorder's presence. AD/HD is a disability that, without proper identification and management, can have long-term complications. Parents and teachers are cautioned against making the diagnosis by themselves.