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All children may be overly active at times, their attention spans may be short, and they may act without thinking. However, if your child seems more active than others the same age; if your child is notoriously forgetful, disorganized, and always losing things; if the teacher complains that your child can?t stay seated or quiet, blurts out answers instead of waiting to be called on, pays more attention to the traffic in the hall than to her, behaves aggressively, or struggles academically, then you may want to have your child evaluated for AD/HD. Determining if a child has AD/HD is a multifaceted process. Many biological and psychological problems can contribute to symptoms similar to those exhibited by children with AD/HD. For example, anxiety, depression and certain types of learning disabilities may cause similar symptoms. A comprehensive evaluation is necessary to establish a diagnosis, rule out other causes and determine the presence or absence of co-occurring conditions. Such an evaluation should include a clinical assessment of the individual?s academic, social and emotional functioning and developmental abilities. Additional tests may include intelligence testing, measures of attention span and parent and teacher rating scales. A medical exam by a physician is also important. Diagnosing AD/HD in an adult requires an examination of childhood, academic and behavioral history. The problems need to be rooted in childhood but persist into adulthood. AD/HD symptoms often arise in early childhood. AD/HD is diagnosed using the criteria in the Diagnostic and Statistical Manual, 4th Edition (DSM-IV). To meet the diagnostic criteria for AD/HD, symptoms must be evident for at least six months, with onset before age seven. Diagnostic criteria are as follows: Inattention: often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities often fidgets with hands or feet or squirms in seat 2. Can my child have AD/HD and not be hyperactive? The Diagnostic and Statistical Manual, 4th Edition (DSM-IV) identifies three types of AD/HD: Predominantly Hyperactive-Impulsive Type, Predominantly Inattentive Type, and Combined Type. Children with the mainly Inattentive type of AD/HD tend to daydream and have difficulty focusing. The following criteria are used to diagnose children with AD/HD, Predominantly Inattentive Type. Symptoms must have been present for at least six months, with onset before age seven: often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities Most experts recommend a multimodal treatment approach for AD/HD, consisting of a mix of medical, educational, behavioral, and psychological interventions. Interventions may include educational modifications and accommodations, behavior modification, parent training, counseling, and medication . Psychostimulants (such as methylphenidate, dextroamphetamine, and pemoline) are the most widely used medication for the management of AD/HD-related symptoms. Between 70-80% of children with AD/HD respond positively to psychostimulant medications. Other medication includes some antidepressants and antihypertensives. These medications increase attention and decrease impulsivity, hyperactivity and aggression. Behavior management is an important intervention with children who have AD/HD. The most important technique is positive reinforcement, in which the child is rewarded for desired behavior. Classroom success may require a range of interventions. Most children with AD/HD can be taught in the regular classroom setting with either minor adjustments to the classroom setting, the addition of support personnel, and/or "pull-out" programs that provide special services outside of the classroom. The most severely affected may require self-contained classrooms. Adults with AD/HD can benefit from learning to structure their environment. Medications effective in child AD/HD also appear useful with adults who have AD/HD. Vocational counseling is often an important intervention. Short-term psychotherapy can help the patient identify how his or her disability might be associated with a history of sub-par performance and difficulties in personal relationships. And extended psychotherapy can help address any mood swings, stabilize relationships and alleviate guilt and discouragement.
The decision to place a child on psychostimulant medications such as Ritalin can only be made by a physician, with the parents? consent. Ritalin treatment therefore cannot be mandated by school personnel; however, teachers might suggest it because they have seen it help other students with AD/HD. A rumor has been circulating that schools can put children on Ritalin without parents? knowledge. This is totally unfounded, since Ritalin is a highly controlled substance. Federal law prohibits doctors and pharmacies from providing Ritalin to schools; prescriptions can only be written and filled for individuals following strict guidelines.
Hundreds of studies on thousands of children have been conducted regarding the effects of psychostimulant medications, making them among the most studied medications in pharmacological history. Relatively few long-term side effects have been identified. Most problems related to these medications are mild and short-term. The most common side effects are reduction in appetite and difficulty sleeping. Infrequently, children experience "stimulant rebound" ? a negative mood or an increase in activity as the medication is wearing off. This tends to occur in younger children, and is more frequent with short-acting medication. These side effects are usually managed by changing the dose and the scheduling for short-acting medications, or by changing to a prolonged-release formulation. There may be an initial, slight effect on height and weight gain, but studies suggest that ultimate height and weight are rarely affected. Some studies suggest that children with AD/HD reach puberty later than their peers. However, for any child who seems to be lagging behind his or her peers, height and weight should be closely monitored. A relatively uncommon side effect of psychostimulant medications may be the unmasking of latent tics ? the medical term for involuntary motor movements, such as eye-blinking, shrugging and clearing of the throat. Psychostimulant medications can facilitate the emergence of a tic disorder in susceptible individuals. Often, but not always, the tic will disappear when the medication is stopped. For many mid-teenagers, vocal tics (throat clearing, sniffing, or coughing beyond what is normal) or motor tics (blinking, facial grimacing, shrugging, head-turning) will occur as a time-limited phenomenon concurrent with AD/HD. The medications may bring them to notice earlier, or make them more prominent than they would be without medication, but they eventually go away in the latter part of the teenage years, even while the individual is still on medication.
Most experts recommend a multimodal treatment approach for AD/HD, consisting of a mix of interventions. Drug-free interventions that have been shown to be effective include educational interventions, behavior modification, parent training, and counseling in anger-management. In an effort to seek help for AD/HD, people may turn to treatments that some claim to work but have not been shown to be effective using rigorous scientific standards. To make sure that treatments are safe and effective, avoid controversial treatments and ask how suggested treatments have been evaluated.
IDEA provides special education for those children who meet the eligibility criteria for one of a number of categories. If the child meets the criteria listed under one of these categories, the disabling condition adversely affects educational performance, and he requires special education, the child may be eligible to receive services under this law. In its regulations implementing IDEA, the US Department of Education includes AD/HD as conditions that may qualify a child for special education services under the "Other Health Impaired" category. A child may be eligible under this category if the disorder limits alertness to academic tasks, adversely affecting educational performance to the extent that special intervention is necessary.
Students with AD/HD have a greater likelihood of grade retention, dropping out of school, academic underachievement, and social and emotional adjustment difficulties, unless they receive adequate and appropriate treatment. This is probably because AD/HD makes children vulnerable to failure in the two most important arenas for developmental mastery ? school performance and peer relations. Children with AD/HD are not unable to learn, but they do have difficulty performing in school due to poor organization, impulsivity/hyperactivity, inattention, and distractibility. However, some children with AD/HD also have learning disabilities, further complicating identification and treatment. Children with AD/HD are guaranteed a free and appropriate education to meet their needs under two federal laws. (1) the Individuals with Disabilities Education Act, Part B [IDEA] and (2) Section 504 of the Rehabilitation Act of 1973. ADHD frequently coexists with other learning, behavioral, emotional, and developmental problems. These include learning disabilities--particularly reading, writing, spelling, and math--speech and language disorders, conduct disorder, oppositional defiant disorder, mood disorders, and anxiety disorders. ADHD also affects memory--especially working memory--and organization. Untreated ADHD can lead to poor self-esteem and poor social adjustment. Children with ADHD commonly experience interpersonal difficulties and peer rejection, and have been shown to elicit more negative feedback from teachers. ADHD occurs across all levels of intelligence, yet even bright or gifted children with ADHD may experience school failure. Despite natural ability, their inattentiveness, impulsivity, and hyperactivity often result in failing grades, retention, suspension, and expulsion. Without proper diagnosis, accommodations, and intervention, children with ADHD are more likely to experience negative consequences.
Children suspected of having AD/HD must be evaluated at the school?s expense and, if found to be eligible, provided services under either of two federal laws, the the Individuals with Disabilities Education Act (IDEA) or Section 504 of the Rehabilitation Act of 1973. Some of the services that could be provided to eligible children include modified instructions, assignments, and testing; assistance from a classroom aide or a special education teacher; assistive technology; behavior management; and the development of a positive behavioral intervention plan.
Almost any program teaching social behaviors involves some form of modeling ? that is, demonstrating appropriate behavior so that the child learns by imitation. Role modeling includes using forceful and interesting verbal cues when speaking, reinforcing good behaviors, greetings at the door, and appropriate smiles and gestures. For younger children, puppets can be appropriate models. A key part of modeling involves the use of good affective skills and body language. Children with AD/HD may have problems understanding facial expressions, if they are taught how to read the emotions behind such facial expressions, the child?s understanding of social interaction may improve. The child with AD/HD will benefit from immediate feedback (is the parent/teacher angry, pleased, etc.?). Strong affective gestures (winks, thumbs up, frowns, etc.) also communicate effectively to the child. The parent who uses direct, encouraging praise will promote good social response. Encouraging praise places the value on the child?s effort, not the quality of outcomes. For example: "I bet you really worked hard on that one." The praise does not judge quality, but specifically states that the child did well. Do not focus on what the child can?t do, but instead focus on the child?s strengths and abilities.
Provide clear, consistent expectations, directions and limits.
Children with AD/HD need to know exactly what others expect from
them. They do not perform well in ambiguous situations that require
determining "shades of gray" or "reading between
the lines." 12. My son has been suspended again. What should I do? The Individuals with Disabilities Education Act has two important offerings for children with behavioral problems. Even when suspended or expelled, children covered by IDEA are still entitled to education services that meet the standards of a free appropriate education. Parents can request an impartial due process hearing when they disagree with the school?s decision in such matters. Under a separate provision, the child can remain in the then-current educational placement until all administrative proceedings are concluded (with the exception of cases where the child has brought a weapon or drugs to school, or is proven to be substantially likely to harm himself or others). IDEA also requires that if a child?s behavior interferes with learning, that a Functional Behavior Analysis be conducted and a Positive Behavior Plan be developed. IDEA prohibits schools from suspending for more than 10 days and expelling students whose behavior results from their disability, unless drugs or weapons are involved or the child is a danger to himself or others. Parents with questions about school actions or their child?s legal rights can contact the Parent and Training Information Center for their state.
Seeking special education or 504 services for a child with AD/HD can often eliminate the need for a private school by making a child?s public school experience more successful. However, some parents may want to locate a school specifically tailored to serve children with learning differences. Parents can learn about such schools and education programs from talking to parents at local CHADD chapter meetings commercial private school compendiums such as Peterson?s, or from the school counselor. If a public school is unable to provide an appropriate education for a child, then the school district may place a child with disabilities in a private school setting at public expense. Because AD/HD has gotten so much media attention in recent years and the public is more aware that it exists, some fear that it is overdiagnosed. The Council on Scientific Affairs of the American Medical Association recently investigated this issue and determined that this is not the case. However, some evidence exists that minority students may be disproportionately identified for special education in some categories, including behavior disorders, serious emotional disturbance, and mental retardation. The National Medical Association has raised concerns that African American children are also being overdiagnosed as having AD/HD.
Unfortunately, CHADD?s national office is unable to make professional
referrals. Members of your local CHADD chapter, however, can offer
a great deal of guidance in determining the best places in your
area to seek diagnosis and treatment. They may also have a list
of professionals in your area that is made available at meetings.
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