Understanding Attention Deficit Disorder
Billy has come home with a note from the teacher because of acting up in class - - again!
Mary just can't stick with her homework---she seems smart enough, but anything distracts her. Today it was a bird in a tree outside the window.
John has lost yet another job because he is often late, can't stay on task, and responds belligerently to correction.
Sound like anybody you know? All of these people could be suffering from Attention Deficit Disorder (ADD). Perhaps the most under diagnosed, over diagnosed, and misdiagnosed behavioral disorder, ADD presents a significant challenge to parents, teachers, friends, co-workers, spouses, and to those who suffer from the disorder.
For years children with ADD or ADHD (Attention Deficit-Hyperactivity Disorder) were thought to be just misbehaving or uncooperative. Adults with ADD were dismissed as lazy ne'er-do-wells, content to sponge off decent society.
In recent years understanding has begun to come for the sufferers of this disorder. Medical, psychological, and educational professionals have found some effective means of managing (not curing) the disorder and enabling the sufferers to realize their potential more fully.
CHARACTERISTICS
ADD is a syndrome that affects approximately five percent of children and three percent of adults. It has been thought that more males than females suffer from ADD, though recent research suggests it is just easier to diagnose in males because of the different way in which the disorder manifests itself in boys and in girls.
Though we are still not completely certain what causes ADD, we do know it is neurological in origin. That is, it is caused by an imbalance of biochemicals in the brain or in the brain processes. We often hear professionals referring to ADD children and adults as being "wired differently" from the population at large.
We are more and more certain of a genetic influence in ADD. There is a much higher incidence of the disorder among siblings and children of people with ADD than among people with instance of no other instance of ADD in their family.
This may bring some comfort to parents of ADD children who have long been told, and had begun to believe, that their child would be okay if only they were better parents. Whatever does cause ADD, it is not caused by poor parenting!
Three types of behavior point to ADD: (1) hyperactivity, (2) distractibility, and (3) impulsiveness. Any one of the three can lead to a diagnosis of ADD, but the hyperactivity must be present for the diagnosis of ADHD. Consider how each of these affects behavior.
Hyperactivity. Excessive and apparently purposeless motor activity distinguishes the ADHD child from the normally active child.
The child with ADHD seems to be in constant motion, or to be doing several things at once--feet tapping, legs swinging, wiggling in the chair, always jumping up and down. If motivated, most children can sit still and concentrate. For ADHD children it is physically almost impossible.
Many parents comment that their ADHD child never sleeps, or is "on the go" even during sleep--kicking the covers or moving all over the bed.
Some ADHD children display their hyperactivity by constant talking. They can never be quiet, even when they know they will be "in trouble" for talking.
Especially in girls, the problem may be under activity. A girl with ADD may withdraw into daydreams and lethargy. She may be referred to as "Space Cadet" or "Airhead." It is primarily this difference that leads to the disorder being diagnosed more frequently in boys than in girls. The hyperactive boy can't help but be noticed! Parents and teachers are desperate to find some way to tame him. The hypoactive girl, however, isn't bothering anybody and is easily overlooked.
Distractibility. These children have difficulty filtering out the irrelevant input that constantly comes to all of us. This problem may result in distractions from visual input--movements of people, clouds, birds; or from sound input--people talking, car horns beeping, telephones ringing.
At the other end of the spectrum, ADD children may become so engrossed in an interesting activity (like watching TV or playing a computer game) that they cannot separate their attention from the activity when appropriate.
Except when engrossed in such an activity, these individuals (children and adults) have a very short attention span and so leave a trail of unfinished projects in their wake. They are always busy, but they accomplish little.
Impulsiveness. ADD individuals may have a short fuse. Unable to think before they act, they may answer the teacher's questions before she finishes asking, get angry and yell, throw, or hit. They do not learn from experience because they cannot pause long enough to reflect before they act.
They are usually disorganized and have extreme difficulty with planning. They have a low frustration tolerance and are unable to delay gratification.
The ADD individual usually has social interaction difficulties. He may get into fights, disrupt activities, refuse to play fair, and throw temper tantrums. In contrast, some ADD children (usually girls) withdraw from social situations to avoid added frustration. The ADD child's low frustration level makes it difficult to acquire and keep friends.
In adulthood people with ADD may be able to calm the physical hyperactivity, though the emotional and mental bouncing from one subject to another continues. The impulsiveness and lack of social skills may create problems in work, marriage, and other relationships for the adult with ADD.
Yet, the prospects for the individual with ADD, and for his family, co-workers, and friends, are far from hopeless. When appropriate management techniques are employed, the person with ADD can lead a happy and productive life.
MANAGING ADD
Managing ADD usually involves a multi-disciplinary approach that includes medical, educational, and psychological professionals. The ADD individual and the family form the final vital link in the management chain.
MEDICAL TREATMENT: Since ADD results from differences in the functioning of the brain, medical intervention of some kind is usually indicated. A major debate among professionals centers on the use, selection, and administration of medication.
In one corner are the authorities who believe medication is the first answer, should always be tried, and should be continued unless the individual reacts adversely to all available medications.
In the other corner are the professionals who question the validity of drug use and insist that medications be tried only as a last resort. They believe medication is more useful in the short-term than in the long-term and that even in the short-term the risk of side effects may outweigh the benefits.
Those who prefer not to use medication usually recommend either sensory integration/developmental optometry, environmental medicine, or a combination of these, along with psychological and educational management.
Environmental medicine specialists are interested in the relationship of ADD to allergies. Some research indicates a higher incidence of allergies among those with ADD. Further, allergies may produce symptoms similar to ADD. Food allergies and sensitivity to dyes and light are particularly suspect. In some instances treatment of the allergy provides the necessary relief to enable the individual to cope with school and life in general.
Success in most schools depends on auditory and visual learning and left-brain dominance. Because many ADD children are kinesthetic (hands-on) learners and right-brain dominant, sensory integration through a developmental optometrist or a physical or occupational therapist can help to correct some learning difficulties. (More on learning style and right-brain/left-brain dominance later.)
Somewhere in the middle of the debate are the majority of professionals, who see medication as one possible approach, in combination with other management strategies. It is important to note that all responsible authorities insist that medication should never be used alone but only in conjunction with psychological and educational strategies.
When medication is used the most common are stimulants such as Ritalin, Dexedrine, and Cylert. In contrast to the effect these drugs have on people without ADD, they seem to have a calming effect on individuals with ADD.
It is important that the individual, the parents, and the teacher know how long the medication is effective. The range of effectiveness may vary from three to eighteen hours. Medication must be administered at appropriate intervals to avoid the see-saw effect that occurs when the medication wears off.
Some ADD individuals who cannot tolerate, or are not helped by, stimulants respond well to tricyclic antidepressants such as Tofranil and Elavil.
EDUCATION: Educational strategies for managing ADD may be as simple as moving the child to a less distracting location in the classroom or as complex as designing a curriculum plan especially for her.
In thinking about education, remember that Attention Deficit Disorder is not mental retardation. Also, although approximately twenty-five percent of children with learning differences also have ADD, they are not the same thing.
People with ADD typically have average or above average intelligence. Their school problems result from attentional difficulty and differences in the way they learn, not from a lack of intelligence.
Most schools accommodate learning primarily through auditory and visual channels--listening to a presentation, discussing concepts, reading books. Many ADD children learn better through tactile (touch) and kinesthetic (motion) channels, "hands-on" activities that allow them to move around and get the whole body involved.
Further, schools usually cater to left-brain (logical, step-by-step) thinking, while many ADD students tend to be right-brain dominant. That is, they see the whole picture and often think in terms of combinations outside left-brain parameters. (For left-brain people "2 and 2" is 4; for right-brain people it might just as easily be 22.)
These differences in the way ADD students learn can lead to much frustration unless they can re-channel their learning to be more in line with the school's methodology, or unless the school makes adjustments to accommodate the way they learn.
Inability to focus and sustain attention creates both academic and social problems. Following instructions and finishing assignments are difficult. If a set of instructions has more than two parts, the ADD child often remembers only the first and last.
Many ADD children have handwriting problems and procrastinate completing written assignments. Many have tried to no avail and eventually quit trying. Consequently, an individual's performance and grades may not reflect intellectual ability.
Because ADD children do better in one-on-one situations, a teaching assistant or a tutor working individually with the child can often bring about very effective results. ADD students require brief, structured, and well-focused sessions, using repetition and particular concreteness in communication.
Parents, teachers, and the ADD child himself, often in cooperation with the school counselor, need to work together to design, implement, evaluate, redesign, and re-implement educational strategies which will enable the child to achieve success.
PSYCHOLOGICAL: Because ADD affects every facet of the life of an individual and his family, a counselor can offer valuable assistance in managing the emotional and social aspects of the disorder. Counseling can help both the individual who suffers from ADD and the entire family.
Each parent may have a different method of handling the ADD child. This can easily result in marital stress. Usually the mother is left with the primary burden of dealing with the child. She may either feel responsible for the problem or resentful of the father for not being more understanding if not more involved. In either circumstance she feels frustrated and inadequate. Feeling overwhelmed, she may doubt herself and behave accordingly.
Other children may feel ignored and unloved if much parental energy and attention are expended on the ADD sibling.
Counselors trained in working with ADD can help the family to establish a behavior modification program and also to work through the marital issues that are raised. Local support groups can also be valuable in helping families learn to cope.
FAMILY: Parents must be the child's primary advocates and the leaders of the management team. This does not mean the parent tries to do the job of the doctor, the counselor, or the teacher. Rather, the parent is the link among all members of the management team and also has the greatest stake (other than the child herself) in finding effective ways to manage the ADD.
It is the parents most of all who can manage the child's environment to maximize his strengths and minimize the distractions and impulsiveness. By watching the kinds of situations in which the child responds well, parents can help him to find points of success upon which to build.
Parents can teach the child to take responsibility for her own behavior by developing a plan for using positive discipline. Immediate feedback and deliberate consistency will pay significant dividends in improved relationships.
SPIRITUAL: The person with ADD needs to know s/he is important not only to friends and family, but also to God. Accepting God's declaration of us as persons of worth and value, regardless of whatever limitations we may have, is the first step for anyone--with or without ADD--in fulfilling our potential.
Spiritual resources are important for a balanced approach to handling any circumstance of life. In a relationship with God in Jesus Christ, people have the assurance that God is with them always.
To the person with ADD and to their caregivers, God's promise is: "I know the plans I have for you, declares the Lord, plans to prosper you and not to harm you, plans to give you hope and a future."
The good news about ADD is:
There is HOPE when everyone, in God's strength, pulls together.
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