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Understanding Attention Deficit Hyperactivity Disorder

As mentioned in this book's introduction as well, many people continue to use the two distinct terms of ADD (Attention-Deficit Disorder) and ADHD (Attention-Deficit Hyperactivity Disorder). Some use the two terms interchangeably, and others specifically use ADD when referring to those who do not have the symptoms of hyper-activity. However, the most current and official term or acronym is ADHD (with or without the slash). This is the umbrella term or acronym under which all three types of the disorder are included The predominantly inattentive type of ADHD (those without hyperactivity) The predominantly hyperactive impulsive type of ADHD (those without a significant number of the inattentive symptoms) The combined type (the most common type of ADHD those with a significant amount of symptoms in all three core areas inattention, impulsivity, and hyperactivity) In the first edition of this book (1993) I had used ADD ADHD, and it remains as such in the title of this new edition. However,...

Behavioral Characteristics of ADHD

The fourth edition of the Diagnostic and Statistical Manual (DSM-IV), published by the American Psychiatric Association APA in 1994, is the source of the official criteria for diagnosing attention-deficit hyperactivity disorder. The DSM-IV and more recently the DSM-IV-TR (text revised) lists nine specific symptoms under the category of inattention and nine specific symptoms under the hyperactive impulsive category. Part of the diagnostic criteria is that the child or teen often displays at least six of the nine symptoms of either the inattentive or the hyperactive impulsive categories. The lists below contain those symptoms or behaviors found in the DSM-IV (1994) and DSM-IV-TR (2000). Below are the symptoms specifically listed in the DSM (which are indicated in italics), as well as additional common and related behaviors (Rief, 2003).

ADHD and the Executive Functions

When discussing difficulties associated with ADHD, many of them center on the ability to employ the executive functions of the brain. The following are some definitions descriptions of what is referred to as executive functioning. Many specialists and researchers believe Dr. Russell Barkley's theory (2000a, May) that the deficit in inhibition (the core of ADHD) impairs the development of these executive functions. Apparently, in children with ADHD, the executive functions (at least some of them) are developmentally delayed compared to other children of the same age. The individual with ADHD, therefore, does not fully utilize his or her executive functions for self-management. It is important to realize that executive function weaknesses cause academic challenges (mild to severe) for most students with ADHD, irrespective of how intelligent, gifted, and capable they may be. Consequently, most children and teens with attention-deficit disorders will need some supportive strategies and or...

What Is Not Known About ADHD

There is still a great deal that we do not yet know about ADHD, including How to prevent ADHD or specific symptoms that cause impairment in a person's functioning An easy, conclusive diagnosis for ADHD What may prove to be the best, most effective treatments and strategies for helping individuals with ADHD Just in the past few years there has been a great deal of interest and focus on ADHD in adulthood. This has generated a lot of research, resulting in much more information and better treatment options for this population. ADHD in the early childhood years (prior to age six) is also an area that requires more research and understanding. Gender issues and the differences between males and females with ADHD has gained considerable recognition, and consequently, has been the focus of various research studies in the past few years. Also, cultural variables and the effects of cultural factors on the diagnosis, treatment, and care of individuals with ADHD is another area that has only...

Multimodal Treatments for ADHD

Once a child is identified and diagnosed with ADHD, there are many ways to help the child and the family. It is important to realize that ADHD is not something that can be cured, but it can be treated and managed effectively. The best way of doing so in most cases is through a multifaceted approach a multimodal plan of interventions, tailored to the needs of the individual child and family. (AAP, 2001a). This typically includes a combination of medical, behavioral psychosocial, and educational interventions, implemented as needed at different times in the child teen's life. Children with ADHD often do best with a combination of structuring of their environment (home, school, and other settings), medication, behavior modification and specific behavior management strategies implemented at home and school, educational supports accommodations, and counseling of some kind (for example, parent counseling and training, family or individual counseling) (Goldstein, 1999 Rief, 2003).

Attention deficit hyperactivity disorder ADHD

ADHD and learning disability frequently occur together, but they are not the same. Learning disabilities include difficulty with receiving, organizing, processing, understanding, remembering, and offering information. ADHD involves difficulty with paying attention to information. Between 10 percent and 20 percent of all school-age children have learning disabilities. Of those with learning disabilities, between 4 percent and 12 percent of all school-age children will also have ADHD, making it the most common childhood neurobehavioral disorder. Although ADHD is a common childhood behavioral disorder, it can be difficult to diagnose and even harder to understand. Once viewed as a disorder of childhood primarily involving hyperactiv-ity and the inability to pay attention, ADHD is now seen as a lifelong condition that may not include physical restlessness or hyperactive behavior at all. It may also be the source of unusual talents or gift-edness in specific areas. In recent years there...

Possible Causes of ADHD

ADHD has been extensively researched, but its exact cause is unknown. According to the organization Children and Adults with Attention Deficit Hyp-eractivity Disorder (CHADD), current research suggests a neurobiological basis for this disorder. This means that there may be an imbalance of neuro-transmitters or a lack of the chemical dopamine, which is used by the brain to control behavior. When individuals concentrate, the brain releases neurotran-smitters that enable them to focus on one thing and block out others. People with ADHD seem to have decreased amounts of these neurotransmitters. Some research suggests that abnormal glucose metabolism in the central nervous system may be a possible cause. Research indicates that the areas of the brain that control attention use less glucose, suggesting that these areas are less active for those with ADHD. Other studies suggest that prenatal drug and alcohol exposure may have an effect. Some doctors believe that environmental toxins and...

How Is ADHD Diagnosed

There is currently no single test that can be given to diagnose ADHD. Since some biological and psychological disorders can appear similar to ADHD, these should be considered and ruled out before a diagnosis of ADHD is made. Conditions such as stress- related anxiety, depression, oppositional defiant disorder, the effects of child abuse or neglect, or obsessive compulsive disorder may look like ADHD but require different treatments. A comprehensive evaluation is necessary to determine a diagnosis of ADHD. This includes information and observations from parents, teachers, school psychologists, and pediatricians. Parents see their children at home and in small social groups. Classroom teachers can be of assistance since they see how well children perform school work and how children interact with their peers. School psychologists can make behavioral observations in multiple settings and interview the child. Pediatricians provide needed medical information. Completion of behavioral...

The Impact of ADHD on Families

Children with ADHD may have significant impairments that can have a profound impact on their families. Children often forget what they have been told or defiantly oppose what is requested of them. They tend to be demanding, unpredictable, restless, quick tempered, forgetful, inconsistent in their school work, and socially immature. These experiences lead to increased levels of parental frustration. Many parents struggle with deciding on the best methods for disciplining their child. They may question if they are being too strict or too permissive. Parents may feel guilty and at fault for their child's problems. Fair and consistent disciplinary practices can help change behavior in a positive way. When the condition is identified early and adequate treatment plans are implemented, children with ADHD can have successful school experiences and can develop positive relationships with peers and adults.

ADHD and Social Skills Interventions

Children and teens with ADHD frequently have difficulty with interpersonal relationships getting along with others at home and school, and in other settings. Social challenges can result in a lot of negative outcomes and low self-esteem, as well as be a source of great pain and frustration not just for the child, but for the entire family. Some common struggles in children and teens with ADHD that negatively affect their interactions and social acceptance are In addition, children and teens with ADHD often miss important verbal and nonverbal cues that may alert them to regulate their emotional reactions and to modify their behaviors when things are not going well in social interchanges (Teeter & Goldstein, 2002). Individuals with the predominantly inattentive type of ADHD may have social problems that are different from those who are impulsive and hyperactive. They tend to be unsure, anxious, initially withdrawn in social situations, and reluctant to take social risks. They may...

Attention Deficit Disorder

Children and adolescents who ''act out'' their feelings, frustrations, and emotional conflicts are said to exhibit externalizing behavior. Within the framework of the American Psychiatric Association's Diagnostic and Statistical Manual, 3rd edition, revised (DSM-III-R), once a certain level of severity is demonstrated, these youth qualify for the umbrella diagnosis of disruptive behavior disorder. Three disorders are encompassed within this general diagnostic category (1) attention deficit hyperactivity disorder (ADHD) (2) CONDUCT Disorder (CD) and (3) oppositional defiant disorder. It should be noted that in recent years some controversy has developed concerning diagnostic techniques. It has been suggested that with the introduction of the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition (DSM-IV) in 1994, accurately diagnosing ADHD in adults has become problematic ''because of the vague nature of the criteria'' in DSM-IV (Higgins, 1999)....

Relation Of Adhd To Drug Abuse

Serious psychiatric disorder is common among adults with a history of ADHD. ANTISOCIAL PERSONALITY disorder, alcohol and substance abuse, depression, and anxiety are the most common associated disorders. These associated disorders should not be viewed as invariant outcomes of ADHD but rather as disturbances for which ADHD youth are at increased risk. Whether any of these psychiatric outcomes are manifested depends on a variety of factors besides ADHD, including the child's self-esteem, opportunity for normal socialization with peers, success in school, and level of social and family support (Tarter, 1988). With respect to alcohol and other drug abuse, augmented risk appears to be circumscribed to youth who have both ADHD and a conduct disor der. The association, however, between ADHD and substance abuse is complex. Alcohol and other drugs may be more subjectively rewarding for ADHD youth and adults than in the general population. Drug use is commonly tied to a general pattern of...

Wondering about attention deficit hyperactivity disorder

You may wonder whether your real problem could actually be attention deficit hyperactivity disorder (ADHD), a syndrome characterized by chronic disorganization, distractibility, inattentiveness, and impulsivity. Sometimes people with ADHD are also hyperactive, but adults with ADHD are far less likely to be hyperactive than are children with the disorder. Of course, everyone is disorganized, distractible, and so on on some occasions but for the person with ADHD, these are constant problems. If your primary problem is chronic pain all over, pain that doctors can't attribute to anything other than fibromyalgia, FMS is most likely the cause of your problems with disorganization, distractibility, and the rest. (Of course, as with other conditions, you could have both fibromyalgia and ADHD.) Some researchers have found that adults with the primary problem of untreated ADHD are more likely to have fibromyalgia and chronic fatigue than others, and when their ADHD is treated, the muscle pain...

How Can We Be Sure Our Child Has ASHFA and Not ADHD or OCD or Something Else

Caused this rapid rise, one factor that has certainly contributed is that as professionals and the general public have become more familiar with the autism spectrum disorders, the number of children diagnosed with them has soared. And as their diagnosis has become more prevalent, misdiagnosis is also more likely. Sometimes a proper assessment by a specialist reveals that this diagnosis is wrong. It's been our experience that in earlier years almost all children referred to our specialty clinics for a diagnostic evaluation did in fact meet criteria for an autism spectrum disorder. In the last year alone, however, one-quarter of the diagnostic evaluations performed in our clinics overturned previously suggested diagnoses of either high-functioning autism or Asperger syndrome.5 Almost all the children had multiple serious behavioral difficulties. It was never a straightforward case of dyslexia or ADHD having been misdiagnosed as Asperger syndrome, but one of a child presenting a...

Children and Adults with Attention Deficit Hyperactivity Disorder

Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD) A nonprofit organization founded in 1987 in response to the frustration and sense of isolation experienced by parents and their children with ADHD. At that time, there were very few places for support or information, and people misunderstood ADHD. Many clinicians and educators knew little about the disability, and individuals with ADHD were often mistakenly labeled a behavior problem, unmotivated, or unintelligent. From one parent support group in Florida, the organization grew dramatically to become the leading nonprofit national organization for children and adults with ADHD. Today the organization continues to be run by volunteers, with the support of a small national staff, and offers education, advocacy, and support. (For contact information, see Appendix i.)

Substance Abuse And Attention Deficit Disorder

Children with attention deficit hyperactivity disorder (ADHD) have been noted to be at risk for development of alcoholism and cocaine abuse as they grow into adolescence and adulthood. Family studies of children with ADHD and alcoholism have demonstrated higher rates of alcoholism in family members than that seen in the general population. Goodwin (1975) compared previously hyperactive adult adoptees with and without alcoholism. As children, these alcoholics were hyperactive, truant, shy, aggressive, disobedient, and friendless. In these adoptees, those with alcoholism clearly had an excess of alcoholism in their biological parents. No alcoholism was found among the biological parents of the nonalcoholic hyperactive adoptees. These findings suggest that in the case of alcoholism and hyperactivity, the risk for alcoholism comes from a genetic basis and not necessarily from just having ADHD. It has been estimated that 15 to 20 percent of cocaine users might also be afflicted with ADHD....

Math Difficulties Associated with ADHD

Many students with ADHD and or learning disabilities experience academic difficulty with mathematics, due to the multiple processes and brain functions involved in executing math problems. Some math challenges may be specifically related to weaknesses with ADHD (for example, inattention, organization, working memory, self-monitoring). Others may result more directly from a learning disability (for example, sequential learning, perceptual-motor, language). Remember, some children have both ADHD and co-existing learning disabilities. The following list of impairments is associated with ADHD and LD, and how they negatively impact performance in math is described (from Rief, 2003)

Attentiondeficit Hyperactivity Disorder

What are the primary characteristics of attention-deficit hyperactivity disorder (ADHD) Which gender is most likely to be affected by ADHD By definition, ADHD symptoms must be evident by which age to be given the classification of ADHD How long must the symptoms of ADHD be present to be given the classification of ADHD What percentage of the general child population in the United States is affected by ADHD What is the intelligence level of persons with ADHD What percentage of ADHD patients have symptoms that persist into adulthood What are the primary treatment modalities of ADHD What is a non-stimulant medication for individuals with ADHD greater than the age of 6 Which single drug is most widely prescribed for ADHD

Services and Supports for Students with ADHD

Students with ADHD whose school performance is significantly impacted by their ADHD may be entitled to services and supports under two federal laws (1) IDEA and (2) Section 504 of the Rehabilitation Act of 1973. If the team feels that a student may be in need of special education, they should make a referral for an evaluation under IDEA. However, many students with ADHD don't need a special education evaluation or qualify for special education. Instead, they should be considered for a Section 504 Plan evaluation, as described below.

Which One May Be Better for a Student with ADHDA 504 Plan or an IEP

As I point out in another publication (Rief, 2003), this is a decision that the team (parents and school personnel) must make considering eligibility criteria and the specific needs of the individual student. For students with ADHD who have more significant school difficulties, IDEA is usually preferable because Remember A diagnosis of ADHD does not guarantee or automatically qualify a student for services or accommodations under either IDEA or Section 504. A school-based assessment must determine that the ADHD is adversely affecting the child's learning or educational performance. Under IDEA, that negative impact on the child s functioning at school must be to the degree that the team feels special education is necessary. Under Section 504, the negative effect of ADHD on the child's learning must be evident, but not necessarily to the degree that special education is needed.

ADHD and the Impact on the Family

It is important to be aware of the challenges that exist in the home when one or more children (or a parent) have ADHD, as this disorder significantly impacts the entire family (Rief, 2003). Unfortunately, teachers are generally unaware or underestimate the struggles that families face. Typically, in homes of children with ADHD there is a much higher degree of stress than the average family has, along with depression or other pathology in one or more family members. Note Remember, it is likely that more than one family member also has ADHD. Living with a child who has ADHD often takes a heavy toll on marriages. It is common for parents to be in different stages of a grieving process about having a child who struggles compared to other children, and whose differences may even be considered a disability. Parents frequently disagree about treatment, discipline, management, structure, and so forth. There are generally major issues surrounding the battle with homework as well as morning...

What May Be the Causes of ADHD

ADHD has been researched extensively in the United States and a number of other countries. There have been hundreds of well-designed and controlled scientific studies trying to determine the causes and most effective treatments for children, teens, and more recently, adults. To date, the causes of ADHD are not fully known or understood. However, based on the enormous amount of research, there is a lot of consensus in the scientific community about most probable causes, which include the following. This is the most likely common cause of ADHD, based on the evidence Heredity accounts for about 80 percent of children with ADHD, according to leading researchers (Barkley, 1998). ADHD is known to run in families, as found by numerous studies (especially twin studies with identical and fraternal twins, adopted children, family studies) (Lombroso, Scahill, & State, 1998). It is believed that a genetic predisposition to the disorder is inherited. Children with ADHD will frequently have a...

The Components of a Comprehensive Evaluation for ADHD

An evaluation for ADHD will require taking a thorough history (Rief, 1998, 2003). This is a critical part of the diagnostic process. The history is obtained through interviewing the parents, use of questionnaires (generally filled out by parents prior to office visits), and a review of previous medical and school records. By using these techniques and instruments, the evaluator obtains important data regarding the child's medical history (prenatal, birth, illnesses, injuries), developmental history (milestones reached in various language, motor, adaptive, and learning skills), behavioral, and school history. This is a means of also obtaining from the parents the family medical and social history, any significant circumstances stressors (serious illness in family, death, divorce, family moved), a sense of the parents' style of discipline and interactions with the child, and their perceptions of the child's strengths as well as difficulties. These are useful in determining the degree to...

The Advantages of Cooperative Learning for Students with ADHD

The crux of differentiated instruction (see Section 3.1) requires teachers to employ methods and strategies that enable all students, with their diverse learning abilities and differences, to be able to master the curriculum and content performance standards. This is achieved through instruction, assessment, and learning activities that are meaningful and engaging. Cooperative learning is one of the best means of doing so, with decades of research that validates its efficacy. All teachers should be trained in best practices for implementing cooperative learning in the classroom. Teachers may mistakenly believe they are using cooperative learning when they simply have students working together in groups. This is not cooperative learning. In fact, students (particularly those with ADHD) often have difficulty learning and functioning productively in unstructured group work. Cooperative learning involves a high degree of careful planning and structuring, and as such it is an excellent...

Dr Bobs Guide to Stop ADHD in 18 Days

Guide to Stop ADHD in 18 Days' Stop wdu*tint ADHD, ADO, QCD - Tmt Hvj-fiitiTa. ajjuult' Anyone can successfully overcome ADHD and Hyperactivity without drugs. This book details how to get your children and family off medications and detrimental junk foods filled with trans-fatty acids, dairy products, sugar, and preservatives, so they can have optimal, natural health. This is a simple, effective step-by-step plan that includes adding FLAX OIL and modifying your diet and vitamin mineral intake. The protocol will improve your nervous system function and help people diagnosed with ADHD overcome behavioral and learning problems. You will improve insomnia, mood swings, and irritability. Your body will heal itself naturally. Participants in the pilot program saw improvement in only 18 days. NATURALLY Stop wdu*tint ADHD, ADO, QCD - Tmt Hvj-fiitiTa. ajjuult' Dr. Bob's Guide to Stop ADHD in 18 Days

The Schools Role and Responsibilities in the Diagnosis of ADHD

As described in Section 1.2, the diagnosis of ADHD is dependent on gathering sufficient information to get a clear picture of how ADHD symptoms observed (currently and in previous years) affect the child in key environments. Obviously, the school is a key environment where the child spends much of his or her life. The school's role is to provide the information and data to enable the evaluator to determine past and present school functioning. Parents have a right to expect the school to be supportive and responsive in the diagnostic process. Schools need to provide information requested by the child's physician or mental health professional conducting a clinical evaluation for ADHD. It will be necessary for parents to sign a release of information form before school personnel can communicate with other professionals outside of school or provide documentation and data regarding the child. See Section 1.2 for data that is valuable to be provided by the school when a child is being...

School Based Assessment for ADHD

Some school districts are very proactive and involved in helping to identify, diagnose, and provide effective interventions for students with ADHD. These school districts generally have specified procedures and a process for school-based screening evaluation of students for ADHD. The following steps or variations are typical in such school-based ADHD screening assessment (Rief, 2003). Most school-based screening evaluation for ADHD begins with the student support team (SST) process, with parents as members of the team. In the case of a child suspected of having ADHD, teachers may be advised to carefully observe the student in comparison to other children in the classroom (for example, degree of off-task behavior, out-of-seat behavior, completion of assignments) and to start documenting or collecting evidence of difficulties in school performance (for example, work samples, anecdotal records of behavioral incidents) in preparation for the SST meeting. During the SST meeting If the team...

Innovative Collaborative Programs for Helping Children with ADHD

Some unique projects and programs are being implemented with success in the nation that involve collaborative efforts in the community (between clinicians, schools, and parents) to best address the needs of children with ADHD. This section turns the spotlight on three such innovative programs 1. The Utah Model Intermountain Health Care's (IHC's) Care Management System for ADHD (Salt Lake The Utah Model is taking place in the Salt Lake City area, with involvement and interest by policymakers at the state level. It may very well become the model of care for children with ADHD throughout the state of Utah. The PARD project affects all children with ADHD in a large school district those attending San Diego City Schools. The project in Tulsa, Oklahoma, is a smaller-scale collaborative involving a targeted school, with a school-based mental health provider and the University of Oklahoma Pediatrics Clinic in Tulsa. Two of the projects (Utah's and Tulsa's) were part of the National Initiative...

What Is Currently Known About ADHD

There are degrees of ADHD ranging from mild to severe types of ADHD with a variety of characteristics and no one has all of the symptoms or displays the disorder in the exact same way. Symptoms vary in every child, and even within each child with ADHD the symptoms may look different from day to day. ADHD is not new. It has been around, recognized by clinical science, and documented in the literature since 1902 (having been renamed several times). Some of the previous names for the disorder were minimal brain damage, minimal brain dysfunction, hyperactive child syndrome, and ADD with or without hyperactivity. We know that ADHD is not a myth. It is not a result of poor parenting or lack of caring, effort, and discipline. ADHD is not laziness, willful behavior, or a character flaw. There is no quick fix or cure for ADHD. Many children teens with ADHD slip through the cracks without being identified and without receiving the intervention and treatment they need. This is particularly true...

Definitions and Descriptions of ADHD

There are several descriptions or definitions of ADHD based on the most widely held belief of the scientific community at this time. The following are some of those provided by leading researchers and specialists in the field ADHD is a neurobiological behavioral disorder characterized by chronic and developmentally inappropriate degrees of inattention, impulsivity, and, in some cases, hyperactivity (CHADD, 2001c). ADHD is a brain-based disorder that arises out of differences in the central nervous system (CNS) both in structural and neurochemical areas. ADHD is a dimensional disorder of human behaviors that all people exhibit at times to certain degrees. Those with ADHD display the symptoms to a significant degree that is maladaptive and developmentally inappropriate compared to others that age. ADHD is a developmental disorder of self-control, consisting of problems with attention span, impulse control, and activity level (Barkley, 2000b). ADHD is a chronic physiological disorder...

ADHD and Other Disorders

ADHD can coexist with a number of psychological conditions, including conduct disorders, mood disorders (such as depression), anxiety disorders, and impulse control disorders (such as eating disorders and alcohol abuse). Some children may be depressed as a result of having ADHD, whereas others may have a mood disorder that exists independently of ADHD. Nearly half of all children with ADHD also have oppositional defiant disorder characterized by stubbornness, outbursts of temper, and defiance. Many children with ADHD also have a specific learning disability, which means that they might have trouble mastering language or other skills, such as math, reading, or handwriting. Although ADHD is not categorized as a learning disability, its interference with concentration and attention can make it even more difficult for a child to perform well in school. The issue of coexisting conditions makes diagnosis, treatment, and understanding of ADHD particularly complex. There is no cure for ADHD,...

Why Writing Is Such a Struggle for Students with ADHD

Weaknesses in written language are very common in those with ADHD because the process is so complex. It involves the integration and often simultaneous use of several skills and brain functions (for example, organization, spelling, fine motor, planning, self-monitoring, memory, language). Writing difficulties are manifested because the process requires Pre-Planning and Organization. This requires being able to generate, plan, and organize ideas. This stage of the writing process is often the most challenging and neglected, especially for those who experience difficulties with written expression. When given a written assignment, students with ADHD often get stuck here. They do not know what to write about, how to organize and begin, or how to narrow down and focus on a topic that will be motivating to write about (Rief, 2003). Grapho-Motor Skills. Many children with ADHD and or learning disabilities have impairments in grapho-motor skills. This affects the physical task of writing and...

ADHD in Preschool and Kindergarten

Most children with ADHD are not diagnosed until first grade or higher. However, those exhibiting significant core symptoms (hyperactivity, impulsivity, inattention) are often identified in kindergarten, preschool, or even earlier. With very young children it is often hard to distinguish between what is normal rambunctious, active, uninhibited early childhood behavior and what may be abnormal (maladaptive and outside the limits of what is developmentally appropriate behavior for that age). There are children with ADHD diagnosed under the age of five and receiving various treatments (including medication) with great success. However, most children enter preschool and kindergarten programs without having been evaluated or diagnosed with the disorder. At this stage, most teachers and parents don't know whether or not the child has ADHD or any other developmental disorder. Typically, they are doing the best they know how in managing the child's challenging behaviors and may be wondering if...

Recommended Treatment for ADHD

Although there is no cure for ADHD, there is a recommended treatment plan that requires parents, educators, and members of the medical profession to work cooperatively. This plan includes parent training in managing behavior, counseling, educational supports, and medication when needed. The counseling portion of the treatment plan may include both individual and family counseling. Family counseling may be useful in planning and evaluating workable strategies, such as conflict resolution, and providing needed emotional support. Individual counseling for the ADHD child can provide training in social skills, anger control, and relaxation techniques. Drugs such as Ritalin are sometimes administered to children diagnosed with ADHD in an effort to provide a decrease in impulsiveness, aggressiveness, hyperactivity, and inappropriate social interaction. (A P Wide World Photos) Drugs such as Ritalin are sometimes administered to children diagnosed with ADHD in an effort to provide a decrease...

Therapeutic management and options to address comorbid sleep disorders in ADHD

The effect of immediate (IR) or extended (ER) release stimulants in ADHD is well known and beyond the purpose of this review. Stimulants still represent the first line of treatment of ADHD in pediatric populations across the world. The majority of subjective report studies indicate increased parental complaints of sleep disturbance in medicated versus unmedicated ADHD children, irrespective of stimulant type or regimen (Cohen-Zion & Ancoli-Israel, 2004). However, objective studies, whether actigraphic or PSG, show overall conflicting results as far as sleep measures, continuity and architecture, major differences going in opposite directions with regard, in particular, to REM sleep (Chatoor et al., 1983 Greenhill et al., 1983) no influence, though, on specific sleep disorders such as SDB or PLMD. A consistent co-morbidity with depression in many ADHD children could account for increased subjective and actigraphically confirmed sleep fragmentation in the most severe cases. Besides...

Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) begins in early childhood and has a significant impact on how children develop and how families function. This disorder affects how information in the brain is processed and is currently diagnosed in 3 to 5 percent of school-aged children. Children with ADHD are easily distracted, impulsive, have difficulty focusing and sustaining attention, and can be easily oversti-mulated. In addition to these characteristics, some children with ADHD are also hyperactive. While all children can be highly active or lack the ability to stay focused at times, children with ADHD exhibit these behaviors in combination with one another more frequently and with greater severity than other children of the same age.

Managing ADHD

Section 1.1 Understanding Attention-Deficit Hyperactivity Disorder Section 1.2 Making the Diagnosis A Comprehensive Evaluation for ADHD Section 1.3 Multimodal Treatments for ADHD Section 1.6 Critical Factors in the Success of Students with ADHD Section 1.7 ADHD and Social Skills Interventions Section 1.8 ADHD in Preschool and Kindergarten Section 1.9 ADHD in Middle School and High School

Type of ADHD

Those individuals with this type of ADHD have a significant number of hyperactive impulsive symptoms they may have some, but not a significant number of inattentive symptoms. Children and teens with ADHD may exhibit many of the following characteristics (not all of them). Even though each of these behaviors is normal in children at different ages to a certain degree, in those with ADHD, the behaviors far exceed that which is normal developmentally (in frequency, level, and intensity). Again, those written in italics are the behaviors that are listed in the DSM-IV and DSM-IV-TR. Other Common Characteristics in Children and Teens with ADHD Criteria for a Diagnosis of ADHD It is not just the existence of symptoms that indicate ADHD. It must be proven that there is a history of those symptoms having been evident since before age seven and lasting for a while (at least the past six months). In addition, those symptoms must be (a) more severe than in other children that same age (b) evident...


ADHD is both a medical and behavioral disorder, and there are a number of professionals who can evaluate for attention-deficit disorders. This includes clinicians such as psychiatrists, clinical psychologists, neurologists, clinical social workers, pediatricians, family practitioners, and other qualified medical and mental health professionals. Many school psychologists are also qualified to evaluate for ADHD. In selecting a professional to evaluate their child, parents are advised to do their homework and investigate before selecting a professional. It is important to find someone well qualified, and preferably recommended by others. Parents seeking professionals to evaluate (and treat) their child may wish to first speak with other parents of children teens who have ADHD (for example, through the local chapter of CHADD) regarding recommended professionals in the community. School nurses and school psychologists are also excellent resources and very knowledgeable in most cases about...

Identifying ADHD

The primary tool for identifying the symptoms of ADHD is the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. This diagnostic manual specifies three groups of behaviors that are characteristic of ADHD. Children need only demonstrate behaviors in any one group to be diagnosed with ADHD. Children in the first group show signs of being consistently inattentive. Children in the second group will show hyperactive and impulsive behaviors. The third group of children exhibit a combination of behaviors from both groups (inattention, hyperactivity, and impulsiveness). According to the diagnostic manual, an inattentive type of ADHD child is identified when six or more of the following symptoms have persisted for at least six months to a degree that significant impairments in a child's daily activities are noted. These symptoms must be seen in two or more environments, such as at home, at school, or in social settings. Symptoms include The...

ADHD Look Alikes

Not everyone who displays symptoms of ADHD has an attention-deficit disorder. There are a number of other conditions and factors (medical, psychological, learning, psychiatric, emotional, social, environmental) that can cause inattentive, hyperactive, and impulsive behaviors. The following can cause some of the symptoms that may look like or mimic ADHD Emotional and environmental factors that have nothing to do with ADHD can also cause a child or teen to be distracted, unable to concentrate, and have acting-out or aggressive behaviors. For example, if the child teen is experiencing or witnessing physical sexual abuse violence or family stresses such as divorce and custody battles a victim of bullying peer pressure and other peer social issues or has a chaotic, unpredictable, unstable, and or neglectful home life with inappropriate expectations placed on the child. Inattention and disruptive classroom behaviors can be school-related (again without having anything to do with ADHD)....

ADHD and sleep

Items more often referred to by subjective studies on sleep and alertness in ADHD include (Cortese et al., 2006) bedtime resistance, sleep onset insomnia, night awakening, sleep duration, restless sleep, parasomnias, problems with morning awakening, sleep disordered breathing (SDB) excessive daytime sleepiness (EDS). No major differences between adolescents with ADHD and controls were detected (Mick et al., 2000) after excluding confounding factors such as medications and psychiatric comorbidity. As for ADHD children, significantly over reported by comparison with controls were EDS (Marcotte et al., 1998, Owens et al., 2000), whether or not sleep disordered breathing (SDB) related, movements during sleep (Corkum et al., 1999, Owens et al., 2000). Also a longer sleep duration with increased night awakenings and parasomnias were observed upon comparison with controls (Owens et al., 2000). Despite the fact that bedtime resistance and sleep onset insomnia did not come across as...

Statistics and Risk Factors

ADHD is associated with a number of risk factors. Compared to their peers of the same age, youth with ADHD (those untreated for their disorder) experience More serious accidents, hospitalizations, and significantly higher medical costs than those children without ADHD (Centers for Disease Control and Prevention, 2003) Without early identification and appropriate treatment, ADHD can have serious consequences that include school failure and drop out, depression, conduct disorder, failed relationships, underachievement in the workplace, and substance abuse (CHADD, 2003b). Yet despite the serious consequences, studies indicate that less than half of those with the disorder are receiving treatment (Barkley, Cook, Dulcan, et al., 2002) Prevalence of ADHD Approximately 3 to 5 percent of school-aged children have ADHD, according to much of the literature over the past several years, including the Surgeon General's Mental Health Report (1999, 2001). Nearly 7 percent of elementary-aged children...

AAP Guidelines and Additional Points

The American Academy of Pediatrics (2001) published guidelines for clinicians with the following recommendations for the treatment of ADHD in children aged six to twelve years 1. Primary care clinicians should establish a treatment program that recognizes ADHD as a chronic condition. 3. The clinician should recommend stimulant medication and or behavioral therapy as appropriate to improve target outcomes in children with ADHD. 4. When the selected management for a child with ADHD has not met target outcomes, clinicians should evaluate the original diagnosis, use of all appropriate treatments, adherence to the treatment plan, and presence of co-existing conditions. 5. The clinician should periodically provide a systematic follow-up for the child with ADHD. Monitoring should be directed to target outcomes and adverse effects by obtaining specific information from parents, teachers, and the child. When pursuing any treatment, parents should seek out doctors and therapists who are...

Atomoxetine Strattera

There is a new class of medication that is a selective norepinephrine reuptake inhibitor. This class of ADHD treatment works differently from the other ADHD medications available. This new drug is called Strattera and its generic name is atomoxetine. It was recently approved by the U.S. Federal Drug Administration (FDA) in the treatment of ADHD. Strattera is the first FDA-approved treatment for ADHD that is not a stimulant and is not a controlled substance (Sallee & Smirnov, 2003). Studies available in the literature at this time suggest that atomoxetine-related relief of ADHD symptoms is similar to the effect of methylphenidate (stimulants) when both are administered by clinical titration. Atomoxetine has demonstrated efficacy for ADHD symptoms irrespective of age and gender, and it appears to have advantages that include continuous coverage of symptoms throughout the work school day, evening, and potentially for an entire twenty-four hours (Sallee & Smirnov, 2003).

Are You and Your Child Alone in This

As the label of Asperger syndrome has become better known by professionals, both its use and its misuse have increased. Every day, many children with multiple, difficult, complex developmental and behavioral problems are seen in clinics around the world, and the professionals who see them can occasionally be at a loss for a diagnosis. With the advent of the Asperger label, some of these children have been diagnosed with Asperger syndrome. Some indeed have it, but many do not, as we discuss in more detail in Chapter 2. A similar phenomenon occurred a decade ago with attention-deficit hyperactivity disorder (ADHD), which some observers now consider overdiagnosed or applied inappropriately. Such developments are usually guided by a desire to advocate for children and help them obtain services, but in the process they exaggerate the prevalence of the disorders. If high-functioning autism spectrum disorders become the ADHD of the new millennium, we will certainly see...

Interventions for Social Skills Problems

Research indicates that the most effective interventions for addressing interpersonal social skills difficulties in children and teens with ADHD are multimodal. These involve a combination of (a) psychosocial behavioral interventions, (b) medication (if indicated), and (c) educational strategies interventions involving teachers, parents, and, of course, the child. According to Dr. William Pelham Jr., one of the foremost researchers in the study of psychosocial interventions for children with ADHD, the essential components of treatment for ADHD are the psychosocial ap Although the Multimodal Treatment Approach Study (MTA, 1999) found that medication treatment for children with ADHD had the greatest effect on the reduction of symptoms and impairment, it also showed that appropriate use of behavioral interventions can reduce the dose of medication needed. Another finding from the MTA study was that, looking at parent measures of satisfaction, parents were twice as likely to report strong...

Child Social Skills Interventions

Many children with ADHD are not socially accepted because they have poor skills in playing various games sports. It helps to involve them in as many opportunities as possible to build their skills and competencies so that peers will want to include them in their play and sport activities. As Dr. Pelham points out, in their renown summer treatment programs for children with ADHD, there is a major focus on teaching sports skills to the children. If you teach a child to be a better baseball player, and therefore make him more popular among children in the neighborhood, he'll be a better baseball player forever. Medication will help him pay attention when he's playing baseball, but it won't teach him to catch, throw, and hit. That's an example of where a child might have an attention problem and a skills deficit, and both forms of treatment might be helpful (Pelham, 2002).

Coping with temporary confusion

You may want to try some tricks that help people with ADHD cope with confusion, such as creating simple lists, always keeping your car keys in the same place, and quickly checking yourself in the mirror before you leave home. (Yes, your clothes are right side out and your hair is combed. Or they aren't, so you fix them.)

Parent Concerns and Recommendations

It is highly recommended for parents to start early in seeking help learning how to parent a child with ADHD. It can be exhausting and frustrating trying to cope with and manage the challenging behaviors and knowing how to best provide the necessary structure and support for the child. There are many resources available to help parents learn how to do so (for example, parenting classes, behavior management training, counseling, parent support groups such as CHADD, books videos, and other materials). When a child has ADHD and or LD, behaviors that impact on social and academic performance generally do not improve by just providing more time to mature. Other interventions will be necessary to specifically target their areas of weakness and build their skills. Early intervention makes a significant difference preventing for many children the devastating effects of failure, and often the need for special education in the future.

Management Techniques in Kindergarten

Behavior management techniques for children with ADHD in kindergarten are basically the same as those in higher grades (for example, using a high degree of feedback visual prompting cueing proximity control group positive reinforcement systems corrective consequences that are applied consistently and individualized behavioral plans supports). The following are recommendations and examples from the nineteen kindergarten teachers regarding what they have found to be successful in their classrooms.

Giving the Child Space

Children with ADHD often have difficulty knowing and understanding their physical boundaries. They tend to invade other people's space and react adversely to being crowded, bumped into, and so forth. They need concrete visual structuring of their space (for example, colored masking or duct tape on the floor or table, a carpet square, or other means) that reminds them about what is their space. This includes the child's acceptable space on the rug, at tables, in line, and so on.

Building Trust and Connecting with the Child

It is important to find at least one other child for a student to attach to (someone accepting). For all children, especially those with special needs, having a friend makes all the difference in the world and can save the day. Children with ADHD often have significant difficulty making and keeping friends. Teachers will find themselves in the role of facilitator, trying to find a friend for this child.

Why is PD called a movement disorder

PD, PSP, and MSA, described in Question 17 earlier, fall into a category of disorders in which movement is either slowed or absent. Although the tremor in PD may resemble a hyperkinetic disorder, the fact that it occurs when the limb is at rest places it in the hypoki-netic category.

Observation of Your Child

Mosomes or levels of any particular chemicals to tell us if your child has Asperger syndrome or high-functioning autism. We can take pictures of his brain (for example, with magnetic resonance imaging MRI scans), but that won't tell us his diagnosis. As you will read in Chapter 3, we have found a few brain abnormalities in some people with autism and Asperger syndrome but nothing present in all (even most) AS-HFA people or not present in some non-AS-HFA people. So currently there are no specific biological tests for the autism spectrum disorders. Professionals rely on the presence of the specific behaviors described in this chapter to diagnose the conditions. But this is not necessarily the problem it may sound like. All disorders in the DSM-IV are diagnosed on the basis of behavior (rather than biology), and the autism spectrum disorders happen to have among the very highest reliability of these disorders. That means that if several different professionals were to see the same child...

Noticing Patterns and Intervening

It is important for teachers to be observant, and to try to determine the conditions or antecedents that precede challenging behaviors. With many children who have ADHD, their behavior and performance might fluctuate greatly depending on the day, situation, and even time of day. One teacher gave an example of a student who was falling apart and crying frequently. The teacher noticed that this was actually happening around 11 00 every day. Aware of the pattern and time factor, the teacher gave the child something she liked to do during this time (lead number rock music), which significantly helped the situation. She also shared with the parents and school nurse her observation about the child's deteriorating behavior at around this time. With this information, the physician changed the child's medication schedule, which completely eliminated the problem.

Clinical Manifestations

To meet criteria for ADHD, a child must evidence the onset of inattentive or hyperactive symptoms before age 7 symptoms must also be present in two or more settings (e.g., school, home). Symptoms in only one setting suggest an environmental or psy-chodynamic cause. It is important to distinguish symptoms of ADHD from age-appropriate behaviors in active children (running about, being noisy, etc.). Children can also appear inattentive if they have a low or a high IQ and the environment is overstimulating or under-stimulating, respectively. In either instance, IQ testing and careful evaluation of the school program will clarify the diagnosis. Symptoms that resemble ADHD can occur in children before age 7, but the etiology is typically a side effect of a medication (e.g., bronchodilators) or a psychotic or pervasive developmental disorder these children are not considered to have ADHD. Of course, ADHD may be comorbid with any of the above disorders. A dual diagnosis is made only when it...

The Value of Mentorship

He had a history of physical and emotional distress, which centered around his experiences in school. His behavior was impulsive and his teachers frequently telephoned home to tell his parents that Dan would not stay in his seat, was disruptive, and that they should try to better control his behavior at school. By fifth grade, Dan had several interventions, including stimulant medication and counseling. Although he achieved fairly well, but not up to his potential, he had been held back a grade due to emotional immaturity. Dan now had much difficulty with peer relationships. His parents pursued every avenue they could find in their search to help him, but not enough changed.

Why Cant They Act Their

Adolescents with ADHD may appear mature physically and grown up, but looks are deceiving. They are typically far less mature socially and emotionally than peers their own age, with a two-to four-year developmental delay in skills affecting their self-management. Parents and teachers need to be aware of this and not inadvertently place unrealistic expectations on them. Although they may be of an age when the expectation is to demonstrate more independence, responsibility, and self-control, the reality is that adolescents with ADHD take longer to exhibit those behaviors. They need more adult monitoring and direct support than their peers. These are years when it is very difficult for parents and teachers to find that proper balance how to teach our children to assume responsibility for their own learning and behavioral choices, and how to intervene as we guide and support them to success.

Challenges Results and Implications

In the extreme dualist camp, some educational issues are in danger of becoming entirely 'medicalised'.When educational issues become associated with biological issues, they can sometimes be characterised as entirely biologically determined and so removed from educators' domain of influence. One example is management of the increasing numbers of pupils considered to have challenging developmental disorders such as ADHD. Here, the increasing use of psychoactive drugs and images of differences in brain activity can lead to an increased sense of biological determinism (Degrandpre, 1999), and thus a diminished sense that outcomes are amenable to educational intervention. Another example might be the tendency for debates around dyslexia to be unhelpfully

Warning Signs of Learning Disabilities in Secondary School Children

As co-existing learning disabilities are common in children with ADHD, parents and teachers should be aware of signs of learning disabilities (LD). Some children may have learning disabilities that have gone undetected to this point. They may have achieved well in earlier grades, especially if they are very bright children. Academic performance problems most likely had been attributed to their ADHD. To determine whether or not a student has learning disabilities requires a psycho-educational evaluation. Educational interventions must be provided, addressing the student's individual learning needs.

Classroom Management and Positive Discipline Practices

Children with ADHD are in particular need of a classroom that is well-structured meaning they know precisely what the expectations are from the minute they enter the room until the time they are dismissed at the end of the day. The structure that is necessary comes from teachers who clearly teach what is acceptable and unacceptable behavior and who provide predictability, consistency, and follow-through. These are probably the most important steps teachers can take to prevent or minimize common behavioral problems in the classroom.

Complications Of Lyme Disease

Some argue that Lyme produces many chronic symptoms in children, including attention deficit disorder and other unexplained conditions. It is important to recognize that Lyme disease is common. Therefore it will be found in a significant number of children with a wide variety of coincidental problems that are unrelated to Lyme disease. The issue seems clear-cut if the child's problems resolve with treatment, they were due to the Lyme disease, but if the problems are not related to Lyme, months or even years of antibiotics are unlikely to provide real relief.

Provide Many Visual Prompts and Cues

Students with ADHD, but also many others (for example, English language learners, students with learning disabilities in auditory processing), respond better to visual cues and prompts as opposed to a lot of verbal reminders and directions. Teachers should always maintain a visual schedule, write on the board or other consistent location all class and homework assignments, and post all daily weekly student responsibilities.

Neurological Effects

Aggressive behaviour The DHA component of fish oils has been used to reduce aggressive behaviour in children and adolescents. One placebo-controlled study of 42 college students showed that DHA supplementation (1.5-1.8 g day) prevented an increase in aggression toward others at times of mental stress (Hamazaki et al 1996) however, another placebo-controlled trial found that DHA supplementation had no effect on aggressive behaviour under non-stressful conditions (Hamazaki et al 1998). Attention-deficit hyperactivity disorder It has been reported that many children with ADHD have EFA deficiency (mainly n-3 FA) with a high correlation between severity of symptoms and severity of deficiency (Yehuda et al 2005). Deficiency may be due to insufficient dietary intake or inefficient conversion of EFA to longer chain fatty acids. Several studies have investigated the effects of supplemental fatty acids to children with ADHD with mixed results however, interpretation of findings is difficult...

Classroom Transitions

Students with ADHD typically have the greatest behavioral difficulties during transitional times of the day in the classroom, as well as the school settings outside of the classroom that are less structured and less supervised (for example, playground, cafeteria, hallways, bathrooms).

Activity Rewards and Privileges for Students

It is important to realize that students with ADHD need the opportunity to earn the reward of participation more frequently than the average child. It is often the case that they are penalized for their difficulties with work production by having to miss out on rewarding activities in order to complete unfinished assignments. When this is the case, teachers have to find ways to provide more support and accommodations to help ADHD students get caught up with their work, so that they can participate in rewarding activities along with their peers.

Preventing or Minimizing Behavior Problems During Transitions and Less Structured Times

Students with ADHD typically have the greatest behavioral difficulties during transitional times of the day in the classroom, as well as the school settings outside of the classroom that are less structured and less supervised (playground, cafeteria, hallways, bathrooms). In the average classroom, the time spent changing from one activity to the next cumulatively adds up to a significant number of minutes in the school day. Children with ADHD often have behavioral problems disengaging from or stopping one activity to move on to the next. The struggle they have with self-regulation and inhibition of their behavior frequently results in getting themselves in trouble during recess, riding the bus, waiting in the lunch line, on the way to the bathroom, in school assemblies, and so forth.

Individualized Behavior Management Interventions and Supports

Teachers are often frustrated with the disruptive and challenging behaviors of many students with ADHD. It is important to build a large repertoire of strategies and skills to effectively address and manage those behaviors in the classroom. This section will provide tips for dealing with challenging or hard-to-manage students. It will focus on the individualized supports and interventions the research-based approaches that work with this population of children and teens. These students typically need far closer monitoring, a higher rate and frequency of feedback, and more powerful incentives to modify their behavior than the average child.

Home Notes and Daily Report Cards

Home notes and daily report cards (DRCs) (Rief, 2003) are excellent tools for tracking and monitoring a student's social, academic, and or behavioral progress at school. They are highly effective for communicating between home and school and for monitoring a child's daily performance. When parents are willing and able to consistently follow through with reinforcement at home for positive performance at school, it is a very powerful motivator for the student. Any means to forge a partnership between home and school and work together on improving specific behavioral goals is very beneficial for children with ADHD.

Strategies to Aid Calming and Avoid Escalation of Problems

It is important that teachers and parents of children with ADHD be aware of strategies to prevent behavioral problems and how to intervene in a manner that helps the child teen regain self-control, rather than trigger an escalation of problem behavior. Such strategies and interpersonal skills are particularly necessary with a child teen who is emotionally fragile, overreactive, and or has a tendency to be oppositional and confrontational. The following tips can be applied in school or home situations (Rief, 2003).

Strategies to Increase Listening Following Directions and Compliance

One of the key frustrations for teachers and parents of children with ADHD is getting the child to stop, listen, and comply with adult directions or commands. There are a number of reasons children or teens with ADHD may have difficulty with compliance that have nothing to do with being deliberately defiant. These include (a) their struggle inhibiting and controlling their behavior (b) being unable to readily stop and disengage from what they are doing (particularly if it is a fun activity or of high interest to the child) or (c) not being able to quickly switch gears at the adult's request to do something that is less motivating. In addition, (d) inattention reduces the likelihood that the child actually listened or heard the directions and (e) working memory weaknesses may also result in the child more easily forgetting the directions that were given.

What Differentiation Means

To address the learning differences in all of our students and maximize their levels of performance and achievement, teachers need to differentiate instruction in the classroom. What does this mean Differentiated instruction is a way of thinking about teaching and learning that recognizes the fact that one size does not fit all learners. Some students are not successful in school because there is a misfit between how they learn and the way they are taught (ASCD, 2002). This concept or awareness certainly is not new for teachers (particularly special educators). But the term differentiated instruction is relatively new, and so is the recognition in the general education community that teaching must change in order to fulfill our responsibility to reach and teach all of the diverse learners in our classrooms. Students with ADHD are among those who most need teachers to embrace differentiated instruction in order to achieve school success. A number of the other sections in this book...

Other Antidepressants

Bupropion (Wellbutrin, Wellbutrin SR, Zyban) appears to work by inhibiting the uptake of dopamine and norepinephrine. Bupropion has a low incidence of sexual side effects. In addition to its efficacy in treating major depression, bupropion has been shown to be effective in smoking cessation (marketed as Zyban) and attention deficit disorder. Bupropion has a higher than average risk of seizures compared with other antidepressants. The risk of seizures is greatest above a daily dose of 450mg or alter a single dose of greater than 150mg of immediate-release bupropion.

Other Medications Used in FM

Cyclobenzaprine (sigh-clo-BEN-zah-preen) is often thought to be a muscle relaxant, but chemically it is more aligned with tricyclic antidepressants. Used at night, cyclobenzaprine may help people with mildly disordered sleep. Unfortunately, when used during the day, it can contribute to fatigue or fibro-fog. Dopamine agonists (compounds that mimic the effect of the neurotransmitter dopamine) are increasingly used in FM. At low doses they are helpful for Restless Legs Syndrome (RLS). At higher doses they can treat many of the symptoms of FM. Stimulants such as Ritalin that are commonly used in attention deficit disorder (ADD) are sometimes prescribed for daytime fatigue and fibro-fog, though currently there is scant evidence to support the use of these agents.

Language Impairment Developmental

It has been estimated that approximately thirteen percent of all children have some form of language impairment (Beitchman et al. 1986a). The most common known causes of developmental language impairments are hearing loss (including intermittent hearing loss resulting from chronic otitis media), general mental retardation, neurological disorders such as lesions or epilepsy affecting the auditory processing or language areas of the brain, and motor defects affecting the oral musculature. Many other developmental disorders, such as pervasive developmental disability (including AUTISM), attention deficit disorder, central auditory processing disorder, and Down's syndrome, may include delay in language development. In addition to these known causes of developmental language impairment, a recent epidemiological study of monolingual English-speaking kindergarten children in the United States found

Treatment And Prevention Of Deficiency

Iodine deficiency is accepted as the most common cause of brain damage worldwide, with IDD affecting 740 million people (Higdon 2003). Although it is well accepted that severe deficiency is responsible, evidence is now emerging that mild deficiency during pregnancy is also important and can have subtle effects on brain development, lowering intellectual functioning and inducing psychomotor deficits in early childhood. Preliminary data are also emerging to suggest an association between iodine deficiency hypothyroidism of pregnancy and the incidence of ADHD in the offspring however, this still requires confirmation in larger studies (Soldin et al 2002, Vermiglio et al 2004).

Address Physical and Sensory Needs

Provide for students (particularly ADHD students) who have a physiological need for mobility. Build in many movement opportunities throughout instruction. Be aware of their need to exercise, and avoid using loss of recess time as a consequence for misbehavior or incomplete work. Allow exercise breaks, running the track, and doing errands for the teacher that enable children to leave the classroom (for example, to take something to the office). Build in stretch breaks or exercise breaks after sitting any length of time (Rief, 2003).

Treatments Other Than Diet

In considering dietary interventions, it is important to note that there are two other forms of treatment with proven efficacy. These are stimulant medications and behavior modification. Considerations about dietary interventions have to be considered in the context of these other interventions. The nature of the main beneficial treatments, stimulant medication and behavioral interventions, makes the issue of diagnostic criteria for ADHD extremely important. Both of these treatments are not specific for the disorder so that the determination about which children are treated is very dependent on who is diagnosed. Effective behavioral interventions have generally consisted of direct contingency management programs (e.g., point or token programs or a response cost program) and social skills training. Like stimulant medication, these interventions are not specific to ADHD and have no proven long-term benefit when used in isolation. Other approaches, such as traditional psychotherapy and...

Abused Prescription Drugs

In 1954, the Ciba Pharmaceutical Company (later called Novartis) introduced a drug called Ritalin (methylfenidate) that was originally used to treat depression, chronic fatigue, and narcolepsy. Beginning in the 1960s, it was used to treat children with attention deficit hyperactivity disorder (ADHD), known at the time as hyperactivity or minimal brain dysfunction (MBD). Investigators Joanna Fowler, Nora Volkov and their colleagues of Brookhaven National Laboratory showed that methylphenidate is a dop-amine reuptake inhibitor, which increases the concentration of synaptic dopamine in the brain by blocking the transporters that remove it from synapses. Positron emission tomography (PET) showed that administering therapeutic doses of methylphenidate to healthy adult men increased synaptic dopamine levels. During the mid seventies to early eighties, research showed that stimulant drugs improve the performance of most people, regardless of whether they have a diagnosis of ADHD, on tasks...

Planning Around College

It is important to know that, for children receiving special education services, services can be provided through the age of 21. Although there are differences between high schools and post-secondary programs in the services that they must provide, colleges will provide accommodations to enable the student with a disability to access the curriculum. In addition, many colleges offer more extensive supports for students with disabilities, and there are colleges and post-second-ary programs around the country that have been specially designed for students with ADHD, learning disabilities, and or emotional difficulties. More minor accommodations that may be helpful to students entering college include reducing the number of courses taken (in some instances, a college student with bipolar disorder may be considered a full-time student even with a reduced course load),

Learning Disabilities

It is estimated that 5 percent to 10 percent of schoolage children and adolescents have learning disabilities (LDs), with some estimates approaching 17 percent. LDs fall on a continuum and range in severity from subtle to marked impairment. A substantial number of learning-disabled students receive special education services. In 1975 the U.S. Congress enacted the Education for All Handicapped Children Act (PL 94-142), which was an educational bill of rights assuring children with disabilities a free and appropriate education in the least restrictive environment. Disabilities that qualified for services under this law included mental retardation, hearing deficiencies, speech and language impairments, visual impairments, emotional disturbances, orthopedic impairments, a variety of medical conditions (categorized as ''other health-impaired''), and specific learning disabilities. This law was reauthorized under the Education of the Handicapped Act amendments and, subsequently, the...

Class Room Desk and Work Areas

Students with ADHD need a desk or table with as much tabletop space as possible, with tools and structuring to limit the clutter. Help children minimize the amount of materials on and in their desks. Some do better with a basket or box on the floor next to the desk table for keeping needed papers and books easily accessible and visible, but not on the desk or tabletop until needed.

Restless Legs Syndrome RLS

Symptoms include an irresistible urge to move the legs, sensations of creeping, crawling, numbness, itching, tugging, and tingling. These symptoms tend to become worse during prolonged sitting or at night and improve when the legs are moved. Severe RLS can also involve the arms and even the trunk. RLS is thought to be occasionally associated with attention deficit disorder (ADD) and commonly occurs with end-stage renal (kidney) disease dialysis. The diagnosis is based on history and physical exam, and sometimes a sleep study will be ordered to check for other sleep disorders, such as sleep apnea. For those whose RLS disrupts or prevents their sleep, medications used to promote sleep might include anticonvulsants, benzodiazepines, opioids, and dopamine agonists. People who do not respond to treatment with sleep medications also may benefit from iron, B-12, and folic acid supplements. Pregnant and perimenopausal women are at higher risk for RLS due to iron...

Reading Disabilities Dyslexia

Roughly 30 to 60 percent of children with ADHD also have specific learning disabilities. Among the various learning disabilities, reading disorders are most common. Some children have specific processing deficiencies (auditory or visual perception, short-term memory, phonological awareness, or receptive expressive language) that affect their acquisition of reading skills.

Disruptive or Externalizing Behavior Disorders

The disruptive or externalizing disorders consist of attention deficit hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder. Because the latter two are both considered disruptive behavior disorders, they are typically considered together. Attention Deficit Hyperactivity Disorder ADHD has as its primary symptoms inattention, impulsivity, and hyperactivity. Research has shown that inattention symptoms tend to cluster apart from symptoms of impulsivity and hyperactivity, while the latter two tend to cluster together. The DSM-IV maintains this distinction by including two sets of symptoms. In order to meet diagnostic criteria for ADHD, the child's parents or teachers must report the presence of at least six symptoms of inattention (e.g., is often easily distracted by extraneous stimuli) or six symptoms of hyperactivity-impulsivity (e.g., often fidgets with hands or feet or squirms in seat). In both cases, the symptoms must (1) have been present and been...

Learning Disabilities Association

But an appropriate remedial reading program can help learners make great strides. With age, and 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.

Personality Disorder The concept

(SEE ALSO Attention Deficit Disorder Causes of Substance Abuse Psychological (Psychoanalytic) Perspective Comorbidity and Vulnerability Conduct Disorder and Drug Use Epidemiology of Drug Abuse Personality As a Risk Factor, for Drug Abuse Vulnerability As Cause ofSubstance Abuse)

Oral Reading Strategies

Note Many children with ADHD have a difficult time maintaining their focus and paying attention to the words they are reading especially during silent reading. They may need to hear the words as they read (softly saying the words aloud) to help themselves attend to and process what they are reading. Allowing them to take their books to a quiet corner and read to themselves aloud should be permitted. Another strategy is to provide a curved plastic device that is held to the ear as a receiver and in the other end the child can softly whisper

The Cognitive and Academic Profile of Individuals with ASHFA

One of Joseph's greatest sources of difficulty is his trouble with organization, planning, and goal-directed activities (often called executive function skills). Joseph frequently daydreams, which causes him to miss what the teacher is saying or what he is supposed to be doing. He is not distracted by external stimuli, however, as in the case of individuals with attention-deficit hyperactivity disorder (ADHD), but internally he can get totally absorbed in his own thoughts and lose track of what is going on in the classroom. Joseph also has trouble managing time and works very slowly and methodically consequently, he often falls behind during class, resulting in hours of homework in the evening. He can't seem to get organized when he sits down to do homework, he has invariably forgotten something he needs to complete the assignment. Either he's left it at school or he goes off in search of it and gets distracted by something of higher interest and an hour elapses. Joseph's backpack is...

Clinical heterogeneity of ASD

Clinical heterogeneity of autism showed three major categories idiopathic autism, autistic spectrum disorder (ASD), and syndromatic autistics that usually resulted from an identified syndrome with known genetic etiology. Traditionally, ASD includes autism, Asperger syndrome, where language appears normal, Rett syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS), in which children meet some but not all criteria for autism. Rett syndrome (RTT), occurring almost exclusively in females, is characterized by developmental arrest between 5 and 18 months of age, followed by regression of acquired skills, loss of speech, stereotypic movements (classically of the hands), microcephaly, seizures, and intellectual difficulties. These disorders share deficits in social communication and show variability in language and repetitive behavior domains 1 . Autistic individuals may have symptoms that are independent of the diagnosis. Mental...

Effect of Bipolar Disorder on Psychosocial Functioning

Onset of illness assessment of functioning in these same subjects found a marked deterioration in academic achievement, work effort, peer relationships and extracurricular involvement 29 . Similar results have been shown in prepubertal and early adolescent bipolar populations. Geller et al found that 93 prepubertal and early adolescents with BD had significantly poorer psychosocial functioning in a variety of spheres, including maternal, paternal and peer relationships, as compared with 81 children with attention deficit hyperactivity disorder (ADHD) or 94 community controls 30 .

Bipolar Symptoms in Youth versus Adults

Differences in the symptomatic expression of BD in youth versus adults have not been consistent across studies. For instance, Ballenger et al 31 found psychotic symptoms to be more common among manic patients under the age of 21 as compared to manic patients over the age of 30, yet McElroy et al 32 in a larger, more recent study, found that adolescents had fewer psychotic features during mania than adults. There has been more consistency in the findings that youth with BD appear to have higher rates of mixed mania 32-34 and rapid or ultra-rapid cycling 33 . Of interest, an Indian study found that 21 youth with DSM-III-R diagnosed BD had presentations that were very similar to adults with the illness. The most common symptoms among the youth with mania were psychomotor agitation (100 ), reduced sleep duration (90 ), and pressure of speech (90 ). Rapid cycling was only evident in 19 of the youth, and none had a comorbid diagnosis of ADHD 35 .

Minimal brain dysfunction

Historically, minimal brain dysfunction (MBD) was the term used to define and classify learning and behavioral difficulties now classified under the category of attention deficit hyperactivity disorder. It generally includes hyperactivity, impulsivity, and any of a number of learning and language disabilities such as dyslexia and problems with math.

Challenges and Strategies

According to Sousa (2001), about 6 percent of school-aged children have some form of difficulty with processing mathematics. Among those children are frequently students with learning disabilities and or ADHD. This section will address common mathematical difficulties, current information regarding math standards and expectations in grades K-12, numerous strategies to build math skills and proficiency, as well as various accommodations modifications for struggling students.

You Will Be Known by Your Fruit

Your daily habit patterns create the state of the environment and fruit in your life. I treat many children who have behavioral and emotional issues that are categorized as Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit Disorder (ADD) or Hyperactivity. I have noticed a number of these children have parents with similar patterns. Sometimes I have to be firm with parents, helping them see that their choices and habits are mimicked by the fruit of their womb their children. A common eating pattern is soda consumption. Soda is loaded with ingredients that stress the liver and nervous system. Sodium benzoate which is used as a preservative can be a cause of chronic allergies and ADHD or ADD. Grazing on partially hydrogenated snack foods impairs the body's ability to make essential brain fat. You may need to tend to your own garden more effectively.

Onset Make a Difference

As Shulman et a note, another source of diagnostic dilemma for childhood BD is its frequent comorbidity with attention deficit hyperactivity disorder (ADHD). Most BD youth meet diagnostic criteria for ADHD, with prevalence figures ranging from 60 to 90 8, 12-14 . Faraone et a . 10 found that adolescents with childhood-onset BD had the same rates of comorbid ADHD as manic children (90 ) and that both these groups had higher rates of ADHD than adolescents with adolescent-onset BD (60 ). Sachs et a 15 reported that, among adults with bipolar disorder, a history of comorbid ADHD was only evident in those subjects with onset of BD before 19 years of age. Chang et a . 16 reported that the onset of BD in adults with a history of ADHD was 11.3 years of age. These findings suggest that early onset of BD may identify a developmental subtype of the disorder that is frequently comorbid with ADHD 10, 17, 18 . The high levels of comorbidity between BD and ADHD raise a fundamental, nosologic...

The Necessity of a Team Approach

As ADHD is a chronic disorder that is managed not cured (such as asthma or diabetes), various supports and treatments (Rief, 1998, 2000) will typically be needed throughout childhood and adolescence. The most effective approach in treating ADHD is multimodal, involving a number of interventions from a variety of different professionals and service providers. A physician or mental health professional evaluates the child for ADHD. Treatments outside of school may include counseling for the ADHD child teen, his or her parents, or the family. Often it involves a combination, with counseling of various types (for example, by clinical psychologists) as needed at different times in the child's life. Support groups for parents of children teens with ADHD will be comprised of a number of people who can serve as resources and support a very helpful intervention for parents. Most students with ADHD require close monitoring and mutual support between the home and school to be successful.

Learn as Much as You

There is a great deal of reliable information about ADHD available. It is recommended that parents obtain as much knowledge and training as they can by attending conferences and seminars, as well as reading books, magazines, and information available on reputable websites. Knowledge about ADHD and the treatments that work will empower parents with the necessary confidence, hope, and skills. Parents must become educated in the school laws (IDEA and Section 504 of the Rehabilitation Act). Children with ADHD may be eligible for special education, related services, and or accommodations in the classroom. With awareness of these laws, parents can help their child obtain school supports.

Communication and Advocacy Tips for Parents

Parents of children with ADHD will find that they need to learn advocacy strategies to ensure that their child receives the help he or she needs (Rief, 1998, 2003). As a parent, it is your responsibility to step in and intervene on behalf of your child whenever the situation arises that your son or daughter needs more support, intervention, and understanding of his or her disorder. Parents can be very helpful by providing resources and information about ADHD to teachers, coaches, and other adults directly working with their child on a regular basis. Much of the teacher training and public awareness regarding ADHD is a direct result of parents' strong efforts (for example, individually or through organizations such as CHADD) to educate others about the needs of their children. They should learn about their child's rights under federal laws to a free, appropriate public education and to accommodations and or direct special services if the ADHD is affecting the child's ability to learn...