October is National ADHD Awareness Month. ADHD (Attention-deficit/hyperactivity disorder) can affect anyone. It is non-gender, age, ethnic or other specific. It is believed to be the most common neurobehavioral disorder of childhood and can profoundly affect the academic achievement, well-being, and social interactions of children.
ADHD affects 5-8% of school children, and its effects can be life long, challenging adults (up to 60%) in many life areas. It is characterized by developmentally inappropriate levels of inattention, impulsivity, and hyperactivity. Without identification and proper treatment, ADHD may have serious consequences, including school failure, family stress and disruption, depression, problems with relationships, substance abuse, delinquency, risk for accidental injuries and job failure. Early identification and treatment are extremely important.
Characteristics of ADHD usually appear in early childhood, and for a current official diagnosis, appear before age 7. Some professionals disagree with this age ceiling as too restrictive, noting that symptoms may manifest later in childhood. There are three generally recognized categories of ADHD.
ADHD predominantly inattentive type (ADHD-I) is characterized by someone who fails to give close attention to details or makes careless mistakes, has difficulty sustaining attention, does not appear to listen, struggles to follow through on instructions, has difficulty with organization, avoids or dislikes tasks requiring sustained mental effort, loses things, is easily distracted, and is forgetful in daily activities.
ADHD predominantly hyperactive-impulsive type (ADHD-HI) is characterized by someone who fidgets with hands or feet or squirms in chair, has difficulty remaining seated, runs about or climbs excessively, has difficulty engaging in activities quietly, acts as if driven by a motor, talks excessively, blurts out answers before questions have been completed, has difficulty waiting or taking turns, and interrupts or intrudes upon others.
ADHD combined type: (ADHD-C) is characterized by someone who meets both sets of inattention and
Children with ADHD may appear younger acting than their peers due to delays in learning consistent independent functioning. Reduced ability to focus and practice normal childhood activities such as interactive play and development of fine motor skills through coloring, block building, etc., contribute to the delay.
Two-thirds of children with ADHD have additional conditions, such as learning disabilities or depression, which exacerbate treatment and success in learning coping skills. Difficulty in treatment also may occur when treatment for one condition may be the opposite of treatmrnt for another condition.
Recently, research has found that many individuals with ADHD show a deficit or developmental delay in the brain’s executive functioning ability. Executive function refers to the variety of functions within the brain that activate, organize, integrate and manage other functions. This deficit can prevent individuals from understanding long term consequences for their actions, thus hindering their ability to appropriately control behavior across time. Concerns include deficits in working memory and the ability to plan for the future, as well as maintaining and shifting strategies in the service of long-term goals.
There is not a defining test that can be used to diagnose any type of ADHD. One diagnostic step is to rule out other causes for ADHD type symptoms, such as learning disabilities, depression or other psychological or physical conditions.
The diagnostic process may take time and observation from several people familiar with the child’s behavior in different settings. A child may present differently in a more regimented school setting, for example, than in a home setting, where behavior and focus are not as required to produce a desired outcome. Checklists and anecdotal notes that track behavioral patterns and can help pinpoint some triggers that either aid in or detract from a child’s ability to function appropriately. These observations can also help clinicians determine the presence or absence of other conditions that may be diagnosed through further testing procedures. A medical exam is also crucial in determining if any physical conditions (such as hearing loss or poor vision) affect a child’s behavior.
Professionals who can help diagnose ADHD include school psychologists, clinical psychologists, clinical social workers, nurse practitioners, neurologists, psychiatrists and pediatricians. The release of the fifth version of the Diagnostic and Statistical Manual is now used for diagnosing ADHD and other conditions.
Research indicates that ADHD runs in families, but is not an inherited condition which will surely be passed from parent to child, although genetic predisposition can play a large part in emergence of ADHD. Other factors, such as prenatal behaviors, may also contribute to occurrence of ADHD, especially when combined with genetics.
Treatment for ADHD is varied and depends on the type, severity and other factors of the ADHD behaviors. Much treatment involves behavioral intervention, and the earlier implemented, the more likely the child will learn self-monitoring and self-correction of behaviors. Medication may be used to treat some ADHD symptoms or comorbid conditions, which can have a positive effect on ADHD symptoms. If medication is used, its use must be carefully monitored to ensure the correct dosage for the child’s age. Use of medication can be tailored so it is targeted only when most needed, such as improving a child’s ability to focus during the school day hours so learning can be most effective.
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