What is Attention Deficit Disorder (ADD)?
Attention Deficit Disorder, also commonly referred to as ADD, is a group of symptoms that affect concentration and a person's ability to focus. It can also cause mood swings and other social problems.
How Does ADD Manifest in Children?
Children (under 12 years of age) with attention deficit disorder lack the ability to focus and concentrate. Attention deficit disorder in children affects daily functioning, as they may have difficulty in completing their school work and are often in trouble with parents and teachers. This is similar to adults with ADD who often experience problems at work or in relationships.
Usually, ADD child symptoms will appear over the course of many months rather than all at once. If the appearance of these symptoms is not managed correctly, it can lead to low self-esteem and other behavioral problems in the years to come.
Children who have ADD of the inattentive type are not hyperactive. However, they may have a hard time keeping their minds on any one thing and may get bored after only a few minutes on a task.
If they are doing something they really enjoy, they may have no trouble paying attention. However, focusing deliberate, conscious attention to organizing and completing a task or learning something new is very difficult.
The Difference Between ADD and ADHD
These three groups are defined as follows:
- ADD Inattentive Type - A main characteristic of inattentive behavior is the inability to concentrate and focus. This lack of attention may only be noticed when a child enters the challenging environment of school. This is not classified as ADHD, as hyperactivity is not present.
ADD Hyperactive/Impulsive Type - A child with hyperactive and impulsive behavior is commonly ‘all over the place’ and very active (both mentally and physically), making hasty decisions at any moment. This is classified as ADHD as hyperactivity is present.
ADD Combined Type - ADD child symptoms of inattentive type are combined with the symptoms of hyperactive/impulsive type. This is the most common form of ADD. A child with more than six ADD combined type symptoms should have a comprehensive
evaluation. This is classified as ADHD, as hyperactivity is present.
Diagnosing ADD in Children
Many of the techniques and principles used to diagnose attention deficit disorder in children are the same as those used to diagnose the adults with ADD, including teens.
To assess whether a child has ADD or is displaying ADD child symptoms, specialists consider several critical questions:
Are these behaviors excessive, long-term, and pervasive?
Do they affect the ability to perform life tasks?
Do these behaviors occur more often than in other people the same age?
Are they a continuous problem and not just a response to a temporary situation?
Do the behaviors occur in several settings, or only in one specific place like the
playground or at home?
It is often very difficult to diagnose ADD in young children below 5 years of age. This is
because many preschool children have some symptoms of the disorder in various
situations. In addition, children change very rapidly during the preschool
years.
Since children mature at different rates and are very different in personality, temperament, and energy levels, it is useful to get an expert's opinion of whether the behavior is appropriate for the child's age.
Steps in Making the ADD Diagnosis
A diagnosis of ADD is only applied to children who consistently display certain characteristic behaviors over a period of time. Given that children diagnosed with ADD are often treated with high-schedule drugs, it is important that the process of diagnosing ADD is comprehensive.
This requires several steps and involves gathering a multitude of information from multiple sources. Generally, the child's pattern of behavior is compared against a set of criteria and characteristics of the disorder.
Health care professionals and psychologists often ask questions such as the following:
How is your child doing in school?
Are there any problems with learning that you or your child's teachers have seen?
Is your child happy in school?Is your child having problems completing class work or
homework?Are you concerned with any behavior problems in school, at home, or when your child is
playing with friends?Your health professional/psychologist will want to know how you handle different situations and may want to observe you interacting with your child.In addition to looking at your child's behavior, they may do a physical examination.
A full medical history will be needed to put your child's behavior in context and screen for other conditions that may affect their behavior. Your health care professional/psychologist will also talk to your child about how he/she acts and feels.
As a parent, you will more than likely be asked to provide crucial information about your child's life at home, behavior in school, and in other social settings.
Your health care professional/psychologist will want to know what symptoms your child is
showing, how long the symptoms have occurred, and how the behavior affects your child and your family.
You may need to fill in checklists or rating scales about your child's behavior. In addition, sharing your family health history can offer important clues about your child's condition.
For an accurate diagnosis, your healthcare professional/psychologist will need to get information about your child directly from your child's classroom teacher or another school professional.
Children 6 to 12 years of age spend many of their waking hours at school. For this reason, it is important that your child's teacher provide relevant information.
Your child's teacher may write a report or discuss the following with your health care professional or child psychologist:
Your child's behavior in the classroom
Your child's learning patterns
Any school records that report a problem in the past
How long the symptoms have been a problem
How the symptoms are affecting your child's progress at school
Ways the classroom program is being adapted to help your child
Whether other conditions may be affecting the symptoms
In addition, your health care professional/psychologist may want to see report cards and samples of your child's schoolwork. Other caregivers may also provide important information about your child's behavior. Former teachers, religious leaders or coaches may have valuable input.
If your child is home-schooled, it is especially important to assess their behavior in settings outside of the home. Your child probably does not behave the same way at home as he does in other settings.
Direct information about the way your child acts in more than one setting is required. It is important to consider other possible causes of your child's symptoms in these settings.
In some cases, other mental health care professionals may also be involved in gathering information for the diagnosis. Ideally, the diagnosis should be made by a professional in your area with training in ADD treatments or in the diagnosis of mental disorders.
Child psychologists, developmental/behavioral pediatricians, or behavioral neurologists are those most often trained in differential diagnosis. Clinical social workers may also have such training.
Psychometric tests are available to test neurological, intellectual, and emotional development problems. These tests may only be administered and interpreted by clinical and educational psychologists who are trained and licensed in the use of this category of test.
Most of these tests involve learning and problem-solving tasks that help define the particular areas that are most disabling. Clinical or educational psychologists will perform a battery of tests over a number of sessions.
These psychometric tests may include tests of intellectual functioning, memory, attention, concentration, planning and organizational skills. In addition, scholastic tests and tests to screen for emotional problems, learning disabilities, hearing and vision dysfunction may be used.
Currently psychometric testing by a qualified psychologist is arguably the most comprehensive and accurate diagnostic procedure available to correctly diagnose attention deficit disorder in children.
Together with a good heath history and information from multiple collateral sources, such an assessment can help to rule out other possible causes of the problem and can also be very important in deciding on a treatment plan.
Recognizing the Symptoms of ADD
It is important to realize that ADD is not a physical ailment like a broken arm or chicken pox. ADD does not have clear physical signs that can be seen in an x-ray or show up on a lab test.
It can only be identified by looking for certain characteristic behaviors, and these behaviors vary from child to child. Symptoms of ADD typically occur in early childhood, but may also be developed later in life.
The symptoms of ADD in children are often quite different from those of ADD in adults. However, the biggest indicator of ADD in children is usually inattention that is inappropriate for the age and not caused by any other environmental, psychological, or physical factors.
This means that a child with a primary diagnosis of depression, for example, should not be diagnosed with or treated for ADD.
The following symptoms are common indicators of ADD in children:
Difficulty keeping attention on work or play activities at school and at home
Losing or forgetting things like toys, pencils, books, or tools needed for a task
Avoids or dislikes activities that require sitting still or a sustained effort
Seems disorganized and doesn't pay close attention to details
Has trouble with tasks that require planning ahead
Forgets things and is easily distracted
Does not follow directions or finish tasks, often skipping from one uncompleted activity to another
Does not appear to be listening when someone is speaking
Does not pay attention and makes careless mistakes
Is forgetful about daily activities
Has a tendency to daydream
Becomes easily distracted by irrelevant sights and sounds
Rarely follows instructions carefully and completely
To help recognize ADD, some of the symptoms that cause impairment must:
Be present before seven years of age
Be present consistently for a period of six months
Above all, the behaviors must severely compromise at least two areas of a child's life, such as school, home, or social settings.
A child whose schoolwork or friendships are not impaired by these behaviors would not be diagnosed with ADD. Similarly, a child who seems overly active at school but functions well elsewhere would not be diagnosed with ADD.
To complicate things further, different symptoms may appear in different settings, depending on the child and the demands of different surroundings:
A child who can't sit still will be noticeable in school, but the daydreamer may be overlooked. Yet both may have different types of ADD.
The impulsive child who acts before thinking may be seen as a 'problem child', while the child who is sluggish may be seen as 'unmotivated'. Yet again, both may have different types of ADD.
Inattention may not become apparent until a child enters the challenging environment of school. Homework is particularly hard for these children. They will forget to write down an assignment, or leave it at school.
They will forget to bring a book home, or bring the wrong one. The homework, if finally finished, is often full of errors and erasures. Homework is often accompanied by frustration for both parent and child.
True ADD symptoms appear on a regular basis across a wide variety of situations and can interfere with learning. That is why a teacher sometimes is the first to notice inattention, hyperactivity and/or impulsivity, and bring these symptoms to the parents' attention.
What Causes ADD in Children?
One of the first questions a parent will ask is "Why is this affecting my child? What went wrong?" or even, "Did I do something to cause this?"
When correctly diagnosed, there is little evidence that ADD can arise purely from social factors or child-rearing methods. Most substantiated causes appear to fall in the realm of neurobiology and genetics.
Environmental factors may influence the severity of the disorder, and especially the degree of suffering the child may experience. However, these factors do not seem to give rise to the condition by themselves.
Experts in the field are finding more and more evidence that legitimate ADD does not stem from the home environment, but from biological causes. Knowing this can remove a huge burden of guilt from parents who might blame themselves for their child's behavior.
The exact cause of ADD in children is not known, although researchers continue to study the brain for clues. They suspect that there are several factors that may contribute to the condition, including:
Heredity and genetics: The fact that ADD tends to run in families suggests that children may inherit a genetic tendency to develop an attention-deficit disorder from their parents. Studies indicate that 25 percent of the close relatives in the families of ADD children also have ADD, whereas the rate is about 5 percent in the general population.
Many studies of twins now show that a strong genetic influence exists in the disorder. The relatives of ADD children (both boys and girls) have much higher rates of ADD, anti-social, mood, anxiety, and substance abuse disorders than the families of non-ADD children.
Chemical imbalance: Children who have ADD may not make enough chemicals in key areas of the brain that are responsible for organizing thought.
Experts believe an imbalance of the chemicals that helps nerve cells in the brain communicate with each other, called neurotransmitters, may be a factor in the development of ADD symptoms. Without enough of these chemicals, the organizing centers of the brain don't work well.
Brain changes: Areas of the brain that control attention are less active in children with ADD than in children without the disorder.
Myths Surrounding the Causes of ADD
Although the following factors may present symptoms similar to those of ADD, research has shown that there is no evidence that legitimate ADD is caused by the following:
- Immunizations
Too much TV
Poor home life
Poor schools or colleges
Bad parenting
Aspartame (or sugar substitutes)
Lack of vitamins
Fluorescent lights
Video games
However, in some cases, the above factors could certainly cause symptoms similar to those seen in ADD in certain individuals, and it is worth investigating their impact if a link is suspected.
Help for Children with ADD
Children with ADD are often treated using conventional prescription medications.
While there is a place for prescription medication in certain cases of ADD, careful consideration should be taken regarding possible side effects and cautions.
There are also alternative treatment options available for children with attention deficit disorder. Making simple changes in diet, sleep, exercise and routine can also help. Even trying more involved approaches like incorporating relaxation therapies such as guided imagery, meditation techniques, or yoga can be beneficial.
There are also many herbal and homeopathic remedies which can help maintain harmony, health and systemic balance in the brain and nervous system, without side effects or sedation. These products are known for their supportive function in maintaining brain, nervous system, circulatory health, and well-being.
More Information on ADD in Children
Other Symptoms & Behaviors that can Manifest as ADD
Many symptoms and behaviors can appear to be symptoms of ADD in children, but this is
not always the case. These include:
- Underachievement at school due to a learning disability. Children who suffer from dyslexia or other learning disabilities may feel embarrassed or incompetent, and keep their inner struggle a secret from their parents and teachers. This may then result in problematic behavior.
Attention lapses caused by petit mal seizures also known as absence seizures. Children who suffer with absence seizures appear to be staring into space (with or without jerking or twitching movements of the eye muscles). These periods last for seconds, or even tens of seconds. Those experiencing absence seizures sometimes move from one location to another without any purpose.
Concentration and learning difficulties due to a sleep disorder, or breathing problem. Sleep disorders and breathing problems can interfere with mental and emotional function. Lack of adequate oxygen during the night and disruptive sleep patterns can cause a child to be tired, moody, and unable to function properly at school or at home.
A middle ear infection or hearing impairment. This may cause an intermittent or chronic hearing problem, which can then present itself as a symptom of ADD. If a child cannot hear properly, they may seem distracted and uninterested in schoolwork or participation in class.
Difficulty sitting still due to low muscle tone. Low muscle tone is especially prevalent in young boys that are growing. This is not a disease, but rather an ailment that causes great discomfort in the limbs, especially the legs when a child is required to sit still for long periods of time. This may result in pronounced squirming and restlessness while sitting in the classroom.
Disruptive or unresponsive behavior due to physical abuse. Understandably, physical abuse can cause great emotional distress. As a coping mechanism a child may then seem distant, unresponsive, and distracted.
Disruptive or unresponsive behavior due to parents' substance abuse or dependency on alcohol. Substance abuse in the home often leads to problems manifesting in the child. It is important that the root problem be treated (the substance abuse) rather than the symptom (behavioral problems in the child).
Attention-seeking behavior due to parents' lack of interest. A child may feel negative attention is better than no attention!
A sudden life change. Children often have difficulty adjusting to a change in routine and can be adversely affected by a parents' divorce, a death in the family, moving, or a change in neighborhoods and friends.
Substance abuse. Children may be over-medicated for another unrelated condition, which
can then bring on hyperactivity, restlessness, sleep disorders, and in severe cases, hallucinations.Medical disorders affecting brain function. A brain in its developmental stages that is not functioning at its best will affect physical and mental abilities.
Incorrect level of schooling. An education level that is too easy or too difficult for a child can cause great frustration, resulting in troublesome or agitated behavior. A child in a class that is too advanced for their level may quietly struggle to do the work required, and 'act out' due to feelings of inadequacy or embarrassment. Similarly, a child who is ahead of his/her peers may need extra stimulation, and may feel frustrated and bored.
Chronic fear due to a traumatic event. Psychological trauma can have an enormous mpact on a child. Fear may then manifest as physical, emotional, and psychological symptoms, affecting a child's ability to function at a normal level.
Disruptive or unresponsive behavior due to anxiety or depression. Emotional disorders can take their toll on a child's ability to function. This is especially delicate when a child's relationship with peers and his or her identity is being formed in a school environment. Both anxiety and depression can cause physical and psychological symptoms that range in severity.
Under no circumstances should ADD be diagnosed in any children who have been diagnosed with emotional disorders such as anxiety or depression.
This list is not comprehensive, and there are many other factors that affect a child's behavior and concentration levels. This is why it is very important that children are thoroughly evaluated, and an in-depth history is investigated before the diagnosis of ADD is reached.
This is especially vital for the treatment for ADD. Drastic behavioral changes are not to be taken lightly. It is important that a health care professional/psychologist first determine any other causes for these behaviors and address them accordingly.
Special Tests for Diagnosing ADD in Children
Screening Tests - The Continuous Performance Test is sometimes helpful in evaluating sustained attention and impulsivity (but not ADD/ADHD specifically). The child sits in front of a computer screen and is asked to press or not press certain keys in response to images on the screen.
Investigative Objective Tests - To date, there are no objective physical tests for diagnosing ADD. Blood or other laboratory tests are currently recommended only if your psychologist/health care professional suspects lead toxicity or other medical problems. Some, however, are being investigated for diagnosing ADD using recent knowledge of specific brain abnormalities.
The quantitative electroencephalographic procedure (QEEG) assesses the electrical activity in a part of the brain called the prefrontal cortex. Evidence suggests that ADD may sometimes be associated with low activity in this region.
Studies are reporting that it may be highly accurate in both diagnosing and ruling out ADD in patients (Zametkin AJ, Nordahl TE, Gross M, et al. "Cerebral glucose metabolism in adults with hyperactivity of childhood onset." N Engl J Med. 1990 November 15;323(20):1361-6. PMID 2233902).- Drug Trials - A trial of Ritalin is sometimes used to facilitate diagnosis, but experts strongly recommend against this method of diagnosis, because it is not always accurate. An improvement in symptoms is considered suggestive of ADD, while in non-ADD children the stimulant often increases agitation and hyperactivity. However, many children without the disorder have a similar response, and such a diagnostic trial may lead to unnecessary prescriptions of this drug.
Controversial Treatments for Children with ADD
No comprehensive discussion of ADD is possible without considering the benefits and disadvantages of prescription drugs – a subject fraught with controversy.
The Controversy
Oftentimes, parents feel that by researching alternatives to prescribed drugs, they are in some way neglecting their child and endangering their health. Ironically, side effects of these prescription drugs can also seriously endanger a child’s health.
Therefore, investigating the possible side effects and long term impact of prescription drugs is almost certainly an example of good parenting! Educating yourself on each of the prescription drugs used to treat ADD as well as exploring alternatives is a necessity if you want to provide the safest treatment for your child.
Do not allow teachers, social workers, or doctors to bully you into giving prescription drugs to your child without doing your own research. While prescription drugs for ADD may sometimes be the only way to help your child, many children will respond to alternative and less harmful alternatives, and it is important that other options are attempted before considering drug therapy.
Remember that ADD represents a growing market for pharmaceutical companies. Although psycho-stimulants may be helpful for many families, no one should underestimate the influence of the economic issues involved.
Furthermore, the long-term effects of prescription drugs for the treatment of ADD has not yet been determined, especially in the case of children (the main target market for these drugs)!
For this reason, treatment of ADD with prescription drugs or stimulant drugs should be regarded a last resort when all other avenues have been exhausted.
Available Medications & Known Side Effects
While there is a place for prescription medication in certain cases of ADD, careful consideration should be taken regarding possible side effects and cautions.
The following information on the most commonly-prescribed drugs has been compiled using a database of pharmacy-based literature, outlining their precautions and warnings.
It is recommended that parents considering drug therapy for their children should thoroughly investigate both the risks and the benefits involved.
Although there are some Web sites that may sensationalize the dangers of prescription drugs, you will find information on side effects and possible risks on the manufacturer’s Web sites as well as on reputable web sites associated with professional bodies/individuals or universities.
Before deciding to administer stimulant drugs to your child, please heed the following cautions:
- Exceeding the recommended dose or taking these stimulants for longer than prescribed may be habit-forming.
Laboratory and/or medical tests, including heart function, blood pressure, complete blood counts and platelet counts should be regularly performed both before and during prescription drug use in order to monitor your child’s progress and to check for side effects. This is particularly important with stimulant drugs.
Before your child has any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that your child is using these medicines.
Serious side effects including heart attack, stroke, and sudden death have occurred with the use of stimulant medicines in patients with heart defects or other serious heart problems.
Recently there have been similar side effects associated with the use of some of these stimulant drugs in children without pre-existing heart problems – some of which have resulted in death. This has lead to at least one drug, Adderall, being taken off the market in Canada.
These stimulants may cause drowsiness or dizziness.
These stimulants may affect growth rate and weight gain in children and teenagers. They may need regular growth and weight checks while taking this medicine.
Caution is advised when using these stimulant medications on children because they may be more sensitive to the effects of the medicine. Particular problems can be loss of appetite, stomach pain, trouble sleeping, and fast heartbeat.
There has been some evidence of an increase in suicidal thoughts and tendencies in
children taking prescription medication for ADD.
Other Important Facts
Physicians still have a difficult time predicting which prescription medications will produce beneficial results, so treatment is individualized and performed on a trial and error basis.
This ‘hit and miss’ technique requires close observation and cooperation between all participants and is understandably not ideal.
If an initial regimen doesn't work, doctors often change the dosage, switch to a different drug or even add another medication! Some doctors even recommend trying a second psycho-stimulant if a first one fails.
If the child still doesn't respond, anti-depressants or other second-line drugs may be prescribed. Before long a child may be taking a cocktail of drugs to treat the side effects of the initial medication and a domino effect is created.
Remember that medications don't cure ADD-- they only control the symptoms on the day they are taken. Although the medications may help the child pay better attention and complete school work, they can't increase knowledge or improve academic skills.
The medications can only help the child to use those skills he or she already possesses. However, this result may just as easily be obtained through behavioral therapy and other proactive techniques, such as out-of-the-box creative teaching methods.
It is vital that you educate yourself on all aspects of ADD before making a decision.
While teachers can provide valuable insight, it is important to keep in mind that they are often under great pressure in the classroom, as having to manage many children at once can be extremely hard and stressful.
This means that their account of the classroom environment and your child’s position within it may be a little distorted. This is just another reason why an in-depth analysis of your child’s behavior from as many different sources and viewpoints as possible is so important.
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