By Steve Waksman, Ph.D., Licensed Psychologist, is a specialist in ADD/ADHD in Portland Oregon
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Approximately 3-5% of all children display a collection of behaviors psychologists
and physicians call hyperactivity, or more recently, attention
deficit/hyperactivity disorder (ADHD/ADD). Some of these children are
inattentive (fail to finish projects, don’t seem to listen, or
are easily distracted). Others are impulsive (act before thinking)
and hyperactive (on the go or fidgety). And others are inattentive,
impulsive and hyperactive. Such children tend to get bored much
quicker, behave more inconsistently and act more immaturely than
other children their age. Usually parents will notice these behaviors
when their hyperactive child is very young. Teachers who have a
difficult time educating these children identify other children
with attention problems. There is no cure for these attention problems
but many techniques exist for managing and/or changing these behaviors.
What causes attention deficits?
Psychologists and physicians are not sure of all the reasons why children (more
often boys) develop or are born with these behaviors. These behaviors appear
to be genetic and “run in families”, and are often accompanied by other learning
and behavior problems. Other children with attention problems experienced severe
birth complications or prenatal insults such as drug abuse by their mothers.
And recently, researchers at the National institute of mental health have demonstrated
that there are abnormalities in the brains of some individuals with attention
There is no reason to believe that these children will outgrow these behaviors.
Many hyperactive children do tend to get less active, or less hyperactive,
as they grow older, but most still behave in impulsive, immature
an/or inattentive ways. Children with attention deficits often
need special management procedures as long as they attend school
or live with their families. Such children have a much more positive
prognosis if they do not develop severe behavior, academic or peer
problems. The combination of attention, conduct and learning problems
often leads to school failure, early school dropout and/or serious
How do we test for attention deficits?
Most young children display some of these behaviors at times. However, psychologists
only consider a child hyperactive or attention deficit disordered if s/he
displays many of these behaviors often and in different settings (e.g. school,
home, community). There is no single test for attention deficits, and it
is not easily diagnosed until children reach school age. Psychologists will
usually ask parents and teachers to describe the child’s behavior using standardized
rating scales or checklists, and take a careful history of the problems.
Psychologists may also make systematic observations or administer some tests.
If children are rated very severely on hyperactivity rating scales by both
teachers and parents, behave inattentively during formal testing, and display
these behaviors in various settings, then psychologists will describe the
child as attention deficit disordered or hyperactive. In most cases a thorough
evaluation is necessary to rule out medical, emotional and/or educational reasons
for these or similar behaviors.
How is it treated?
The management of attention deficit disorders involves a variety and combination
of methods. The child’s physician may prescribe stimulant or psychoactive
drugs such as Ritalin, Dexedrine or Concerta to improve the child’s attention
span and task performance. Such drugs are not habit forming and produce favorable
results in about 70% of the cases. At times clonidine or an antidepressant
medication is prescribed. Often the improvements are dramatic, but determining
the correct medication and dosage is not always easy. Medication alone however,
is often insufficient to change the prognosis of children with attention
With medication, children are able to control their behavior and impulses, and
seem to get along better with their peers. They are also more easily
managed and more responsive to special education procedures and
parental tutoring. There are, however, unpleasant side effects
from the drugs in about 20% of the cases. Such side effects may
include sleep disturbances, loss of appetite, stomachaches or headaches.
Also the medications alone do not seem to improve long-term academic
achievement or reduce antisocial behavior patterns. Ultimately
parents and children along with their physicians must decide whether
the positive effects of the medication outweigh the negative aspects.
Regardless of whether parents decide to use medication or not, attention deficit
disordered children require special management procedures, special
counseling, special accommodations, and often special education
instruction. Special management procedures may include the use
of specific behavioral objectives with rewards, the use of family
contract systems, the use of appropriate modeling and problem-solving
techniques, the use of specific praise and reprimands, the use
of “self management” techniques, and the use of “token” reward
or daily school report card systems. Such management procedures
are needed for both home and school behavior, and should be taught
and coordinated by a psychologist who specializes in children and
schools. Most parents and teachers are able to learn these techniques
in several weeks. However, since attention deficit disorder is
a life-long disorder for most individuals, periodic follow-up sessions or “booster-shot” sessions
are highly recommended.
Children with these attention problems may require some or all of these procedures
during most of their school years. Research has shown that these
procedures and techniques can radically improve a child’s learning,
behavior and attitude. Parents who learn to implement these procedures
when their child is young have the greatest success. Parents and
teachers who use these procedures consistently and conscientiously
are rewarded with more positive behavior and less frustration,
and learn to enjoy these children more. Research studies demonstrate
that those ADHD children and adolescents with behavior and learning
problems who receive comprehensive long-term services have a much
more positive outcome than similar children who receive medication
alone or with brief short-term therapy.
Special counseling includes information about what attention deficit disorder
is and how it will affect future school, work, and home life. Appropriate
counseling also includes techniques for parents, teachers and children
to deal with their frustration in managing these behaviors. Social
skills group counseling is also very helpful for children to learn
and practice new social and peer relationship skills. However,
individual psychotherapy or play therapy is not usually necessary.
ADHD students (and adults) often require special accommodations or modifications
in their school, work or home requirements. Such accommodations
often include less homework or chores, shorter assignments or tasks,
the use of tape recorders or computers, additional time to complete
tests or assignments, peer “note takers” and alternative methods
to prove one’s knowledge. The scheduling of resource room or study
skill classes to allow students extra time to complete assignments
or homework is also very helpful. Just as physically handicapped
individuals are provided ramps and special considerations, ADHD/ADD
individuals need school accommodations. It’s not only a good idea,
it’s the law! The Americans with Disabilities ACT (ADA, P.L. 101-336),
Section 504 of the Rehabilitation Act of 1973, and the Individuals
with Disabilities Education Act (IDEA or P.L. 105-17, formerly P.L. 94-142) clearly require “reasonable
accommodations” and a “free and appropriate” education for individuals
Many children with attention deficit disorders require special education methods
to reach their potential and/or to control their social behavior
in school. To receive “official” special education services, students
must be evaluated and certified based upon federal and state regulations.
Not all children with attention disorders require special education
services. If a child meets the criteria s/he would be eligible
for free special education services, such as remediation in reading
and basic skills, placement in a special program or class for part
of the school day and perhaps a “token” reward system. Many children
and adolescents have mild attention problems or are disorganized
and do not meet the criteria for a diagnosis of ADHD. Such children
or adolescents would benefit from similar systematic monitoring or behavior management procedures.
Other treatments such as diet therapies appear popular but have very little support
from researchers and experts. While common sense suggests that
parents monitor their child’s diet, there is no scientific evidence
that special diets will cure hyperactivity. There is evidence that
some individual children are allergic or sensitive to certain foods
or chemicals. However, there is no evidence to support the claim
that hyperactive children can be treated with diet changes alone
and that other treatments (e.g. medication, behavior management
or school interventions) are not necessary. There is also no scientific
evidence to support the use of megavitamin therapy, bio-feedback,
visual training, sensori-motor training, anti-motion sickness medication, or low sugar diets.
More information from a specialist?
If you would like additional information about attention deficit hyperactivity
disorder, learning disabilities or behavior problems, please call:
Licensed Clinical Child Psychologist and Certified School
Additional Copies of this pamphlet are available from the author at:
Steven Waksman, Ph.D.
5441 SW Macadam Ave., Suite 206
Portland, OR 97239
Copyright 1983,1991,1994, 2002 Steven Waksman, Ph.D.
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