From Dreamy to Disruptive . . . The Many Faces of Attention Deficit Hyperactivity Disorder

Have you ever worried that your child or grandchild may have Attention Deficit Hyperactivity Disorder (ADHD)?

To test your knowledge of the disorder, which of these eight-year-olds do you think has ADHD symptoms?
a) a boy who can't stay in his seat, talks excessively, doesn't listen to directions and blurts out answers.
b) a girl who sits quietly all day, but can't focus on what is expected. She is disorganized, distracted and seems to be daydreaming.

Actually, both children may have symptoms of the disorder, says Kathryn Doby, M.A., director of Clinical Neuropsychology services at WFUBMC who conducts evaluations to diagnose ADHD.

"There are currently three reported subtypes of ADHD, and with one type there is no hyperactive behavior," says Doby. "The common image of ADHD is a child who acts without thinking and can't sit still. But some children with ADHD may sit in class daydreaming and not bother anyone. As a result, they may go for a long time without being diagnosed."

Without proper diagnosis and treatment, children with ADHD can become underachievers and often have a higher rate of school or job failure. On the other hand, a "false" diagnosis of ADHD can result in a child unnecessarily taking Ritalin®, Dexedrine® or other stimulants used as treatment.

"You've got to be sure the diagnosis is correct," said Doby. "You don't want to make a child worse by medicating them when they don't need it."

As many as 3.8 million school children are diagnosed with ADD/ADHD according to the American Academy of Pediatrics. At least 2 million of these take Ritalin for symptoms of inattentiveness, impulsivity and hyperactivity. Criteria for diagnosing the condition are set by the American Psychiatric Association.

Because there is no single test for ADHD, an evaluation often involves ruling out other causes for the behavior. A physician, for example, may check for physical causes such as epilepsy or a sleep disorder. And psychologists and neuropsychologists may test for learning disabilities.

Doby says a thorough evaluation usually includes:

• An interview about specific symptoms, including when and where they occur.
• Checklists for parents/teachers to rate behavior and identify symptoms.
• Testing -- tailored to each patient -- may include measuring cognitive skills, reading comprehension, writing ability, math skills and memory.
• Continuous performance tests for attention. This involves doing a simple task, such as identifying a certain letter as various letters flash on the computer screen.

If a diagnosis of ADHD is made, treatment can include medication but also training in how to cope with the disorder. Doby, for example, works with ADHD patients of all ages - including adults - to teach them strategies for dealing with symptoms.

"ADHD is not a disease, it's a condition you are born with," says Doby. "It cannot be cured, but fortunately you can learn to compensate."

from BestHealth November 2000