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Attention Deficit/ Hyperactivity Disorder

 

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Introduction

Attention Deficit Hyperactivity Disorder is a diagnostic label that we give to children and adults who have significant problems in four main areas of their lives: 

  • Inattention, 
  • Impulsivity, 
  • Hyperactivity, and 
  • Boredom. 

Attention Deficit Hyperactivity Disorder, or ADHD, is a neurologically based disorder, not the result of “bad parenting” or obnoxious, willful defiance on the part of the child (although a diagnosis of ADD or ADHD does not rule out that there is either bad parenting or defiant behaviors by the child taking place in the home). 
Attention Deficit Disorder comes in various forms. Today they all fall under the category of Attention Deficit Hyperactivity Disorder (ADHD), and then the main category is subdivided into 

  • ADD Inattentive Type, or 
  • ADD Impulsive-Hyperactive Type, or 
  • ADD Combined Type. 

In the recent past the terms attention deficit disorder "with" or "without" hyperactivity were also commonly used. Attention Deficit Disorder comes in various forms, and truly, no two ADD or ADHD kids are exactly alike. 


A guide and introduction to AD/HD


Definitions

The American Psychiatric Association's Diagnostic and Statistics Manual (DSM-IV) criteria for Attention Deficit (ADHD)

A. Either (1) or (2):

(1) Inattention: at least *6* of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities;
(b) often has difficulty sustaining attention in tasks or play activities;
(c) often does not seem to listen to what is being said to him/her;
(d) often does not follow thru on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions);
(e) often has difficulties organizing tasks and activities;
(f) often avoids or strongly dislikes tasks (such as schoolwork or homework) that require sustained mental effort;
(g) often loses things necessary for tasks or activities (e.g., school assignments, pencils, books, tools, or toys);
(h) is often easily distracted by extraneous stimuli;
(i) often forgetful in daily activities.

(2) Hyperactivity-Impulsivity: at least 4 of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity:
(a) often fidgets with hands or feet or squirms in seat;
(b) leaves seat in classroom or in other situations in which remaining seated is expected;
(c) often runs about or climbs excessively in situations where it is inappropriate (in adolescents or adults,
may be limited to subjective feelings of restlessness);
(d) often has difficulty playing or engaging in leisure activities quietly.

Impulsivity:
(e) often blurts out answers to questions before the questions have been completed;
(f) often has difficulty waiting in lines or awaiting turn in games or group situations.

B. Onset no later than age 7.

C. Symptoms must be present in two or more situations (e.g., at school, work, and at home).

D. The disturbance causes clinically significant distress or impairment in social, academic, or occupational functioning.

E. Does not occur exclusively during the course of PDD, Schizophrenia or other Psychotic Disorder, and is not better accounted for by Mood, Anxiety, Dissociative, or Personality Disorder.


Issues

The principle issues associated with ADHD are related to:

  1. diagnosis — whether there is in fact such a condition (see Dissident Views in References section below) — and whether a diagnosis is too easily made which thus unnecessarily classifies behaviour which is in the normal range as a "disorder"
  2. treatment — whether to use drugs such as methylpenidate (known as Ritalin) or other forms of treatment (See Fewster in Readings, below)
  3. the less well-documented incidence of AD/HD in girls and in adults
  4. the management of AD/HD children in the school setting

Readings
The following readings are available on this site:

A recent discussion on WebMD

Briefing paper on AD/HD from National Information Center for Children and Youth with Disabilities

Fewster, G. The Medical Model is Alive and Well and Killing Child and Youth Care. Journal of Child and Youth Care, Vol.12 No.4

Discussion paper from ADD CLINIC on AD/HD in Adults and Families and Concurrent Disorders

Judith Stubbs: A.D.D and Success in School : Practical Advice for Surviving the End of the School Year

Linda Carroll Overlooked ADHD patients: girls MSNBC News feature

Causes and features, with further material on attention, impulsivity, hyperactivity and boredom


References

The Myth of the A.D.D. Child, by Thomas Armstrong, Ph.D.

The Myth of the A.D.D. Child exposes the mislabeling of millions of children as A.D.D./A.D.H.D., and the use of powerful mind-altering drugs such as Ritalin in treating children's hyperactivity. Not long ago, children who behaved in certain ways were called "bundles of energy", "daydreamers," or "fireballs." Now they're considered "hyperactive," "distractible," or "impulsive" — victims of the ubiquitous Attention Deficit Disorder. Tragically, such labeling can follow a child through life. Worse, the mind-altering drugs prescribed for A.D.D./A.D.H.D. are unnecessary — and they are harmful.
By tackling the root causes of a child's attention and behavior problems — rather than masking the symptoms with drugs — parents can help their children begin to experience fundamentally positive changes in their lives.

The Myth of the Hyperactive Child & Other Means of Child Control, By Peter Schrag and Diane Divoky

Millions of children have been "diagnosed" as "hyperactive" or having "attention deficit disorder" and millions are now taking brain-damaging amphetamine-type medication, in many cases by order of school officials. Millions of other children have been labeled predelinquent, found to have "deviant" tendencies, or said to exhibit "maladaptive behavior." Can these illnesses be in fact so widespread, or is this a new way the schools have found to deal with healthy children who seem, to parents or teachers, to present some form of difficulty?

This meticulously documented book covers all aspects of the rapidly spreading ideology of "early intervention," demonstrates how common problems become medical ones, and exposes the shoddy research that underlies those practices. Examining the "scientific" literature as well as searching out the underlying causes of this new and frightening trend, Peter Schrag and Diane Divoky document in telling detail the ways in which old-fashioned punishment and control are being replaced by new forms of medical and social treatment, teaching the younger generation that it must trust the state and its new "science" to define and manage the ways it grows up. The information and ideas they examine are critically important and profoundly disturbing.


Internet

The ADD/ADHD Online Newsletter Vol 4 No 1 January 2000 http://www.nlci.com/nutrition/

Insure Kids Now - http://www.insurekidsnow.gov/
Dept. of Education - Attention Deficit Disorder: What Parents Should Know
Dept. of Education - Attention Deficit Disorder: What Teachers Should Know
Dept. of Education - Attention Deficit Disorder: Beyond The Myths
Dept. of Education - What is meant by "Learning Disabilities"?
NIMH - Attention Deficit Hyperactivity Disorder: Decade of the Brain http://www.nimh.nih.gov/publicat/adhd.htm
Americans with Disabilities Act of 1990 gopher://wiretap.spies.com/00/Gov/disable.act
National Institutes of Mental Health http://www.nimh.nih.gov

Coexisting Disorders:
Anxiety Disorders Association of America http://www.adaa.org
Learning Disabilities Association http://www.ldanatl.org
Oppositional Defiant Disorders http://www.sundial.net/~techman/index3.html
National Depressive and Manic Depressive Association http://www.ndmda.org
Tourette Syndrome Association http://tsa.mgh.harvard.edu/

Special Education, Disability, Health Issues:
The Dana Alliance Brain Awareness Week 2000 - http://www.dana.org/brainweek
American Academy of Child and Adolescent Psychiatry http://www.aacap.org
National Health Law Program http://www.healthlaw.org
Federal Resource Center for Special Education http://www.dssc.org/frc.
Learning Disabilities Online http://www.ldonline.org
Council for Exceptional Children http://www.cec.sped.org/home.htm
National Association of School Psychologists http://www.naspweb.org/index.html
Disability Rights Education Defense Fund http://www.dredf.org
Council of Parent Attorneys and Advocates http://www.copaa.net
National Association of Protection and Advocacy Systems http://www.protectionandadvocacy.com
National Information Clearinghouse on Children and Youth with Disabilities http://www.nichcy.org
American Academy of Child and Adolescent Psychiatry http://www.aacap.org
ERIC Clearinghouse on Disabilities & Gifted Education http://www.ericec.org
Federation of Families for Children’s Mental Health http://www.ffcmh.org
National Mental Health Association http://www.nmha.org
The Bazelon Center http://www.bazelon.org
Pacer Center http://www.pacer.org
National Clearinghouse on Post Secondary Education for Individuals with Disabilities-HEATH Resource Center http://www.acenet.edu
American Academy of Pediatrics http://www.aap.org
Integrated Neuroscience Consortium http://www.cnsresearch.com

Additional AD/HD Organizations
The National Attention Deficit Disorder Association http://www.add.org
Milton Keynes – A UK AD/HD Support Group
ADDNet UK http://www.web-tv.co.uk/addnet.html
CHADD Canada http://www.members.tripod.com/~chaddcanada/index.html


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