Attention Deficit Disorder

What is it?

Attention deficit disorder is a neuro-biological condition (i.e., based in the brain) that can affect the academic performance and behavior of school-age children. The disorder runs on a continuum so that it is possible to have only a very mild impairment a moderate or a very serious impairment. There are actually three conditions that typically fall under the label Attention Deficit Disorder. They are:

• Predominantly Hyperactive – Impulsive Type - Adults typically refer to children with this condition as “hyper” because of their very high level of activity. It is actually more of a disorder of behavior regulation than of impaired attention. Children with ADHD are typically very impulsive, distractible, restless, often thrill-seeking, tire easily of repetition, seek constant stimulation etc... They also tend to have highly variable performance in school, performing well on some days and poorly on others. Because of their behavior regulation problems, they often draw attention to themselves and receive frequent corrective feedback about their behavior.
• Predominantly Inattentive Type – This condition is more truly a disorder of attention. Children with ADD have trouble filtering out irrelevant information and attending appropriately to relevant information. They are often characterized by sluggish, confused thinking or by inconsistent memory, as well as by a spacey, day-dreamy demeanor. In addition, they tend to be somewhat lethargic or under-active and are often socially reticent.
• Combined Type – This type of disorder reflects characteristics of both types listed above and is probably the most common form of the disorder.

How Do I Know If My Child Has Attention Deficit Disorder?

There are lots of ways to begin to answer this question. Listening to what your child’s teacher has to say about his/her behavior and work habits is an important place to start. Children with these disorders usually display more symptoms in school than at home due to the nature of the requirements in school. It is possible to ask school personnel (teachers, school psychologists, social workers) to assist in collecting information that can be helpful in diagnosis. Since the conditions are considered to be medical conditions in nature, it is necessary to have a physician or psychiatrist make the diagnosis.

There are many books available at libraries and bookstores that have lots of information about Attention Deficit Disorder. There are also many good web-sites that have information about diagnosis and treatment.

What Can Be Done To Help Children Who Have These Disorders?

There are lots of supportive strategies that can be used with children who have problems related to Attention Deficit Disorder. Behavioral strategies are extremely important. To design the appropriate strategies it is important to accurately identify the main problems the child is experiencing (e.g., does not complete work, does not listen to directions, talks frequently out of turn, solves disputes with peers in an aggressive manner etc.). Once the key problems are defined, it is then a matter of developing strategies that can be used at home and in school to help the child perform better.

Home-based strategies provided by the Macomb Intermediate School District in a handbook entitled A Handbook to Assist in Identifying and Providing Educational Accommodations to Students with ADHD/ADD include:

1. Share with others in your child’s life how they deal more appropriately with the child with ADD.
1. Meet with your child’s teacher to share information about medication and/or about strategies which have been effective in the past.
2. Help relatives, close friends, Sunday school teachers and parents of playmates understand you child’s special needs.
3. Inform babysitters and other caretakers about ways you have found to be most successful in managing your child’s behavior.
4. Be prepared for the chronic nature of ADD. Expect that behavior management techniques will be needed on a continuing basis.
5. Help your child learn appropriate skills. Expect that you may need to teach your child the learning strategies and social skills that other children learn without specific instruction.
2. Provide structure and teach strategies for organization.
1. Give short, clear firm and specific directions to your child. A child who has difficulty paying attention may have forgotten the first thing you said before you finished saying the second or third thing.
2. Help your child learn strategies for coping with his/her short attention span. For example, if your child has difficulty remembering directions, write a list. As the child with ADD grows, he/she will benefit from instruction in learning how to make his/her own lists to keep things organized.
3. Praise your child for jobs well done. Avoid falling into the trap where all you do is criticize and correct your child. Find small things to praise and make a point of doing it often. Remember, children with ADD need more frequent reinforcement than children who are not handicapped.
4. Establish a consistent daily routine for your child to follow for such activities as getting ready for school, performing chores and doing homework. This will help your child to organize his/her day and know exactly what is expected. It is often helpful to have the daily routine/schedule in written or picture form. These written or visual reminders are important to the child with ADD.
5. Establish rules for performing everyday experiences (e.g., chores need to be completed right after the child gets home from school, homework needs to be completed before TV is watched, etc.) These rules should be consistently followed by everyone in the home.
6. Make sure that your child has all the necessary materials needed in order to complete his/her responsibilities on time.
3. Set appropriate expectations for your child.
1. Make alternate arrangements for situations that will be difficult for your child (e.g., have your child sit on the end of the pew in church or synagogue so that the child can get up and move rather than be expected to sit for long periods of time.
2. Plan playtimes that incorporate physical activity. Your child’s difficulties will be much less apparent if he/she is playing outside rather than playing in a small room with puzzles or games.
3. Plan to supervise your child with ADD more closely that brothers and sisters who do not exhibit ADD. Children with ADD often take risks without considering the consequences and it is therefore important that they be regularly supervised.
4. Try not to let your child become overly tired. Self-control breaks down when children are fatigued. Regular bedtimes can help avoid serious evening difficulties.
5. Try to determine whether your child is refusing to complete a task or whether he/she is unable to do the task at this time. These behaviors need to be treated differently. Behaviors that a child can’t do require teaching of that behavior or skill. Behaviors that a child won’t do require discipline such as setting specific rules, rewarding appropriate behavior and removing a privilege for inappropriate behavior.
4. Serve as a role model for your child in terms of the appropriate ways to get things done without being distracted. For example, show your child how to follow a routine by following one yourself and getting things done on time.
5. Demonstrate and practice with your child the performance of a new task (e.g., setting the table, several times before expecting your child to do it by himself/herself.
6. Reduce distracting activities which interfere with your child’s ability to complete Tasks (e.g., turn off the TV when it is time to set the table, do not allow friends to come over when it is time to do homework, etc.)
7. Initially, limit the number of chores that are assigned to your child or break chores into more manageable parts. Then gradually increase the number of chores that are assigned to him/her as your child demonstrates the ability to successfully perform them.
8. Carefully consider what your child is capable of doing before you assign chores. If too much is expected of him/her, he/she may become frustrated and overwhelmed and fail to complete the chore. Do not expect perfection immediately. Look for gradual improvement.
9. Be sure to reward your child for successfully completing tasks such as chores and/or homework. Possible rewards may include: verbal praise, hugs, pats on the back, “high five,.” special privileges, points, stickers, etc.
10. Write a contract with your child.
11. Make sure that your child sees the relationship between his/her behavior and the consequences (e.g., you cannot go outside to play until your chores are done, you cannot watch TV until your homework is done.)
12. Let your child participate in deciding what his/her routine and responsibilities will be.
13. Provide your child with a “chores checklist” and have your child “check off” Chores as they are completed.
14. Be sure your child also gets some free-play time and exercise.

Does My Child Need To Take Medication?

Use of medication for a child with Attention Deficit Disorder is a decision that is between you and your physician. There are many children who benefit from the use of medications because they help to stimulate the brain to work more efficiently and reduce the symptoms of the disorder, thus allowing the child to behave more appropriately and to remain more focused and organized in relation to schoolwork. They also assist the child in being more responsive to behavioral strategies that might be being carried out. None of the currently available medications “cure” Attention Deficit Disorder. When medication is stopped, symptoms often resurface. It is extremely important to make sure that a comprehensive evaluation for Attention Deficit Disorder has been carried out and a solid diagnosis has been make based on data before considering a child for a trial of medication. It is a lack of comprehensive evaluation that often leads to misdiagnosis and unnecessary use of medication.