Q: What is Attention Deficit Hyperactivity Disorder (ADHD)?
A: Attention Deficit Hyperactivity Disorder (ADHD) is a common disorder diagnosed in both children and adults. Those diagnosed with ADHD either display a frequent lack of attention (inattention) or too much activity (hyperactivity), compared to what is expected for one's developmental age. However, some of these symptoms must be evident before the age of seven and must be present in at least two environments. School, work and home are examples of environments. In addition, the symptoms must clinically impair school, social or occupational functioning for at least six months. ADHD is prevalent in approximately 3% to 7% of children who are of school age. Additionally, ADHD is more common among boys. As the child ages into adolescence and adulthood, the symptoms of ADHD appear to lessen; only a small amount of those diagnosed with ADHD still experience full blown symptoms into the adult years.

Q: Is my child mentally ill?
A: ADHD affects one's behavior, thoughts, and relations with peers. ADHD is a mental health disorder that is treatable and those diagnosed can live productive lives. One cannot "catch it" from another. The National Mental Health Association (2003) states, "Attention-deficit hyperactivity disorder (ADHD) is one of the most common reasons children are referred for mental health services."

Q: What causes ADHD?
A: ADHD is recognized to occur due to numerous risk factors such as, one's biology, heredity, and/or environmental factors. However, Barkley (2003, p.121) maintains that heredity appears to be the largest contributor to one's ADHD symptoms; he states that much evidence supports "genetic and developmental neurological factors as likely causal of this disorder..." Complications in pregnancy, contact with toxins or neurological disease are also linked as causes of ADHD.

Q: Is it inherited?
A: According to Barkley (2003), heredity appears to be the largest contributor to one's ADHD symptoms. ADHD appears to be more prevalent in children who have first-degree biological relatives who have ADHD when compared to the general population. "Between 10% and 35% of the immediate family members of children with ADHD are also likely to have the disorder, with the risk to siblings being approximately 32%" (Barkley, 2003, p. 116). If a parent with ADHD has a child, the child's risk to inheriting it is approximately 57% (Barkley, 2003).

Q: How can I tell if my child has ADHD?
A: No definite physical characteristics exist in those diagnosed with ADHD. However, physical differences such as, low set ears or hypertelorism may be more noticeable in those with ADHD when compared to the general population. (Hypertelorism is "an abnormally increased distance between two organs or parts, usually used to refer to as widely spaced eyes in a variety of syndromes" (Oxbridge Solutions, 2003). Furthermore, those with ADHD may experience greater accidental physical injuries, sleep problems, social problems, poor motor coordination, and difficulties in academics. In order for one to be diagnosed with ADHD, he or she must meet the criteria in the DSM IV-TR (Diagnostic and Statistical Manual of Mental Disorders). It is important if you think your child has ADHD that you seek an evaluation from a trained practitioner, in order to assist your child in learning to cope with this disorder and to rule out other reasons for your child's behavior (possible poor vision or hearing). Currently, "there are no laboratory tests, neurological assessments or attentional assessments that have been established as diagnostic in the clinical assessment of ADHD" (APA, 2000, p.88-89). An ADHD diagnosis is made after an assessment of the child's history and after other sources for the "troublesome behaviors" are ruled out. If your child exhibits at least six of the following symptoms, for at least six months, it is recommended that you schedule an appointment with a practitioner to assess your child for possible ADHD:

Symptoms of inattention:

1. "often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
2. often has difficultly sustaining attention in tasks or play activities
3. often does not seem to listen when spoken to directly
4. often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand (instructions)
5. often has difficulty organizing tasks and activities
6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
7. often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
8. is often easily distracted by extraneous stimuli is often forgetful in daily activities" (APA, 2000)

Symptoms of hyperactivity-impulsivity:

Hyperactivity

1. "often fidgets with hands or feet or squirms in seat
2. often leaves seat in classroom or in other situations in which remaining seated is expected
3. often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
4. often has difficulty playing or engaging in leisure activity quietly
5. is often on the go or often acts as if driven by a motor
6. often talks excessively" (APA, 2000)

Impulsivity

1. "often blurts out answers before questions have been completed
2. often has difficulty awaiting turn
3. often interrupts or intrudes on others" (e.g., butts into conversations or games) (APA, 2000).

Q: What makes ADHD worse?
A: While social factors alone cannot be confirmed as the cause of ADHD, it can make one's symptoms worse. Family chaos, stress, disorganization (such as unstructured home and school environments) and sexual or emotional abuse can increase ADHD symptoms.

Q: What can parents do?
A: Children who have strong social supports at home, which are willing to work with the school staff and doctors, have better chances of developing into well-adjusted adults. Some children may also benefit from medication and counseling, but this should be determined individually for each child. Your practitioner can assist you in making this determination. It is important to understand that parenting a child with ADHD may be challenging. Here are several tips that may help assist both you and your child:

• Educate the child (and yourself) about his/her condition so he/she can understand why they may have some of the challenges they have.
• Be positive and encourage your child to have positive influences for friends. Praise and reward your child for good behavior—rewards don't have to be material.
• Create an organized schedule for your home with times for accomplishing tasks. Make it visual, according to your child's age, display it where the child can see it and go over it with the child. If you make changes tell the child in advance.
• Make rules short, easy and write them down; make sure your child understands them. Let your child know what happens if a rule is broken, as well as what happens if the rules are followed. Punishments should be swift, fair, and steady.
• Be a good role model and do as you say you will do.
• Have someone supervise your child. Children with ADHD may be more impulsive than children in the general population.
• If mornings are difficult for your child, help him/her get ready for school the night before.
• Give your child a regular, distraction free place to do homework. Give your child breaks and help organize homework into smaller, more manageable parts, but let your child do his/her own homework.
• Be involved in what is going on at school. Find out about the good and the bad things that are happening.

Q: Where can I get more information on ADHD?
A: If you think your child may have ADHD contact your physician, or another qualified healthcare provider. If a child with ADHD is given treatment, he/she will learn how to manage daily stresses, which is essential as he/she grows into adulthood. The following sources may be helpful for more information on ADHD and children:

Support Group:

• Children and Adults with Attention-Deficit/Hyperactivity Disorder:
  www.chadd.org

Web Resources:

• ADHDinfo.com:
  www.adhdinfo.com
• ADHD ADDHelpline for help with ADD:
  www.addhelpline.org/

Book:

• The ADHD Parenting Handbook: Practical Advice for Parents from Parents (1994) by Colleen Alexander-Roberts

References:

American Academy of Family Physicians (2002). ADHD in Children. Retrieved September 12, 2003, from World Wide Web:
familydoctor.org/handouts/118.html.

American Psychiatric Association (2000). (4th ed., rev.) Diagnostic and Statistical Manual of Mental Disorders -IV-TR. Washington DC.

Barkley, Russell (2003). Attention-Deficit Hyperactivity Disorder. In Eric J. Mash and Russell A. Barkley Eds. Child Psychopathology, 2nd Ed.. NY: Guilford Press.

Gottesman, Mary Margaret (2003). Helping Parents Make Sense of ADHD Diagnosis and Treatment. Journal of Pediatric Health Care. 17(3):149-153. Retrieved September 2, 2003, from Medscape:
www.medscape.com/viewarticle/453700_1.

Hescheles, Jennifer and Camarata, Susan (2000). Attention-Deficit/Hyperactivity Disorder- Child. In William J. Reid Eds. The Task Planner: An Intervention Resource for Human Service Professionals. Columbia University Press: New York.

National Mental Health Association (2003). Attention-Deficit/Hyperactivity Disorder (ADHD). Retrieved September 12, 2003, from World Wide Web
www.nmha.org/children/children_mh_matters/adhd.cfm.

Oxbridge Solutions (2003). Hypertelorism. Retrieved September 27, 2003, from World Wide Web:
www.gpnotebook.co.uk/cache/-402259960.htm.

PsychNet-UK.com (1998-2003). Attention-Deficit/Hyperactivity Disorder. Retrieved September 9, 2003, from World Wide Web:
www.psychnet-uk.com/dsm_iv/attention_deficit_disorder.htm.

Psychiatric Institute of Washington (2001). Attention-Deficit/Hyperactivity Disorder. Retrieved September 12, 2003, from World Wide Web
www.psychinstitute.com/mental_illness/adhd.html.

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