Attention Deficit Disorder (ADD) and the related Attention Deficit/Hyperactivity Disorder (ADHD) is the most common neurological condition in children, affecting roughly 3-5% of the school-age population. Brain scans of children with ADD/ADHD show that these children’s brains develop along normal lines but are somewhat delayed, especially in areas of the brain that are linked to planning, focusing and thinking. Other areas of the brain show delayed growth and abnormal communication patterns as well.
ADD is characterized by daydreaming, being fidgety, or the inability to maintain focus on activities. For sufferers of ADD/ADHD, the symptoms have very real consequences. Children with ADD describe being unable to filter out other stimuli and decide what is important to pay attention to. Children with ADHD are described in psychiatric literature as seeming to always be on the go, as though driven by a motor.
ADD and ADHD sometimes continues into adulthood, and for those who are not diagnosed and not treated, life can be frustrating. Planning and organization can be overwhelming. Paying bills on time, remembering appointments, and other normal activities can be affected. Adults with ADD can be prone to depression or other mood disorders and may try to self-medicate. A diagnosis of ADD can sometimes be a relief, and beginning treatment at any age can have immediate benefits.
Causes of ADD
It is not known conclusively what causes ADD or ADHD in children, although studies suggest that genetics plays a large role. It is likely that some combination of factors in addition to genetics triggers the brain development changes. Studies are regularly conducted to investigate links to other causes in the environment, but no conclusive links to any one cause have been established.
ADD has been shown to run in families, and geneticists are looking at several genes that may be linked to the development of ADHD. One gene seems to be responsible for the reduced thickness of the brain covering around the area of the brain connected to focus activities in children with ADD. As these children grow up, the brain covering normalizes, and the ADD symptoms appear to abate.
There are several myths about ADD that have been ruled out as causes such as watching too much TV, bad parenting, poor schools and other negative images of ADD. There does appear to be a link between drinking alcohol while pregnant and a child developing ADD. Lead exposure through old pipes or lead paint may also be a contributing factor for some children.
A diagnosis of ADD or ADHD can’t be made on the basis of just one test. The experienced healthcare professional looks at surveys from the child’s teacher, conducts interviews with parents and the child about whether behavior is normal compared to children who do not have ADD, assesses the severity of any symptoms and the impact they have on the child’s life; and determines whether a diagnosis of ADD or ADHD is appropriate.
The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychological Association, requires meeting six or more symptoms from the list of inattention symptoms, hyper-activity symptoms or both. Those ADD symptoms include:
- The inability to sustain attention during work or play activities
- Careless mistakes in school work or activities, failure to catch details
- Not able to plan tasks or organize thoughts
- Loses things, forgetful. Can’t find or organize things necessary for tasks, papers, school supplies.
- Frequent daydreaming
- Doesn’t appear to listen
- Avoids activities that require sustained mental effort
- Constantly fidgets; can’t seem to sit still
- Leaves seat when expected to remain seated, climbing about when inappropriate
- Difficultly playing or engaging in quiet activities
- Excessively talkative, interrupts others, blurts out answers without waiting for the question.
- Difficulty taking turns
In order to quantify ADHD symptoms and provide a more objective measurement tool for diagnosing, doctors use surveys of teachers and parents to score a patient’s symptoms. The most popular of these ADD tests is the Vanderbilt ADHD Diagnostic Rating Scale (VADRS). The Vanderbilt survey also helps doctors spot other potential factors that frequently manifest in children with ADHD such as depression, anxiety and oppositional/defiance behaviors. The Behavioral Assessment System for Children (BASC) might also be requested by your child’s doctor, as well as other questionnaires used to help doctors diagnose ADD or ADHD.
Excluding Other Causes
When you or your doctor suspect a diagnosis of ADD or ADHD, your child’s pediatrician will likely want to conduct a complete physical to eliminate other potential problems that may be the cause of ADD and ADHD symptoms. Some of the issues that might mimic ADD/ADHD might be surprising:
- Vision or hearing problems
- Sleep disorders
- Depression or anxiety disorders
- Thyroid problems
- Language or developmental problems
- Seizure disorders
- Tourette’s Syndrome
Treatments for ADD/ADHD
There is no cure for ADD or ADHD. Current treatments focus on reducing symptoms of the disorder as well as improving the functionality of the sufferer. While some people with ADD seem to grow out of some symptoms, for many, the symptoms of the disorder continue through adulthood. Long-term strategies for management and maintenance are important to develop.
The use of ADD medication classed as stimulants help up to 90% of children improve performance in school and manage symptoms of ADD and ADHD, but the use of these medications is not without controversy. There is worry that the rates of ADD diagnoses increasing may lead to children being misdiagnosed, and consequently medications may be overprescribed. Another concern is that the reliance on stimulants for managing symptoms will prevent children from learning other problem-solving and coping skills to manage the symptoms without medications. Overall, however, the positive response of children taking stimulant medications often outweighs the risks. In addition to improved school performance, children often report being happier and more confident.
Other medical treatments for ADD symptoms may also include drugs classed as antidepressants such as Strattera and Wellbutrin. These drugs take longer to work and require a more constant dosage to remain effective, but they may also be a good alternative if stimulant medications are not an option because of other medical risk factors.
Side Effects of Medications for ADD
The psycho-stimulants used to treat ADD include methylphenidate and amphetamines. These medications are prescribed under the strict control of the prescribing physician because of the possibility of serious side effects such as:
- Difficulty falling asleep, sleep disturbances
- Decreased appetite and weight loss
- In rare cases, some children may experience heart problems related to taking stimulant medications.
- Increased risk of suicide might be a possible side effect of antidepressant medications used to treat ADD.
Alternatives to Drug Intervention
There are several alternative and complimentary treatments for children with ADD, some of which can prove very successful for some children with ADD. But not all treatments are created equally. Consider who will be providing treatment and what studies and research backs up the claims. Consult with your child’s pediatrician or primary healthcare provider before making any decisions about treatment options.
Often children who experience ADD symptoms can benefit from talking about their thoughts and feelings with a psychiatrist or psychologist. Often children with ADD have a difficult time relating to peers or making friends. A therapist can help a child learn strategies for handling interpersonal relationships. Families can also benefit from speaking with an expert counselor to help alleviate family issues and learn to cope with this neurological disorder as a family.
There are several treatments developed to help children develop areas of the brain that may assist in dealing with symptoms of ADD. Some of those treatments include:
- Sensory Integration Training: Developed by occupational therapists for children who have sensory integration disorders to help them learn to cope with sensory overload. The theory behind the application for children with ADD is that the experience of some children is similar to sensory overload. The evidence for this therapy is anecdotal with no research to show its efficacy in treating ADD.
- Interactive Metronome Training: This treatment involves the child listening to a metronome and attempting to mimic the rhythm by clapping or tapping the foot. It is thought this type of training activates portions of the brain involved in planning and timing. One well-conducted study of metronome training on boys with ADHD showed improvement in symptoms, so this treatment method may show promise with further study.
- EEG Biofeedback Training: Based on the principle that a focused, aware brain will emit different brain wave patterns than a brain that is daydreaming or unfocused. By providing aural feedback of EEG patterns, the patient learns to increase periods of attentive brain patterns. To date, six studies are published or in progress that show positive results for EEG feedback treatment.
There is no scientifically established link between sugar or food additives and ADD symptoms, however some children who suffer from ADD may have sensitivities to food dyes or additives, and eliminating dyes and additives from a child’s diet has anecdotal support for relieving symptoms in some children. Usually these dietary interventions take one of two forms:
- Elimination diets: This involves eliminating things from a child’s diet to find a potential cause of ADD symptoms in the diet. Common suspected culprits are refined sugars, artificial dyes and food additives and gluten. No scientific studies support the connection between these factors and an increased risk of ADD, however those with allergies or sensitivities may find symptom relief from a strict diet.
- Nutritional Supplements: There are numerous supplements on the market that promise to treat ADD and ADHD, however, no rigid scientific study supports these claims.
Parenting and ADD/ADHD
Parenting a child with ADD can be a challenge. Children with ADD often suffer from low self-esteem and have trouble relating with their peers. Parents feel stress over children who don’t appear to listen and display behavior that is inappropriate. Even providing helping with school work can be difficult.
Parents raising children with ADD can help kids by being advocates for them with the school system and teachers. School budgets are increasingly strained, placing more demands on special education departments and teachers. In addition, the National Alliance on Mental Illness recommends the following tips for parents:
- Maintain a positive attitude
- Create and maintain a structured environment
- Clearly communicate rules and expectations
- Encourage good exercise and sleep habits
- Focus on social skills
Parents of kids with ADD also need to take care of themselves. Consider counseling or support groups, and reach out to resources for help. One such group is Children and Adults with Attention Deficit/ Hyperactivity Disorder (CHADD). There are also online magazines and social groups for people who have ADD.
Adults and ADD
For some, ADD symptoms seem to diminish with age, but that is not the case for everyone. For many people, the symptoms of ADD continue through adulthood. Undiagnosed and untreated ADD in adults can lead to numerous interpersonal problems, work performance problems, depression and other problems.
Adults with ADD often find work life a challenge. Even things as seemingly simple as getting ready for work on time can prove to be a big challenge. These people are often very intelligent but often feel that their professional accomplishments do not meet their abilities. In extreme cases, it might even be difficult for the person to keep a job. Personal relationships often suffer for people with ADD, as well.
Diagnosis and treatment for adults with ADD is similar to that for children. A licensed health care provider will want to do a complete medical work-up to eliminate other causes for symptoms. To reach a diagnosis of ADD, the patient must have symptoms of ADD beginning in childhood and continuing through adulthood. Statistical tests provide doctors with the tool to determine a diagnosis of ADD and to quantify the severity of ADD in adult patients.
Getting Support for ADD and ADHD patients
Having ADD or ADHD can be a struggle for the people who suffer from this neurological disorder as well as for the people around them. There are several organizations that provide support and information for ADD patients such as ADD.org and CHADD.org.
Finding help and the emotional support from other people who understand the challenges of ADD and ADHD can be beneficial. People with ADD can find themselves feeling isolated and frustrated; professional help and support can be invaluable. Depression is a very real concern for people with ADD, but no one has to suffer alone. Diagnosis and treatment can make a huge difference in the lives of people with ADD/ADHD.