What is ADHD?
According to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), the essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
Although many children may seem overly active, inattentive, and “out of control” at times, children with ADHD exhibit these symptoms to such an extent that their overall functioning is affected. It should be noted that “ADD” and “ADHD” are one in the same- the terminology has simply been changed in recent years to reflect variation in the disorder. What used to be ADD is now called ADHD, inattentive presentation.
When left untreated, ADHD can have a profound negative impact on a child’s functioning. The most obvious effect of ADHD is the impaired ability to learn in a classroom environment. Tasks such as sitting through a lesson or completing a homework assignment can be extremely challenging for children with this disorder. Children with undiagnosed ADHD are often mistakenly labeled “slow learners” or “trouble-makers”. They can also present as disorganized, forgetful, and frequently make careless mistakes, earning them the label of “lazy” or “unmotivated”.
Another difficulty associated with ADHD is impaired social functioning. Children who struggle with hyperactivity and impulsivity are often rejected by peers because their behaviors are experienced as extremely annoying to others. This becomes especially obvious as children become older and the ADHD child’s peers are less willing to tolerate seemingly immature behaviors. In many cases, social difficulties extend to relationships with parents and siblings.
Children who struggle with the hyperactive/impulsive symptoms of ADHD may also engage in behavior that puts them in physical danger. These children tend to “act without thinking” and engage in high-risk behaviors to a greater extent than children without ADHD.
Finally, untreated ADHD can lead to problems in adulthood, such as difficulty with relationships, inability to sustain employment, and problems with the legal system.
Although there is considerable debate about whether the disorder is overdiagnosed, the American Academy of Pediatrics reports that ADHD affects between 4 and 12 percent of school aged children, and that boys are three times more likely than girls to receive the diagnosis.
There are three types of ADHD:
ADHD, Predominantly Inattentive Presentation is diagnosed when symptoms of inattention are present, yet the child does not present as hyperactive. Symptoms of inattention include poor attention to detail, inability to sustain attention and concentration, poor follow through on tasks, disorganization, forgetfulness, and distractibility.
ADHD, Predominantly Hyperactive-Impulsive Presentation is diagnosed when symptoms of hyperactivity and impulsivity are present, yet inattention may or may not be a significant problem. Symptoms of hyperactivity include inability to stay seated, excessive fidgeting or restlessness, and behavior that is likened to being “driven by a motor.” Symptoms of impulsivity include difficulty controlling behavior, inability to wait one’s turn, and constant interrupting.
ADHD, Combined Presentation is diagnosed when symptoms of inattention are present along with symptoms of hyperactivity and impulsivity.
In each of the three types of ADHD, symptoms must have been present before age 12, and for at least 6 months, in order for the diagnosis to be assigned.
There are many childhood disorders that involve symptoms that are similar to those of ADHD, which adds to the confusion for parents. For example, children who have difficulty with attention and concentration may often be experiencing depression or anxiety. Children who seem very bright may perform poorly in the classroom due to a learning disability. Gifted children may be mislabeled with ADHD because have difficulty paying attention when lesson material is not challenging enough to hold their interest. Therefore, it is very important to obtain an accurate assessment and diagnosis, to ensure that the selected interventions are appropriate to address the given problem.
The course of treatment for ADHD varies, depending on the nature and severity of the disorder. In mild cases, ADHD coaching and parent training may be sufficient intervention. In more severe cases, it may be necessary to involve school staff in a comprehensive behavior management program. In addition, a referral to a child psychiatrist may be indicated, in order to assess the need for medication.