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Defining ADHD What it is, and most importantly for worried parents, what it isn't It has been nearly a century since ADHD was thought to be a moral defect. Yet, despite a more finely tuned definition and greater understanding of the condition, public perception often remains unchanged. Parents continue to be judged as having little control over their children; children with the disorder are often seen as being difficult and defiant. Dr. Francis Crinella, a neuropsychologist and professor of pediatrics at UCI Medical Center, along with other experts, believes that part of the stigma and misunderstanding about ADHD stems from prior definitions. "The disorder has been defined in many ways over the years. The first were based on moral assumptions, which were not uncommonly held beliefs regarding most behavioral disorders," he says. "These were followed by naive biological assumptions such as 'post encephalitic syndrome' and 'minimal brain dysfunction.'" According to the National Resource Center on ADHD, other previous names for the condition include hyperkinetic impulsive disorder and attention deficit disorder (ADD). While many people, including professionals, still refer to the condition as ADD, this more commonly known term has been revised as well. Today, it would likely be referred to as ADHD, predominantly inattentive type. Such variances in the definition are not uncommon, says Crinella. "Our thinking has evolved, based on scientific evidence," he says. "We could look at schizophrenia, epilepsy, anxiety states, personality disorders and learning disabilities and find the same evolution in the nomenclature based on scientific findings." Looking deep for answers Biological research, such as brain imaging and genetic studies, represents one area that has brought new insight into the disorder. Research, for example, shows a genetic link to ADHD. According to the National Institute of Mental Health, children with ADHD usually have at least one close relative who also has the disorder. At least one-third of all fathers who had ADHD in their youth have children with the disorder. And when one twin of an identical twin pair has the disorder, the other is likely to have it as well. The definition today Today, ADHD is defined as a neurological disorder. The condition, which affects 3-7% of all school-age children, is characterized by developmentally inappropriate levels of inattention, impulsivity and hyperactivity. Some children are impacted in only one area, such as inattention; others, and typically the more severe cases, in all three. Among the signs of ADHD, cited by the National Institute of Mental Health: • Restless, squirming while seated • Difficulty waiting in line or taking turns • Blurting out answers before hearing the whole question • Easily distracted by irrelevant sights and sounds • Rarely follows instructions carefully and loses or forgets things like toys or school books • Skips from one uncompleted task to another Experts caution that just because a child displays one or more of these symptoms, it does not necessarily mean that he or she has ADHD. "A lot of children may have some symptoms of ADHD, but if they don't have enough symptoms, they don't meet the criteria of having ADHD," says Dr. Julie Reeker, manager for the CHOC psychology program. The behaviors also must be present before the age of 7 and have lasted for at least six months. Additionally, they must be creating a hardship in at least two areas of the child's life, such as at school, in social settings, or at home. No one way to say "With a lot of medical diagnoses, there is a single test that is able to determine whether or not you have, say, diabetes, or something a little more definitive like that," says Reeker. "ADHD is technically a psychiatric disorder, but it is also considered a behavioral disorder, which means that the only way to diagnose the ADHD is to literally take a very good history and then observe the child and/or get information about the child in multiple settings and decide whether or not they really meet the criteria." Part of this process involves ruling out conditions that mimic ADHD. At the top of the list, says Reeker, is learning disabilities. A child with dyslexia, for example, may appear to have a problem with attention, but it is really a problem of processing. Other common possible causes of ADHD-like symptoms include other behavioral disorders, such as oppositional defiant disorder, anxiety and depression. "Sometime the chaos in the family or just the daily schedule - the hectic schedule - it can all induce ADHD-like symptoms," says Katherine Ko, an Irvine-based clinical psychologist. "Having a good understanding of what's developmentally appropriate can help parents better distinguish what's normal and what's outside the norm." Sandy Bennett is managing editor of OC Family Magazine. Signs and symptoms: A child with ADHD often shows some of the following: • Trouble paying attention • Inattention to details and makes careless mistakes • Easily distracted • Loses school supplies, forgets to turn in homework • Trouble finishing classwork and homework • Trouble listening • Trouble following multiple adult commands • Blurts out answers • Impatience • Fidgets or squirms • Leaves seat and runs about or climbs excessively • Seems "on the go" • Talks too much and has difficulty playing quietly • Interrupts or intrudes on others Resources: If you suspect your child has ADHD, Julie Reeker of CHOC suggests you first contact your pediatrician. He or she will be able to give you a referral to a behavioral pediatrician, psychologist or psychiatrist. Here are some other resources: • Children and Adults with AttentionDeficit/Hyperactivity Disorder: chadd.org • National Resource Center on AD/HD (a program of CHADD) help4adhd.org • American Academy of Child and Adolescent Psychiatry: aacap.org • National Institute of Mental Health: nimh.nih.gov |
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