Attention Deficit Disorder, or Attention Deficit Hyperactive Disorder, are often one and the same syndrome and for simplicity's sake, we shall refer to them as ADHD.
Some doctors see ADHD as part of the normal spectrum of development, but most now see it as a specific syndrome. Most researchers feel that there are certain areas of the brain which normally put brakes onto unwise behavior, which do not function well. The messages are not "filtered" correctly and a person with ADHD acts before he thinks of the consequences. Very young children do the same, of course, but as they mature, experience teaches them which behaviors are acceptable to their peers and to adults.
Although research has been concentrating on the frontal lobes and the basal ganglia, it is likely that other areas of the brain are also affected. CAT scans showed the skull to be normal. But in the last ten years or so, PET scans have come up with some fascinating findings. In PET scans, sugar is tagged with a radioactive marker and injected into the body. The sugar accumulates in the areas of the brain which are doing the most work, and these "light up" with high levels of tagged radioactive isotopes.
It is worth mentioning that this research is not carried out on children due to the high levels of radiation. Much of this research into the functioning of the brain is carried out on volunteers. However, with the new technique of MRI which does not have the disadvantages of radiation, and also gives a hard picture which can be sent throughout the world, information is beginning to be more accurate. Although it has been proven that some people with ADD have a slight assymmetry of the frontal lobes in the brain, not all of them do. And, as just mentioned, these scans are not normally carried out on children.
So how do psychologists diagnose ADD and how does a parent know if the diagnosis is correct? The American Psychiatric Association in their manual DSM IV, published the criteria for diagnosing ADHD. This list is too long to include in this short article, besides which they stress that a child need not have all the symptoms to be suffering from the malady. However, parents who go to a doctor or clinic in desperation, are delighted to grasp at the diagnosis. Dr. Christopher Green, author of Toddler Taming and Dr. Green's Baby Book, wrote: "If our task was to tell the difference between a friendly German Shepherd dog and a wild wolf, we would create a series of objective check lists, tests and measurements. But even without these, few of us would be confused if one of them ran at us." An experienced parent, or even one who is not so experienced but knows that this child is not like others, who brings the child to a practitioner, knows without a long checklist of tests that something is wrong.
Once the child has been tested and found to have ADHD, what then? There are some children, statistics vary as to the percentage, who combine ADD with Oppositional Defiant Disorder. ADHD children may be unthinking and impulsive but are usually genuinely remorseful after the event. They promise to improve -- and do the same thing a few minutes later. They can be immensely irritating, but most are truly sensitive, and inwardly, at least, they wish to please.
ODD children seem to say "no" on principle. They refuse, they argue that black is white, they challenge their parents and blame everyone else for their problems. Children can have ODD without ADD, in which case they are charming outside the house but deliberately defiant at home. They give their families a terrible time, but as they do not have ADD, no drug therapy is going to help them. Behavior therapy does not work very well on these children, who seem to enjoy creating trouble. Nevertheless, they may mature into wonderful adults!
It seems that over half the children with ADD are further burdened by an additional problem, either psychiatric, neurological, or a specific learning disability. If the psychiatrist does not see the association between the two conditions, the child will be misunderstood and treated incorrectly.
When reading medical journals or journals of psychiatry, it sometimes seems that diagnosis of ADHD is impossible without a team of pyschiatrists and at least a month of time. But some of their ideals are impractical and academic. Moreover, some of the diagnosis remains a matter of trial and error. In fact, Dr. Sydney Walker writes: "Hyperactivity is not a disease. It is a hoax perpetrated by doctors who have no idea what's really wrong with these children." He claims, whether rightly or wrongly, that hyperactivity and attention deficits are merely symptoms. He continues that literally hundreds of children suffering from minor, major or even life- threatening problems, are labeled ADD or ADHD.
According to Dr. Walker, diagnosing a child as having ADD just by asking questions and administering the standard tests, is like treating a cough with a cough medicine instead of finding out whether it is bronchitis, tuberculosis or even cancer.
Before discussing drug therapy, which is still a controversial subject, although much less so then it was forty years ago, it is worth looking into behavior therapy. No reputable psychiatrist should give the one without the other.
Psychologists and psychiatrists believed, until relatively recently, that bad behavior was the result of family stress and poor parenting. When children were diagnosed with ADD, all blame landed on the parents without mention of the benefits of medication, genetics or the brain. Now that parents, pediatricians and pyschologists work together, we can accept the child for what he is, without attributing blame, and try to work out ways to help the child mature into a responsible adult.
Accepting, supporting, guiding and encouraging are the first steps. This does not mean that this difficult child can get away with murder. On the contrary, all children prefer to be guided by rules, and the ADD child is no exception. Rules must be laid down at a time of clear thought and calm, not in the middle of a major confrontation, and must be followed through. Apart from these rules, though, letting some annoyances pass without comment, and making allowances, however difficult that may be, especially in a large family, will pay great dividends.
With ADHD, even the best balanced parents will secretly feel they are in some way to blame. It is often the behavior of the ADD child which makes excellent parents appear to be poor parents. It is not poor parenting which creates ADD. Mothers become snappy, irritable and inconsistent. Moreover, some parents say they cannot treat one child differently from the rest. They have to abide by the same rules as everybody else. With this attitude, the parents make no allowance for ADD and so, the child is always in trouble. Home is unhappy and the constant criticism erodes his self esteem. If the child had an obvious disability, they would make allowances. ADD is not "obvious" to all. Unfortunately no amount of hitting or shouting is going to knock it out of him. Acceptance is the beginning of his treatment. Siblings will just have to be told that Yankele has different and fewer rules to keep. It is unfair, but there it is.
An ADD child demands more than his share of time and energy. It is worth making use of all resources. Grandparents can be an excellent safety valve either for the siblings or the one with ADD. They are not emotionally involved, nor do they have to discipline the child on a regular basis.
The best behavior modification plan ever devised will never work as well on the child as it does in the books. It is not true that managing an impulsive, insatiable and demanding child is easy. Best results are achieved by clear communication, simple instructions, a small number of important rules and repeated regular rewards when deserved. Discipline is not all about punishment. To change behavior, we have to know when to back off, what misdemeanor to ignore, and to notice and encourage the good.
Tips on managing an ADHD child and modifying his behavior may be discussed at a later date. Also, the various arguments for and against amphetamine drugs like Ritalin as a tool for behavior modification.
