ADHD (Attention Deficit/Hyperactivity Disorder) often comes to my attention in my private practice; it’s frequently the reason that parents call me for help with their child. I worked in the school system for many years and ADHD was the most frequent reason that children were referred to me for assessment, counseling, or parent and teacher consultation.  What exactly is ADHD and how can I manage my child, both at home and at school?

ADHD is one of the most common chronic health conditions affecting school-age children.  It is a specific developmental disorder with respect to controlling and/or regulating behaviors, impulses, and/or attention, and is observed in both children and adults.  About  5-8% of the childhood population and 4-5% of the adult population meets the criteria for ADHD that has been established and researched by the medical field.  The latest research now points to ADHD as a disorder of inhibition and self-regulation.  Although their have been many names for this disorder, it is now referred to as ADHD.

What causes ADHD? There is a very strong biological contribution to its occurrence although specific causes have not yet been determined. Several genes associated with the disorder have been identified, however, it is such a complex disorder, it’s almost certain that more genes will likely be identified. Given that ADHD represents a set of complex behavioral traits, a single gene is unlikely to account fully for this disorder.  The popular notions that excessive sugar, food additives, excessive TV viewing, or poor behavioral management by parents contribute in some way to ADHD have not been supported by research. Factors that MAY contribute outside heredity include difficulties during pregnancy, prenatal exposure to tobacco and alcohol, prematurity or low birth weight, excessive lead levels in the body, as well as postnatal injury to the prefrontal area of the brain.

ADHD presents with both core and peripheral, or related, symptoms that tend to occur together to spell this diagnosis. The core symptoms are related to inattention, hyperactivity, and impulsivity. Peripheral symptoms include academic problems, social skills deficits, behavioral problems, and other disorders such as anxiety or depression.  The expression of ADHD is highly variable so that all children won’t likely have all of the core and peripheral symptoms. Individuals with ADHD demonstrate vast differences from each other within the ADHD diagnosis.

Given the above, there are specific diagnostic criteria for ADHD, too numerous to mention here. To reach a diagnosis of ADHD, symptoms must cause impairment in school, social, or work settings and signs of this must present before age 7.  Some impairment must be present in two or more settings (such as school AND home). The symptoms must not be better accounted for by other mental disorders, such as anxiety disorder, mood disorder, dissociative disorder, or a personality disorder, nor can it be explained by a different diagnosis, a stressful experience, or any other factor within the child’s environment.  Finally, the child’s symptoms must create dysfunction for the child in areas such as academic performance and interpersonal relationships.

There are three types of ADHD based on specific diagnostic criteria:

• ADHD, predominantly inattentive type:  This is identified if criteria for inattention are met, but criteria for hyperactivity/impulsivity are not met for the past 6 months.
• ADHD, predominantly hyperactive/impulsive type:  Identified if criteria for hyperactivity/impulsivity are met but criteria for inattention are not met for the past 6 months.
• ADHD, combined type:  If both criteria for inattention and hyperactivity/impulsivity are met for the past 6 months.

There is NO treatment that has been found to cure this disorder, but many treatments exist to help manage the symptoms.  Next time, I will write about assessment and treatment options for ADHD.  If you have any specific questions, please address them to me at rtlapidus@gmail.com or respond via this blog in the upper right corner’s speech balloon.