Attention Deficit Disorder
What is Attention Deficit Disorder? How is it treated? Can it be treated with medicine and, if so, is the medication safe? Why has it been so highly publicized lately? Why are so many people being diagnosed, and why is this disorder suddenly growing at such an overwhelming rate? Where was this disorder twenty or even ten years ago? Over the past decade, ADD., or rather its diagnosis, has become one of the most rapidly growing disorders among children and adults, not only in the United States but throughout the world. Three to six percent of school age children and half that number of adults in the United States have already been diagnosed with ADD. Although the majority have yet to be diagnosed, it is estimated that approximately 15 million people in the United States have Attention Deficit Disorder. Is ADD. a "fad disorder", a matter of over-diagnosis in the population, or is it a neurological disorder?
What is ADD?
Attention Deficit Disorder (ADD.) is a neurological syndrome rooted in the central nervous system, which affects approximately three to six percent of the child population in the United States (Merrow). Its most defining symptoms include distractibility, impulsivity, and restlessness (Hallowell). "ADD. is a breakdown of the filter systems of the brain," according to Dr. Edward Hallowell, a world-renowned expert on ADD. and author of several best-selling books on the subject. ADD. is not an indicator of low intelligence, nor is it a learning disability. The ADD. brain cannot filter the information coming in and cannot filter what is going out. It is constantly bombarded with stimuli which can't be fully processed--resulting in unpredictable responses.
When was ADD first recognized as a neurological disorder?
Although Attention Deficit Disorder has gained world-wide recognition in the 1990's, its discovery actually occurred in 1937. Dr. Bradley of Providence, Rhode Island, discovered while treating severely destructive children that by using amphetamines, a stimulant, these children would become more tranquil and could concentrate better. Since his discovery, many others in his field have continued his work; however, Attention Deficit Disorder wasn't known by the vast public until the last decade. The fact remains that ADD. has always been around and was simply being over-looked until recently. It was present twenty years ago, it was present fifty years ago, two hundred years ago, a thousand years ago--essentially, it has been present throughout the ages (Hallowell).
Who is affected by ADD?
Attention Deficit Disorder has no biases. It affects people from all walks of life, wealthy or poor, black or white, male or female, high intelligence or low intelligence--virtually anyone could have ADD. While it is not proven to be a genetically predisposed disorder, as many as 75% of children diagnosed with ADD. have at least one relative who also has it, be it a parent, sibling, or uncle (Mascia).
How is Attention Deficit Disorder Diagnosed?
Doctors agree that making a diagnosis is not a simple task and that many questions regarding the patient's symptoms, behavior, and life situation must be raised to rule out other possible disorders which could produce symptoms similar those of ADD.
The most official means used to diagnose Attention Deficit Disorder was published by the American Psychiatric Association in a volume entitled "The Diagnostic and Statistical Manual of Mental Disorders" which was last published in 1994. For short, it is called "DSM-IV". Using this guide, doctors look for six or more of the following symptoms in their patient:
- often fails to give close attention to details or makes careless mistakes in school work, work or other activities.
- often has difficulty sustaining attention in tasks or play activities.
- often does not seem to listen when spoken to directly.
- often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace. (not due to oppositional behavior or failure to understand instructions)
- often has difficulty organizing tasks and activities.
- often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort. (such as schoolwork or homework)
- often loses things necessary for tasks or activities.
- is often easily distracted by extraneous stimuli. i) is often forgetful in daily activities.
In addition to six of the above, the following symptoms all should be apparent:
- some hyperactive, impulsive symptoms that caused impairment were present before age seven years.
- some impairment from the symptoms is present in two or more settings (e.g., at school or work, and at home).
- there must be clear evidence of clinically significant impairment in social, academic or occupational functioning (Hallowell and Ratey, Answers).
In an interview with Dr. Robert Mascia of Brookfield Family Medicine, he commented "a lot of times people come in here thinking they have ADD. and in fact they don't have the true diagnosis." He believes that there are many factors to take into consideration. You must consider whether the behavior of the child at home coincides with the behavior of the child at school. "Sometimes," Mascia says, "parents are looking for simple answers and are hopeful that a simple pill is going to answer some of their other problems, but it just doesn't happen."
There is no way to be absolutely 100 percent sure that ADD. is correctly diagnosed--no blood test to give positive fool-proof results. There are several psychological tests that are administered by psychologists in attempts to detect Attention Deficit Disorder; however, these tests are given under conditions which are exactly suited to get the best results from the person with ADD. They are given in a structured setting, with one-on-one motivation and novelty of subject matter. The results of these "ideal" test situations will often indicate that a person who actually has the disorder does not, thus masking a true diagnosis of ADD. Some of these tests include the Wechsler Intelligence Scale for Children (WISC), the Continuous Performance Test (CPT), and the Test of Variability of Attention (TOVA) (Hallowell).
How is Attention Deficit Disorder Treated?
There are five steps to the treatment of ADD., as outlined below.
- Diagnosis. This is the primary starting point. Once the diagnosis has been made, the individual can begin to deal with the problem.
- Education. The more information an individual can learn about ADD., the more they will be able see how it affects them personally in their daily life. Once they understand what effects ADD. has, they will be able to see options and opportunities to deal with the problems.
- Structuring. Structuring is a vital part of the ADD. treatment. People with Attention Deficit Disorder need controls and reminders, such as lists, appointment books, daily planners, goals and most importantly "yellow sticky notes." All of these help to keep the mental chaos to a minimum.
- Coaching. People with ADD. greatly benefit from having a coach to help keep them on task. The coach can be anyone except a close family member. It should not be a close family member because then it becomes nagging and it simply does not work out to well. It could be the school janitor, a neighbor, a friend. Someone who keeps them focused on tasks at hand on a daily basis (i.e., "What are the goals for today?" they might ask each morning).
- Medication. Many different medications are available to help correct Attention Deficit Disorder symptoms. The medications help the individual to focus. The medication also reduces the anxiety and inner turmoil common to people with ADD. It works to correct a chemical imbalance of the neurotransmitters in parts of the brain which regulate attention, impulse control and mood (Hallowell and Ratey, Answers). Medication is not the only answer, but when used properly it is effective and safe. As Jan Menzie, a 46 year-old Toledo, Ohio, schoolteacher, who herself has ADD., says, "Medication doesn't solve one's problems, but it does create a sane starting point (Lane)."
There are two main classes of medication used in treating Attention Deficit Disorder: stimulants and antidepressants. Medication is effective in approximately 80% of ADD. cases (Hallowell and Ratey, Driven). Finding the right medication and correct dosage for each individual may take several months as it is a trial and error process. Each person responds to the medications differently. According to Dr. Mascia, a rule of thumb is to start children with 1 milligram of medication for each kilogram of weight and adjust according to the results.
Some of the most common stimulants used to treat ADD. are: Ritalin, Cylert, and Dexedrine. As their name implies, the stimulants act on neurotransmitters to activate or stimulate the central nervous system. In ADD. this helps the individual to focus more fully. They also have a mood-leveling effect. These drugs do not cloud the sensory system, and they are not addictive in the prescribed amounts (CVS Monogram). Among the anti-depressants used to treat ADD. are: Norpramin, Pamelor and Toranil. These drugs have a similar effect on ADD. symptoms as the stimulants, although they are completely different chemically. When stimulants are not effective, doctors will turn to the antidepressants as an alternative.
As with any medication, some people do experience some side effects with both the stimulants and antidepressants used to treat Attention Deficit Disorder, including: loss of appetite, weight loss, blurred vision, dizziness, nausea, headache, rapid heart beat and sleeplessness. For the great majority of people the side effects are slight and the medication is very safe (CVS Monograph).
Why is Attention Deficit Disorder So Highly Publicized? Is It A Fad Disorder?
Attention Deficit Disorder is so highly publicized because there is such a large percentage of the population is affected by the disorder. As estimated, as much as five percent of the population has ADD. With the advancements in information technology and the limitless access to the Internet, the awareness and interest continue to grow at an unprecedented pace. There are currently more than 875,000 web sites relating to Attention Deficit Disorder. There are also many non-profit organizations, such as CHADD. (Children and Adults with Attention Deficit Disorder), which are being set up across the country. Virtually everyone comes into contact with people affected by ADD.
ADD. may have the appearance of being a fad disorder; however, this can be attributed to the snowball effect of the awareness of the symptoms and the disorder says Joyce Moscaritola, MD, Vice-President of Medical Affairs for Ciba-Geigy, the producer of Ritalin, the leading medication for ADD. for more than 40 years (Merrow).
Is Attention Deficit Disorder Over Diagnosed or Misdiagnosed?
There are circumstances when doctors misinterpret the symptoms displayed by a patient and incorrectly diagnose them as ADD. An explanation for this is given by Dr. Hallowell as "pseudo-ADD.," which is environmentally or culturally induced. We live in a fast-paced, frenetic society of instant gratification. A society in which we must be on the fast-track, take the short-cut, use the remote control to flip quickly through 99 channels on the television--the do whatever works, "go for the gusto" way of life. All of these attitudes and actions are consistent with those of people with ADD. This is a major reason why ADD. can be overly-diagnosed. The main symptoms of the disorder can be induced by the society in which we live and therefore can sometimes be mistaken for the true neurological disorder. For this reason, it is most important for the diagnostician to talk with more than one person in obtaining information regarding the historical experience and symptoms of the patient (Hallowell).
There are some illnesses which can also be mistaken for ADD. since the symptoms are closely related, such as: anxiety disorder, bi-polar disorder or mania, chronic fatigue, fetal alcohol syndrome, lead poisoning, learning disabilities, substance abuse, seizure disorders and personality disorder (Hallowell and Ratey, Driven).
Positive Aspects of Attention Deficit Disorders
Despite all of the problems inherent to ADD. and the negative publicity it has received, having Attention Deficit Disorder has as many positive aspects as it does negative. People with ADD. typically are able to hyper-focus meaning they can focus better then almost anyone at any given time, occasionally showing signs of a photo memory. They are born entrepreneurs or mavericks; they have more spontaneous ideas and have a unique creativity since the brain is always moving from one idea to the next. They have a better tolerance for chaos and can adapt to volatile situations (Hallowell and Ratey, Driven). Among famous people believed to have ADD. are: Beethoven, Carl Lewis, Michael Jordan, Nolan Ryan, Babe Ruth, Robin Williams, Walt Disney, Isaac Newton, Alexander Graham Bell, Thomas Edison, Albert Einstein, Ben Franklin and Whoopie Goldberg (C.A.R.D.).
ABOUT THE AUTHOR
Mimi Rothschild is a homeschooling parent, children's rights activist, author, and Founder and C.E.O. of online education company Learning by Grace, Inc. Rothschild and her husband of twenty-eight years reside in suburban Philadelphia with their eight children.
Feeling that “our current system of education has broken its promise,” Rothschild co-founded Learning By Grace, Inc. to provide families with Internet-based multimedia education to PreK-12 children all over the world.
In addition to her twenty years of experience as a homeschool mother, Rothschild has written a number of books dealing with education published by McGraw Hill and others. Her Home Education Websites Blog consists of helpful online content and activities for Christian homeschooling families.