Attention Deficit Hyperactivity Disorder (ADHD / ADD)

Attention Deficit Hyperactivity Disorder (ADHD) is also known as Attention Deficit Disorder (ADD) or Childhood Hyperkinesis. It is a problem that is associated with the symptoms of inattentiveness, over-activity, impulsivity or a combination of these. Almost all children manifest behavioral issues from time-to-time but for those children diagnosed with ADHD the behavioral problems need to be persistent and occur over a long period of time. The problems are such that they create great difficulties and challenges in school, home and in their social development. In order for the diagnosis of ADHD to be made, these symptoms must be out of the normal range for the child’s age and developmental stage.

Examples of the problems that this diagnosis brings are a child’s being easily distracted, poorly organized in their homework efforts, experiencing difficulties remaining seated and frequently interrupting others. Depression, sleep deprivation, learning disabilities, tic disorders and behavioral problems may be either confused with or accompany an ADHD diagnosis. Every child suspected of having ADHD deserves careful evaluation in order to sort out exactly what are the contributing factors to the behavioral problems.

ADD is the most commonly diagnosed behavioral disorder affecting an estimated 3-5% of school-aged children and is diagnosed much more often in boys than in girls. The parents of these children present problems with exhaustion and frustration. Neurological imaging suggests that these children’s brains are different from those of other children in that their neurotransmitters operate differently from their peers. The problem has been often found to be genetic and whatever the specific cause, it seems to begin early in life while the brain is developing. The Diagnostic and Statistical Manual (DSM-IV) divides the symptoms of ADHD into those concerning inattentiveness and those of hyperactivity and impulsivity. Children should have at least six attention or activity and impulsivity problems to a degree that would be considered abnormal for children of that age and the symptoms must be present for at least 6 months and observable in at least two settings and not caused by another problem. Some symptoms must be present before age 7.

Problems with Diagnosis:

Problems with diagnosing any sort of behavioral or academic problem in a child are that of overdiagnosis or underdiagnosis. The problem is based in the fact that a child’s brain is changes a great deal over time. If overdiagnosis is the problem a stigmatizing label may be ascribed to an otherwise healthy child. If underdiagnosed, a condition may be left to fester and grow worse with time for a child. Dr. David Axelson, Associate Professor of psychiatry and the Director of the Child and Adolescent Bipolar Services program at theUniversityofPittsburgsaid “Since you’re talking about kids whose brains change a lot over time, illnesses are simply harder to diagnose.” Essentially, there are no lab tests. It’s hard to find a child who’s not hyperactive or short on attention some of the time. In addition, since the diagnosis is more c0mmon in boys, it’s easy to mistake gender typical rambunctiousness for a problem. Undetected hearing or vision problems or common learning disorders may also masquerade as ADHD.

In my psychotherapy practice it was not uncommon for misdiagnoses of ADHD to be made either by armchair psychologist-parents or well-meaning educational personnel. There are specific guidelines for treating ADHD set down by theAmericanAcademyof Pediatrics. There is structured testing available through professionals who deal in these types of problems. Some of the guidelines for treating ADHD are:

  • A complete diagnostic history obtained by a professional from parents should precede any plan or implementation of treatment;
  • Setting specific, age-appropriate target goals to guide therapy;
  • The use of medication and behavioral therapies being started as needed;
  • When treatment hasn’t met the target goals, a re-evaluation of the original diagnosis and/or the presence of other conditions should be made as well as how well the treatment plan has been implemented;
  • Systematic follow-up is important to regularly reassess target goals, results and any side effects of medications.

As a professional on a team of experts in a school system for several years, I was able to work with hundreds of children, parents, teachers and administrators evaluating learning disabilities in children. The age group studied was from Kindergarten through 6th grades with a follow up of these youngsters through high school. Many of the children with learning difficulties were also diagnosed with ADD or ADHD. My main role was to establish programs for these children, both within the school system per se as well as within their homes and communities that would incorporate their involvement rather than isolating them from the general population of children who were so-called “normal.”

The real value of a child is that despite their lack of knowledge, experience and wisdom, they do have a sense of what is good for themselves. Although they may not excel in a classroom setting, they may do so in sports or in possessing other talents such as in industrial arts, etc. I remember a youngster who at the age of 10 was able to take a failed power mower apart and return it to “brand new” condition. I urged his parents to go to junk yards and purchase old motors for him to rebuild and repair. As it turned out, neighbors got wind of his expertise and he was in business as an entrepreneur by the age of 12. He was also an excellent hockey player who particularly enjoyed checking opponents into the boards which was a “legal way” of ridding himself of excess energy. The secret to helping a child with this diagnosis is not to isolate but to begin thinking “out of the box” about ways in which he (usually males) can contribute to society in a manner that provides him a niche that will eventually result in his own personal happiness.

In effect, being careful not to jump to conclusions is very necessary and important in assessing and dealing with symptoms of ADHD or ADD. Parents who have concerns based in their own experience with the child and/or indications presented by the school should consult a professional who is familiar with the CORRECT DIAGNOSIS. ADHD is a long-term, chronic condition and children who have the problem will continue to have troublesome symptoms of inattentiveness and impulsivity as adults. However, adults are more capable of controlling such behavior and masking the difficulties.


Both as a consultant and author, Charles Bonasera’s story-telling have motivated people to change patterns and resolve problems in their lives. All of his books contain valuable, practical lessons that people can easily apply to bettering and managing their lifestyles. He has also written a myriad of articles which can be found on his website at www.charlesmbonasera.com.

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