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By Dr. Melissa Fiorito-Grafman
Although it is in a child’s nature to be active, energetic, and curious, there comes a point when parents begin to question whether or not such activity exceeds their child’s age group. The term Attention Deficit/Hyperactivity Disorder (AD/HD) has infiltrated the masses and has sparked the interest of many parents who have questions about what is considered typical development vs. atypical. Clinicians and parents alike continue to debate the reasons for the growing number of children (and adults) diagnosed with ADHD. Some have proposed that it is simply “overdiagnosed.” Others assert that parents are too eager to get their kids evaluated as they are motivated to obtain school related services; and let’s be honest, any child (with or without ADHD) would benefit from extra help. On the contrary, some folks emphasize the advancements in research and medicine as contributing to the increase in the number of children diagnosed. Perhaps, it is a little bit of everything. Despite the reasons for its growing popularity or skepticism, ADHD is a chronic condition that affects many children that often persists into adulthood.
Definition, signs & symptoms:
Ok, before we get started, let’s clear the air about the whole ADD vs. ADHD dilemma. It appears that the change from Attention Deficit Disorder (or ADD) to Attention Deficit/Hyperactivity Disorder (ADHD) has many parents confused; and rightly so. One of the most basic reasons why a change (in the name) was implemented was due to advancements in research that repeatedly identified two (not just one as the original ADD label had suggested) distinct behavioral problems/symptoms thought to characterize Attention Deficit Hyperactivity Disorder. These two dimensions are Inattention and Hyperactive-Impulsive behavior. It is important to note that not all children with ADHD present with both dimensions. That is, some parents get confused with the added term Hyperactive because they think “Well, Jane is inattentive, but not hyperactive, so how could she possibly have ADHD?” So, just to be clear, ADHD is just the umbrella term and it comes along with subcategories that are more specific in describing whether or not your child presents with inattention, impulsivity/hyperactivity, or both. Needless to say, don’t get confused about the added term (hyperactivity) to the title, it’s just their to reflect that the disorder has many dimensions and whether or not your child has one, two, or all the dimensions will be addressed in the subcategory of the diagnosis. So, in other words, when given a diagnosis of Attention Deficit Hyperactivity Disorder, the individual is then given a more specific label to reflect the type of ADHD they actually present with, including:
o Pre-dominantly Inattentive Type
o Pre-dominantly Hyperactive-Impulsive Type
o Combined Type (meaning meets criteria for the two above)
Signs and symptoms of inattention may include, but not limited to:
o Difficulty paying close attention to details
o Trouble sustaining attention and/or listening
o Disorganized, losses things, forgetful, distractible
o Can’t seem to finish tasks
Signs and symptoms of hyperactive and impulsive behavior may include, but not limited to:
o Exhibits excessive activity, when not appropriate
o May be observed talking excessively, interrupting or blurting out anything on their mind
o Appears to be intrusive
o Appears to be restless, fidgets, or is moving around excessively
o Doesn’t think before acting
Whether your child has some or all of the aforementioned difficulties, there are many things to consider prior to labeling a child as having ADHD. For example, let’s say your child begins to exhibit such behaviors on the heels of a divorce. Chances are, their behavior can be better explained by a change in the family dynamics rather than ADHD. If in fact it is a true case of ADHD, it is typically the scenario that behaviors have been present prior to the age of 7, has been persistent for more than 6 months, occurs in more than just one setting, consistently disrupts daily functioning, as well as causes problems with interpersonal relationships. In general, though not exclusive, boys present differently than girls when it comes to ADHD. That is, boys are more likely to be hyperactive, whereas girls more inattentive. Many feel that this is the reason the prevalence rate amongst boys is higher, as boys tend to grab the attention of their teachers and parents as their symptoms manifest more frequently as disruptive behaviors, unlike girls who tend to be more inattentive, so their behaviors are often more conspicuous.
Causes & risk factors:
There appears to be both a genetic component (inherited traits) and environmental factors that, either causes and/or contributes to a child’s behavior. For example, whereas a child may be born with a genetic disposition to ADHD, environmental factors may contribute or worsen their behaviors. Researchers have identified several factors that may play a role:
o Heredity: ADHD has a tendency to run in families
o Altered brain function/anatomical brain structures: while the exact cause of ADHD is still unclear, research has suggested that there appears to be less activity in brain structures responsible for attention.
o Exposure to toxins, drug use and smoking in-utero increases the risk of the offspring to have ADHD and other developmental disabilities.
o Childhood exposure to toxins in the environment, such as lead, is at increased risk of developmental and behavioral problems.
Although ADHD doesn’t cause other psychological or developmental problems, per se, children with ADHD are more likely than other children to also have conditions such as:
o Oppositional Defiant Disorder
o Conduct Disorder
o Learning Disabilities
o Tourette Syndrome
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