ADHD

Grand Traverse Children's Clinic, P.C.

3537 W. Front St.<= /st1:address>, Ste. G

Traverse City, MI 496= 84

(231) 935-8822

<= /span>

Attention Deficit Disorder (ADD)

What is ADD?

ADD is a disorder that affects 3% to 5% of children. Children with ADD often have problems with attention span, hyperactivity, and impulsive behavior. ADD is also called ADHD (Attention Deficit and Hyperactivity Disorder). ADD is more common in boys than in girls.

A normal attention sp= an is 3 to 5 minutes per year of a child's age.&= nbsp; Therefore, a 2-year-old should be able to concentrate on a particular task for at least 6 minutes, and a child entering kindergarten should be ab= le to concentrate for at least 15 minutes.&nb= sp; (Note: A child's atten= tion span while watching TV is not an accurate measure of his or her attention span.)

•    A child with ADD has tr= ouble listening when someone talks, waiting his turn, completing a task, or retur= ning to a task if interrupted. (Th= ese can be normal characteristics of children less than 3 or 4 years old.)

•    80% of boys and 50% of = girls are also hyperactive. A child= who has symptoms of hyperactivity is restless, impulsive, and in a hurry.

•    50% of children also ha= ve a learning disability. The most common learning disability is an auditory processing deficit (that is, they have difficulty remembering verbal directions). However, the intelligence of most children with ADD is usually normal.

If you suspect that y= our child has a short attention span, ask another adult (a teacher or day care provider, for example) if they have observed this also.

What is the cause?

Attention deficit dis= order (ADD) is the most common developmental disability. "Developmental" means th= at the disability is caused by delayed brain development (immaturity). This delay results in poor self-co= ntrol, requiring external controls by the parents for a longer period of time. Often this type of temperament and= short attention span is hereditary. A small percentage of children with ADD are reacting to chaotic home environments, but in most cases the parents' style of child-rearing has not caused the disability. Minor = brain damage has not been proven to be a cause of ADD but scientists are conducti= ng research into this area.

Similar conditions=

Disruptive children, children who don't mind, and aggressive children are sometimes included und= er the broad category of hyperactivity. Many problem 2-year-olds are considered "hyperactive." These children should be looked up= on as children with behavior problems and approached with appropriate discipline techniques.

How long does it last?

Children with ADD can improve significantly if parents and teachers provide understanding and direction and preserve the child's self-esteem. When these children become adults,= many of them have good attention spans but remain restless, have to keep busy, a= nd, in a sense, have not entirely outgrown the problem. However, not only does society lea= rn to tolerate such traits in adults, but in some settings the person with endless energy is prized. Children wi= th severe ADD may need vocational counseling as adults.

When should I call my child's health care provider?=

Call your child's hea= lth care provider for referral to a child psychiatrist or psychologist If:

•    Your child shows unprov= oked aggression and destructiveness.

•    Your child has repeated accidents. =

•    Your child has been sus= pended or expelled from school.

•    Your child can't make o= r keep any friends.

•    You have "given up= " hope of improving your child.

•    You can't stop using ph= ysical punishment on your child.

•    You are at your wit's end.

What can I do to help my child?

Attention deficit dis= order is a chronic condition that needs special parenting and school intervention. If your child s= eems to have a poor attention span and is over 3 years of age, these recommendat= ions may assist you in helping your child. Your main obligations involve organizing your child's home life and improving discipline. Only af= ter your child's behavior has improved will you know for certain if your child = also has a short attention span. I= f he does, specific interventions to help him learn to listen and complete tasks ("stretch" his attention span) can be initiated. Even though you can't be sure abou= t poor attention span until your child is 3 or 4 years of age, you can detect and improve behavior problems at any time after 8 months of age.

1.     Accept your child= 's limitations.

Accept the fact that = your child is intrinsically active and energetic and possibly always will be. The hyperactivity is not intentional. Don't expect to eliminate the hyperactivity but merely to bring it u= nder reasonable control. Any criti= cism or other attempt to change an energetic child into a quiet or model child w= ill cause more harm than good. No= thing helps a hyperactive child more than having a tolerant, patient, low-keyed parent.

2.     Provide an outlet= for the release of excess energy.

This energy can't be bottled up and stored. Daily outdoor activities such as running, sports, and long walks are good outlets. A fenced yard helps.= In bad weather your child needs a recreational room where he can play as he pleases with minimal restrictions= and supervision. If no large room= is available, a garage will sometimes suffice. Your child should not have too many toys, for this can cause him to be more easily distracted from playing with= any one toy. The toys should be s= afe and relatively unbreakable. Encourage your child to play with one toy at a time.

Although the expressi= on of hyperactivity is allowed in these ways, it should not be needlessly encouraged. Don't initiate roughhousing with your child. Forbid siblings to say, "Chase me, chase me," or to instig= ate other noisy play. Encouraging hyperactive behavior can lead to its becoming your child's main style of interacting with people.

3.     Keep your home we= ll organized. =

Household routines he= lp the hyperactive child to accept order. Keep the times for wake-up, meals, snacks, chores, naps, and bed as regular as possible. Try to k= eep your environment relatively quiet because this encourages thinking, listeni= ng, and reading at home. In gener= al, leave the radio and TV off. Predictable daily events help your child's responses become more predictable. ADD symptoms are= made worse by sleep deprivation and hunger.&nbs= p; Be sure your child has an early bedtime and a big breakfast on school days.

4.     Try not to let yo= ur child become fatigued. <= /span>

When a hyperactive ch= ild becomes exhausted, his self-control often breaks down and the hyperactivity becomes worse. Try to have yo= ur child sleep or rest when he is fatigued.&n= bsp; If he can't seem to "turn off his motor," hold and rock hi= m in a rocking chair. <= /span>

5.     Avoid taking your= child to formal gatherings.

Except for special occasions, avoid places where hyperactivity would be extremely inappropriate and embarrassing (such as churches or restaurants). You also may wish to reduce the nu= mber of times your child goes with you to stores and supermarkets. After your child develops adequate self-control at home, he can gradually be introduced to these situations. Be sure to praise your child when = he plays independently rather than interrupting you when you are talking to gu= ests or are on the telephone.

6.     Maintain firm discipline.

These children are unquestionably difficult to manage. They need more carefully planned discipline than the average child.<= span style=3D'mso-spacerun:yes'> Rules should be formulated mainly = to prevent harm to your child and to others.&= nbsp; Aggressive behavior, such as biting, hitting, and pushing, should be= no more accepted in the hyperactive child than in the normal child. Try to eliminate such aggressive behaviors, but avoid unnecessary or unattainable rules; that is, don't expe= ct your child to keep his hands and feet still. Hyperactive children tolerate fewer rules than the normal child. Enforce a few clear, consistent, important rules and add other rules= at your child's pace. Avoid cons= tant negative comments like "Don't do this," and "Stop that."= ;

7.     Enforce rules with nonphysical punishment. =

Physical punishment suggests to your child that physically aggressive behavior is OK. We want to teach hyperactive child= ren to be less aggressive. Your child needs adult models of control and calmness. Try to use a friendly, matter-of-f= act tone of voice when you discipline your child. If you yell, your child will be qu= ick to imitate you.

Punish your child for misbehavior immediately. When= your child breaks a rule, isolate him in a chair or time-out room if a show of disapproval doesn't work. The time-out should last about 1 minute per year = of your child's age. Without a time-out system, overall success is unlikely.

8.     Stretch your chil= d's attention span.

Encouraging attentive (nonhyperactive) behavior is the key to preparing your child for school. Increased attention span and persi= stence with tasks can be taught at home. Don't wait until your child is of school age and expect the teacher = to change him. By age 5 he needs= at least a 25-minute attention span to perform adequately in school.

Set aside several bri= ef periods each day to teach your child listening skills by reading to him. Start with picture books, and grad= ually progress to reading stories. Coloring pictures can be encouraged and praised. Teach games to your child, gradual= ly increasing the difficulty by starting with building blocks and progressing = to puzzles, dominoes, card games, and dice games. Matching pictures is an excellent = way to build your child's memory and concentration span. Later, consequence games such as checkers or tic-tac-toe can be introduced.= When your child becomes restless, stop and return for another session later. Praise your child for attentive behavior. This proc= ess is slow but invaluable in preparing your child for school.

9.     Buffer your child against any overreaction by neighbors.&nbs= p;

Ask neighbors with wh= om your child has contact to be helpers. If your child is labeled by some adults as a "bad" kid, it= is important that this image of your child doesn't carry over into your home life. At home the attitude th= at must prevail is that your child is a good child with excess energy. It is extremely important that you= not give up on him. Your child mu= st always feel loved and accepted within the family. As long as a child has this accept= ance, his self-esteem will survive. If your child has trouble doing well in school, help him gain a sense of succe= ss through a hobby in an area of strength.&nb= sp;

10. From time to time, get away from it all.
Exposure to some of t= hese children for 24 hours a day would make anyone a wreck. Periodic breaks help parents to to= lerate hyperactive behavior. If just= the father works outside the home, he should try to look after the child when he comes home, not only to give his wife a deserved break but also to understa= nd better what she must contend with during the day. A baby sitter one afternoon each w= eek and an occasional evening out can provide much-needed breaks for an exhausted mother. Preschool is another helpful option. Parents need a chance to rejuvenate themselves so that they can continue to meet their chi= ld's extra needs.

11. Utilize special programs at school.=

Try to start your chi= ld in preschool by age 3 to help him learn to organize his thoughts and develop h= is ability to focus. However, you should consider enrolling your child in kindergarten a year late (that is, = at age 6 rather than 5) because the added maturity may help him fit in better = with his classmates.

Once your child enters grade school, the school is responsible for providing appropriate programs = for your child's attention deficit disorder and any learning disability he might have. Some standard approache= s that teachers use to help children with ADD are smaller class size, isolated stu= dy space, spaced learning techniques, and inclusion of the child in tasks like erasing the blackboard or passing out books (as outlets for excessive energ= y). Many of these children spend part = of their day with a teacher specializing in learning disabilities who helps improve their skills and confidence.

If you think your chi= ld has ADD and he has not been tested by the school's special education team, you = can request an evaluation. Usuall= y you can obtain the help your child needs with schoolwork by working closely with the school staff through parent-teacher conferences and special meetings. Your main job is to continue to he= lp your child improve his attention span, self-discipline, and friendships at home.

12. Medications are sometimes helpful.<= span style=3D'mso-spacerun:yes'>

Some stimulant drugs = can improve a child's ability to concentrate.&= nbsp; You may want to discuss the use of drugs with your child's physician. In general, medica= tions should not be prescribed before school age. They should also not be prescribed= until after your child has been evaluated by a doctor and a school psychologist or special education teacher, an individualized educational plan (I.E.P.) is i= n effect at school, and you have followed the suggestions in this handout. Medications without special educat= ion and home management programs have no long-term benefit. They need to be part of a broader treatment program.

Written by B.D. Schmit= t, M.D., author of "Your Child's Health," Bantam Books.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis = or treatment by a healthcare professional.