What Does It Mean for Parents and Families when Their Child is Diagnosed with ADD or ADHD?
By Anne S. Robertson
"What is ADD and ADHD?"
Some specialists estimate that anywhere from 3-10% of school age children are affected by attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) (Goldstein, 1992; Rief, 1993). Behavioral characteristics of attention deficit disorder include: being easily distracted, difficulty listening and following directions, difficulty focusing and sustaining attention, difficulty concentrating and staying on task, inconsistent performance in school (some say the one common aspect of ADD ADHD children is that they are "consistently inconsistent"), being tuned out or "spacey," disorganized or having poor study skills, and difficulty working independently (Reif, 1993). Children with ADHD may have characteristics similar to a child with ADD, but ADHD children may also demonstrate impulsive behaviors, a high activity level, difficulty with transitions, being easily over-stimulated or aggressive, social immaturity, a high frustration level, and low self-esteem (Rief, 1993).
All children may have some of these behaviors, at an age-appropriate level, or during a transitional phase, such as after the birth of a new baby in the family. However, the ADD ADHD child will show a pattern, over a period of years, of having a number of these characteristics at levels that are not situation- or age-appropriate.
The scientific study of the ADD ADHD condition has been extensive although the name has changed over the past few decades. In the past, children who have had signs of this condition have been labeled as fidgety, minimally brain damaged, hyperkinetic, or having minimal brain dysfunction (Goldstein, 1992). The American Psychiatric Association outlines the criteria for defining ADD ADHD, including the presence of at least 8 of 14 behavior characteristics (Wodrich, 1994).
The diagnosis of ADD ADHD should not be made quickly. It should include information from a variety of significant adults in the child's life including the parents, teachers, physician, and psychologist who specializes in the field, as well as input from the child. It may also be helpful to have a learning specialist involved since ADD ADHD children frequently have special education needs such as giftedness or difficulty in math. As research continues, some specialists are encouraging people to think of ADD ADHD not as a disorder, but simply as a different style of learning which, when supported, can enhance the student's innate abilities.
It is not unusual for ADD ADHD children with high intellectual abilities to go undiagnosed until middle school or junior high since they have learned how to compensate enough to "get by" in elementary school (Goldstein, 1992). When a student is diagnosed later in life, research shows that elementary teachers reports had often attributed these students inattention and inconsistencies to boredom, laziness, or behavior problems. However, the increased demands of secondary school make it difficult for even the brightest student to keep up both academically and socially. An accurate evaluation with appropriate support becomes essential for these students to help them fulfill their potential and increase their self-esteem, which may have already been damaged by behavior problems or poor social relationships.
"Could I have prevented ADD ADHD in my child?"
When parents have a child with any type of problem, it is not unusual for the parents to feel guilty or blame themselves. Parenting education and support has been shown to be very helpful for families with an ADD ADHD child and its value cannot be overemphasized (Goldstein, 1992; Rief, 1993). However, as scientists and medical professionals learn more about the possible causes of this condition, there is growing evidence that parents likely had little control over the cause of ADD ADHD (Rief, 1993; Wodrich, 1994; Goldstein, 1992). The following are commonly accepted as the most likely causes:
- Heredity/Genetic predisposition: Another member of the family--grandparent, uncle, aunt, etc.--had a similar temperament or pattern of behavior.
- Biological/physiological causes: Possible chemical imbalance that inhibits the efficiency of the neurotransmitters of certain portions of the brain.
- Lead poisoning: Ingesting toxic levels of lead, either by mouth or absorption.
- Allergic/medical conditions: Predisposition toward asthma, food allergies, and ear infections.
- Pregnancy/birth complications: Premature birth, lack of oxygen, or history of prenatal exposure to drugs/alcohol.
- Brain injury: Present in a very small number of ADD ADHD children.
- As researchers continue to look at the causes of ADD ADHD, continued advances will likely be made so that the diagnosis will not be confused with other unrelated conditions.
"Will it go away?"
It was previously thought that the majority of children outgrew many characteristics of ADD ADHD by adolescence. Many parents and teachers felt that if they could just get their child through the elementary school years then ADD ADHD issues would diminish. It is now clear that as many as 75% of ADD ADHD youngsters will continue to have problems related to attention deficit throughout their adolescence and into adulthood (Wodrich, 1994). While the adolescent may not be as conspicuously hyperactive as a younger child, he will likely still struggle, in excess of the normal teenage experience, with impulsiveness and inconsistency, which will affect school, family, and peer relationships. This may become particularly problematic during unsupervised times with peers, and during a stage when parents, teachers, and society in general have increased expectations of adult-like behaviors.
As many as 65% of children who struggle with hyperactivity will still have some ADHD characteristics as adults, and a much smaller number, 25%, will continue to have significant difficulty related to ADD ADHD during adulthood (Wodrich, 1994; Goldstein, 1992).
"What can be done now?"
Some of the information and statistics about hyperactivity can be worrisome. It is important for parents to remember that the majority of adults with ADD ADHD are successful, contributing members of society. But it also clear that there are several non-medical factors that can affect that outcome. These factors include early diagnosis and treatment, intelligence, family status, friends, activity level, ability to delay rewards, aggression, and parenting style (Goldstein, 1992).
Once an assessment has determined that a child has ADD ADHD, it is important that a comprehensive plan of treatment be developed. Effective management at school, within the family, and within peer relationships is important. Most experts recommend a three-step plan that involves the school environment, home environment, and medical support.
Parents can meet with the teacher and the district's special education coordinator to request an Individualized Educational Plan (IEP) for their child that will address the child's need for academic or behavioral support. Parenting education and support is a critical component to consistent management. Key elements to parental support include: understanding, distinguishing between noncompliance and incompetence, giving positive directions, and fostering success (Goldstein, 1992). While some ADD ADHD children do not need medication to help with managing their condition, many others do during some stage in their life. Parents need to investigate the alternatives available for their child and when medication would be helpful.
Drs. Sam and Michael Goldstein suggest the following ways of encouraging success for your hyperactive child (Goldstein, 1992):
- Educate yourselves.
- Exercise effective management strategies at home.
- Foster parental unity.
- Develop positive parent-child relationships.
- Maintain family stability.
- Cultivate good friends.
- Get and use problem-solving training.
- Work toward school success.
- Do not ignore nonhyperactive problems.
- Seek appropriate medical treatment.
- Occasionally reviewing these areas and maintaining consistent progress for your ADD ADHD child in all categories will help with management.
"How will this affect our family and our other children?"
The impact that the ADD ADHD child may have on the family will vary greatly depending on the extent that the child is affected, the family culture, and other siblings. If the family culture and the parents place a high value on activities and athletic prowess, then it is likely that a very active child will be admired and given appropriate outlets for physical activity. The same may be true of an intensely emotional child in a family that values dramatics and the arts. However, it may be very difficult for a highly active or intense child if the family culture is more sedate or less vocal. In a situation where the childs behavior is significantly different than family expectations, it is easy when problems arise for the ADD ADHD child to become the family "scapegoat." Understanding how the family culture can change to positively impact the childs temperament is an important goal of parenting education.
Also, any parent with more than one child knows that children within the same family can have vastly different personalities. Under the illusion of "fairness," parents often feel that siblings should be treated identically, have the same rules, and aspire to similar expectations. There is evidence to suggest that parents shouldnt be quite as concerned about equal treatment since children do understand, and think it is all right, when parents treat them differently (Kowal, 1997). Learning to understand and respect the different strengths in your children, and encouraging their individual development, will likely help the siblings respect and accept each other.