|Disorders of attention, usually combined under the term Attention-Deficit
Disorder (ADD), make up a pattern causing the most common
biobehavioral disorder in children. It affects one school-age
child in 20... about two million children at any given time. If you
include adolescents and adults who have outgrown childhood but not
necessarily outgrown ADD, there are 15 million Americans with the
disorder. Incidence is about six times higher in boys than in girls.
Heredity plays a major role, and 25-50 percent of first degree
relatives (mother, father, sister, brother) will also have ADD.
A bare-bones definition of the disorder would include
- Inattention and distractibility
- Hyperactivity and impulsivity
- Problems with:
- Social skills
Everyone at some time has some symptoms of ADD. However, to be of
concern, problems in any or all of these three categories must be great
enough to cause significant impairment at school, at home, with
self-esteem, socially, or at the workplace.
There is no question about the validity or existence of the problem.
All 126 medical schools in the United States have clinics for treating
ADD, and all use stimulant medication of some form. The main public and
professional criticism, often justified, is that ADD is often
incorrectly diagnosed, hurriedly evaluated, or given slipshod follow-up.
Finally, after two years’ study, a large group of prestigious experts
presented the "gold-standard" recommendations for the diagnosis
and treatment for ADD. The first part, guidelines for diagnosis and
evaluation, came out in the May 2000 issue of the Journal of Pediatrics.
We have used almost identical recommendations in our office for years.
This may bring an end to some of the critical publicity in the media
--much of which was written by the uninformed as scare-tactics to gain
circulation. The children who have the classic syndrome of ADD and are
treated are immensely improved. If ADD is even suspected it should
be investigated. It may be one of the most important changes for the
better in the child’s life.
The first consideration in treatment of any disorder is making a
Some important things to remember:
- The primary objective in treating ADD is not merely to improve grades.
We want the child to be able to think of him or herself as a competent
person who likes school, is liked by others, and can learn just about
anything with hard work. We want the children to learn to work smarter,
- The main issue to address is to identify problems, not just
make a diagnosis.
- ADD never exists in isolation: Learning disorders, anxiety,
dysfunctional family situations, immaturity, faulty discipline,
depression, or low self-image may make it much more difficult to weigh
the interplay of each problem on the other.
- It takes about three visits to evaluate the child who is
suspected of having ADD. If the results of the work-up point to ADD
and the child is started on a treatment program, we see the children
at least twice a year and have frequent telephone progress reports.
The child may ask "Why do I have to do all this stuff? Is
something wrong with me?" We explain to the child that everyone
has a special way of learning and that we are going to find out
what his or her special way is, and to make school easier and more
fun. A critical point to remember is that one has to learn how to
learn. Learning how to learn is an art, just like learning to play
the piano or play basketball. In fact, most of our strategy now is to
teach the children how to pay attention, focus (and maintain focus),
listen, remember, and recall. The basic principles of learning apply
to everyone, whether ADD is involved or not.
- The child will be given an initial physical examination, including
baseline height, weight, and blood pressure.
- It is crucial to realize that a combination of psychoeducational
intervention and medication is needed. Neither alone will work.
- Stimulant medications to treat ADD have been the most intensely
studied of all medications used in pediatrics. They have been labeled
as "safe and effective."
- A book, The ABCs of ADD: The basics of Attention-Deficit Disorder
by Dr. Stoutt, is given to the parent(s) on the initial visit. This
book of only 88 pages gives most of the essential information about
the disorder. It is easy to read. The book outlines the entire process
of evaluation and treatment. Defining and demystification of a
complicated disorder such as ADD are of utmost importance.
- Because the diagnosis of ADD is made entirely by history, two
sets of questionnaires are given to the parents and teacher to
complete and return to us. Part of the questionnaires include the
American Psychiatric Association’s criteria as outlined
in the Diagnostic and Statistical Manual of Mental Disorders,
- Most problems that can be defined can be solved. Also, all behavior
has meaning. Any child having difficulties in the classroom should be
evaluated. What are the problems? What is causing them? Do they fit
into a pattern? Learning disorders may be present. Children with
learning disorders are often unable to learn; children with ADD
are unavailable to learn because of lack of focus,
distractions, inattention, hyperactivity, impulsively and so on--all
symptoms of ADD.
- This brief outline is offered as an introduction to ADD and a
description of some of the ways it is diagnosed in our office. The
impressions given by the teacher are probably the best indication of
whether the child needs help in attaining his or her potential.
A treasure trove of information about ADD is in the Web site of CHADD
(Children and Adult with Attention-Deficit Hyperactivity Disorder): Their address is:
8181 Professional Place
Landover, MD 20785