By Steve Waksman, Ph.D.
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Approximately 3-5% of all children display a collection of behaviors
psychologists and physicians call hyperactivity, or more recently, attention
deficit/hyperactivity disorder (ADHD). Some of these children are inattentive
(fail to finish projects, don’t seem to listen, or are easily distracted).
Others are impulsive (act before thinking) and hyperactive (on the go or
fidgety). And others are inattentive, impulsive and hyperactive. Such children
tend to get bored much quicker, behave more inconsistently and act more
immaturely than other children their age. Usually parents will notice these
behaviors when their hyperactive child is very young. Teachers who have
a difficult time educating these children identify other children with attention
problems. There is no cure for these attention problems but many techniques
exist for managing and/or changing these behaviors.
What causes attention deficits?
Psychologists and physicians are not sure of all the reasons why
children (more often boys) develop or are born with these behaviors.
These behaviors appear to be genetic and “run in families”, and
are often accompanied
by other learning and behavior problems. Other children with attention
problems experienced severe birth complications or prenatal insults
such as drug
abuse by their mothers. And recently, researchers at the National
institute of mental health have demonstrated that there are abnormalities
in the brains
of some individuals with attention deficit disorder.
There is no
reason to believe that these children will outgrow these behaviors.
Many hyperactive children do tend to get less
active, or less hyperactive, as they grow older, but most still
behave in impulsive,
immature an/or inattentive ways. Children with attention deficits
often need special management procedures as long as they attend
school or live
with their families. Such children have a much more positive
prognosis if they do not develop severe behavior, academic or peer problems.
The combination of attention, conduct and learning problems often
leads to school
early school dropout and/or serious psychological problems.
do we test for attention deficits?
Most young children display some of these behaviors at times. However,
psychologists only consider a child hyperactive or attention deficit
disordered if s/he displays many of these behaviors often and in
(e.g. school, home, community). There is no single test for attention
deficits, and it is not easily diagnosed until children reach school
will usually ask parents and teachers to describe the child’s behavior
using standardized rating scales or checklists, and take a careful
the problems. Psychologists may also make systematic observations
or administer some tests. If children are rated very severely on
scales by both teachers and parents, behave inattentively during
formal testing, and display these behaviors in various settings,
then psychologists will describe the child as attention deficit
disordered or hyperactive.
In most cases a thorough evaluation is necessary to rule out medical,
and/or educational reasons for these or similar behaviors.
How is it treated?
The management of attention deficit disorders involves a variety
and combination of methods. The child’s physician may prescribe
stimulant or psychoactive drugs such as Ritalin, Dexedrine or
Concerta to improve
the child’s attention span and task performance. Such drugs are
not habit forming and produce favorable results in about 70%
of the cases. At times
clonidine or an antidepressant medication is prescribed. Often
the improvements are dramatic, but determining the correct medication
and dosage is not always
easy. Medication alone however, is often insufficient to change
the prognosis of children with attention deficits.
children are able to control their behavior and impulses, and
seem to get along better with their peers.
They are also more easily managed and more responsive to special
education procedures and parental
tutoring. There are, however, unpleasant side effects from
the drugs in about 20% of the cases. Such side effects may include
sleep disturbances, loss of appetite, stomachaches or headaches.
Also the medications
do not seem to improve long-term academic achievement or reduce
antisocial behavior patterns. Ultimately parents and children
along with their physicians
must decide whether the positive effects of the medication
outweigh the negative aspects.
Regardless of whether parents decide to
use medication or not,
attention deficit disordered children require special management
procedures, special counseling, special accommodations, and
often special education
instruction. Special management procedures may include the
use of specific behavioral objectives with rewards, the use of family
the use of appropriate modeling and problem-solving techniques,
the use of specific praise and reprimands, the use of “self
and the use of “token” reward or daily school report card systems.
Such management procedures are needed for both home and school
should be taught and coordinated by a psychologist who specializes
in children and schools. Most parents and teachers are able
to learn these techniques
in several weeks. However, since attention deficit disorder
is a life-long disorder for most individuals, periodic follow-up
sessions or “booster-shot”
sessions are highly recommended.
Children with these attention problems may require some or all
of these procedures during most of their school years. Research
has shown that these procedures and techniques can radically
improve a child’s learning,
behavior and attitude. Parents who learn to implement these
procedures when their child is young have the greatest success.
Parents and teachers who
use these procedures consistently and conscientiously are rewarded
with more positive behavior and less frustration, and learn
to enjoy these children
more. Research studies demonstrate that those ADHD children
and adolescents with behavior and learning problems who receive
services have a much more positive outcome than similar children
who receive medication alone or with brief short-term therapy.
counseling includes information about what attention deficit
disorder is and how it will affect future school, work,
and home life. Appropriate counseling also includes techniques
for parents, teachers and children to
deal with their frustration in managing these behaviors.
Social skills group counseling is also very helpful for children
and practice new social
and peer relationship skills. However, individual psychotherapy
or play therapy is not usually necessary.
ADHD students (and
adults) often require special accommodations or modifications
in their school, work or home requirements.
Such accommodations often include less homework or chores,
shorter assignments or tasks, the
use of tape recorders or computers, additional time to
complete tests or assignments, peer “note takers” and alternative
methods to prove one’s knowledge.
The scheduling of resource room or study skill classes
to allow students extra time to complete assignments or homework
is also very helpful. Just
as physically handicapped individuals are provided ramps
considerations, ADHD individuals need school accommodations.
It’s not only a good idea,
it’s the law! The Americans with Disabilities ACT (ADA,
P.L. 101-336), Section 504 of the Rehabilitation Act of 1973,
and the Individuals with Disabilities
Education Act (IDEA or P.L. 105-17, formerly P.L. 94-142)
clearly require “reasonable accommodations” and a “free
and appropriate” education for individuals
Many children with attention deficit disorders require
special education methods to reach their potential and/or
to control their social behavior in school. To receive
education services, students
must be evaluated and certified based upon federal and
Not all children with attention disorders require special
education services. If a child meets the criteria s/he
would be eligible for free special education
services, such as remediation in reading and basic skills,
placement in a special program or class for part of the
school day and
perhaps a “token” reward system. Many children and adolescents
or are disorganized and do not meet the criteria for
a diagnosis of ADHD. Such children or adolescents would benefit
or behavior management procedures.
Other treatments such as diet therapies appear popular
but have very little support from researchers and experts.
While common sense suggests that parents monitor their
child’s diet, there
is no scientific evidence
that special diets will cure hyperactivity. There is
that some individual children are allergic or sensitive
to certain foods or chemicals. However, there is no
evidence to support
can be treated with diet changes alone and that other
treatments (e.g. medication, behavior management or
school interventions) are not necessary.
also no scientific evidence to support the use of megavitamin
therapy, bio-feedback, visual training, sensori-motor
anti-motion sickness medication,
or low sugar diets.
If you would like additional information about attention
deficit hyperactivity disorder, learning disabilities
or behavior problems,
please call: Steven Waksman, Ph.D., Licensed Clinical
Child Psychologist and Certified
School Psychologist, at (503) 222-4046
Copies of this pamphlet are available from the author at:
2302 NE Tillamook Street
Portland, OR 97212
Copyright 1983, 1991, 1994, 2002 Steven Waksman, Ph.D.
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