ATTENTION DEFICIT/
HYPERACTIVITY DISORDER:
A DIFFICULT DIAGNOSIS

Many parents of children who have school-related problems have been told by teachers that their children may have attention deficit disorders. Parents struggle with whether or not to ask physicians to provide medication for the problem and are not sure how to determine if their children truly have the disorder. Teachers are also often uncertain whether or not to suggest that an attention disorder may be at the root of their students’ problems. The problem is exacerbated because the symptoms of Attention Deficit-Hyperactivity Disorder (ADHD) may be caused biochemically, environmentally, or both. Actual diagnosis of this disorder should be made by a qualified and experienced professional. Psychologists, psychiatrists, pediatricians, or counselors are typically trained to make an ADHD diagnosis. To further add to the problem of diagnosis, it is even possible for professionals, with the pressure to shorten consultations, to overdiagnose and overprescribe medication for attention deficit disorders.

ADHD SYMPTOMS

It’s important for parents to know what symptoms to look for because communicating their observations will be important to their doctors for diagnosis. After all, parents see their children regularly and can observe them under many conditions. There are two types of Attention Deficit-Hyperactivity Disorders: inattentive and hyperactive-impulsive. The characteristics of both types are listed in the next section. The greatest problem with the characteristics is that they also describe many normal children. As a matter of fact, they seem almost typical, so it’s important not to make the mistake of assuming your children have Attention Deficit-Hyperactivity Disorder unless:

• THEY SHOW MANY OF THESE SYMPTOMS.
• THE SYMPTOMS ARE EXTREME.
• THE SYMPTOMS BEGAN BEFORE AGE SEVEN.
• THE SYMPTOMS ARE PRESENT IN MORE THAN ONE ENVIRONMENT (LIKE HOME AND SCHOOL).

To add to the confusion, there is absolutely no biological test for Attention Deficit-Hyperactivity Disorders. Observation checklists based on the characteristics of the disorder are administered to parents and teachers, and the results are reviewed by an appropriate mental health professional. It is also helpful to observe children in their school environment. When an objective professional compares the child’s behavior to that of other children and also notices the positive and negative attention the child attracts, it can help to determine if the child’s symptoms are caused biologically or environmentally.

OTHER CAUSES OF THE SYMPTOMS OF
ATTENTION DEFICIT-HYPERACTIVITY DISORDERS

In order to determine if your child has a true attention deficit disorder, it is important to be aware of other life events that may produce similar symptoms, such as allergies, inappropriate school curriculum (e.g. an undiagnosed learning disability or lack of challenge), too much positive or negative attention at home or school, traumatic experiences at home (e.g. divorce, illness, accident), extreme sibling rivalry, parents’ extreme leniency, giving children too much power, inconsistency between parents, or parents’ lack of follow-through.

You may wish to make some changes in your home environment before seeking professional help. Below is a list of potential changes you can make at home:

• Structure your child’s time positively.
• Encourage your child’s interests.
• Minimize roughhousing.
• Eliminate violent television and computer games.
• Provide appropriate and stimulating outlets like sports.
• Communicate with and support schools.
• Avoid saying negative things in front of the child about him or her.
• Compromise with your spouse for consistency.
• Follow through firmly with appropriate consequences.

Medication should not be used for diagnosis. Normal children may also improve their attention with Ritalin, but should not have it.  If the problems continue, consult a mental health professional who will work with you, your child, and the school. Be sure the mental health professional has knowledge and experience in the field of attention deficit disorders and does not have a reputation for overdiagnosing the disorder.

ADHD AND MEDICATION

If your child is diagnosed by a mental health professional, the child can be treated with behavioral psychotherapy and a stimulant medication such as Ritalin or Adderall. However, don’t hurry to your doctor to ask for medication even if your child’s characteristics match those on the list. Try behavioral changes first. Medications can have side effects such as sleeplessness and loss of appetite. Furthermore, there is no long-term research that finds that children's achievement improves. The medications should only be used with careful supervision by a physician. For some children who have severe symptoms, medication can be very helpful for both control of attention and impulsivity. Remember, medication alone is not enough. You and your children also need good advice to make some changes.

TEACHER SUGGESTIONS FOR CHILDREN WITH
BEHAVIOR PROBLEMS OR ADHD

Use moderate praise words to encourage your children when they behave well. The praise should be geared to the characteristics you’re trying to encourage (e.g. gentle, kind, caring, sharing, good-thinking, loving, good helper, persevering, good concentration, creative thinking, etc.). Extreme praise may backfire.

Inappropriate behavior should be handled privately. Overt negative comments will only trigger more negative behavior. Although it isn’t always possible to ignore or signal children privately without drawing negative attention, it will be helpful.

Refer to my book Why Bright Kids Get Poor Grades - And What You Can Do About it (Scottsdale, AR: Great Potential Press, inc, 2008) for instructions on when to use time-out in the classroom (p. 364). It’s helpful to explain to children when they're in a good frame of mind about how you plan to use the time-outs. You can also permit them to use time-out voluntarily if they feel they need a little time to themselves. Quietly escorting them to time-out will be appropriate if they’re out of control. Be sure that they understand that it is your way of helping them to get themselves under control and that it won’t be for very long. If the child has hurt another, have them apologize to the child privately after time-out.

It’s also possible to use a sticker or star system for the good days children have. The stickers can be awarded at home where they can be placed on a calendar or in a sticker book so children can see their improvement. Again, this sticker system should be private with absolutely no class attention. Don’t ask the class to help the child with his or her problems; it seems to make children's problems worse.

Using positive signals is another helpful way to encourage children's concentration. Explain to children that you're watching how well they concentrate and pay attention. When you notice them working hard, you might wink your eye at them or scratch your head (pick one). Although no one else will know, they’ll know that you’ve noticed their good behavior. They’ll feel as if you're watching for good behavior and it should increase.

Adapted from:

How to Parent So Children Will Learn by Sylvia Rimm, (Great Potential Press, 2008)

Why Bright Kids Get Poor Grades and What We Can Do About It by Sylvia Rimm, Great (Great Potential Press, 2008)

©2010 by Sylvia B. Rimm. All rights reserved. This publication, or parts thereof, may not be reproduced in any form without written permission of the author.