Paying Attention to ADD
By Marisol Montoya
In the classroom, at home or at play, the diagnoses most commonly applied to children with behavioral problems are Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD). These disorders are not a sign of the times, a symptom of our modern, fast-paced, hyper-stimulation era. In the early 1900s, ADD and ADHD were also common, but were explained away as a moral deficit in troubled children. We've come a long way in labeling and recognizing the symptoms now attributed to these disorders, though there is still much more to learn and controversy to address.
What exactly are the symptoms of ADD and ADHD? They include the inability to pay attention and hyperactivity or impulsivity, which show up in making careless mistakes, not listening well, being easily distracted, squirming in your seat, restlessness and incessant talking. These symptoms must last for at least six months to merit a diagnosis of ADD or ADHD. You may be saying, "That sounds like me or that sounds like my child or my neighbor or my friend." Actually, these are characteristics many people may experience at various times because they can also be symptoms of excessive stress, sleep disturbance or a mental or physical ailment.
The discussion of whether ADD/ADHD is a neurological disease or a behavioral problem is controversial and is key in determining treatment. Pharmacological treatment of ADD/ADHD involves amphetamine drug therapy. There is no denying that amphetamine treatment is an effective remedy for inattention and hyperactivity-impulsivity, but some question whether the risks outweigh the benefits. Concern on the part of parents and many child psychologists and medical doctors has created strong opposition to the practice of medicating children and adolescents with amphetamine drugs. The long-term side effects are not yet known and immediate side effects may include irritability, upset stomach, sleep disturbance and addiction. Some suggest that changing a child's brain chemistry during critical stages of development may affect their ability to cope later in life, without dependency on amphetamine drugs, as well as stunt their physical and psychological growth. Because of these concerns, many child specialists believe that behavior modification is the most effective and safest remedy.
The services provided at Casa Mia Ranch in Silver City, using equine and adventure-based therapy, rely on a curriculum whose focus is behavior modification. The hands-on, experiential approach is effective in keeping children with ADD/ADHD engaged. Individuals labeled with either of these disorders do best in a structured yet stimulating environment. Another author wrote of equine therapy, "Many parents of ADHD riders enrolled in a therapeutic program marvel at their child's newfound skills. The riding center may be one of the first places where their child experiences success and acceptance. The motivating lure of the large, gentle animal, the calm and consistent support of the therapeutic riding team, and the naturally accepting environment of the stable provide opportunities for the child to learn and develop. These opportunities may help to turn the often disparaging label of ADD into a child who is Absolutely Delightfully Driven."
ADD/ADHD becomes apparent in children in preschool or early school years because they show signs of uncontrollable behavior and cannot pay attention to the degree that other children do. It is estimated that between three and five percent of children have an attention disorder, or approximately 2 million children in the United States. In a classroom of 24 to 30 children, it is likely that at least one will have ADHD, according to the Learning Disabilities Association of America (LDAA). ADD/ADHD is not considered a learning disability, though it does fall under the Individuals with Disabilities Education Act, which allows students with the disorder to receive special education services in schools.
In school, children who don't have learning disabilities but who are diagnosed with ADD or ADHD are often placed in special-education classes. The social stigma around such placement can become a substantial detriment to their self-esteem as well as interfere with their abilities to adapt to normal classroom structure. In order to keep the child in the regular classroom, a classroom teacher can enact a team-teaching effort, which involves structuring a class in ways that support a child with ADD to succeed. This involves seating arrangement in rows rather than clusters, which discourages distraction from others; allocating a space in the classroom where the children are free to move about and engage in predetermined games or engaging activities; assigning an ADD child a social buddy who is a positive peer model; and scheduling intermittent seatwork with short periods of time spent in the free space. It's also beneficial to have a teacher's assistant.
Children do not outgrow an attention disorder. Adolescents and adults face daily challenges associated with ADD and ADHD, such as problems in interpersonal relationships, substance abuse, depression, anxiety and job loss, which can all lead to serious socioeconomic downfall. Many people with ADD/ADHD who have good social skills and/or high intelligence levels can often overcome the pitfalls of living with an attention disorder.
What causes ADD/ADHD? Many scientists investigating the cause of ADD/ADHD believe it to be a disorder of the frontal lobes of the brain. The frontal lobes are the seat of executive function, which is responsible for the ability to initiate action, sustain activity appropriately, inhibit impulses and shift from one task to the next as needed. Interestingly, head trauma to the frontal lobes mimics the symptoms of ADD and ADHD.
Many conditions may mimic symptoms of ADD/ADHD. Parents and teachers should be aware of these in order to avoid hasty diagnosis and unnecessary medication. According to J.S. Haber, author of The Great Misdiagnosis—ADHD, "Problems, disorders and illnesses that have similar symptoms include: hearing and vision abnormalities, allergies, neurological problems mental retardation, problems with learning and school, various medical illnesses, autism disorders, depression and family altercations and disruptions" A child with vision or hearing abnormalities will not respond to normal sensory stimuli involving hearing and vision and can therefore become inattentive and restless. Learning disabilities such as dyslexia or dysgraphia will interfere with successfully completing schoolwork and can lead to low self-esteem and maladaptive behavior if not recognized. Personality conflicts or bullying in the classroom, if not recognized can lead to withdrawal, anxiety and inattentiveness.
"Several forms of mental illness can begin with symptoms of inattention, increased activity and impulsivity," according to Haber. "These include depression, childhood psychosis, oppositional defiant personality disorders, Tourette Syndrome and autism disorders." Issues at home such as a death in the family, frequent moves, divorce, fighting and substance abuse will affect a child's ability to focus and be attentive as well as producing maladaptive behaviors reflecting family dysfunction. Poor nutritional health or anemia may also produce symptoms, which correlate with ADD characteristics. Research in the New England Journal of Medicine has even reported symptoms similar to ADHD in a group of patients with thyroid disease.
Sometimes events in a child's life can cause sleep disturbance, which may also mimic symptoms of ADD such as nonstop activity, crankiness and impulsivity. Many problems will produce symptoms characteristic of ADD/ADHD lasting at least six months, which may affect a person's ability to concentrate and function appropriately within their environment. These conditions must be recognized and addressed for the mental, emotional and physical health of the child in question.
Child psychologist David B Stein, who opposes the use of stimulant medication, developed and practices the Caregiver's Skills Program. Stein believes that a diagnosis for ADD/ADHD stigmatizes the child and impedes their development; thus Stein created the terms Highly Misbehaving or HM and Inattentive or IA. "The Caregiver's Skills Program (CSP) is a comprehensive parenting approach designed for IA and HM children that teaches you how to bring your child's behaviors under control," Stein writes.
Steven Robinson, director of Casa Mia Ranch, incorporates certain criteria that engage children with ADD and ADHD. One is having simple, yet consistently upheld rules, which the children participate in creating and upholding. The clients at the ranch also take part in developing the consequences for breaking their rules. This technique is emerging as a widely effective means of empowering children as they experience a sense of control and ownership in their own growth process. The issue of self-esteem appears crucial. Throughout the life stages, low self-esteem affecting cognitive development (a person's thoughts and beliefs about themselves and the world) has been shown to produce insidious and counter-productive effects on people with attention disorders. Based on cognitive reasoning, a person's level of self-esteem can influence their capacity to reach their fullest potential.
If you are dealing with a child who has been diagnosed with ADD or ADHD, experience has shown that creating a structured yet interesting environment, being consistent with rules, and allowing for healthy and engaging activities, best supports their learning and development. Showing the child that they are valued and capable of doing good also goes a long way towards developing "A Delightfully Driven" child.
Marisol Montoya is a graduate student at WNMU and