Connecticut 

Baby & Child Magazine   April, 1998

Attention Deficit Disorder in Children

By Ron Weinstein

Over the past few years, there has been an enormous amount of both positive and negative exposure regarding attention deficit disorders. Unfortunately, much of this information is confusing to parents whose child has been diagnosed or who they may suspect to be ADD/ADHD. Many parents are also concerned because they see themselves in their children.

We live in a society that produces ADD-like behaviors. Our lives are saturated with stress which produces anxiety making us less able to concentrate, more distracted, impulsive and overwhelmed. There are times when some of us just can't sit still. We need to keep in mind that these are normal human behaviors, but for someone with ADD they are the rule, rather than the exception, they are often inappropriate and have been or are on their way to becoming a serious problem. If undiagnosed or ignored, the problems we often see are academic failure, drug and alcohol abuse, depression, anxiety, compulsive behaviors (including gambling) and job and relationship failures.

Imagine living in a world where sounds, images, and thoughts are constantly shifting. You get bored easily, yet it's difficult to keep your mind on tasks you need to complete. You get distracted by unimportant sights and sounds, and your mind drives you from one thought or activity to the next. Sometimes you get so wrapped up in your thoughts that you don't notice when someone speaks to you and it may be hard to tear you away from something you are doing. You may be unable to sit still. To everyone who knows you, it seems you exist in total disorganization or in the midst of frenzied activity. However, on some days and in some situations you can seem "fine". This often leads others to think that you can actually control these behaviors. For many people, this is what it's like to be ADD.

It's easier to understand ADD by looking at it not as a problem with paying attention, but rather as a difficulty controlling impulses. The urge to act immediately is not being inhibited. For example, one of the most crucial events in the evolution of the human species was developing the ability to wait. Individuals who are ADD don't lack the ability to wait, but their difficulty with inhibiting their behavior affects their ability to wait. 

"Why doesn't he learn from his mistakes," is commonly heard from frustrated teachers and parents. There is a process to learning. While individuals with ADD have no problem with learning, they have a problem with the process of learning.

If you can wait, you can hold a thought, an idea, a suggestion, or an experience in your mind. It becomes fixed. You can analyze it and it becomes part of your memory bank. If you can't wait or stop your response, then the information doesn't remain in your mind long enough to make an impression. Then you can't reflect on or benefit from past experiences and you wind up doing the same thing over and over again. 

"She isn't motivated to do the work," is another statement commonly heard. This difficulty with impulse control also affects the ability to postpone immediate gratification. For example, most non-ADD kids can stick with an unpleasant task if there is a reward at the end. In ADD, the reward must be in the task itself, not after it. As a result, telling children or adults to try harder is futile. Rather, the motivation needs to be built into the task itself. Since everything is happening now, telling someone with ADD that the reward will be a vacation in 6 months is pointless.

 "She's always been so emotional. She makes big deals out of the smallest things!" If you're able to wait, you can be objective and examine something without immediately responding emotionally. If you don't wait, you will continue to be emotional, and will have difficulty separating facts from feelings. Those with ADD are usually more emotional over the entire spectrum, from happy to sad; and they feel their emotions more intensely than non-ADD people.

"She doesn't stop talking. It's driving me crazy!" At 3-4 years of age we develop internalized speech which is necessary for self-control. You can talk to yourself in order to control what you are doing. With the inability to "hold on to that thought", ADD children are 'chatty' and much of their conversation deals with the present, not the future. Their thoughts only become "real" when they hear themselves speak.

A major complaint I hear from schools is that more children seem to be diagnosed with ADD than ever before. That statement is true for at least two reasons. The first reason is that more people are aware of ADD than ever before. The second reason is that ADD is overdiagnosed due to inadequate evaluations. There are many things that can produce ADD-like behaviors. Anything from allergies, chronic fear to mild seizures can make a child seem overactive, quarrelsome, impulsive, or inattentive. A chronic middle ear infection can also make a child seem distracted and uncooperative. So can living with family members who are physically abusive or addicted to drugs or alcohol. Such children may be showing the effects of other problems, not necessarily ADD.

Also, during certain stages of development, many children tend to be inattentive, hyperactive, or impulsive--but do not have ADD. Preschoolers may have lots of energy and run everywhere they go, but this doesn't mean they are hyperactive. And many teenagers go through a phase when they are messy, disorganized, and reject authority. It doesn't mean they will have a lifelong problem controlling their impulses.

An inadequate assessment results in inadequate treatment. Although some people think that they can diagnose themselves by reading a book or using a checklist, the assessment of ADD, especially for adults, is neither clear cut nor simple. It must be comprehensive enough to rule out other conditions that may have "ADD-like symptoms" and should include information gathered from numerous sources. 

The use of medication, especially Ritalin, has received a great deal of negative press in the past few years — some of it warranted, some not. While the use of medication is useful in many situations, I too often hear parents complain that their child seems to be drugged, or is becoming irritable or depressed, or has lost his appetite. However, the reason for this is simple — the medication being used is usually not being prescribed, monitored or evaluated properly. Furthermore, the parents are rarely educated or informed about the use of medication or alternatives, let alone about ADD. 

The first step to a fulfilling life is acceptance. Many educators and parents frown upon the use of a label. For someone with ADD, the label is important since ADD defines who you are, how you respond to the world and often, how the world responds to you. While we talk about acknowledging and accepting the great amount of diversity in our population, we need to accept the fact that this also includes individuals with a "hidden disability" called ADD. All parents need to support their children, understand them, build on their strengths and assist them in their areas of weakness. If they can accomplish this, their children will become everything they are capable of being.

This article is from an upcoming book by Ron Weinstein. He has been working with children, adolescents and adults with ADD/ADHD for over 15 years. For more information  send an e-mail.