Attention Deficit Hyperactive Disorder (ADHD)

In 1998, the National Institutes of Mental Health agreed that attention-deficit hyperactivity disorder (ADHD) is indeed a legitimate psychologic condition even though its definition has not been fully pinned down. ADHD is a syndrome generally characterized by the following symptoms that first occur before the age of seven:

Inattention, Distractibility, Impulsivity, Hyperactivity.

Some experts further categorize ADHD into three subtypes:

Behavior marked by hyperactivity and impulsivity, but not inattentiveness.

Behavior that is marked by inattentiveness, but not hyperactivity and impulsivity.

A mixed type.

There are some issues with these criteria, and arguments exist for both an over- and underdiagnosis of this problem. Defining ADHD is made particularly difficult because one-third of the cases are accompanied by learning disabilities and other neurologic or emotional problems. It is likely that the term attention-deficit hyperactivity disorder will eventually give way to subgroups of problems that include some of these general symptoms. [For more details, see How is Attention-Deficit Hyperactivity Diagnosed? below.]

General Description of a Child with ADHD

Studies now indicate that ADHD can be diagnosed in children by age four. Parents may notice symptoms even earlier. (One mother reported that three days after delivery, nurses were referring to her ADHD son as "Wild Willie.") The classic ADHD symptoms, inattention, distractibility, impulsivity, and hyperactivity often do not adequately describe the child's behavior, nor do they describe what is actually happening in the child's mind. Other behaviors also often coincide with the classic symptoms.

Some experts are focusing on deficits in so-called "executive functions" in the brain as the key to understanding all ADHD behaviors. Such impaired executive functions may include the following:

Inability to hold information in short-term memory.

Impaired organization and planning skills.

Difficulty in establishing and using these goals to guide behavior, such as selecting strategies and monitoring tasks.

Inability to keep emotions from becoming overpowering.

Inability to shift efficiently from one mental activity to another.

Hyperactivity. The term hyperactive is often confusing for those who expect to observe a child racing unceasingly about. A boy with ADHD playin...

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...y coincide with short-term memory problems.) In one study, although children with probable ADHD were able to self-report many ADHD symptoms, they tended to believe they used their time wisely, in contrast to reports by their teacher.

Lack of Adaptability. ADHD children have a very difficult time adapting to even minor changes in routines, such as getting up in the morning, putting on shoes, eating new foods, or going to bed. Any shift in a situation can precipitate a strong and noisy negative response. Even when they are in a good mood, they may suddenly shift into a tantrum if they meet with an unexpected change or frustration. In one experiment, ADHD children were able to closely anchor their attention when they were directly cued to a specific location, but they had difficulty shifting their attention to an alternative location.

Hypersensitivity and Sleep Problems. ADHD children are often hypersensitive to sights, sounds and touch, and complain excessively about stimuli that seem low key or bland to others. Sleeping problems usually occur well after the point at which most small children sleep through the night. In one study, 63% of children with ADHD had trouble sleeping.