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Types of ADD/ADHD
As more research is carried out on attention deficit disorder (ADD), also called attention deficit hyperactivity disorder (ADHD), the diagnosis becomes more refined. In 2011, mental health professionals use two sets of criteria to make the diagnosis, which may include symptoms of one or the other, or both. The first set of criteria concerns inattention and the second hyperactivity-impulsivity. Your child may have a combined type, predominantly inattentive type, or predominately hyperactive-impulsive type of ADD/ADHD.
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In children, at least six of the following nine symptoms must have been present for at least six months to a degree inappropriate for their developmental level:
- Difficulty keeping attention on tasks or play activities (for example, daydreaming while doing homework)
- Does not pay attention to detail and makes careless mistakes (perhaps in a rush to be the first one done with a math test)
- Loses things needed to complete tasks and activities (can never find the stylus to play DS3)
- Easily distracted (does not pass phone messages because he or she was playing video games at the time of the call, and then the pizza came…)
- Forgetful (cannot remember to go home straight after school and goes to a friend’s house instead)
- Difficulty with organization (toys strewn across the floor but overwhelmed with the task of putting them away)
- Avoids tasks that require sustained mental effort (puts off reading a book for a book report until the last minute)
- Does not follow through with instructions and does not complete schoolwork or chores (circles the correct answers instead of underlining or skips directions altogether)
- Does not seem to be listening even when spoken to directly (called for dinner three times and is still messing around with the piano)
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The first six of the following symptoms deal with hyperactivity, the next three with impulsivity. But, any six of the nine are necessary for a diagnosis of ADD/ADHD:
- Fidgety and squirmy (cannot keep still, drums fingers on the desk, swings legs under the table, continually picks up items to have something to do with his or her hands).
- Leaves seat when expected to stay (gets up to sharpen pencils while the teacher is talking)
- Talks excessively (a chatterbox, requiring your attention and response)
- Difficulty with quiet time (bursts loudly and obnoxiously into song during bedtime routine)
- On the go constantly (running around with the dog, then zooming through the house, then jumping on the bed…)
- Runs, climbs, is on the go at inappropriate times or places (sitting on the back of the pew at church or standing on chairs at school)
- Blurts out answers before questions are finished (“What’s the capital --“ “North Dakota! North Dakota!")
- Interrupts often and intrudes on others (breaks in on others’ conversations or when being spoken to, rudely tries to join a game already in progress)
- Difficulty taking turns (not chosen as the goose in Duck, Duck, Goose but gets up to run around the circle anyway)
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Isn’t This Normal Behavior?
While it’s true that all children display some of these characteristics at one time or another, the overriding factor is that the attention deficit disorder symptoms are present much more than usual and to a greater degree than appropriate for age or developmental level. You might expect a preschooler to have a five-minute attention span but not a kindergartener. By the time a child is 5 years old, he or she should be able to pay attention for 15 to 20 minutes. You may expect younger children to interrupt conversations, but a sixth-grader should be able to control that impulse.
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Stress for Family and Child
Attention deficit disorder makes life challenging for children. They may be intelligent but not capable of earning good grades because they can’t focus on schoolwork. The hyperactive behavior of these children may make them unpopular with their classmates -- and with teachers -- earning them an unfavorable reputation as they advance through school. At home, other problems arise. Being overwhelmed by a messy room can lead to yelling and frustration for both parent and child, and fights may break out between siblings. A certain amount of this type of behavior is normal, but with an ADD/ADHD child, these kinds of incidents happen every day and often multiple times per day. The stress on the family dealing with this disorder can, in extreme circumstances come close to tearing it apart.
Often, children with attention deficit disorder symptoms know they are not behaving appropriately, especially with adults telling them so all the time. They may be distressed because no matter how much they try to pay attention and “be good," they can’t -- the deficit in the executive function of an ADD/ADHD brain makes it almost impossible for them to do so. These children do not understand why they cannot control their actions and impulses, and they are likely to believe the upheaval in the family and the problems at school are their fault. Many adults will believe that too, putting the behaviors down to laziness or defiance. The ultimate result is withdrawn, unhappy children with low to no self-esteem.
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You Can Make a Difference
Understanding the symptoms of attention deficit disorder and why those symptoms occur are amongst the most important things you can do for your child. Understanding leads to patience, and patience is what your child needs. Knowing that his or her behavior is not deliberate and that neither of you is to blame frees you from the “bad parent" and “bad child" guilt. It allows you to consider the choices available to help you and your child live with this disorder. Whether you choose behavior therapy, medication, a combination of the two or another avenue altogether, you will almost certainly be giving your child a better chance at a happy and productive life.
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Centers for Disease Control and Prevention, http://www.cdc.gov/ncbddd/adhd/data.html
A.D.D. Resource Center, http://www.addrc.org/executive-function-and-school-success/
Mental Health: A Report of the Surgeon General, http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec4.html
National Institute of Mental Health, http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml
Centers for Disease Control and Prevention, http://www.cdc.gov/ncbddd/adhd/diagnosis.html