Attention-Deficit / Hyperactivity Disorder

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As a preschooler Tim was always on the go. Whether he was climbing and jumping on the furniture, rocking in his chair, running through the house, banging his toys, or talking constantly and loudly, it seemed that his motor was always running at high speed. When he started kindergarten, he was always interrupting other children, he had a hard time waiting in line, and he was too restless to sit for very long. Although his parents and teachers marveled at his energy and enthusiasm, they were exhausted trying to help him sit still, pay attention, and wait for his turn at home and school.

Most children prefer to be on the go, and they would rather learn by moving and doing than by sitting and listening quietly. But when their restlessness and high level of activity far exceed the norm for their age level, then they are showing signs of attention deficit/hyperactivity disorder (ADHD). Children with ADHD are excessively active, unable to sustain attention, and deficient in impulse control to a degree that is unusual for their developmental level (Barkley, 2003). The signs of ADHD emerge early, usually before the age of 7, and they persist throughout childhood and often into adolescence and adulthood. Most children with ADHD show two phases of the disorder (Barkley, 2003).

• First, parents and caregivers notice signs of hyperactivity, usually by the time the child is 3 or 4 years of age. Tim, for example, was showing the classic signs of hyperactivity .
• Second, by age 5 to 7, children with ADHD begin showing signs of inattentiveness. This side of the disorder usually becomes apparent when children begin formal schooling. They have a hard time finishing assignments, staying on task, and following rules and instructions. They can't concentrate; they seem to daydream; and they are disorganized, forgetful, and easily distracted.

As you can imagine, this combination of inattentiveness and hyperactivity can be challenging. As children grow into middle childhood, the hyperactive symptoms tend to decrease, but the attention problems remain. Currently, clinicians recognize three types of ADHD: (1) ADHD—predominantly inattentive, (2) ADHD—predominantly hyperactive impulsive, and (3) ADHD—combined (American Psychiatric Association, 1994).

Although parents and teachers describe as many as one-half of all children as "hyperactive," only 4 to 6% of children actually meet the clinical criteria for some type of ADHD. ADHD rates are three times higher among boys than among girls. About 85% of children with ADHD show either type 2 or type 3: primarily hyperactive-impulsive or hyperactivity combined with inattentiveness (Barkley, 2003; Biederman et al., 2002). The causes of ADHD are not known, but most of the research points to a strong genetic component (Saudino & Plomin, 2007). Problems with areas in the frontal lobes of the brain that are responsible for attention, organization, and the inhibition and control of behavior are likely involved.

Children with ADHD have great difficulty in school. By the time they are adolescents, about 40% of children with ADHD have received some form of special education. One quarter of students with ADHD get expelled from school, 35% are retained at least one grade level, and up to 30% drop out of school (Barkley, 1996). The majority do not go onto college (Barkley, 1998). Although there is little research on ADHD in adulthood, clinicians believe that nearly half of all children with ADHD carry the symptoms into their adult years-and experience significant problems in their work and social relations as a result.

There is no cure for ADHD, but there are effective treatments. Behavior management programs can be helpful to children with ADHD. These programs train parents and teachers to reward children when they cooperate and stay on task and to remove privileges or give timeouts for disruptive behaviors. Behavior management programs work best when parents and teachers apply them consistently in both home and school settings and combine them with medications such as stimulants (Barkley, 1998; Owens et al., 2003).