Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurobehavioral disorder in children. In spite of high prevalence of this disorder, little is known about how it makes children's behaviors abnormal, and even less about how treatments actually work. Treatment guidelines based on rigorous reviews of the latest science were recently published by the American Academy of Pediatrics.
Overview of ADHD
Children with ADHD have difficulty paying attention to what's in front of them, or what adults think they should focus on. This decreased attention or focus may not be a matter of depth—they may focus quite clearly for a while—but typically not for long. Other thoughts and ideas penetrate their attention, without being suppressed. Often these thoughts are acted on and lead to apparently irrelevant behaviors.
These concepts lead to a classification of three types of ADHD.
- Mostly Inattentive. These children seem bored quickly (unless the subject is entertaining). They are easily distracted, forgetful, and move from one activity to another. They just can't seem to stay focused on a task.
- Mostly hyperactive/Impulsive. These are the squirmers, the children who seem to be constantly in motion, who fidget and can't seem to sit still. These children are often impulsive. They blurt out inappropriate comments. They are impatient, like not waiting for their turn to play. They have emotional lability, showing anger and joy without restraint.
- Combined, showing characteristics of both.
Behavior Therapy for ADHD
Behavior therapy is the first line of treatment for pre-schoolers. It can be important for other ages. There are three general techniques. (1) Positive reinforcement: giving a reward for a child's good performance. (2) Response cost: removing a reward or other benefit as a cost for unacceptable behavior. (3) The Token Economy: The child may earn tokens or other rewards for desired behavior, but loses them for undesirable behavior.
ADHD Runs in Some Families
Tell the child about ADHD as a family trait. It can be an important component of behavioral therapy, Understanding that ADHD is something a person is born with may sooth some guilt (“It’s not something I did”), and helps understanding that undesired behaviors are not intentional, according to Dr. Paul Hammerness, Staff Physician, Pediatric Psychopharmacology, Massachusetts General Hospital (Medscape Psychiatry and Mental Health, Aug. 8, 2011).
The genetics of ADHD are, indeed, quite interesting. It is more prevalent in white than black families. It is as prevalent in Puerto Rican as in non-Hispanic blacks. And it is much less common in Mexican families. It is being diagnosed more often now in the southern USA than other regions, and it is least diagnosed in the West. Some of these differences can be explained by differences in diagnosis by pediatricians, but differences in genetic makeup are probably present as well. (National Center for Health Statistics Data Brief No. 70. Hyattsville, MD: National Center for Health Statistics.2011)
The American Academy of Pediatrics also made specific recommendations about available medications.
James Cooper - I'm on the faculty of a health science department at a large university. Most of my articles derive from conferences or presentations ...
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