Nearly 8 percent of U.S. children aged 4 to 17 have been diagnosed with attention-deficit hyperactivity disorder; most are being treated with drugs. According to the U.S. Centers for Disease Control and Prevention, boys are much more likely to be diagnosed than girls, especially boys from poorer families.
To be diagnosed with ADHD a child must have six or more symptoms for six months including frequent failure to pay attention in schoolwork or play, frequent mistakes due to inattention to schoolwork, frequent failure to listen when spoken to directly, failure to follow up on chores and forgetfulness.
It’s a wonder so few children are diagnosed.
The quote above is a little loose in terms of the criteria for diagnosing ADD/ADHD. ADD is usually diagnosed by the prevalence of a certain set of behaviors; ADHD adds to those behaviors. ADD is the inattentive, distractable part, ADHD adds hyperactivity and impulsivity. There are separate checklists for both and an additional set of indicators for impulsivity, which is frequently comorbid with ADHD. Note that while all of these behaviors are normal behaviors, what enables the diagnosis is the frequency and intensity of the behavior.
Note also that many of these characteristics are also exhibited by gifted and highly gifted students. On the gifted end of the spectrum, it is often very difficult to separate the diagnosis. In fact, ADHD and giftedness are found in the same individual in a surprising number of instances.
ADD Checklist
a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
(b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace ( not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort ( such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities
Hyperactivity/Impulsivity Checklists
Hyperactivity
(a) often fidgets with hands and feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often “on the go” or often acts as if “driven by a motor”
(f) often talks excessively
Impulsivity
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g. butts into conversations or games)
I wonder what the correlation is between ADHD and parenting. Is there some common denominator among ADHD kids and the way they were raised, the way their families function, the structure of the family? What percentage of boys with ADHD come from single-parent homes, and how does that compare to male children from intact families?
It’d be nice to know how the word “often” is defined in this context since it appears in every one of the indicators for ADD, Hyperactivity and Impulsivity.
The inventories used to support an ADD/ADHD diagnosis use a five choice response pattern ranging from ‘Never” to “Always”. There are two pages of questions, approaching the critical points from different perspectives. Usually, these inventories are provided to each parent and to teachers who have a significant amount of daily contact with the child. Adults can be asked to do self assessments. If the inventories are completed accurately, they can be compiled to get a broad behavioral picture.
As to the correlation between ADHD and parenting. I sense an attempt to blame ADD/ADHD on environmental factors. That’s not really a well-founded view. However, in my opinion, there are correlations between the level of coping skills developed by the child and the degree of understanding and involvement by the parents.
ADD/ADHD is a genetically passed condition, which may skip generations. We don’t understand how that works just yet. But an ADD/ADHD child may be born into an otherwise “normal” family and be the permanent odd man out, or may be born into a family which is predominantly ADD/ADHD. Because ADD/ADHD is a relatively recent diagnosis, many adults with the condition have been branded throughout their lives as “disorganized”, “scatter-brained”, “hyper”, “spastic”, “weird”, etc. Overall, adults with ADD/ADHD tend to fall well short of their potential: educationally, professionally and economically. The combined stress of trying to make things work is rough on relationships and the percentage of single-parent homes could well be higher - I don’t have any figures. But the end result is that a large percentage of ADD/ADHD people are significantly displaced from the roles and positions their abilities would otherwise indicate. For those who identify their ADD/ADHD as adults, it’s tough to deal with, but not impossible. For upcoming generations, the outlook is better if we can get better at helping children learn to recognize what is going on and to develop the coping strategies necessary to function at a high level in modern society.
I am afraid too many parents and educators stop at the medication level. That’s unfortunate. Ritalin and Adderall alone don’t “cure” anything. In fact, there is no “cure” for ADD/ADHD. It is a physical condition, the way the brain is wired. The drugs balance one aspect of that condition, but effect no permanent changes. The key part of making a permanent change is in helping the child/individual learn how to counter the distractibility, the impulsivity, the forgetfulness, the tendency to procrastinate and all the other behaviors associated with ADD/ADHD. The medication is a tool to help with that. If we don’t use it as such and capitalize on developing the necessary coping strategies, then all we are doing is deferring failure and making life easy for the system until they bump on out of school and into the real world.
Dave, I appreciate the detailed response. It changes the way I think of ADHD. As one who has suffered from depression/anxiety and found complete relief due to medication, I understand that the wiring in the brain may be off-tilt and that this may be corrected by meds. What prompted my questions was my perception (probably wrong) that ADHD has been on the increase in the last 50 years, making it seem that the cause may have been environmental. However, if it is genetic, and you seem to know what you’re talking about, then I see it more like I see depression, OCD and other psychological aberrancies that are treatable not only by meds but by behavior mod, self-hypnosis, changed thinking, etc. Thanks.