ADHD: What It Is, What It Isn't

ADHD.

The term rolls off the tongues of anxious parents, doctors and educators with practiced ease, yet its meaning and affect on children is widely misunderstood. That’s partly because research is still homing in on the disorder—really a big basket of symptoms. Some researchers think this basket contains several different disorders. Adding to the misunderstanding, ADHD (Attention Deficit / Hyperactivity Disorder) is often blamed when anxiety, depression or the frustration of a learning disorder is what’s really wrong.

Because educators and doctors may share in the confusion, warns Larry B. Silver, psychiatrist and author of Dr. Larry Silver's Advice to Parents on ADHD, parents have to be strong advocates for their kids. “You have to go in knowledgeable enough to educate your family doctor.”

What to look for

Estimates on the numbers of school age children with the disorder range from 3% to 7%. Is your child one of them? The first step in finding out is to educate yourself about ADHD (ADD is an outdated term). Russell A. Barkley, a psychologist and author of Taking Charge of ADHD: The Complete, Authoritative Guide for Parents, describes the three hallmark symptoms of ADHD; however not every person with ADHD displays all the symptoms:

Hyperactivity, impulsiveness: Think of kids popping out of classroom seats or fidgeting, constantly tapping their fingers and toes—constantly subject to more motor activity than normal. Impulsiveness means they lack the ability to think before acting or speaking.

Distractibility: Kids who have trouble ignoring unimportant sights or sounds. Any noise—birdsong or a car motor outside, what have you—distracts. Some kids over-respond to visual distractions. Say you tell Julie to get dressed, but when you check on her 15 minutes later she’s moved on to something else and has forgotten all about needing to get dressed. These kids can’t follow through from minute to minute.

Trouble focusing: These kids can’t process information quickly. They’re confused by complexity, day dream, can’t attend to the task at hand, are spacey or foggy.


The types—and a big exception

To make a diagnosis, professionals follow the Diagnostic and Statistical Manual for Mental Disorders, which defines three broad types of ADHD:

Combined hyperactive and attention deficit—most ADHD kids are in this category

Predominately inattentive (without significant hyperactivity)

Predominately hyperactive-impulsive (without, at least at this stage of their development, an attention deficit)

These categories weren’t developed by scientists, but were created to help organize symptoms for diagnosis and insurance reimbursement, says Barkley. That’s why there’s a lot of similarity. For the most part, the differences among these types are in the degree or number of symptoms—often because of the age or developmental stage of the child. Kids usually outgrow hyperactivity, but may still be inattentive in school or at home.

There is one big exception. Researchers found that some ADHD children in the “predominately inattentive” category are quite different from all others. In Barkley’s opinion, these kids don’t really have ADHD, but another little-explored disorder. It’s called “sluggish cognitive tempo disorder,” or SCT (sometimes referred to as “ADHD without much hyperactivity: predominantly inattentive type”), though this type still falls under the ADHD umbrella.

What is—and isn’t—ADHD?

Obviously, not everyone who has trouble sitting still and paying attention has ADHD. In fact, according to Silver, the most common cause of those symptoms is anxiety. Second is depression, and third is frustration, often from learning disabilities. (Half those with ADHD have a learning disability, too.)

ADHD is, statistically, only the fourth most common cause of hyperactivity, inattentiveness and impulsiveness, says Silver, who also wrote The Misunderstood Child: A Guide for Parents of Children With Learning Disabilities.

Luckily, identifying the disorder isn’t difficult, but it takes effort. Often parents must push for a thoughtful, thorough evaluation. “There are too many clinicians who forget that there are many reasons for the behaviors,” Silver says. “Often what we do is put them on medication and sit back. They can pay attention, but that doesn’t deal with the learning disability.”

Here’s how to distinguish: With its genetic component, ADHD appears at an early age. Kids have been hyperactive, distracted or had trouble focusing since they were small. Their problems happen in school and on vacation, with friends, with family or when they’re alone. Anxiety, depression and situational frustration, however, are linked to an event (when a child starts first grade, say, or when parents separate or a beloved grandma dies) or to certain circumstances (in class but not at home, or while doing homework but not during baseball practice).

“Parents have to be informed consumers and assertive advocates,” Silver says. “It’s the same with school. If the kid’s not learning, you’ve got to go in and say, ‘They are blaming the victim.’ I have yet, in 35 years in practice, to find the first kid who doesn’t want to please their parents and teachers. So, if they are not, there has got to be a reason.’ ”

ADHD Types, Symptoms and Treatment

Understanding the types of ADHD is crucial to getting the right treatment for your child. The following chart outlines the three main types of ADHD. The second and third columns describe the symptoms, such as ability to focus and hyperactivity. The fourth column briefly discusses suggested treatment.

Understanding therapy options

Psychotherapy provides a patient with unconditional support from a therapist. It often delves into the past for reasons why a child has a particular behavior. This is not often recommended for ADHD patients.

Behavioral therapy focuses on modifying or "unlearning" a maladaptive behavior without delving into underlying causes, such as family or school issues.

Cognitive therapy works to change the way patients think in order to alleviate symptoms and helps them learn effective ways of dealing with the difficulties of their condition.

Type

Attention

Hyperactivity

Treatment

TYPE 1: Hyperactive-Impulsive

Difficulty sustaining attention. Hyperactivity emerges first; the inattention usually doesn’t come out until a couple of years later. Most grow up to be combined type.

Hyperactive, impulsive.

Responds to medication and behavioral therapy may also help in some cases.

TYPE 2: Predominantly Inattentive (problems with attention but without significant hyperactivity)

Difficulty sustaining attention.

Normal activity, without serious impulsiveness.

Responds differently to treatment, depending on the particular subtype.

TYPE 3: Combined Hyperactive and Attention Deficit (classic ADHD)

Little difference between this and Type 1. Attention skips around the room. Trouble sustaining attention. Schoolwork is usually accurate but problems with productivity.

Impulsive, difficulty resisting distractions or sustaining attention.

Responds to medication and behavioral therapy; does not respond well to psychotherapy.

Subtypes of Type 2 ADHD

ADHD Type 2 is the diagnosis for children who are inattentive but not hyperactive. These Type 2 children show different symptoms. Some children may have a milder form, with just inattentiveness (Type 2, Subtype A), while other children’s symptoms might include sluggish, dreamy and unfocused behavior (Type 2, Subtype C).

Each of the four Type 2 subtypes requires different treatment, which often includes medication and therapy.

Understanding therapy options

Psychotherapy provides a patient with unconditional support from a therapist. It often delves into the past for reasons why a child has a particular behavior. This is not often recommended for ADHD patients.

Behavioral therapy focuses on modifying or "unlearning" a maladaptive behavior without delving into underlying causes, such as family or school issues.

Cognitive therapy works to change the way patients think in order to alleviate symptoms and helps them learn effective ways of dealing with the difficulties of their condition.

Type 2 Subtypes

Attention

Hyperactivity

Treatment

Subtype A: Mild form of combined-symptom type with insufficient number of symptoms to meet threshold for diagnosis

Trouble sustaining attention. Schoolwork is usually accurate but problems with productivity.

Impulsive.

Responds to medication and behavioral therapy.

Subtype B: Older children who were probably combined type but have outgrown hyperactivity with age

Not true inattentive type.

Formerly hyperactive, but hyperactivity has lessened as the child has aged.

Responds to medication and behavioral therapy; does not respond well to psychotherapy.

Subtype C: Sluggish cognitive type (or SCT)

Day-dreamy, foggy, easily confused, has trouble focusing. Can’t discern what’s important. Information-processing problems.

Passive, lethargic, hypoactive, not at all impulsive. Shy, withdrawn, passive, uninvolved. Productivity is okay but problems with accuracy.

Does not respond well to stimulant medication; may respond to social skills training and cognitive therapy.

Subtype D: ADHD type but without hyperactivity in adults

Trouble sustaining attention. Work is accurate but problems with productivity.

Not hyperactive and not unusually impulsive.

May respond to therapy; does not respond well to medication.


MSN Health & Fitness - ADHD: What It Is, What It Isn't