Overview of Attention Deficit Hyperactivity Disorder

Foster and adoptive parents frequently hear from physicians that a particular child has Attention Deficit Hyperactivity Disorder (ADHD). The diagnosis itself does not educate us as to what ADHD is, what it means for a child, or how it will impact our families. It is my sincere hope that this training module will support you as you work to find appropriate help for your child or children. I know how frazzled parents of children with ADHD can be at the end of a day. I hope you can find some quiet time to read through this material so you can think about how you can apply the information to your family.

If you will click on [Overview] (at the top of this page), you will be able to read information I have written about ADHD. Because there are several excellent sources for current information about ADHD on the web, I have provided many links to those sources. You may read all of them, or choose to read those topics you may need help with right away and return to read the rest on another day. If you conduct your own web search, be aware that there are some sites on the web that include out dated information that perpetuate myths and try to undermine sound medical treatment for children with ADHD. In the content of some web sites, you will find claims that have no scientific research as support. Most of the sites that are problematic usually try to sell you something - either services or products. I have carefully selected sites with credible information so that we can start our discussions from the same information base.

One of the most important concepts that I hope you will keep in mind as we look at information on ADHD (Attention Deficit Hyperactivity Disorder) is that this condition has been and is presently being researched extensively by professionals in many different fields. There are a lot of things that we know about ADHD, but there are certainly many things that we do not know about ADHD. What you learn about ADHD today may provide a building block for new understanding for tomorrow's research, or it may be completely replaced with better or more complete information in a few months or years. It is important that parents keep updated on new research on ADHD. The more you know about ADHD and how it affects your child, the better prepared you will be to parent effectively!

ADHD is a disorder of numerous inconsistencies. You may find numerous statements and descriptions of children with ADHD that describe your child perfectly; but you may also find statements and descriptions of children with ADHD that do not describe your child at all. As researchers are finding different abilities in children, all labeled ADHD, you will become aware that some children are very hyperactive, while others are quiet and under active. Some children with the ADHD label have serious behavior problems and have few friends, while others have rarely caused problems for parents or teachers and are well liked. Some children with ADHD may have specific learning disabilities, while other children with ADHD are gifted students. We must all remember that our child with ADHD is first of all a child who needs our love and understanding support. The more we learn about this disorder, the more we can help.

After reading some basic information about ADHD, you may want to return to this page and then go to the discussion page. If you have questions about any of the readings, or comments about any of the materials you find about attention deficit disorders, please let me know. We can learn from each other!

J. MARLENE SNYDER, Ph.D.


J. Marlene Snyder, Ph.D. is an independent educational consultant from Whitefish, Montana. If you think you have seen her before, you probably have! Marlene is a native Nebraskan and previously was the Curriculum and Human Resource Specialist at the Center on Children, Families and the Law at the University of Nebraska - Lincoln (UNL). Marlene was a member of the Nebraska Humanities Council Speakers Bureau and has delivered many presentations throughout the state as Clara Bewick Colby.

In 1989, as a volunteer parent, Marlene founded CH.A.D.D. (Children and Adults with Attention Deficit/Hyperactivity Disorder) of Southeast Nebraska and served as its coordinator for six years. She served on the National CH.A.D.D. Board of Directors from 1992-1997. She conducts teacher training entitled, Accommodating the Child (Teen) with Attention Deficit Disorders for elementary school teachers and Teaching Teens with ADHD for secondary school teachers. Dr. Snyder provides consultation to school administrators and elected school board officials regarding the school district's responsibilities to students with ADHD. She has also provided training about attention deficit disorders for child protective service workers and foster and adoptive parents. Dr. Snyder also presents Unique Challenges, Hopeful Responses; Youth with Disabilities in the Juvenile Justice System to people working in the justice system. This training module explores ADHD and other disabilities relative to the juvenile justice system

What is Attention Deficit Hyperactivity Disorder (ADHD)?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiologically based disorder that impacts an individual's learning and behavior. Specifically, the disorder may involve attention deficits, impulsivity, hyperactivity, mood swings, low stress tolerance and difficulty in following rules. It is a hidden disability which often impacts upon an individual's performance in the early school years, college and throughout life. ADHD is not the result of poor parenting, inadequate teaching, laziness or emotional disturbance. It is frequently mislabeled, misdiagnosed and misunderstood.

Typically, children with ADHD have problems in following through on instructions. Parents often comment that these children don't seem to listen even when they are being spoken to directly, but will hear a whispered secret from an upstairs room! Children with ADHD are often poorly organized and lose things. They rarely seem to plan ahead, or consider the consequences for their actions. They are easily distracted or forgetful. They have trouble starting tasks, attending to details, staying with a task, and finishing tasks. They seem to lose interest quickly. On the other hand, Nintendo games or a favorite television programs, or something they are interested in can hold their attention for hours!

Some children with ADHD are constantly in motion and are often described as Fidgety Phils. They sometimes talk constantly, intrude on others' conversations, or impulsively say whatever comes to their minds. Individuals with ADHD have trouble waiting for their turn in games and often ignore the rules. These children are often shunned by their peers. Even though parents try to teach good social skills, and the children know what they are to do, the child has problems doing what they have been taught.


Good Sources of Information:

There are two national membership organizations that provide excellent information for parents and professionals working with families who are experiencing ADHD.

CH.A.D.D. (Children and Adults with Attention-Deficit/Hyperactivity Disorder) CH.A.D.D. works to improve the lives of individuals with ADHD through family support and advocacy, public and professional education, and encouragement of scientific research. CH.A.D.D. sponsors local chapters throughout the United States. They publish ATTENTION! magazine and the Chadderbox Newsletter four times a year. This site also includes information about legislation and public policy issues that are important to families and individuals with ADHD.

ADDA (Attention Deficit Disorder Association)This site provides information and support primarily to adults and young adults with ADHD. This web site offers extensive information through interesting general articles and interviews.

How is ADHD diagnosed?

ADHD (Attention Deficit Hyperactivity Disorder) should be diagnosed only by a qualified health professional who is experienced in working with ADHD. This person may be a neurologist, psychiatrist, pediatrician, a general medical practitioner, a clinical social worker, or a psychologist. Sometimes families may be alerted to the possibility of ADHD by a school psychologist. It is very important that the individual be knowledgeable about ADHD and have experience in working with families with ADHD.

A comprehensive evaluation should include: ADHD (Attention Deficit Hyperactivity Disorder) is a diagnosis applied to children and adults who consistently display certain characteristic behaviors over a period of time. The most common core features include: In order to meet diagnostic criteria, these behaviors must be excessive, long-term, and pervasive. The behaviors must appear before age seven, and continue for at least six months. A crucial consideration is that the behaviors must create a real handicap in at least two areas of a person's life, such as school, home, work, or social settings. These criteria set ADHD apart from the normal distractibility and impulsive behavior of childhood, or the effects of a hectic and over stressed lifestyle prevalent in our society.

The diagnostic criteria characteristics and sub-types of ADHD are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). After years of study, DSM-IV has made it official that there are subtypes of ADHD. There is ADHD with hyperactivity called the Predominately Impulsive Type, and there is ADHD, Inattentive Type, without any evident hyperactivity or impulsivity. We now know as many as 40 percent of all people with ADHD are not hyperactive. In the past, children as well as adults with this condition were frequently criticized for their inattentiveness and failures, but they were rarely diagnosed.

A good discussion about what causes ADHD can be found on the Causes page of the ADDA web site.

ADHD Treatments

Clinical experience has shown that the most effective treatment for ADHD (Attention Deficit Hyperactivity Disorder) is a combination of therapy or counseling for the child to learn coping skills and adaptive behaviors, education of parents about the disorder and behavior modification training to handle the child's behavior, medication (when necessary), and educational accommodations for the child at school.

Medication is often used to help normalize brain activity, as prescribed by a physician. Stimulant medications are commonly used in treatment because they have been shown to be most effective for most people with ADHD (Attention Deficit Hyperactivity Disorder). Other medications such as antidepressants and anti-hypertensives may also be used at the discretion of the physician. For a discussion of medications used in the treatment of ADHD, go to the Child Development Institute's Attention Deficit Hyperactivity Disorder Medication Information.

A word about medications: It is important that Foster and Adoptive Parents understand the different kinds of medications given for ADHD. As a part of cost containment, generic medications are automatically given to those receiving services as a state ward. Be aware that some people have experienced the generic stimulants to be effective at first and their effectiveness seems to wane. Pharmacists will insist that the generics are exactly the same as the brand names, but many families using medications for treatment of ADHD have experienced widely varying differences.

In too many instances, there are reports of Foster Parents, Adoptive Parents and Biological Parents deciding that the child must not have ADHD because the medication is not working. The diagnosis and treatment may be correct, but the use of a generic medication that is not effective for that particular child may be the problem. Parents must constantly monitor behaviors and carefully watch how a child reacts to the medications prescribed. It is not uncommon for children with ADHD to have to change amounts of medication frequently as they grow. Several kinds of medication may need to be tried to find the best one for the child. Overrides for filling a specific brand name instead of a generic medication can be secured from the prescribing physician. Parents need to communicate with prescribing physicians often.

If the child is a positive responder to medication, many physicians are now prescribing medications to be used on the weekends and during summer vacations as well as during the school year. Dr. Jim Souterfield has conducted research on the social well being of children using medications for ADHD (Attention Deficit Hyperactivity Disorder) and has found that they are more able to participate in classroom and extra curricular activities, have more friends, and have more social success than those who do not use the medications. The use of medication may be a quality of life issue for children with ADHD.

Parenting Children with ADHD

Parenting a child (or children) with ADHD (Attention Deficit Hyperactivity Disorder) can be an overwhelming experience! For many foster and adoptive parents, managing behavior of these children can be frustrating and exhausting. Even though you may have raised other children without problems, these children require a lot of attention and need much more consistent discipline. For some pointers, please see The National Deficit Disorder Association for tips on living with ADHD.

Parenting a child or children with ADHD (Attention Deficit Hyperactivity Disorder) is hard work. The best way you can learn to do this is to learn all that you can about ADHD and how it impacts your child. The best advice for parents of children with ADHD is from Dr. Russell Barkley. I have often used his guidelines for parenting children with ADHD in workshops for teachers as well.

If there were ever children that needed good, consistent parenting and educated family support, these children are it! Dr. Robert Brooks did a research study where his research assistants shadowed children with ADHD through a typical day. The results of this study showed that 80 percent of the interactions these children had with other people in their environments (parents, siblings, bus drivers, teachers, community people, and peers) were negative interactions. When the study was repeated with children that did not have ADHD, 80 percent of a child's interactions with others were positive. Please think about this simple, yet profound study for a moment. How would you feel if four out of five people you had contact with during the day were negative contacts? Is it any wonder that children with ADHD have poor self esteem and often give up? Our most important job as a parent is to help keep this child's self esteem intact; to build upon their strengths, and to build resiliency within the child.

Parenting foster or adoptive teenagers with ADHD (Attention Deficit Hyperactivity Disorder) can cause extra confusion for parents. It is sometimes difficult to determine what behaviors are characteristic of adolescence, or attention deficit disorder, or struggles with the issues of adoption or separation from biological parents. Parents may need additional support from counselors, teachers, and caseworkers during particularly turbulent times.

This is also the time in the child's life that they must learn how to advocate for themselves when they need accommodations from teachers in junior and senior high school. Teens need to learn about ADHD and how it impacts them. Parents of children with ADHD will find occasional people (other parents, relatives, or professionals) who are very quick to reject the idea that ADHD exists at all. Some well meaning people have gotten misinformation from irresponsible media or commercial publications and will be quick to criticize parents of children with ADHD.

Unfortunately, when families need extended families the most, sometimes grandparents, aunts, uncles and others can be overly critical of a child's behavior and the parents' attempts at managing difficult children. Many families of children with disabilities report being isolated and that family holidays are especially difficult. Some tips on managing holidays.

ADHD and School

School is often the environment that is the most difficult for children with ADHD. It may be that the schools may have been the first to note your child's behavior as being problematic or a cause for concern. When you stop to think about the skills needed for school success, it is easy to see why children with ADHD have problems in that environment.

To be successful in school, children must: CH.A.D.D. (Children and Adults with Attention-Deficit/Hyperactivity Disorder) has a list of 50 tips for classroom management of attention deficit disorders. Even though this list was written for teachers, parents can use the same ideas at home.

Most authorities now believe the key symptoms are far more complex than the term Attention Deficit Hyperactivity Disorder implies. The attention features of the disorder reveal more typically inconsistency rather than deficiency. ADHD involves not only impairments in attention and behavior control, but a wide variety of cognitive functions which affect organizational skills.

Most children (and adults) with ADHD have difficulty with the concept of time. Many researchers report that children with ADHD have great difficulty with executive skills. These skills include planning ahead, time management, and the ability to break tasks down into manageable segments so that a project or an assignment reaches completion. Children with ADHD rarely speak about their plans for the future unless they are prompted. Rarely do they prepare for school tests on their own. Children with ADHD seem to live in the moment without regard for impending academic doom!

ADHD is recognized as a disability under federal legislation (The Rehabilitation Act of 1973 - Section 504; the Americans with Disabilities Act; and the Individuals with Disabilities Education Act - IDEA). Appropriate and reasonable accommodations can be requested if a child is failing school requirements or needs the accommodation to work more efficiently and productively.

CH.A.D.D. Has a discussion of legal rights and services for children with ADHD. If you are needing help in learning about these laws and how to advocate for your child, please contact:
PTI Nebraska (Parents Training and Information)
3135 North 93rd Street
Omaha, NE 68134

or call (800) 284-8520
A technical assistance document entitled, Guide for Educators and Parents in Nebraska Public Schools; Section 504 of the Rehabilitation Act of 1973 is available from:
Nebraska Department of Education
301 Centennial Mall South
P. O. Box 94987
Lincoln, NE 68509-4987

Phone (402) 471-2471
A free copy is available upon request. The document contains information for parents and includes examples of accommodations which can be requested in the regular classroom for students with disabilities such as ADHD (Attention Deficit Hyperactivity Disorder).

New Research Findings

Without doubt the most important "new" developments pertaining to ADHD (Attention Deficit/Hyperactivity Disorder) has been the now-widespread recognition that this is a condition which does not somehow go away at the end of childhood or adolescence. In more than half of the diagnosed childhood cases, significant symptoms continue into adult life and may be as severe at age 45 as they once were at age 5 or 10. It is evident the classical "hyperactivity" seen in most ADHD children is less and less prominent as they age, but severe impulsivity and inattentiveness not only often continues in force, but in many adults gets worse and even more impairing. This finding can have great impact in the work place for undiagnosed or untreated adults with ADHD.

Another important advance in our understanding of ADHD (Attention Deficit/Hyperactivity Disorder) is recognition of the familial nature of the condition. While only 10 years ago there were few studies of the genetics of ADHD, there are now hundreds, and the Human Genome Project is actively pursuing the identification of genes which govern development of this condition, and when one carefully looks at cousins, aunts, uncles and other extended family ADHD is far more prevalent than in the general population.

A further advance, during the past few years, is the growing recognition that ADHD, Tourette Syndrome (TS), and Obsessive Compulsive Disorder (OCD) are evidently, to some extent, genetically linked. In the course of evaluation of an ADHD child, it is common, for example, to find an OCD older sibling, and uncle with TS, a parent with OCD/TS, and a grandmother with ADHD/OCD. When the clinician then carefully evaluates cousins, a sprinkling of these related conditions is often quickly identified.

As a foster parent, you may be asked to interact with the biological parents of a child you are fostering. It may be helpful to keep in mind that this parent may also have behavioral characteristics of ADHD. For example, they may impulsively say things without thinking, forget scheduled meetings, or may seem distracted during meetings. To be helpful, case managers should give a written reminder of the scheduled meetings, as well as a follow-up phone call as a reminder for the best chance of meetings being held as scheduled.

For additional information about Directions for ADHD Research, see the ADD (Attention Deficit Disorder) Association's Research Directions page.

Summary

With adequate information about the range of disabilities common among children, adoptive and foster parents can provide meaningful interventions, appropriate accommodations and emotional support to more positively help children. Each youth manifests a disability in ways that are unique to that individual, so there are no definitive one size fits all responses as to "What can we do?"

Many children with ADHD (Attention Deficit/Hyperactivity Disorder) may also have additional coexisting disabilities, compounding the challenges experienced by foster and adoptive parents. Combined with the impact of other risk factors in a foster or adoptive child's life, it is often difficult to identify, diagnose, treat disabilities and respond to them effectively and consistently. Parents need to build a team of professionals upon whom they can depend for professional advice, and a group of friends they can turn to for emotional support.

Long term studies of resiliency - finding out how some people have withstood incredible adversity and uncertainty in their lives, and still came to a positive outcome as an adult, repeatedly show the importance of just one adult in their youth, who believed in, advocated for, and stood by the child in their youth. Foster and adoptive parents have an incredible opportunity to be that all important person in a child's life.

It is my sincere hope that this information and our future discussions will help foster and adoptive parents and case managers to be more encouraged and enabled to more effectively act to help their children learn how to handle the challenges life with ADHD will certainly bring.