Josh is an eight-year-old third grader whose parents are very upset with their son's behavior. His teachers complain that Josh talks all the time in school, and can never wait his turn when standing in line for any activity. He cannot stay seated and seems to be constantly bothering other pupils. He regularly blurts out answers before his teacher has a chance to finish asking the question. Josh's mother feels like her son is giving her a nervous breakdown. He does not listen to any of her demands, and seems to ignore or forget her requests. Karen is a fourth-grade pupil. She does not bother anyone and sits quietly in her seat. Her teacher is very concerned because she never completes any of her homework. Her friends describe her as a space cadet. In fact, when her mother asks her, she often states that she does not remember that her teacher had given her any homework. Josh and Karen have attention-deficit hyperactivity disorder (ADHD). They are not alone. ADHD is the most common developmental disorder of childhood, affecting 3% to 7% of children and often continuing into adulthood. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR 2013) identifies three patterns of behavior that indicate ADHD. There is the predominantly hyperactive-impulsive type (Josh), the predominantly inattentive type that does not show significant hyperactive-impulsive behavior (Karen) and the combined type (that displays both inattentive and hyperactive-impulsive symptoms). A competent physician such as a pediatrician, child neurologist or child psychiatrist can diagnose ADHD. Many non-medical professionals such as educational psychologists, clinical social workers and clinical psychologists can also evaluate children suspected of having ADHD. Regardless of the specialist's profession, his/her first task is to gather information that will rule out other possible reasons for the child's behavior. Among possible causes of ADHD-like behavior are emotional loss, trauma, learning disabilities, mood disorders such as depression or bipolar disorder or illness. To assess whether a child has ADHD, specialists consider several critical questions: Are these behaviors excessive, long-term, and pervasive? Do they occur more often with this child than they do in other children the same age? Are they a continuous problem and not just a response to a temporary situation? Do the behaviors occur in several settings, rather than appearing only in one specific place like at the playground or in the classroom? In order to be considered ADHD, these behaviors must appear early in life, before age seven, and continue for at least six months. Above all, the behaviors must create a real handicap in at least two areas of a person's life, which may include the classroom, the playground, at home, in the community or in social settings. For example, a child who shows some symptoms, but whose schoolwork and friendships are not impaired by these behaviors would not be diagnosed with ADHD. Nor would a child who seems overly active on the playground but functions well elsewhere, receive an ADHD diagnosis. During the information-gathering period, the child's teachers, past and present, are asked to rate their observations of the child's behavior on standardized evaluation forms, known as behavior rating scales, to compare the child's behavior to that of other children who are the same age. Read: Part II: My child has ADHD. Now what? Experts today believe that ADHD is a neurochemical disorder. Calling the problem an attention deficit disorder is actually misleading, since most ADHD children can concentrate just fine in activities that interest them, whether computer games, sports or interesting conversations. However, these kids struggle to stay focused when the demand or activity, like listening in class, is mundane or not stimulating. Disruptive behavior, hyperactivity and daydreaming are in fact the child's way to compensate for the under stimulation of the specific neurochemical, dopamine that is responsible for attention and staying on task. It is paradoxical that what ADHD children do to make themselves feel more normal are the very same behaviors that get them in trouble with their parents and teachers. Both parents and teachers complicate the matter when they get angry with the child who exhibits hyperactive-impulsive behavior, or with the spacey child who does not listen, since ADHD kids are supersensitive to criticism and disapproval. These children are more likely to become confrontational if they feel misunderstood or rejected. Eventually, they may be labeled as a troublemaker, or in the case of an inattentive child, branded as lazy. There is a need for parents and teachers to understand the biochemistry of ADHD that underpins ADHD behavior, so that they do not blame the child for his or her behavior, and rather try to find more constructive ways to help these children. ADHD children are in fact intelligent, creative and gifted, but often poorly understood. Their sensitivity and difficult behaviors can be channeled in a positive direction that builds good self-esteem. Parents and the educators of these children need guidance and effective strategies to get beyond the mask that covers up these children's positive capabilities. In Part 2, I will write about interventions for parents and teachers that can be very effective in helping children with ADHD. The writer is a marital, child and adult cognitive-behavioral psychotherapist with offices in Jerusalem and Ra'anana. www.facebook.com/drmikegropper; drmikegropper@gmail.com
