AD/HD, the most common childhood mental health disorder to date, currently affects 5 to 12% of school-aged children. This means that in a classroom of 25 to 30 children, at least one or two will likely have AD/HD (Canadian AD/HD Resource Alliance).
Even though AD/HD has been around for over 60 years, there is still a lot of controversy about it. Current evidence suggests it is a brain and nervous system disorder that can be passed down from parent to child. Scientists believe some individuals with AD/HD do not have enough chemicals in the parts of the brain that control planning, problem solving and behaviour management.
As a result, studies show people with AD/HD may have difficulty planning ahead, flexible thinking, understanding others’ actions and controlling impulses (National Institute of Mental Health–NIMH).
AD/HD is more than just simple ‘acting out’ and restlessness. Its symptoms cover a range of behaviours, from discreet daydreaming to extreme excitation. Based on the Diagnostic and Statistical Manual of Mental Disorders, there are three main types, each with its own symptoms:
Inattentive: difficulty focusing on a task, listening and following instructions, excessive daydreaming, procrastination and losing things.
Hyperactive-impulsive: over activity, often without prior thinking, difficulty sitting still and working quietly, interrupting and intruding on others.
Combined: symptoms of both inattention and hyperactivity-impulsivity.
Not all children who are overly inattentive, hyperactive or impulsive have AD/HD. Most children daydream, blurt things out, are disorganized and forgetful, and can focus on fun activities such as video games but lack focus when it comes to routine tasks such as homework or chores. To tell the difference between a child ‘just being a child’ and a child with AD/HD, several key questions must be considered:
Are these behaviours appropriate for the child’s age? Some level of motor restlessness or ‘day dreamy’ behaviour is expected in all children. However, behaviour that is too impulsive or inattentive for a particular age may be suggestive of AD/HD.
Are these behaviours seen in more than one situation? The problems related to AD/HD tend to appear regardless of where the child is, with similar problems often being seen both at school and at home. After all, skills such as listening, following instructions, planning ahead and not interrupting are important everywhere, not just at school.
Are these behaviours ongoing? Some problems may surface in response to a difficult event, such as a stressful family situation. Ongoing or more chronic difficulties may be more suggestive of AD/HD.
Are these behaviours causing problems in more than one area of life? AD/HD is a pervasive disorder, typically affecting more than one area, including school functioning, family relationships and peer relationships. Children with AD/HD often suffer from lower grades which can have a negative impact on self-esteem and self-confidence. Also, children with AD/HD often display disruptive behaviours which can lead to rejection from class peers and frustration between family members.
Are these behaviours due to other existing conditions? As with any disorder, it is important to rule out the effects of co-existing disorders, which seem to occur more commonly with AD/HD. Unfortunately, the likelihood of co-existing disorders with AD/HD is high. For example, dyslexia (a reading and writing learning disability) is likely to occur in about 40% of children with inattentive AD/HD. Many children with AD/HD may also show symptoms of oppositional defiant disorder (overly aggressive and disobedient behaviour).
As there are many common misconceptions about AD/HD, we need to know what it is – as well as what it isn’t. Some common myths about AD/HD include:
There is no such thing as AD/HD. The existence of AD/HD is well supported, with reliable evidence coming from research on human behaviour, genes, the brain and brain chemicals.
Only boys have AD/HD. Boys tend to outnumber girls in referrals, as boys are more likely to have the hyperactive-impulsive type, which is easier to spot than the quieter child who is inattentive. However, in adults, the proportion between women and men with AD/HD is almost equal. Therefore, many girls are being missed or ignored (Dr. Kathleen Nadeau – Understanding Girls with ADHD).
People with AD/HD are just lazy. Based on research, people with AD/HD are quite motivated to do well, but often lack the skills to help them accomplish what they set out to do.
Sugar and additives may cause AD/HD. Research does not support the idea that increased sugar in the diet causes AD/HD. Some research does suggest a possible relationship between food additives and increased hyperactivity, but this is mostly seen in AD/HD children with food allergies or sensitivities to certain food preservatives or dyes.
Children with AD/HD will outgrow their condition. While many children with AD/HD do improve with age, as many as 80% will continue to have symptoms into their teens. Over 60% will still show some symptoms as adults (CADDRA), and this may contribute to various other problems, including anxiety, depression and unemployment.
Parents can be easily overwhelmed about what to do next. Does your child need medication? Are there any ‘natural’ treatments available? What about training programs to boost brainpower? Examine all options carefully, and weigh the pros and cons of each.
Medication. A lot of media attention focuses on the negative side effects of medication for children. Unfortunately, many of these stories only focus on the ‘dramatic side effects, which are very rare, yet contrary to media reports have been very well researched, documented and shared.’ (Heidi Bernhardt, Director of the Centre for ADHD Awareness, Canada). In the case of AD/HD medication, it is not a ‘one size fits all’ scenario, so it may take some time for the doctor to find the best fit for your child.
Remember – medication does not cure AD/HD. Its effects may only last as long as the child is taking it. Discuss available options and potential side effects with your family physician or psychiatrist before making any decisions about medication.
Natural remedies. Many parents ask about natural remedies, such as omega-3 fish oil, to enhance focus and concentration. There is a lot of confusing information about these types of therapies. Again, speak to your physician about alternative options and the associated risks and benefits.
Brain training programs (e.g. Biofeedback). Some positive results have been seen with the use of CogMed and some biofeedback brain training programs. However, because many of these are relatively new, it’s too early to determine whether the skills learned can be consistently moved from the training environment to the school environment. For more information about a particular program, contact the program provider.
Psychological, social and academic support. Various other support systems and strategies are available for individuals with AD/HD and their families. These include: academic organizational skills; specific academic remediation; social skills training; individual psychotherapy; parent training; family therapy.
For more information about AD/HD, contact Dr. Karen Ghelani, Clinical Psychologist, Chrysalis Centre for Psychological and Counselling Services. Tel: 905.752.6789, Ext 101.
Canadian AD/HD Resource Alliance (CADDRA); caddra.ca
Centre for ADHD Awareness, Canada (CADDAC); caddac.ca
Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD); chadd.org
Learning Disabilities Association of Ontario; ldao.ca