Attention Deficit and Hyperactivity Disorder – Condensed

Attention deficit (ADD) and Hyperactivity Disorder (ADHD) is a disorder affecting the child his family, friends and teachers. It is estimated that three to five percent of the school aged children will be  affected with the disorder. The major classes of symptoms classifying ADHD are disturbances in attention, impulse control difficulties as usually seen in specific impulsive behaviors and in some instances, an irritable motor component. In addition to the classic symptoms, certain symptoms seem to accompany the disorder. Those additional symptoms affecting the medical condition of the child, his psychological status, behavior and social interactions all seem to define multi factorial disturbances.  Differential diagnosis defining the source, nature, stability and intensity of the symptoms as well as the  therapeutic horizon are vital to a successful treatment for the child and adults with ADHD. Different symptoms presented by the patient with ADHD are often under estimated and thus lead to only partial diagnosis.  

Conventional diagnosis of the disorder is based on clinical evaluation of all the symptoms present, gathering all the relevant information from parents, teachers and colleagues. As consequences of many internal misleading factors regarding the accurate diagnosis of ADHD, a computerized “continuance performance test” (TOVA) has been developed. Nonetheless, because of specific inaccuracies the test still remains under experimental restrictions. 

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Everything to know about Attention Deficit and Hyperactivity Disorder (AD(H)D)

Attention deficit and hyperactivity disorder is the most abundant disorder referred to neurological, psychiatric or general practitioner's clinics. Among the diverse symptoms presented in ADHD, three major symptoms compose the syndrome, namely attention deficit, impulse control disturbances and a motor component. The motor component is not present in all ADHD cases which can be defined as ADD eliminating the motor component.

The different names attached to ADHD along the years, such as “Brain injury, Hyperkinetic disorder Minimal brain damage (MBD) and Hyperactive child syndrome” represent many years of research trying to understand and resolve ADHD.

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Insufficient attention to notice details

Inability to sustain attention

Difficulties to complete chores

Distractibility (The child is distracted by every stimulus)

“Organizational problems “

The child often forgets things

The child is very talkative and never ends talking

The child is impulsive, “jumps” talks and starts to act in the middle of receiving instruction

Every child presents different "set" of symptoms. Presently it is still impossible to predict the symptoms of any single specific child with ADHD, nor the intensity of the symptoms like any other characteristics of the syndrome. Because of the fact that any predictions are possible to be made regarding ADHD it is still defined as a disorder and not a syndrome.

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Additional symptoms

Specific learning disorders

Speech and articulation disorders

Motor and coordination disturbances

Asthma and different allergies

Bed-wetting

Sleep disorders

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Unknown symptoms of ADHD

Super- or insensitivity to ambient temperatures (Hot or cold). Sometimes the child walks with  T shirt and shorts in cold weather and contrary, walks in sweat shirt in hot weather feeling “cold”.

Super or insensitivity to pain

Super sensitivity to specific odors

Super or insensitivity to “touch”. The child simultaneously shows insensitivity to touch, hugs forcefully and very often, simultaneously, is very sensitive to either human or object touch, takes off cloth, shoes etc.

Tics. Careful investigation of the medical history of the children with ADHD most often reveals an  existing past history of mild to moderate “motor and vocal” tics. Since the tics have passed away after a while, they have been disregarded at the time and the child has been characterized ever since as having ADHD. Since the tics resemble common regular mannerisms, movements and sounds on the one hand and on the other hand they are usually mild in nature they are disregarded and thus under diagnosed. The presence of tics in the medical history of the child, as well as his family members points to the existence of a wider neurological complex or a syndrome. A specific careful differential analysis is recommended to evaluate the etiological roots of the present syndrome, their implications and optimal

therapeutic options.

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Common difficulties found in ADHD

Behavior disturbances

Many of the children with ADHD have very low frustration thresholds causing the children to set for themselves very low standard of behavior and learning. Often the children experience extreme changes in their mood ranging from mild depression and dysphoria all the way to euphoria and hilarious laughter with rage attacks and explosive behaviors. The child’s demands and immediate need to receive gratification annoys everyone and since these behaviors change in frequency and intensity as the days pass, often the behaviors are thought to be intentional or controlled by the child. It should be stated over and over and over again by professionals speaking of ADHD, that these behaviors reside from the neurological and not the psychological “learned “ behaviors of the child and thus being uncontrollable and unintentional by the child. The common question “why does the child behave so well with some people and places and not with others” raised by parents and teachers will be addressed under a different account.

Social problems

Being confused by his own set of unstable feelings ranging from sensitive attitudes and perceptions to being simultaneously totally insensitive, the child with ADHD often reacts with confusing reactions. Such behaviors cause distress to all parties involved including himself. While he reacts with frustration the society will reject his confusing, “strange” behaviors followed with poor communicative capabilities restricting his social interactions with his friends and family. Following such a path the child with ADHD confronts a vicious circle and finds himself often all alone rejected by his friend and peers having no one to talk or play with.

Psychiatric disturbances

Most often psychiatric disturbances reside alongside ADHD. Such psychiatric disturbances include depression ranging from dysphoric sadness to fully depressed children, different fears and specific phobias including “School and zoophobia (animals) phobias” and anxiety attacks.

Learning disabilities

Alongside the above mentioned disturbances, the child with ADHD usually possesses different learning disabilities the child has to struggle with, during his development. Frequently motor coordination as well as graphomotor disturbances are found alongside ADHD making the writing process difficult, forcing the child to invest abundant amount of energy, thus slowing down the process of writing. Visual perception problems impair the reading process and often articulation and speech disturbances are present as well along several other learning disorders which all make learning and

achieving very difficult for the child with ADHD.

Are learning disabilities repairable? Yes!!! – Read all about it in “treatment of ADHD” coming right up.   

The symptoms of ADHD are more intense in situations of monotonous performance required from the child when a high degree of sustained attention is needed. Continuous dull performance without novel stimuli to the child exacerbates the ADHD of the child. Taking such factors into consideration, breaking continuous performance to specific short chores with adaptation to specific daily hours ameliorate the burden of ADHD.  

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Diagnosis of ADHD

Diagnosis of this disorder must evaluate all neurological symptoms along with different physiological, behavioral, social, psychological, psychiatric and schooling factors in order to optimize the relief from ADHD. Toward adulthood, since inherent attention disturbances do not dissipate without medical treatment, occupational and marital considerations ought to be considered in the diagnostic process.

ADHD is diagnosed by either a pediatric neurologist, a child psychiatrist or a child neuropsychologist based on clinical observation of the child suspected of having the disorder and gathering supporting evidence from his family and school.

Trying to quantify the salient symptoms of ADHD a questionnaire was constructed (Conners) and is today still widely in use. Understanding that many of the disorder’s symptoms exacerbate during dull boring chores, a computerized continues performance test (CPT; TOVA) was constructed. Despite all hopes, the test still contains many artifacts restricting its use for the diagnosis of ADHD.

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Advanced diagnosis of ADHD

Novel understanding of the brain’s circuitry and function has lead to better understand the leading factors involved in ADHD and thus further develop a new, scientific, biophysical non-invasive, accurate and reliable method (BDTAK) to diagnose ADHD accurately. The patient performs the test autonomously, at his home setting.

Moreover, the BDTAK enables accurate biophysical monitoring of differential efficacy of the therapy employed leading to better medication adjustments. BDTAK has been tested with patients within the wide age span of 4 to 63 years for different disorders.

BDTAK makes possible to minimize suffering  from the patient and his family by an early, accurate, reliable, time consuming diagnosis.

An optimal treatment of ADHD consists of medical interventions aimed at minimizing the harsh consequences of ADHD inclusive all primary and “secondary” disturbances, and psychological psychotherapy addressing all afflicted angles of the syndrome. 

One should bear in mind that many of the symptoms related to ADHD such as "bed wetting, sleep disorders, specific learning disorders including graphomotor and perception disturbances” could nowadays be resolved.

Taking into account the divers destructive effects of ADHD on the children’s and adult’s development in moderate to severe cases, medication is usually considered.  The most common prescribed medication for ADHD is Ritalin. Besides Ritalin there is an array of medications developed at ameliorating ADHD symptoms. Based on solid scientific documentation, medications has been shown to help attention deficits along with social and different behavioral disturbances. A research conducted in the “Clinic for Advanced Psychology”, specific medications helped specific learning disabilities as motor coordination, graphomotor parameters, eye-hand coordination, visual perception and other afflicted cognitive parameters as well as sleep disorders (Submitted for publication).

Different attempts to help ADHD symptoms with non conventional medication and Restriction Diets testing chocolate, Citrus fruits, different food additives and vegetables from the Succulent family (Tomato) have been reported in non scientific publications to help in sporadic cases with a negligible effects.

While the neurological aspects of ADHD are treated by expert neurologist or a neuropsychologist, the emotional, behavioral and social aspects affected should be handled by an educational psychologist familiar with ADHD. Since the child’s ADHD impose stress on his family members,  the child’s parents should receive proper consultation and care as well.

Additional treatments could be attained via paramedical professionals executing expressive therapy (including art, music, movement, sport, animal etc.) as well as speech and physiotherapist’s.

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Frequently asked questions

Should a child with ADHD be stationed only in special education?

Are medicines a must in treating ADHD?

At what age should a child with ADHD recommended to start receiving medications?

How long should the child stay on medications?

What are the side effects of the medications employed?

Do all medications employed in treating ADHD have side effects?

It should be remembered that despite the destructive effects of ADHD on every day living of the child and adult, ADHD can be overcome with accurate diagnosis and professional treatment!!!.

Dr. A. Kessler, writing this page is a psychologist and a neuropsychologist in the “Clinic of Advanced Psychology”, engaged in treating and consulting patients as well as in clinical research, a member of the Israeli Psychological Association, an affiliate member of the APA and a member of the TIC consortium.