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Attention Deficit/Hyperactivity Disorder

Attention Deficit/Hyperactivity Disorder is one of only a few mental health disorders that is more common in children than adults.  Simply stated, this disorder causes individuals difficulty in focusing, due to inattention, distractability, excessive movement, or any combination thereof. 

It is likely the most common mental health concern facing teachers and parents of students in schools today.  Recent studies show that about one student in every classroom will be diagnosed with having a condition known as Attention Deficit/Hyperactivity Disorder (abbreviated as AD/HD or ADHD)  Specifically, the National Institutes of Health report states that as many as 1:20 students have this disability (the DSM-5 concurs, stating 5% of students have some form of ADHD.)  However, the Centers for Disease Control states that around 11% of the student population has ADHD.  It's generally agreed that boys are more likely to be diagnosed than girls (between two to six times as often).  Let's take a closer look at this disorder and I'll offer some professional guidance about school-based treatment to help curb the effects of this disorder.

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Types of ADHD:

According to the DSM-IV-TR, ADHD is classified into three types.  Therefore, when a student is diagnosed with ADHD, they must also be identified as having one of the the three subtypes of ADHD.  Simply saying that a student has ADHD says little about the particular characteristics of their behavior, unless the subtype of ADHD is also known.  Those three subtypes of ADHD are listed here: 
  • Primarily Inattentive Type: Refers to students who demonstrate a lack of attention to the task at hand.  Some may be seen as easily distractable, while others may be seen as not focused on anything.
  • Primarily Hyperactive Type: Refers to students who demonstrate inappropriately high levels of engagement in off-task behaviors, are overly energetic, or may seem incapable of staying at rest for even short periods of time.
  • Combined Type: As the name suggests, these students demonstrate characteristics of both of the above mentioned types.  They can be off task for a variety of reasons; one minute it could be a complete lack of focus on the teacher, while the next minute they could be repetitively nudging the teacher to request permission to sharpen a pencil.

Gender Differences:

The easiest way for me to explain the differences between males with ADHD and females with ADHD is simply to ask the question, "does the child demonstrate inattention or hyperactivity?"  While it's certainly not 100% reliable, girls with ADHD are often diagnosed as ADHD (inattentive), while boys are often diagnosed as ADHD (hyperactive).

For the girls that are hyperactive, as they grow older it is not uncommon for them to demonstrate a greater ability to control their impulsivity and excitability.  However, families and teachers must be aware that girls with this type of ADHD may begin to internalize many of previously externalized signs of anxiety.  Girls with this type of ADHD have been shown to have an increased risk for self-injury and even suicide as they age.

ADD vs. ADHD:

I may be asked the question, "what's the difference between ADD and ADHD?" 

The short answer is: there is no such thing as "ADD".

Attention Deficit Disorder (ADD) no longer exists, at least in clinical literature.  This historical diagnosis has been merged into ADHD, although many lay people still refer to ADD as a separate diagnosis.  If you were to search the web for ADD, you'd certainly still find results, yet those will likely link to ADHD information, rather than to antiquated information about ADD.   If you do happen to find information about ADD, keep in mind that it is now outdated information, since ADD is no longer a clinical diagnosis. Be cautious with any professional organization that still refers to ADD, rather than to ADHD.  [In case you didn't make the connection, ADHD (Inattentive) took the place of ADD].

Treatment Options:

I'm happy to report that ADHD is one of the easiest-to-treat mental disorders, and boasts a high rate of treatment success.  A review of today's treatment options for ADHD are fairly straightforward.  Students (and adults) with ADHD have the following three avenues to pursue.  There is plenty of evidence for the effectiveness for each of these options.  I'll explain some highlights of each method, below.

  1. Psychotropic Medication

    1. By far the most common treatment of ADHD is the use of psychotropic medication. (Ritalin was one of the first medications prescribed for this purpose - and is still used some today.)
    2. The benefits of medication are easy to describe: it's relatively simple to get a prescription for these drugs, they are quickly taken orally (or via a topical patch), and these medications are often paid for by insurance companies. 
    3. Very importantly, this method has repeatedly been proven effective at remediating the effects of ADHD.
    4. Generally, psychostimulant medications are the first line of treatment.  If stimulant medications aren't effective for a child, a clinician may prescribe another type of medication.
    5. Remember, as with most types of medication, there are possible side effects.

  2. Behavioral Therapy

    1. A second treatment for ADHD is through a series of psychological consultations and cognitive-behavioral therapy. 
    2. Often conducted by a clinical psychologist, the student learns techniques to identify and combat the effects of ADHD. 
    3. A benefit to this type of treatment is that the child is often able to learn to manage their ADHD symptoms for life, without continued reliance medication. 
    4. Negative aspects of this type of treatment are both time and money. Generally, these training sessions occur for 8-16 sessions with a psychologist, with rates sometimes as high as hundreds of dollars per hour.  The costs of these sessions are generally not fully covered by insurance companies. 
    5. Research also shows that cognitive-behavioral therapy training doesn't work 100% of the time.  For many parents, this is an expensive gamble to take, when there's no guarantee that the child will receive any substantial, long-term benefits from such a training program.
    6. Lifestyle changes, such as changes to one's diet and exercise patterns, may also prove to be helpful behavioral changes.
    7. Music therapy has also been shown to help students with ADHD.

  3. A Combination of Medication and Behavioral Therapy

    1. Research has recently shown that the most effective method to treat ADHD is through a combined treatment approach; using both psychotropic medications in conjunction with cognitive-behavioral therapy has the greatest efficacy rate. 
    2. When medication-only methods have such a high efficacy rate (and are much cheaper than integrating behavioral therapy), many families do not consider this treatment method a suitable option.