Attention Deficit Hyperactivity
Kim Lathbury
Scottish Rite Children’s Medical Center
Atlanta, Georgia

Several steps can be taken to aid the child affected by Attention Deficit Hyperactivity Disorder.

Restless, impulsive, difficulty listening and obeying instructions, easily distracted--are these the typical actions of a young, energetic 5-year-old or the classic symptoms of a child with attention deficit hyperactivity disorder (ADHD)? ADHD is one of the most controversial diagnoses given to children. Its existence is difficult to determine since ADHD shares symptoms with a host of other problems, including sleep disorders, learning disabilities, language disorders, other neurological disorders, or even living in a disruptive home. Yet, it is estimated that seven to ten percent of the total United States school-age population has some form of ADHD.

Because a diagnosis of ADHD is subjective, it is important to analyze thoroughly the child who is suspected of having this disorder and look beyond the obvious behavior. Some children may have legitimate behavioral problems, while others may be acting like normal, energetic children.

“In my opinion, ADHD is not a disease, but a cluster of symptoms to which doctors have given a label,” said Linda Nathanson-Lippitt, M.D., a developmental pediatrician on staff at Scottish Rite Children’s Medical Center in Atlanta, Georgia. “It’s too easy to look at the list of ADHD characteristics and make a diagnosis for a child. There are many children who demonstrate ADHD-like symptoms, but are suffering from other problems. And, if a child is not properly diagnosed, the lack of treatment for their other challenges can make matters worse.”

For example, if a child is suffering from sleep disorders, he may appear lethargic, inattentive, and grumpy in school. If a child has a learning disability such as dyslexia, he may become discouraged with his school work. As a result, he may try to draw attention away from his embarrassment by becoming the “class clown,” according to Dr. Nathanson-Lippitt. In both of these situations, the symptoms can match the classic ADHD criteria. Yet, it is apparent that other problems exist.

Because not all children absorb information in the same way, Dr. Nathanson-Lippitt refers to children’s “attention variations” rather than their deficits. She believes not every child is necessarily capable of sitting still and listening intently for hours at a time. Instead, she believes different children can listen and learn in different ways, whether it is while sitting, standing, or walking around.

She points out that our culture and social customs have changed at a faster pace than our brain’s chemistry. For example, in prehistoric days, a person who spotted movement among the trees and reacted to it without hesitation was considered the better hunter. But in today’s structured culture, this energetic, impulsive behavior is not considered socially acceptable.

“The same behavior that is labeled ADHD is also the behavior that allows a child to be creative and a risk-taker,” said Dr. Nathanson-Lippitt. “Unfortunately, that child has to adjust to the typical school environment where he is expected to sit still, not blurt out answers, and pay attention for several hours. You’re just asking for behavioral problems.”

So, what is the answer? Before a child can be treated, parents, doctors and teachers must determine exactly what is causing the child’s “unacceptable” conduct. Dr. Nathanson-Lippitt recommends several steps.

First, the pediatrician should obtain information from the child’s parents and teachers and compare behavior patterns at home and school. This will help determine whether the behavior crosses different environmental conditions. Second, the child’s pediatrician should thoroughly examine the child and review his or her complete health history to rule out any other neurological or physical problems that may duplicate ADHD symptoms. Finally, if a child is diagnosed as having ADHD, a treatment program should be prescribed.

“There are some children who do not have the ability to focus in a structured classroom,” said Dr. Nathanson-Lippitt. “In these cases, medication such as Ritalin®, can adjust their neurotransmitters and allow them to function more efficiently. Just as I wear glasses to help me focus visually, some children need medication to help them focus mentally.”

Yet it is important for parents to realize that medication is not a cure. It is only one component of the entire treatment package. Without behavioral interventions, the child’s difficulties at home and school are likely to continue.

Often, classroom modifications that help children burn off their excessive energy may be necessary. Dr. Nathanson-Lippitt recommends parents and teachers allow the ADHD child to get up and move around, run errands for the teacher or even doodle, if it does not disrupt the class.

Rewards, privileges, or encouragement for good behavior are also effective. Parents and teachers can give tokens or points to the child for exhibiting desired behavior, such as being quiet, remaining seated, or finishing homework. These types of changes allow the child to modify behavior without having to rely on medication entirely. In other cases, a child’s inability to sit still, pay attention, and keep up with school work can be learned behavior from an unstructured household. Giving a child medication in these instances will have little effect. Instead, Dr. Nathanson-Lippitt recommends parents create a more organized environment for children. This should include scheduling regular meals, homework periods, bath, and sleep times.

“Unfortunately, most people with ADHD don’t grow out of the inattention characteristic. They often become underachievers, procrastinators, and job hoppers,” said Dr. Nathanson-Lippitt. “This is why it is so important to teach behavior management techniques and show the child with ADHD how to adjust his or her attention variations.”

Determining what is causing ADHD behavior can be a very confusing and stressful process for children and families. Parents often feel inadequate, and children can lose their self-confidence. Yet it is important to be patient, supportive, and loving during this time. With an early diagnosis, children who display ADHD problems can learn how to cope with their behavior styles and become successful, happy adults.

According to Dr. Nathanson-Lippitt, the key to this success is making the correct diagnosis from the start and implementing proper treatment programs that will help the child perform to his or her fullest potential.

Note: This article is the second in a series titled “Medical Moment.” The series will focus on the language-learning problems of children and health issues of interest to the readers of the Journal. Next month, the series will continue with an article from Arthur L. Rudo, M.D., titled “Headaches.” Articles may be contributed to the series by personnel from the Scottish Rite’s 122 Clinics, Centers, and Programs or other health professionals. Send articles to: Scottish Rite Journal, 1733 16th St., NW, Washington, DC 20009-3103. When possible, in addition to a typescript, enclose (1) a PC format copy on disk (2) photographic illustration (3) a close photo of the author and his/her brief biography in under 100 words.

Contact Dr. John W. Boettjer, Managing Editor of the Scottish Rite Journal, at 202-232-3579 for more information.