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Beyond Just Fidgety

Identifying and coping with a child's hyperactivity

Mental health experts estimate that as many as one in 33 school-age children has Attention Deficit Hyperactivity Disorder, or ADHD. Early diagnosis and treatment are crucial in preventing a child from struggling both academically and socially. Here, Dr. Larry Silver, director of training in child and adolescent psychiatry at Georgetown University School of Medicine and author of Dr. Larry Silver's Advice to Parents on Attention Deficit Hyperactivity Disorder (American Psychiatric Press, 1994), suggests what to do if you suspect your child has ADHD.

What are the signs of ADHD?

Children with ADHD have one or more of three behavioral problems. Some are fidgety or hyperactive. Some are very distractible and have short attention spans. And some are impulsive, meaning they interrupt or act before they think. These symptoms must be chronic and pervasive; that is, they must have existed throughout the child's life. If present, these behaviors can frustrate families and most commonly cause the child to do poorly in school.

Is there a danger that normal active behavior can be misread as ADHD?

Misdiagnosis of the disorder does occur. At present, about 50 percent of the children with ADHD are being diagnosed properly. However, misdiagnosis of the disorder frequently occurs with children who exhibit the symptom of distractibility. They are perceived as being unmotivated daydreamers or lazy rather than as having ADHD.

There are many causes of fidgeting, distractibility and impulsiveness, only one of which is ADHD. If these behavioral problems have only recently begun to manifest themselves or are related to a particular event, your child may not have ADHD. For instance, a child who becomes distractable in the fourth grade may be suffering from emotional problems caused by a divorce. Or if the child starts having trouble in math, a learning disability, which affects 10 percent of school-age children, could be the cause.

Can untreated ADHD be outgrown?

Untreated ADHD can lead to more problems. Children who don't receive treatment fall behind in school. The constant academic failure can result in depression and anxiety. Moreover, the disorder can lead to classroom misbehavior or to getting into trouble in the community. Teachers are often the first to alert parents that their child may have ADHD. Parents must also trust their intuition if they suspect that their child has a problem. Parents should talk to teachers to validate their concerns and then consult a family physician or a mental health professional.

How should ADHD be treated?

ADHD is a neurologically based disorder, so the principal part of treatment involves medication. Correctly managed medication can minimize or eliminate these behaviors in about 85 percent of the kids. Doctors prescribe a variety of drugs, but ritalin is used 85 percent of the time.

Psychological and educational intervention is also valuable. Since ADHD often goes undetected until third or fourth grade, a child will need counseling and extra educational accommodations. Many children need help addressing problems of self-esteem because of years of failure in school. Others have developed additional behavioral problems, such as being aggressive to get attention, or have learned that throwing tantrums helps them get their way. Families who have had to live with a disruptive child may also need some support. Most children require extra tutoring or special education to help fill deficiencies in their knowledge. Schools are required by law to provide these extra educational services.


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