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Counseling & Psychological Services
Montana State University
P.O. Box 173180
Bozeman, MT 59717-3180

Tel: (406) 994-4531
Fax: (406) 994-2485
Location: 211 Swingle
> Counseling & Psychological Services
Counseling Services

Understanding ADHD

Attention Deficit-Hyperactivity Disorder is a much talked-about but often misunderstood disorder. Here are some helpful facts about ADHD.

Statistics

The first documented symptoms of ADHD came as early as 1902 In a class of 30 students, 1-3 kids are diagnosed with ADHD 3-6x more boys are diagnosed than girls

Criteria for ADHD

  1. Six or more symptoms of inattention for at least six months to a degree that is maladaptive and inconsistent with developmental level:
    • Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
    • Often has difficulty sustaining attention in tasks of play, work, or activity
    • Often does not seem to listen when spoken to directly
    • Often does not follow through on instructions and fails to finish work
    • Often has difficulty organizing tasks and activities
    • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (school work, homework)
    • Often loses things necessary for tasks or activities (assignments, pencils, tools)
    • Often easily distracted by extraneous stimuli
    • Often forgetful in daily activities
  2. Six or more symptoms of hyperactivity-impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:
    Hyperactivity
    • Often fidgets with hands or feet or squirms in seat
    • Often leaves seat when remaining seated is expected
    • Often runs or climbs excessively in situations where it is inappropriate (in adolescents or adults this may be limited to feelings of restlessness)
    • Often has difficulty playing or engaging in leisure activities quietly
    • Is often "on the go" or "driven by a motor"
    • Often talks excessively
    Impulsivity
    • Often blurts out answers before questions have been completed
    • Often has difficulty waiting turn
    • Often interrupts or intrudes on others
  3. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7.
  4. Some impairment from the symptoms is present in two or more settings (e.g. school and home, work and home).
  5. Clear evidence of clinically significant impairment in social, academic, or occupational functioning.
  6. Symptoms are not a result of another disease/disorder.

Causes:

Current research suggests that ADHD has biological roots. Brain images show differences in brain structures and in neurotransmitter functioning that may cause symptoms. One hypothesis is that areas of the brain responsible for attention and control under-function, thus creating inattention and hyperactivity.

Research suggests that ADHD is genetic: those with ADHD usually have one close relative with ADHD. One-third of fathers with ADHD have kids who have it, and the majority of identical twins with ADHD share the disorder.

Red-herrings:

In-utero alcohol/drug exposure
Approximately 10% of children are exposed to drugs/alcohol in the womb. About 54% of women report using some combination of illicit drugs, alcohol and tobacco while pregnant. This can cause developmental symptoms similar to ADHD.

Depression:

Difficulty concentrating, thinking, and remembering is common with depression. Agitation/restlessness can occur with depression, particularly in children. Manic episodes associated with Bipolar Disorder may mimic ADHD.

Anxiety:

Difficulty concentrating and restlessness are common with anxiety disorders

Learning Disabilities:

While learning disorders often accompany ADHD, a learning disorder might account for avoidance, discomfort, inattention, etc.

Social Issues:

Undue expectations
Teachers/parents may have unrealistic expectations around a child's ability to hold attention, sit still, and complete work. Adults may have harsh expectations for themselves.

Overburdened teachers/classrooms

Classes with too many students or inexperienced teachers may not be equipped to give individual attention, kids may be labeled as a "problem" or a "trouble-maker"

Gender bias:

Boys have been socialized to be active, rough-house, etc; they don't have practice sitting still and may be unfairly labeled as "bad little boys"

Medication:

Most common: methylphenidate (Ritalin). A stimulant. Others are Dexadrine, Adderall, Desoxyn, and Concerta.

Why a stimulant medication? Stimulates the area of the brain that underfunctions; the medication helps the underfunctioning area responsible for attention/impulse control to function at a more optimal level, thus improving attention and control.

A difficult choice:

When on medications, you should see a decrease in impulsive behavior, hyperactivity, and inappropriate social interactions with increased concentration and academic productivity.

Possible Side Effects:

  • Weight loss
  • Loss of appetite
  • Insomnia
  • Growth stunting
  • Tics
  • Psychotic symptoms
  • "zombie effect"
  • Possibility of future drug abuse
The decision to take medication or put your child on medication is a personal choice, and there are no clear-cut answers. Many experts feel that behavior-modification program should be implemented first, or in conjunction with, medication.

Disability Accommodations:

Those with documented learning disabilities (including ADHD) can receive accommodations at work and school, such as having extra time to complete tasks. In order to obtain accommodations, there needs to be documentation confirming a diagnosis of ADHD.

For MSU Students, contact:

Disabled Student Services
994-2824

Tips for coping with ADHD:

Be aware of where you obtain information. Information provided by pharmaceutical companies may be biased in favor of drugs/medication and may not be 100% objective.

Have other things ruled out, such as depression, anxiety, or hyperthyroidism.

Obtain a thorough evaluation from a professional who specializes in ADHD assessment and diagnosis. A good evaluation includes medical history, psychological testing, and behavior rating scales obtained from several sources: school, family, work, teachers, etc. Those qualified to make the diagnosis include psychologists, psychiatrists, and family doctors, but all must use the DSM-IV criteria.

Get help and support from a group or a counselor who can help you make a plan and give you a place to discuss your struggles and successes.

Educate and involve others. Tell friends, bosses, and coworkers you have ADHD, what you're doing about it, and how they can help. Get feedback from trusted others; those with ADHD tend to be poor self-observers.

Add structure. Devise a structured schedule that the person can follow. Be flexible, but don't deviate from the plan. Keep this schedule in the same place (e.g. affixed to a wall or bulletin board) and carry copies to avoid losing master. Make use of lists, color coding, reminders, etc. Color coding can be helpful because those with ADHD are visually oriented.

Break down large tasks into smaller ones, and attach deadlines to each task. Prioritize your tasks and give yourself a reward when you finish one.

Avoid procrastination; set up a consistent study/work area free from distractions.

Give yourself time in between tasks; transitions are often hard for those with ADHD, so give yourself a moment in between to gather your thoughts.

Take guilt-free time to relax and recharge your batteries. Time to regroup is essential, so go ahead and build it into your schedule to avoid feeling guilty about it.

Exercise regularly. Get rid of excess energy by exercising. Avoid caffeine and other drugs that make you jittery.

For kids:

Involve child in goal setting: S/he will be more likely to comply if s/he's had input. Involve your child's teacher in treating your child's ADHD.

Make a written contract where they agree to complete certain tasks in order to receive a reward. If they don't fulfill the contract, don't give the reward (be consistent!)

Provide a specified time-out location for when they're out of control. This should not be a place for punishment, but a place they can go to calm down and regain control.

Have the teacher make a checklist of homework to be done and items brought to school each day. Before bed, go over with your child to make sure all are completed.

Avoid emotional reactions such as anger, sarcasm, and ridicule. Shaming and making kids feel bad won't help remove symptoms; it will only make them feel bad about themselves and hinder their belief in their ability to improve.

Be clear, consistent, and self-aware. How might your behavior or communication perpetuate your child's ADHD?

Be aware that helping a child with ADHD will require extra time and patience that kids without ADHD may not need. Be prepared for this and adjust your expectations.

Maintain all records and evaluations that indicate diagnoses of ADHD or learning disabilities. In many cases, a well-documented chronology of these issues is necessary in obtaining accommodations for work or school.

Campus Resources:

Disabled Student Services
SUB 155
994-2824

Counseling & Psychological Services
211 Swingle
994-4531

Student Health Services
Swingle Building
994-4531

Additional Resources:

www.adhd.com
"Driven to Distraction," by Hallowell and Ratey.
"Understanding ADHD," by Green and Chee.
"The ADD Hyperactivity Workbook for Parents, Teachers and Kids," by Parker
"ADHD: What Every Parent Should Know," by Wodrich
"Talking back to Ritalin," by Peter Breggin, MD

The preceding is intended for informational purposes only and not intended to replace the assessment or evaluation of a trained professional.

View Text-only Version Text-only Updated: 12/17/08
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