On television, in magazines and newspapers, and in thousands of everyday conversations, there is ongoing debate around whether certain “ADHD-type” behaviors lie within the realm of normal childhood experience or constitute a disorder that requires treatment. The issue of exactly where and how to draw the line between typical behavior and a clinical condition may become even clearer as increasingly sophisticated diagnostic techniques provide researchers with more information about the nature of the precise brain processes involved in children with ADHD, but the use of these tools and techniques for these purposes still lies in the future.
For more than a century physicians have been aware of children displaying the behaviors that we now call ADHD. In 1902 British pediatrician George Still first formally documented a condition in which children seemed inattentive, impulsive, and hyperactive, stating his belief that this was a result of biological makeup rather than poor parenting or other environmental factors. Research in the 1980s supported this hypothesis and led to the use of the term attention deficit disorder. In 1987, in response to even more precise information provided by new studies, the term attention-deficit/hyperactivity disorder was introduced.
Today ADHD is defined by the American Psychiatric Association as developmentally inappropriate attention and/or hyperactivity and impulsivity so pervasive and persistent as to significantly interfere with a child’s daily life. A child with ADHD has difficulty controlling his behavior in most major settings, including home and school. He may speed about in constant motion, make noise nonstop, refuse to wait his turn, and crash into everything around him. At other times he may drift as if in a daydream, failing to pay attention to or finish what he starts. He may have trouble learning and remembering. An impulsive nature may put him in actual physical danger. Because he has difficulty controlling this behavior, he may be labeled a “bad kid” or a “space cadet.” These problems begin to occur relatively early in life (before age 7 years), though they sometimes go unrecognized until later. However, if there are absolutely no indications of ADHD before age 7 years, an alternative explanation for a child’s later behaviors should be sought.
Professionals have identified clear differences between the functioning of a child without ADHD and a child with the condition. The presence of ADHD may be suspected if the
Inattentive, impulsive, or hyperactive behavior is not age-appropriate. That is, if it is not typical of children of the same age who do not have ADHD.
Behavior leads to chronic problems in daily functioning. A mild tendency to daydream or an active temperament, which may cause occasional problems for a child but is not seriously disabling, is not considered evidence of ADHD.
Behavior is natural to the child and not a result of poor care, physical injury, abuse or neglect, disease, or other environmental influence. One way to determine whether the problem is environmental is to look at whether the problem occurs in more than one setting, such as at home and at school. If not, then an environmental cause, such as stresses at home or an inappropriate classroom placement, is more likely than ADHD to be the cause of the problem for the child.
For a child’s condition to be diagnosed as ADHD, all 3 of these conditions must be met. Attention-deficit/hyperactivity disorder can only be recognized by its symptoms, and by the problems that these symptoms create for the child. This is why it is so important for parents, teachers, mental health professionals, and medical experts to work together when evaluating a child for ADHD. Each contributes his or her own observations, experience, and expertise to create a comprehensive picture of the child’s social, academic, and emotional progress.
Attention-deficit/hyperactivity disorder is divided into 3 general subtypes: predominantly hyperactive-impulsive–type ADHD, predominantly inattentive-type ADHD, and combinedtype ADHD. A child with predominantly hyperactive-impulsive–type ADHD may fidget or squirm in his seat, have difficulty waiting his turn, and show a tendency to be disorganized. He may act immaturely, have a poor sense of physical boundaries, and tend toward destructive behaviors and conduct problems. A child with predominantly inattentive-type ADHD, on the other hand, may seem distracted and “spacey” or “daydreamy,” but lacks the hyperactive component of the disorder. He may seem to process information slowly and may also have a learning disorder, anxiety, or depression. A child with combined type ADHD typically exhibits many of the behaviors of the first 2 subtypes.
These subtypes tend to be diagnosed at different ages and stages of development. Because of the hyperactivity and impulsivity, children with predominantly hyperactive-impulsive type or combined type may be diagnosed as early as the preschool years in extreme situations. Children with predominantly inattentive type often go undetected until fourth grade or even later, when increased demands for sustained attention and more homework lead to significant problems in functioning. In the early grades children learn to read, but at around fourth grade they need to begin to read to learn. When this transition takes place, children with inattentive type typically begin to have more problems.
While the problems of hyperactivity/impulsivity and inattentiveness may seem at first to be unrelated, they both influence a child’s inability to focus and function well in school, with peers, and in the family. Attention-deficit/hyperactivity disorder can be thought of as a range of “attentional disorders” with a number of possible symptoms shown at different ages and developmental stages.