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What, Exactly, is Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder?
ADD is a difference in "wiring" of the brain from those of non-ADD people which is frequently distinguished by
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lack of ability to concentrate or focus on tasks
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lack of ability to set a pattern which can be followed in the future (such as deciding where to always place keys so you don't lose them and then repeating that sequence of steps)
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lack of conscious awareness of behavior or habits (which results in not noticing yourself place those keys down, so that later you cannot retrace your steps to find them)
ADHD may have the added features of
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impulsiveness (such as blurting out whatever comes to mind without thinking about possible consequences like hurting someone else's feelings or looking ridiculous oneself)
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lots of extra energy getting dissipated through activities that are either goal-directed (like sports) or not (like pacing).
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skinniness due to this expenditure of energy
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[in very young children] poor bowel control due to lack of control of the impulsiveness
A quick look at the above lists is quite depressing, so it should be noted that these "syndromes" also contain the following highly desireable features:
To back what I say, the following people were thought to have been ADD or ADHD: Henry Ford, Abraham Lincoln, Benjamin Franklin Emily Dickinson, John F. Kennedy, George Bernard Shaw, Thomas Edison, Albert Einstein, and Salvador Dali.
From this description, I think my child/spouse has ADD/ADHD. How can I be sure?
You have asked a critically important question. There are OTHER problems that may mimick ADD/ADHD so it is important to separate out all these. Consider the following possibilities:
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Is there a divorce, separation, physical illness, death, move, job change in the family to which the person is reacting? Is there peer pressure to use drugs? Are there grade problems in school or work evaluation problems on his or her mind? Is the neighborhood safe? Is there financial distress? Both children and adults become "dreamy" or "spacey" when they are troubled. Before any possiblity of diagnosing ADD/ADHD, these issues must be on the table and addressed.
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Has the family member started using drugs? The symptoms of drug use may include spaciness, forgetfulness, drop in grades and so on. Although you are quite sure your child wouldn't use drugs, you can't side-step this issues. Children may be tempted out of curiosity, the desire to belong, the desire not to be made fun of, the desire to enjoy the experience, and so on.
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Is there a learning disorder? Often the inability to comprehend instructions at work or how to do things at school is really a learning disorder. Very smart people can have a disorder in processing math, in reading letters straight, and so on. This must be ruled out.
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Is there abuse going on that you don't know of or don't recognize for what it is? Children may be molested outside of the home, they may be verbally and emotionally abused inside the home, they may be put down or made to feel small by teachers, they may be bullied at school. The result may be dreaminess which mimicks ADD and/or irritability which mimicks the impulsivity of ADHD. People may not realize that verbal abuse is occuring when others "merely" are joking around--at the victim's expense. It is crucial that those concerned be sensitive to this possibility.
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How can I be sure as to the diagnosis?
Unlike drawing blood for diabetes or taking an x-ray for a broken bone, there is no medical way to tell if someone has ADD. However, if all the above possibilities have indeed been ruled out, you can then take a paper and pencil test yourself to rate his or her behaviors. This test is often given as well to teachers. The child himself can fill one out. Your answers and the child's and teacher's answers can then be placed on a scale in which the scores are compared to the average ADD/ADHD child to see whether there really is ADD.
My family member fits the ADHD description and I've ruled out the other possibilities that you just listed, but there's lots more. There's rudeness, aggressiveness, general social problems, and poor performance in school/work. What does that mean?
Who said the famous words, "No man is an island"? Unfortunately, the ADHD child or adult lives, works, and must deal with others constantly. When an ADD/ADHD child is born into a family, the family is rarely ever prepared. But they better be or the child will soon run the house. What frequently happens is that parents who got away with very little discipline towards other children cannot understand why this one child will not listen or cooperate. The house turns into yelling matches, and soon, in the parent's heart, he or she starts to actually dislike that child. There is an attempt at avoidance, certainly avoidance of confrontations, and that just makes things worse because eventually whatever the issue is must be addressed. Sure enough, there is the feared confrontation.
The solution is parent education in proper discipline. Studies show that ADD/ADHD children are more likely to be abused and/or neglected. There is a higher number of them represented in the adult criminal population. This is not the children's fault. It is the fault of improper discipline. So it is very important that the word "discipline" NOT be misinterpreted in such a way as to result in abuse. If you are not clear where discipline ends and abuse begins, see a therapist because they are two entirely different things. Real discipline does NOT feel like punishment. It feels just and fair.
Are you blaming the parents?
Of course not. Suppose you had a child who was physically handicapped, maybe in a wheelchair. Wouldn't it be necessary to know the best way to take care of that child so she/he became self-sufficient, not depressed, and a goal-oriented person? For a non-ADD child, just reminding the child once to do something might work and no special discipline would be necessary. If you've got one of those, you're mighty lucky! You've got it easy, so enjoy it. The usual child requires more; the ADHD child, much more. I'm not particularly into blame. It's a non-productive way to get things done. The idea is that the parents of an ADD child may need special assistance to learn how to handle that child correctly so as to eliminate aggressive and rude behavior and get the child on task.
My child/spouse is down, maybe depressed, because s/he's always messing up due to what I believe is the ADD. Should we consider Medication for that?
The problem here is that all the family members need to come to terms with the ADD. Each of us in life is given challenges, trials, maybe pain. Self-Medication with illicit drugs is not the answer and Medication with legal drugs isn't either. The depression that comes from feeling "less than" as a person because of the ADD must be counteracted with the whole family re-examining their attitude toward it. The meaning of ADD has to change in everyone's eyes. The ADD/ADHD person can be funny, creative, energetic, accomplished, and highly successful in ways that the rest of us just can't. The ADD person is frequently smarter than others and more intuitive. When the ADD person develops study and work skills to overcome the challenge, he or she will have truly accomplished something to be proud of. That individual can take credit for the success where a person without this challenge, who slides easily through life, can't. You notice I have never once used the term "disorder." The notion of disorder is in the eye of the beholder. Get it out of your eye and the depression about it will disappear. I'll go further: Not only get the negative-thinking about ADD out of your mind, but replace it with a focus on what's good and special about the ADD and what's praiseworthy about how your family member is coping with it--or can cope with it once there's an attitude change.
So do you not believe in Medication for ADD/ADHD either?
Woa! I didn't say that. Sometimes Medication is helpful for the ADD or ADHD. However,
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FIRST, you need to rule out all other possible causes of the behavior as I listed above.
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THEN you need to make sure the discipline is right because the medicine won't work without it. Every study shows that.
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THIRD you and the whole family need to rethink your attitude toward the ADD and the person who has it. Only with acceptance and encouragement will the person be motivated to work on overcoming the obstacles that it can present.
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FOURTH there are strategies for making it somewhat more manageable and without these the meds won't work either.
When all that is done, Medication may work but it is a very individual thing. You need a specialist, not a family doctor or pediatrician, but either a pediatric neurologist or psychiatrist that specializes in this problem. You should be aware of side effects, too:
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If a small dose doesn't work, and the dose is increased and increased, ticks can follow which may not be possible to later eliminate.
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There is a problem with Medication suppressing appetite
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and also with sleep inhibition due to the stimulant nature of the meds.
With Medication, an attitude change, and focusing and organizing strategies, we should be all set, right?
Absolutely. You may need to check in with the therapist from time to time as new challenges come up, but basically, that's it. Just don't be down on yourself if that attitude adjustment is hard to make. No one likes being dished out trials and challenges. That's also what the therapist is there to help you with. Nevertheless, where concentration is essential and where strategies for focusing are not sufficient, Medication may be a blessing. A specialist will be able to advise what Medication to try first.
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