What is ADHD?

ADHD is a disorder that affects 5% to 7% of children. Children with ADHD have problems with attention span, hyperactivity, and impulsive behavior. ADHD is the term now used for ADD (Attention Deficit Disorder). ADHD is more common in boys than in girls.

A normal attention span is 3 to 5 minutes per year of a child's age. Therefore, a 2-year-old should be able to concentrate on a particular task for at least 6 minutes, and a child entering kindergarten should be able to concentrate for at least 15 minutes. (Note: A child's attention span while watching TV is not an accurate measure of his or her attention span.)

• A child with ADHD has trouble listening when someone talks, waiting his turn, completing a task, or returning to a task if interrupted. (These can be normal characteristics of children less than 3 or 4 years old.)
• 80% of boys and 50% of girls with attention problems are also hyperactive. A child who has symptoms of hyperactivity is restless, impulsive, and in a hurry.
• 50% of children also have a learning disability. The most common learning disability is an auditory processing deficit. This means they have difficulty remembering verbal directions. However, the intelligence of most children with ADHD is usually normal.

If you suspect that your child has a short attention span, ask another adult (a teacher or day care provider, for example) if they have observed this also.

What causes ADHD?

Current theory suggests that ADHD (like other learning disabilities) is probably due to small differences in brain chemistry and function. ADHD sometimes runs in the family. Changes in daily routine (such as not getting enough sleep or a good breakfast) can make the symptoms of ADHD worse. ADHD is not caused by poor parenting.

What can I do to help my child?

Medicine alone is not the answer. Because ADHD is an ongoing condition, your child also needs special interventions at home and school to help with impulsive behaviors, work on structuring your child's home life and improving discipline. Behavior problems can be addressed at any time after 1 year of age. If your child also has a poor attention span, you can do activities to help him learn to listen and complete tasks.

1. Accept your child's limitations.

   Accept the fact that your child is active and energetic and possibly always will be. The hyperactivity is not intentional. Don't expect to eliminate the hyperactivity but merely to bring it under reasonable control. Any criticism or other attempt to change an energetic child into a quiet or model child will cause more harm than good. Nothing helps a hyperactive child more than having a tolerant, patient, low-keyed parent.

2. Provide an outlet for excess energy.

   Daily outdoor activities such as running, sports, and long walks are good outlets for excess energy. In bad weather your child needs a room where he can play as he pleases with minimal restrictions and supervision. Your child should not have too many toys. This can cause him to be more easily distracted from playing with any one toy. The toys should be safe and relatively unbreakable. Encourage your child to play with one toy at a time.

   Although the expression of hyperactivity is allowed in these ways, it should not be needlessly encouraged. Don't initiate roughhousing with your child. Forbid siblings to say, "Chase me, chase me," or to instigate other noisy play. Encouraging hyperactive behavior can lead to its becoming your child's main style of interacting with people.

3. Follow a structured daily routine.

   Household routines help the hyperactive child to accept order. Keep the times for wake-up, meals, snacks, chores, naps, and bed as regular as possible. Try to keep your environment relatively quiet because this encourages thinking, listening, and reading at home. In general, leave the radio and TV off. Predictable daily events help your child's responses become more predictable. ADHD symptoms are made worse by sleep deprivation and hunger. Be sure your child has an early bedtime and a big breakfast on school days.

4. Try not to let your child become overexhausted.

   When a hyperactive child becomes overtired, his self-control often breaks down and the hyperactivity becomes worse. Try to have your child sleep or rest when he is exhausted. If he can't seem to "turn off his motor," hold and rock him in a rocking chair.

   For children who have trouble slowing down at bedtime, night lights and background music are often helpful.

5. Avoid taking young children to formal gatherings.

   Except for special occasions, avoid places where hyperactivity would be extremely inappropriate (such as churches or restaurants). You also may wish to reduce the number of times your child goes with you to stores and supermarkets. After your child becomes older and develops adequate self-control at home, he can gradually be introduced to these situations.

6. Maintain firm discipline.

   These children are usually difficult to manage. They need more carefully planned discipline than the average child. Rules should be made mainly to prevent harm to your child and to others. Aggressive behavior, such as biting, hitting, and pushing, should be no more accepted from the hyperactive child than any other child. Try to stop such aggressive behaviors, but avoid unnecessary or impossible rules. For example, don't expect your child to keep his hands and feet still. Hyperactive children tolerate fewer rules than the normal child. Enforce a few clear, consistent, important rules and add other rules at your child's pace. Avoid constant negative comments like "Don't do this," and "Stop that." Develop a set of hand signals and use them rather than telling your child to calm down or slow down.

7. Enforce rules with nonphysical punishment.

   Physical punishment suggests to your child that physically aggressive behavior is OK. We want to teach hyperactive children to be less aggressive. Your child needs adult models of control and calmness. Try to use a friendly, matter-of-fact tone of voice when you discipline your child. If you yell, your child will be quick to imitate you.

   Punish your child for misbehavior immediately. When your child breaks a rule, isolate him in a chair or time-out room if a show of disapproval doesn't work. The time-out should last about 1 minute per year of your child's age. Without a time-out system, overall success is unlikely.

8. Stretch your child's attention span.

   While the attention span may never be normal, it can usually be improved. Encouraging an increased attention span and persistence with tasks is helpful for preparing your child for school. Increased attention span and persistence with tasks can be taught at home. Don't wait and expect the teacher suddenly change him. By age 5 he needs at least a 15-minute attention span to perform adequately in school.

   Set aside several brief periods each day to teach your child listening skills by reading to him. Start with picture books, and gradually progress to reading stories. Coloring pictures can be encouraged and praised. Teach games to your child, gradually increasing the difficulty by starting with building blocks and progressing to puzzles, dominoes, card games, and dice games. Matching pictures is an excellent way to build your child's memory and concentration. Later, consequence games such as checkers or tic-tac-toe can be introduced. When your child becomes restless, stop and return for to the game later. Praise your child for attentive behavior. This process is slow but invaluable in preparing your child for school.

   Plan to have your child do homework and other tasks that require concentration in short blocks of time with breaks in between. Try having your child study with low-level background sound such as white noise or instrumental music. Do homework and studying away from the sounds of television, radio, or others talking but where adults can watch.

9. Buffer your child against any overreaction by neighbors.

   Ask neighbors that your child knows to be helpers. If your child is labeled by some adults as a "bad" kid, it is important that this image of your child doesn't carry over into your home life. At home the attitude that must prevail is that your child is a good child with excess energy. It is extremely important that you not give up on him. Your child must always feel loved and accepted within the family. As long as a child has this acceptance, his self-esteem will survive. If your child has trouble doing well in school, help him gain a sense of success through a hobby in an area of strength.

10. From time to time, get away from it all.

    Exposure to some of these children for 24 hours a day would make anyone a wreck. Periodic breaks help parents to tolerate hyper behavior. If just the father works outside the home, he should try to look after the child when he comes home. This not only gives his wife a deserved break but also helps him understand better what she must contend with during the day. A baby sitter one afternoon each week and an occasional evening out can provide much-needed breaks for an exhausted mother. Preschool is another helpful option. Parents need a chance to renew themselves so that they can continue to meet their child's extra needs.

11. Use special programs at school.

    Try to start your child in preschool by age 3 to help him learn to organize his thoughts and develop his ability to focus. However, you should consider enrolling your child in kindergarten a year late (that is, at age 6 rather than 5) because the added maturity may help him fit in better with his classmates.

    Once your child enters grade school, the school is responsible for providing appropriate programs for your child's attention deficit disorder and any learning disability he might have. Some standard approaches that teachers use to help children with ADHD are smaller class size, and a isolated study space. They may also include your child in tasks like erasing the blackboard or passing out books (as outlets for excessive energy). Many of these children spend part of their day with a teacher specializing in learning disabilities who helps improve their skills and confidence.

    Seek a classroom for your child that has individual desks rather than one where students are seated in groups at tables or with clusters of desks.

    If you think your child has ADHD and he has not been tested by the school's special education team, you can request an evaluation. Usually you can get the help your child needs with schoolwork by working closely with the school staff through parent-teacher conferences and special meetings. Your main job is to continue to help your child improve his attention span, self-discipline, and friendships at home.

12. Medicine is usually helpful.

    Stimulant drugs can improve a child's ability to concentrate. If you and your child's teacher both feel that your child's short attention span is interfering with school performance, discuss the use of medicine with your child's healthcare provider. In general, medicine should not be prescribed before school age. It should also not be prescribed until after your child has been evaluated by a doctor, the school education team, you have a individualized education plan (IEP) at school, and you have followed the suggestions in this handout. While medicine is helpful, it needs to be part of a broader treatment plan including special education and behavioral management.

When should I call my child's healthcare provider?

Call your child's healthcare provider for referral to a child psychiatrist or psychologist if:

• Your child shows unprovoked aggression and destructiveness.
• Your child has repeated accidents.
• Your child has been suspended or expelled from school.
• Your child can't make or keep any friends.
• You have "given up" hope of improving your child.
• You can't stop using physical punishment on your child.
• You are at your wit's end.