faq

Frequently Asked Questions from the net!

Archive-name: misc.kids/add.faq
Original from: frankk@Canada.sun.com
Last Changed: 25 Nov 93 REV 1.1 by frankk@Canada.sun.com
misc.kids,sci.med
Attention Deficit Disorders (ADD)

FREQUENTLY ASKED QUESTIONS (FAQ)

1. What is Attention Deficit Disorder?
2. What are some common symptoms of ADD/ADDHD?
3. How is ADD diagnosed?
4. Is this a new disease?
5. What other names has this disease been known by?
6. What causes ADD (Etiology)?
7. What is the long term prognosis?
8. Are there other complications of this disease?
9. What treatment is there for ADD?
10. Controversial treatments for ADD
11. What medications can be used in treatment?
12. What about Caffeine?
13. What are some monitoring tools/scales?
14. What are some myth-conceptions?
15. Are there any support groups?
16. Is there a good commercial source for information?
17. Are there any net based resources?
18. What are some Parenting Tricks and Tips? (Strategies)
19. Books on ADD
20. ADD in Adults?

Attention Deficit Disorder (ADD) is a syndrome which is usually characterized by serious and persistent difficulties resulting in:

1. poor attention span
2. weak impulse control
3. hyperactivity (not in all cases)

ADD also has a subtype which includes hyperactivity (ADHD). It is a treatable (note not curable) complex disorder which affects approximately 3 to 6 percent of the population (70% in relatives of ADD children). Inattentiveness, impulsivity, and oftentimes, hyperactivity, are common characteristics of the disorder. Boys with ADD tend to outnumber girls by 3 to 1, although ADD in girls is under identified.

The term ADD is usually referring to ADHD. ADD without hyperactivity is also known as ADD/WO (Without) or Undifferentiated ADD.

2) What are some common symptoms of ADD?

1. Excessively fidgets or squirms
2. Difficulty remaining seated
3. Easily distracted
4. Difficulty awaiting turn in games
5. Blurts out answers to questions
6. Difficulty following instructions
7. Difficulty sustaining attention
8. Shifts from one activity to another
9. Difficulty playing quietly
10. Often talks excessively
11. Often interrupts
12. Often doesn't listen to what is said
13. Often loses things
14. Often engages in dangerous activities

Recent literature proposes 2 subtypes of ADHD: Behavioral and Cognitive (being split 80/20).

3) How is ADD diagnosed?

The list above is taken directly from the American Psychiatric Association's (APA) latest "Diagnostics and Statistical Manual of Mental Disorders DSM-III-R). To qualify for a diagnosis of ADHD, a child must exhibit 8 of these for a period longer than 6 months and have appeared before the age of 7 years.

EEG abnormalities can appear in up to 50% of ADD children (not used in diagnoses).

However, you don't have to be hyperactive to have attention deficit disorder. In fact, up to 30% of children with ADD are not hyperactive at all, but still have a lot of trouble focusing.

4) Is this a new disease?

No. It had been identified in medical literature more than 100 years ago. A popular German tale (Hoffmann's "Struwel Peter") written in rhyme for children portrays a child with ADHD.

5) What other names has this disease been known by:

Minimal brain dysfunction (MBD) and hyperactivity (hyper-kinetic) or (in Britain) conduct disorder (not the same implications as the North American reference in the DSM-III-R).

6) What causes ADD (Etiology)?

A single cause has not been conclusively proven (idiopathic). Some possibilities are:

1. Genetic/ Hereditary (strongest correlation)
2. Brain damage (head trauma) before, after or during birth (twice as likely to have had labor> 13hrs)
3. Brain damage by toxins (internal: bacterial and viral, external: fetal alcohol syndrome, metal intoxication, eg lead)
4. Strongly held belief by some people (including at least one book, Feingold's "Cookbook for Hyperactive children") that food allergies cause ADD. This has *not* been proven scientifically.

7) What is the long term prognosis?

One book states 20% outgrow it by puberty but other problems can interfere. ADD that lasts into Adulthood is referred to as ADD-RT (Residual Type).

8) Are there other complications of this disease?

Yes. Not really complications in the classical sense but rather clusters of other problems of the Central Nervous System (CNS) such as:

• Learning Disabilities (LDs)
• TIC disorders (such as Tourette`s) 20 % of ADD children whereas 40 to 60% of TIC children have ADD
• Gross and Fine Motor control delays (coordination) 50% of ADD children
• developmental delays (such as speech)
• Obsessive-compulsive disorders (OCD)

9) What treatment is there for ADD?

No simple treatment. Must be a multi-modal approach including (but not limited to):

1. Medication
2. Training of parents
3. Counseling/training of child: such as modeling, self-verbalization and self-reinforcement.
4. Special education environment

10) Controversial ADD Treatments

This section was condensed from an article "Controversial Treatments for Children with ADHD" By S. Goldstein Ph.D. & B. Ingersoll Ph.D.

1. Dietary Intervention. The changing of a child's diet to prevent ADHD. Conclusion: No scientific evidence of effectiveness.
   
2. Megavitamin and Mineral Supplements. The use of very high does of vitamins and/or minerals to treat ADHD. Conclusion: No scientific evidence of effectiveness.
   
3. Anti-Motion Sickness Medication. The advocates of this believe that a relationship exists between ADHD and the inner-ear. Conclusion: No scientific evidence of effectiveness.
   
4. Candida Yeast. Those who support this model believe that toxins created by the yeast overgrow and weaken the immune system making the individual susceptible to many illnesses including ADHD. Conclusion: No scientific evidence of effectiveness.
   
5. EEG Biofeedback. Proponents of this approach believe that ADHD children can be trained to increase the type of brain-wave activity associated with sustained attention. Conclusion: No scientific evidence of effectiveness.
   
6. Applied Kinesiology (Chiropratic approach). This theory believes that Learning Disabilities are caused by 2 specific bones in the skull. Conclusion: No scientific evidence of effectiveness.
   
7. Optometric Vision Training. This proposes that reading related Learning Disabilities are caused by visual problems. Conclusion: No scientific evidence of effectiveness.

11) What medications can be used in treatment?

This is a constantly evolving area. At the time of the writing (Jan 93) of this FAQ and known to this author are:

Psychostimulants (Trade name and chemical name):

1. Ritalin (methylphenidate) also SR Ritalin (Slow Release)
2. Dexedrine (dextroamphetamine)
3. Cylert (pemoline)

Antidepressants (Tricyclic or TCAs) used to treat bed wetting and depression:

1. Tofranil or Janimine (impramine)
2. Norpramin or Pertofane (desipramine)
3. Pamelor (nortriptyline) principle metabolite of ELavil (amitripyline)

Neuroleptics (usually used with stimulant):

1. thioridazine
2. Propericiazine
3. chlorpromazine (unsure of category)

Tranquilizers:

1. Mellaril
2. Atarax

Antihypertensive:

1. Catapres (clonidine)

Others:

1. antidepressants ( called monoamin oxidase inhibitors MAO) fluoxetine or burproprion
2. lithium
3. Tegretol (anticonvulsant caramazepine) mood stabilizer

Note: None of these (listed in other) have been extensively studied for use with children.

12) What about caffeine?

Although caffeine is a stimulant it does not focus specifically enough in the areas of the Brain to be effective. The dose required to be effective introduces too many negative side effects.

13) What are some monitoring tools/scales:

1. Conners Teacher/Parents Rating scales (CTRS,CPRS) *
2. ADD-H Comprehensive teacher rating scale (ACTeRS) *
3. Child Attention Problems (CAP) Rating scale
4. Yale Children's Inventory (YCI)
5. Attention Battery (includes Continuous Performance Task, Progressive Maze Test and Sequential Organization Test (SOT).
6. DSM-III-R
7. Wechsler Intelligence Scales for Children (WISC-R)
8. Child Behavior Checklist (CBCL)
9. T.O.V.A - Test of Variables of Attention*
10. Learning Efficiency Test II (LETT-II)*
11. Developmental Test of Visual Motor Integration (VIM) *
12. Wide Range Achievement Test (WRAT-R) *
    
    (Can be purchased from ADD Warehouse)

14) What are some myth-conceptions about ADD?

a. Medication should be stopped when a child reaches teen years.

Research clearly shows that there is continued benefit to medication for those teens who meet criteria for diagnosis of ADD.

b. Children build up a tolerance to medication.

Although the dose of medication may need adjusting from time to time there is no evidence that children build up a tolerance to medication.

c. Taking medication for ADD leads to greater likelihood of later drug addiction.

There is no evidence to indicate that ADD medication leads to an increased likelihood of later drug addiction.

d. Positive response to medication is confirmation of a diagnosis of ADD.

The fact that a child shows improvement of attention span or a reduction of activity while taking ADD medication does not substantiate the diagnosis of ADD. Even some normal children will show a marked improvement in attentiveness when they take ADD medications.

e. Medication stunts growth.

ADD medications may cause an initial and mild slowing of growth, but over time the growth suppression effect is minimal if non-existent in most cases.

f. Taking ADD medications as a child makes you more reliant on drugs as an adult.

There is no evidence of increased medication taking when medicated ADD children become adults, nor is there evidence that ADD children become addicted to their medications.

g. ADD children who take medication attribute their success only to medication.

When self-esteem is encouraged, a child taking medication attributes his success not only to the medication but to himself as well.

Note: This section was lifted from an article published in the Fall 1991 Chadder titled "Medical Management of Children with ADD Commonly Asked Questions" by Parker et al.

15) Are there any support groups?

National Attention Deficit Disorder Association
P.O. Box 972 Mentor, OH 44061.
Office Line: 216-350-9595
Tollfree Voice Mail:1-800-487-2282
To Fax to ADDA: 216-350-0223
Faxback number: 313-769-6729

National Attention Deficit Disorder-Southern Region
12345 Jones Rd., Suite 287
Houston, TX 77070
(281)-955-3720

LDA
Learning Disabilities Association
4156 Library Road
Pittsburg, Pennsylvania 15234

CHADD. CHildren & Adults with Attention Deficit Disorder
National Office
499 N.W. 70th Ave.
Suite 308
Plantation, Florida 33317
Phone 305-587-3700
Fax 305-587-4599

16) Is there a good commercial source for information?

Yes. ADD Warehouse.
1-800-233-9273 (US only)
Phone 305-792-8944
Fax 305-792-8545

They have a very nice color catalogue.

Source ADD
2345 Harding Ave
Ypsilanti, MI 48197

A terriffic source for everything for ADD.

17) Are there any net (internet, compuserve) based resources?

Yes. There are several sources of information on the networks. This faq (:-)). As well as the National Attention Deficit Disorder World Wide Web site you are viewing now!

There are four forums that I am aware of at this time: COMPUSERVE has an ADD forum, The INTERNET has the ADD parents private e-mail list and an ADD INFO Digest. The World Wide Web has many sites. These sites can be reached using telnet, Mosiac, Netscape and a computer connected to the internet in some fashion. Please see the ADDA internet resource listing at "http://128.196.15.4 (this site). America on Line includes an active ADD area.

1. contact COMPUSERVE for more information. I have not used this service.
   
2. The ADD parents mail list.

Requests to add-request@mv.mv.com.
To subscribe send email to above address with body of message as follows: subscribe add-parents YOUR-NAME

Welcome to the ADD parent's mailing list. This forum is a way for parents of children with Attention Deficit/Hyperactivity Disorder to connect with each other and share information and support.

To send mail to the others on the list, mail to add-parents@mv.mv.com To contact the list administrator (), send mail to add-parents-request@mv.mv.com

c) To get on the adult add mailing list run by Dan Diaz send email to him at BL275@cleveland.freenet.edu

18) What are some Parenting Tricks and Tips? (Strategies)

Fundamentally, parents must understand that much more time/effort has to be invested in raising ADD children.

A difficult concept for older generations to accept is that: There is no such thing as a "BAD CHILD" that lacks "DISCIPLINE". ADD children require additional supports/training to enable them to be successful.

Here are a few tricks and tips that I have assembled from various sources (including books, seminars and practice). These are by no means applicable to, or useful for all ADD children.

a) transitioning

ADD children have a difficult time adjusting to changes (see item c) whether they be immediate requests or longer term ones. The use of warning children of upcoming changes (ie: we are leaving in 5 minutes) can lessen the impact of the change.

b) rules- rewards/consequences The simple act of outlining house rules complete with punishments is the first step in defining behaviors.

|i) timeouts - These are probably the most widely used form of punishments. These have two benefits: removal of the child from the situation and time for contemplation/learning.

ii) removal of privileges - these should be defined by the parents and identified to the child

iii) physical violence (washing mouth with soap, spankings etc) Any form of physical violence against children is extremely discouraged and generally only reinforces negative behaviors.

c) structure/consistency

ADD children seem to be more effective in highly structured environments. Consistency is also a form of structure.

d) deflection/redirection

Sometimes rather than facing a situation/behavior directly it may be more useful/timely to refocus the child on to something else.

e) planned ignoring

The act of ignoring (but letting the child know that you are deliberately doing it) a child's wants/behaviors when they are inappropriate. This probably should |not be used too regularly as it may adversely affect the child's self-esteem.

f) advocacy - education

The parent must become an advocate on behalf of their children. Parents must ensure relatives, teachers and peers understand the issues of the child. This may include teaching people about ADD.

g) praise

This is a very simple but effective method of highlighting things that the child is doing correctly and may include rewards/prizes.

h) meds

I get the impression that a lot of uninformed/uneducated people I assume that medicating a child is wrong/bad. This may come from the thought that children are being given tranquilizers to slow them down, when, in fact, in most cases the children are being given stimulants.

I personally believe that every parent *must* try anything that may help the child (providing, of course, it doesn't harm them).

A simple analogy is to that of a child with diabetes. Should the child be denied a chemical that allows is system to function correctly?

19) Books on ADD.

This is the author's personal list (maybe we can have a net vote if there is enough interest). Ranked in order of preference. (also look at our Resource Listings)

1. "Why Johnnie Can't Concentrate - Coping with Attention Deficit Problems" Robert A. Moss, Bantam, 1990, ISBN 0-553-34968-6 , PB, (p. 203)
2. The Children`s Hosp. of Philadelphia - "A Parents Guide to ADD" 
   Lisa J. Bain, Delta ,1991, ISBN 0-385-300031-X, PB, (p. 216)
3. "COPING ADD" Mary Ellen Beugin, Detselig Enterprises, Calgary, Alberta, 1990, ISBN 1-55059-013-8, PB, (p. 173)
4. "If your child is hyperactive, inattentive, impulsive, distractible...helping the ADD hyperactive child" S & M Garber, 1990, villard ny, ISBN 0-394-57205-x, HB, (p. 235)
5. ADDH Revisited "A concise source of info for parents & teachers" 
   H. Moghadam, Detselig, ISBN 0-920490-78-6, 1988, PB, (p. 101)
6. (PAMPHLET) "A Parents guide to ADHD".
7. (Paper) "Controversial Treatments For Children With ADHD"
   S. Goldstein Ph.D & B. Ingersoll Ph.D.
8. "The Scoutmaster's Guide to ADD" Positive People Press, 4741 Keet Seel Trail, Tucson, Az. 85749

20. ADD in Adults?

Adult ADD (ADD-RT) appears to be getting much more visibility in the media.

I am getting more questions on it so I have included this section. Recently C.H.A.D.D Changed its byline to "Children & Adults with Attention DeficitDisorders".

End of FAQ

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