Ups and Downs Millions of Children Deal with the Unpredictability of ADD

Rob Robinson describes them in the most glowing of terms.

“Often they’re very creative people who possess a lot of energy, have very engaging personalities, and display an unbelievable sense of humor — lively, with a lot of charisma,” he said. “There is an upside to this; the trick is helping people develop the upside and watch out for the downside, which can cause problems in life.”

The vibrant folks he was describing are those afflicted with attention deficit disorder (ADD). And that downside, well, it can be troublesome, to say the least.

Attention deficit disorder is a biological condition characterized by poor attention and distractibility, sometimes with hyperactive behaviors (referred to as ADHD). It’s one of the most common behavioral disorders that develop in children, affecting an estimated 3{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of preschool and school-age children in the U.S., and maybe as many as 8{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}.

The reason it’s tough to pin down more than a rough number is that many of the signs of ADD — restlessness, inability to focus, impulsive behavior — quite frankly describe the behavior of most children, especially boys, at least sometimes.

“Many people are like that some of the time,” said Robinson, a licensed marriage and family therapist and clinical director of Family Care Counseling Associates in Wilbraham.

“But you have to look at the intensity and the duration of the symptoms,” he explained. “If you have symptoms that are intense compared to your group of peers and you’ve had them all your life, you probably have ADD. People under stress can get worked up and become hyperactive, but you need to look at the history, duration, and intensity of it.”

In fact, although ADD is identified by most of the public as a childhood disease, symptoms can continue into adolescence and adulthood between 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} and 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the time.

“Not too long ago, maybe 15 years ago, people didn’t believe this could exist in adults. It was a strictly psychological diagnosis, primarily in children. But now we see that it’s a condition that can affect people into adulthood.”

However, skepticism lingers even today over how pervasive ADD really is, and how many of those diagnosed are simply normal, high-energy kids. But for those who suffer from the condition and those, like Robinson, who treat them, it couldn’t be more real.

Out of Focus

No definitive answer exists to the question of what causes ADD. “It runs in families,” Robinson said, “so it is genetically influenced, but not genetically determined.”

In any given ADD child, symptoms typically include several of the following:

difficulty paying attention or staying focused on a task or activity;
problems finishing assignments at school or jumping from one activity to another;
trouble focusing on instructions and difficulty following through;
losing or forgetting things such as homework;
becoming easily distracted, even when doing something fun;
problems paying close attention to details or making careless mistakes;
trouble organizing tasks and activities;
difficulty waiting one’s turn;
interrupting or intruding on other people;
blurting out answers before questions have been completed;
fidgeting with hands or feet or squirming about when seated;
feelings of restlessness; and
excessive talking and trouble engaging in activities quietly.
“People can struggle in school, which can affect their sense of self-esteem along with their grades,” said Robinson. “Sometimes, there’s a risk that young kids will act impulsively, doing dangerous things, like running across the street without looking — doing things that can affect their well-being.”

While the cause of ADD has not been determined, many research studies currently focus on identifying which genes, or combination of genes, may cause a person to be more susceptible. Characteristics of certain parts of the brain are also thought to be linked to ADD, as brain abnormalities or structural differences have also been found in individuals with the condition.

Many studies have found that the greatest risk factor for ADD is simply being male, as males are three times more likely to be diagnosed with ADD than females. Additional suspected risk factors include maternal use of cigarettes or alcohol during pregnancy, which may affect brain development. Children who have been exposed to high levels of lead also may display ADD symptoms.

Answering the Critics

Despite evidence to the contrary, however, ADD advocates still deal with what they call widespread skepticism over whether ADD exists at all. Pete Quily, an ADD coach who helps adults manage their condition, launched a Web site (www.addcoach4u.com) to dispel some of those beliefs.

“Many people with ADD don’t seek diagnosis or treatment for themselves or their children because of the stigma created by some judgmental, ignorant people,” he writes.

“Would you tell someone who’s a diabetic that he shouldn’t take insulin, it’s not good for them, diabetes is a phony condition thought up by the drug companies, and all they have to do is stay away from the chocolate bars and have happy thoughts? Why is it that people who would not assume they’re knowledgeable enough to make pronouncements of the validity of physical medical conditions assume that they are knowledgeable enough to make sweeping pronouncements of the validity of mental medical conditions?”

Dr. Marc Schwartz, director of the Adult ADD Center of New Haven, writing at www.healthcalls.com, used a similar example.

“It may be true that everyone has some symptoms of ADD,” he notes. “But it is also true that everyone has had some symptoms of pneumonia: cough, fever, and headache. The differences between pneumonia and a cold are that the symptoms of pneumonia are much more severe, the effects of the symptoms on people’s lives are much greater, and patients with pneumonia respond to treatment designed to treat pneumonia.”

Schwartz is an advocate of the stimulant drugs typically used to manage ADD, which tend to dramatically increase focus and alertness, he said.

Stimulants have been prescribed for ADD-like symptoms for decades, said Robinson, citing Ritalin, Focalin, Adderall, and Concerta as some of the more common ones in use today.

Doctors who specialize in the disorder can help families choose treatment paths with the best chance of lessening the symptoms, he added, while trying to avoid common side effects like sleeplessness and loss of appetite — and without suppressing the positive sides of someone’s personality.

But while using medications properly can help a great deal, he said, so can academic support from sensitive teachers, who might allow an ADD student to sit up front, or remind him or her to write down assignments.

“We still run into some teachers out there who don’t believe that ADD really exists,” Robinson said. “But it is a bona fide diagnosis. And as they make some headway in research, at some point there will probably be some kind of brain scan or tests that will more accurately pinpoint it.”

That’s certainly a goal worth focusing on.