Attention Deficit Disorder
Deficit Disorder (ADD) / Attention Deficit Hyperactive
Disorder (ADD) / Attention Deficit Hyperactive Disorder
Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.
While treatment wont cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome.
ADHD has been called Attention Deficit Disorder (ADD) in the past. But ADHD is now the preferred term because it describes both of the primary features of this condition: inattention and hyperactive-impulsive behavior. In some children, signs of ADHD are noticeable as early as 2 or 3 years of age.
People with ADHD / ADD tend to experience:
ADHD, By the
The number of diagnoses of attention deficit disorder (ADHD or ADD) in the United States skyrocketed 43 percent between 2003 and 2011, bringing the total number of American children with ADHD to nearly 6 million, according to 2015 statistics from the Center for Disease Control and Prevention (CDC).
How Many People Are Diagnosed with ADHD Per Year?
Its hard to say how many people receive a diagnosis each year, but the CDC reports that 11 percent of all children in the U.S. aged 4-17 had been diagnosed with ADHD by 2011. The total number of Americans with ADHD continues to rise up from 7.8 percent in 2003 to 9.5 percent in 2007 and 11 percent in 2011.
Boys are nearly three times more likely to be diagnosed with ADHD (13.2 percent) than are girls (5.6 percent). In adults, the rate is much lower (about 4.4 percent), but experts caution that this reflects only reported diagnoses; the prevalence of ADHD may be significantly higher since many adults, particularly women with inattentive symptoms, remain undiagnosed.
Looking at the changes in rates over time, the reader could have several reactions, but perhaps the most common one will be shock at the high and increasing rates of ADHD diagnoses, says Dr. John T. Walkup, who wrote about the CDC study for the Journal of the American Academy for Child and Adolescent Psychiatry. The CDC data suggest that we are getting to a point when children with ADHD in the United States may actually be getting an opportunity for a diagnostic assessment and appropriate evidence-based treatment.
The CDCs estimate mirrors high-quality community-based studies conducted over the past few years, which also show a steep increase in diagnoses, but not treatment. Up to 17.5 percent of the children surveyed by the CDC were not receiving medication or mental health therapy to treat their diagnosed ADHD. The rates of treated ADHD continue to be lower than the rate of ADHD diagnosis, says Walkup, suggesting a pattern of under-treatment of ADHD not of overtreatment, as commonly thought.
Dr. Russell Barkley has been researching ADHD for many years, and offers additional statistics on aspects of ADHD not necessarily studied by the CDC. The statistics below reflect the findings of Dr. Barkley, as well as those published in various medical journals:
Children with ADHD
[Free Download: Your Free Guide to Debunking Annoying ADHD Myths]
Teens with ADHD
Adults with ADHD
Conditions Related to ADHD
ADHD in Women
or Distracted? What Teachers Misunderstand About
The problem starts with the word. Daydreaming implies pleasure and escape. It suggests choice. However, it is much more likely that our students with their heads in the clouds are simply students who have not been identified as having Attention Deficit Hyperactivity Disorder. For them, ADHD may be manifesting as inattentiveness rather than the easier-to-see hyperactivity or impulsivity that most people associate with the disorder.
An estimated 6 million U.S. children ages 2 to 17 have ADHD, according to the Center for Disease Control and Prevention. The noisy brain at the heart of these behaviors is not something anyone chooses. Students who struggle with paying attention consider it a frustrating and sometimes debilitating academic curse. It interferes with their ability to complete assignments in a timely manner (if at all), their ability to listen to and understand directions, as well as their ability to efficiently comprehend content in class. In short, ADHD makes it hard to thrive in school.
An Invisible Misunderstanding
It is hard to understand what we cannot see. Students with this form of ADHD, in eras past known simply as attention deficit disorder, are not the hyperactive ones attracting teacher attention by moving about the room, fidgeting, tapping their feet or tipping their chair. What they are dealing with is essentially invisible.
The misunderstanding surrounding this condition often leads to frustration and harsh judgments on the part of teachers, as well as unnecessary discipline. Certain behaviors like arriving late, turning in incomplete work, losing focus during class, or missing directions are typically seen as indications of a poor work ethic. But common teacher instructions I have heard throughout my years of teaching to "listen better," "focus," or "follow directions" are typically ineffective strategies for these students.
A student struggling with inattentiveness is more likely to be the one who raises her hand to ask a question that has just been answered, or the one who loses track of the discussion altogether. Frequent miscues and obvious confusion make her seem like she is not listening when, in fact, the opposite is true. ADHD makes it difficult to filter out the unessential information and focus on the most essential. A student with ADHD is actually trying to process multiple streams of information at once.
"One-on-one, compassionate conversations with students about their difficulties can be truly profound."
Maybe the cruelest thing about the misunderstanding that surrounds attention difficulties is the toll that it takes on a students sense of potential. Some of my brightest, most creative, and capable minds are the ones who struggle to pay attention in class. I see this in their brilliant contributions in discussions, their original ideas, and their completed projects and assessments. These students do care about their learning, but they struggle to master the practices to help them do so efficiently and effectively.
A Guide for Learning Accommodations
While we teachers should not discount the importance of diagnosis for students who may suffer from ADHD, there is only so much we can do in this realm. We must not wait to offer classroom-based accommodations for our students who have clear issues with attention, regardless of whether or not they have been diagnosed or medicated.
I have found that one-on-one, compassionate conversations with students about their difficulties can be truly profound. Taking the time to privately acknowledge students' often invisible effort (and struggle) is essential. I ask my own students who face these challenges what they think is at the heart of their attention difficulties.
Even if students are not able to offer much clarity, a transformation often occurs in their learning because they finally feel seen and understood. They become more motivated to sustain the extra stamina required for all the school tasks that do not come naturally.
I also find it helpful to directly engage students in designing personalized strategies to sustain their focus and attention during school. My students have suggested various classroom supports for themselves, like preferential seating, noise-cancelling headphones, a quiet corner, and a posted daily schedule or class agenda.
Other helpful instructional accommodations include providing extended time on assessments, using weekly planners, breaking large assignments into smaller chunks, offering instructions in multiple formats (such as oral, written, and digital), setting small, achievable class goals for long-term activities and projects, and providing rubrics that clearly describe the elements of a successful completed assignment. These accommodations do not change the expectations or end goals for these students, only the form of the assignments.
Taking Action for Students
ADHD, for many students, is invisible and complex. It is no wonder that it is often ignored or misunderstood by teachers. But whether or not a student carries an official ADHD diagnosis should not be a prerequisite to taking action. As teachers, we do not need permission to help distracted students. There are no tidy, silver-bullet strategies to eliminate struggles related to attention.
But engaging our individual students in thoughtful conversations about their attention and helping them design strategies to address them can be a good place to start.
Kyle Redford is a 5th grade teacher at
Marin Country Day School, a K-8 school in the San Francisco
Bay Area. She is also the education editor for the Yale
Center for Dyslexia and Creativity.
If you think a lot of American children are being over-diagnosed with ADHD, and perhaps over-medicated, youre right. And if you think a lot of American children arent being diagnosed with ADHD and not given treatment when they should guess what? Youre also right.
The reason for both of these potentially serious problems is the same-and its a scandal. Despite the best wisdom of our mental health profession, the majority of ADHD diagnoses are made with the kind of attention you wouldnt accept from an automobile service department.
Research shows that the most common way children are being diagnosed with ADHD is during a 15-minute appointment with a pediatrician -just 15 minutes! well short of the thorough evaluation recommended by respected organizations such as the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.
The gold standard needed for a valid diagnosis includes not merely conversations with a patient and his or her parents, but a thorough medical history, and, ideally, systematic ratings from teachers and family members, to know for sure if the chief problem is ADHD or whether any one of a host of other possible distraction-causing problems, from anxiety to trauma to a head injury, is the culprit.
A short office visit is usually insufficient to rule out these other problems. Moreover, a simple office assessment that doesnt gather other perspectives can easily miss serious problems that arise in other contexts. In other words, a youth having major ADHD-related problems at school might look just fine when in a one-on-one situation in a new environment, with a doctor wearing a white coat.
I wouldnt argue that there arent some talented, intuitive pediatricians out there who can quickly spot signs of the neurobiological disorder, whose chief symptoms are distraction and impulsivity. But the odds are strong that this quick-and-dirty approach to a major public health issue is taking a serious toll. Many children are being over-treated unnecessarily labeled and prescribed medication that can sometimes have serious side effects, from insomnia to tics to mood changes.
The consequences of under-diagnosis and under-treatment for ADHD are equally serious: longitudinal research shows the disorder can result in many more accidents, injuries, academic and professional failures, and divorces, compared to the rest of the population. This isnt just a problem for families raising children with ADHD: Taxpayers are paying more than $100 billion a year to clean up the mess.
Lets pause here for a short refresher on whats been happening with ADHD diagnosis rates in this country. The most recent survey by the Centers for Disease Control and Prevention showed that the ADHD diagnosis rate for children and adolescents skyrocketed by 41 percent between 2003 and 2012. Today one in nine youth, or more than 6 million in all, have received a diagnosis. More than two-thirds of them nearly 4 million children and teens are taking medication. These numbers are significantly higher than anywhere else in the world, and they are well above the estimated global prevalence rate of between five and seven percent. Whats more, they are much higher in some parts of the nation than in others, suggesting that factors other than accurate diagnoses including pressures from schools to get high scores on standardized tests, although thats a whole other discussion are contributing.
The rise in U.S. rates may now be starting to slow, but it is certain to continue at least for some years. Among the reasons: Obamacare is making doctors visits more accessible to millions of Americans who previously lacked health insurance, while a push for early childhood education means more children are starting school earlier, and being noticed by teachers when they cant keep still. In fact, professional medical associations now recommend that children with ADHD be identified and treated by as early as age four-even as, in those tender years, the need for thorough evaluations is even greater.
All this makes the recent findings of researchers including Jeffrey Epstein, at the University of Cincinnati, extremely worrisome. Epstein has found that half of pediatricians in his Ohio sample failed to gather the kind of feedback from parents and teachers that is so vital to an accurate diagnosis. If that doesnt surprise you, imagine how you might react if you were told that 50 percent of cancer patients werent being diagnosed with the best, evidence-based techniques.
Moreover, whereas more than 90 percent of the diagnosed children Epstein tracked were prescribed medication, only 13 percent were offered the kinds of behavioral therapy including parent-training and classroom supports backed by solid evidence as helpful to seriously distracted children. Even worse, the doctors very rarely at most, 10 percent of the time followed up their treatments with systematic monitoring, a recipe for failure.
As is the case with all mental health problems, theres still no objective test-a blood sample, computer assessment, or brain scan-that can objectively and accurately tell who does or does not have ADHD. Such a test may exist in our future, but right now theres no alternative to devoting what all of us, diagnosed or not, have less and less of today: time and attention.
Its time we face the facts: ADHD
is a genuine medical ailment, and an exceptionally expensive
one. But investing time, bandwidth, and money before the
problem gets worse, as it almost always will, can save
considerable time and money down the line. We need more
specialists, including child and adolescent psychiatrists,
as well as developmental-behavioral pediatricians. We need
medical schools to include evidence-based approaches in
their training. And most importantly, we need reimbursements
that fully compensate doctors who take the time to do it