Attention Deficit Hyperactivity Disorder or ADHD is being diagnosed with increasing frequency in both children and adults. Many of these individuals were previously labeled hyperactive or minimally brain damaged. It is estimated that over one million people presently have this disorder.
The fourth edition of the Diagnostic and Statistical (Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, classifies three types of Attention Deficit/Hyperactivity Disorders: predominantly inattentive, predominantly hyperactive, and combined. Six of nine symptoms of inattention, and six of nine of hyperactivity and impulsivity are necessary for diagnosis.
In each case, the symptoms must be present for at least six months to a degree that is maladaptive and inconsistent with developmental level. In addition, some symptoms must be present prior to age seven, and in two or more settings (e.g. at school, work and home). There must be clear evidence of clinically significant impairment in social academic or occupational functioning, and the impairment cannot be caused by other disorders such as anxiety, psychosis or a pervasive developmental disorder.
Even though it is generally assumed that people diagnosed as having ADHD evidence a common set of characteristics emanating from a common etiology, little agreement is found among researchers regarding these symptoms. Some symptoms seen in children diagnosed as having attention deficits include:
Making careless mistakes in schoolwork
- Difficulty sustaining attention to tasks
- Not listening to what is being said
- Difficulty organizing tasks and activities
- Losing and misplacing belongings
- Fidgeting and squirming in seat
- Talking excessively
- Interrupting or intruding on others
- Difficulty playing quietly
These symptoms are also seen in both children and adults with learning-related visual problems, sensory integration dysfunction as well as with undiagnosed allergies or sensitivities to something they eat, drink or breathe. The chart that follows illustrates this graphically.
|Symptoms||ADHD (DSM-IV)||Sensory Integration Dysfunction (Ayres)||Learning Related Visual Problems (Kavner)||Nutrition Allergies(Rapp, Crook& Smith)||NormalChild
|Inattention (at least 6 are necessary)|
|Often fails to give close attention to details or makes careless mistakes||X||X||X||X|
|Often does not listen when spoken to directly||X||X||X||X|
|Often has difficulty sustaining attention in tasks or play activities||X||X||X||X||X|
|Often does not follow through on instructions or fails to finish work||X||X||X||X||X|
|Often has difficulty organizing tasks and activities||X||X||X||X||X|
|Often avoids, dislikes or is reluctant to engage in tasks requiring sustained mental effort||X||X||X||X||X|
|Often loses things||X||X||X||X||X|
|Often distracted by extraneous stimuli||X||X||X||X||X|
|Often forgetful in daily activities||X||X||X||X|
|Hyperactivity and Impulsivity (at least 6 necessary)|
|Often fidgets with hands or feet or squirms in seat||X||X||X||X||X|
|Often has difficulty remaining seated when required to do so||X||X||X||X||X|
|Often runs or climbs excessively||X||X||X||X|
|Often has difficulty playing quietly||X||X||X|
|Often “on the go”||X||X||X||X|
|Often talks excessively||X||X||X||X|
|Often blurts out answers to questions before they have been completed||X||X||X||X|
|Often has difficulty awaiting turn||X||X||X||X||X|
|Often interrupts or intrudes on others||X||X||X||X||X|
Physicians often recommend that ADHD be treated symptomatically with stimulant medication, special education and counseling. Although these approaches sometimes yield positive benefits, they may mask the problems rather than get to their underlying causes.
In addition, many common drugs for ADD, which have the same Class 2 classification as cocaine and morphine, can have some negative side effects that relate to appetite, sleep and growth. Placing a normal student who has difficulty paying attention in a special class and counseling could undermine rather than boost his self-esteem.
A sensible, multi-disciplinary, developmental approach treats underlying causes rather than the symptoms which are secondary.
TREATMENT OF ALLERGIES to pollen, molds, dust, foods and/or chemicals by eliminating or neutralizing them has also been shown to alleviate the identical symptoms, and without side effects.
VISION THERAPY improves skills that allow a person to pay attention. These skill areas include visual tracking, fixation, focus change, binocular fusion and visualization. When all of these are well developed, children and adults can sustain attention, read and write without careless errors, give meaning to what they hear and see, and rely less on movement to stay alert.
OCCUPATIONAL THERAPY for children with sensory integration dysfunction enhances their ability to process lower level senses related to alertness, understanding movement, body position and touch. This allows them to pay more attention to the higher level senses of hearing and vision.
The public needs to understand that some behavioral optometrists, physicians, educators, mental health professionals, occupational therapists and allergists are all addressing the same symptoms and behaviors. The difference is that medication, special education and counseling can mask these symptoms and behaviors, while vision therapy, occupational therapy and the treatment of allergies may alleviate the underlying causes and thus eliminate the symptoms long-term.
When making a choice about treatment for attention deficits:
- Consult a behavioral optometrist for a developmental vision evaluation
- Have a child evaluated by an occupational therapist with expertise in sensory processing problems
- Consult an allergist regarding possible reactions to foods or airborne particles
- American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-lV), 1994.
Ayres, A. Jean, Sensory Integration and the Child, Western Psychological Services, 1979.
Crook, William G., Solving the Puzzle of Your Hard-to-Raise Child, Professional Books, 1987.
Gesell, Arnold, and Ilg., Frances L., Infant and Child of the Culture of Today, Harper) 1943.
Goodman, Gay, Poillion, M. J., The Journal of Special Education, “ADD: Acronym for Any Dysfunction or Difficulty,” Vol 26, No. 1, l992, pp. 37-56.
Kavner, Richard S., Your Child `s Vision, Simon and Schuster, 1985.
Rapp, Doris J., Is This Your Child?, Morrow, 1991.
Schmidt, M.A., Smith, L.H., Sehnert, K.W., Beyond Antibiotics: Healthier Options for Families, North Atlantic Rooks, 1994.
Smith, Lendon, Foods for Healthy Kids, Berkeley Books, 1981.
FOR RESOURCES IN YOUR AREA
College of Optometrists in Vision Development
Optometric Extension Program Foundation, Inc.
American Occupational Therapy Association, Inc.
Developmental Delay Registry
A nonprofit foundation for education and research in Vision