Attention-Deficit/Hyperactivity Disorder In Children

By Leah Davies, M.Ed.

Attention-Deficit/Hyperactivity Disorder (AD/HD) begins in childhood and can last into adulthood. In the majority of cases, symptoms appear in children between the ages of four and six, although they sometimes occur earlier. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)*, there are three patterns of behavior that indicate an AD/HD disorder. The categories are the predominantly inattentive, sometimes called ADD; the predominantly hyperactive-impulsive, that does not show substantial inattention; and the combined type that displays both inattentive and hyperactive-impulsive symptoms. Having this disorder can contribute to a child having low self-esteem, problematic peer interactions, and poor school performance. However, students with the disorder can be highly intelligent.

In a classroom of 25 to 30 children, it is probable that at least one child has AD/HD. Distinguishing a hyperactive-impulsive child from that of a normal, active child can be difficult. One clue is that children with this disorder tend to be sensitive to stimuli such as sights, sounds and touch. If they become overstimulated, they can exhibit out-of-control behavior. On the other hand, children with the inattentive form of AD/HD may seem oblivious to their surroundings. Different settings bring about different symptoms in these children depending on the demands of the situation and the child's self-control. A child who is in constant motion, disruptive, and acts before thinking will be noticed, but the inattentive child may not. Yet, both of these students may be viewed by a teacher as unmotivated.

Since a child's symptoms may be caused by another disorder, he or she must receive a thorough evaluation and be diagnosed by a well-qualified professional. The child's impairment should exist in a minimum of two areas of a child's life, for example, in the classroom, on the playground, or at home. Thus, if the problem is with a particular teacher or only with parents, the child does not have the disorder.

Children who have the inattentive form of AD/HD are easily distracted and forgetful. These children make careless mistakes and fail to complete schoolwork. They have trouble listening, sustaining attention, and following through on instructions. They avoid work that requires sustained mental effort and have difficulty learning and organizing new tasks. These students often skip from one activity to another and may appear easily confused or lethargic. However, if they are doing something they enjoy, they can pay attention for extended periods of time.

The signs and symptoms of children who have hyperactivity-implusive disorder are fidgeting with their hands or feet and/or squirming while sitting. They are in constant motion and have difficulty playing quietly. They are often out of their seat and may run or climb excessively. Other traits these children can exhibit are excessive talking, interrupting, and being unable to wait their turn or to contemplate consequences of their actions. These children may make inappropriate comments and openly display their emotions.

The most common treatment for children with AD/HD is the use of psychostimulant drugs such as methylphenidate or dextroamphetamine. Many students on medication show academic improvement due to an increased ability to concentrate and stay on task. However, the use of these drugs is being evaluated, since psychostimulant medications do not cure the disorder. Although they relieve the symptoms of AD/HD, some students report that the medications make them feel "restricted" or "empty" inside. Preferential classroom accommodations, school counseling, and individual or family therapy can help these students improve overall functioning. With appropriate assistance and self-confidence, social interaction skills and academic performance can improve.

Children with AD/HD need:

Understanding, creative teachers who believe in their worth and make accommodations for their disorder

AD/HD students progress when the adults in their life provide firm, caring discipline. If the child is out of control, the adult needs to remain patient and in control.

Structure and consistency

Plan the learning environment to be as predictable as possible. Since children with AD/HD have difficulty adjusting to change, provide an ordered classroom with clear rules that are prominently displayed.

Realistic expectations

These children can easily feel overwhelmed with too much information. When possible, give them one instruction at a time, and if needed, provide the directions both verbally and visually. Set goals with the child and notice when he or she has met them.


Frequently acknowledge a new, appropriate behavior (see Rewards in the Classroom). Use special privileges, such as being a class helper, having computer time, or free choice time as reinforcers. (Also see 30 Ideas for Teaching Children with ADHD.)

A close working relationship among educators involved with the child

Open discourse with the student's parents is critical.

A guidance counselor and/or special education teacher can help teachers and parents understand the student's disorder and share effective ways to help the child. Guidance counselors can work with individual or small groups of AD/HD children to foster social and anger management skills as well as feelings of self-worth. Depending on the severity of the disorder, these children may receive Special Education services.

*DSM-IV-TR workgroup The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.

Used by permission of the author, Leah Davies, and selected from the Kelly Bear website [], 10/04

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