What does a teacher need to know about Attention Deficit Disorder (ADD)?
During my teacher training, I took a course on educating special-needs children, and ADD was the subject I chose to research. The reason was my neighbor,
a divorced mother about my age, and her three children. To me, they seemed like normal, active kids, except the oldest boy has a tendency to reverse numbers, the middle girl has trouble organizing her thoughts, and the youngest boy is so active he seems to almost bounce off the walls.
My neighbor also happens to be a psychologist in private practice, so she knew to have all three children professionally tested. All three showed symptoms of ADD, and all three have benefited from medication. Hence my interest, and this is a summary of what I found.
There is a wealth of available information and not all of it agrees. ADD is surprisingly difficult to define. Many sources go directly into detailed descriptions without ever giving a simple layman’s definition. The best definition I found was in the book How the Special Needs Brain Learns by D. A. Sousa: “Attention-deficit hyperactivity disorder (ADHD) is a syndrome that interferes with an individual’s ability to focus (inattention), regulate activity level (hyperactivity), and inhibit behavior (impulsivity).”
Note the terminology change from ADD to ADHD. There are three reasons for this.
First, ADD is not new. Since 1902, it has been known by many names: Still’s disease, postencephalitic disorder, hyperkinesis, minimal brain damage, minimal brain dysfunction, hyperkinetic reaction of childhood, attention deficit disorder, and today, attention-deficit/hyperactivity disorder.
Second, the more we have learned about this condition, the more descriptive the names have become. Names basically reflect the thinking of those respective time periods.
Third, ADD is actually a complex category of conditions, and there is some disagreement about which terms should be used. The current term in vogue is attention deficit/hyperactivity disorder (AD/HD); the slash symbolizes the many people, perhaps half who have ADD, who were never hyperactive.
Are there other complexities? Yes, and the exact variants make for more lively discussion. A couple of examples:
Dr. Harvey C. Parker lists three variants: predominant symptoms of inattention, predominant symptoms of hyperactivity-impulsivity, and combined symptoms of inattention and hyperactivity-impulsivity.
Dr. D. G. Amen lists six (labeled Types I through VI): classic ADD, inattentive ADD, overfocused ADD, temporal lobe ADD (aggressive, dark thoughts, mood instability, severely impulsive), limbic ADD (low-grade depression, low energy), and “ring of fire” ADD (angry, overly sensitive to the environment, extremely oppositional, cyclic moodiness).
Literature searches can turn up other specialized terminology. The point is ADD is receiving a lot of attention and analysis, and much reference literature is now available.
Who can suffer from ADD? Once again, estimates can vary depending upon terminology. For example, a Department of Education study says three to five percent of the children in the United States have AD/HD. Dr. Amen uses the figure five to ten percent for ADD. To complicate matters further, the U.S. Department of Education says more boys than girls are diagnosed with AD/HD, and most research suggests that the condition is diagnosed four to nine times more often in boys than in girls.
So boys are more susceptible? Not really. Dr. Amen has found boys and girls suffer almost equally. Girls are simply diagnosed less frequently because they are less hyperactive, less disruptive, and because of gender bias.
What ages are affected? For years, many assumed this to be a childhood disorder that became visible as early as age three and then disappeared with the advent of adolescence. Now we know the condition is not even limited to children. ADD definitely affects adults, although it always develops in childhood.
What causes ADD? Dr. Amen states directly “ADD is a genetic disorder.” Other sources hedge a bit. D. A. Sousa puts it this way about AD/HD: “The exact causes of ADHD are unknown. Scientific evidence indicates that this is a neurologically based medical problem for which there may be several causes.” Sousa addresses the genetic question this way: “Is ADHD inherited? Probably. Genetic predispositions for ADHD are likely because the disorder runs in families.”
If/when ADD is not inherited, there is some evidence it might be caused by trauma at birth or alcohol/drug abuse by the mother during pregnancy. ADD can also be common in children with other afflictions, such as spina bifida, cerebral palsy, or thyroid disease. Other suspects include maternal smoking and exposure to environmental toxins during pregnancy. But it may surprise some people that research has ruled out elevated levels of sugar as a culprit. The important point to remember is there is no evidence that “bad parenting” is a cause.
What are the signs of ADD? There are many anecdotal stories about hyperactivity. One good description is by Kristi Meisenbach Boylan: “But parents of highly active children will tell you that they didn’t need a label or formal diagnosis to know that their children were different. They knew the second their children were conceived. They were not born. They were released like racehorses shooting from the starting gate.”
But experts caution parents and teachers alike not to self-diagnose. The above story is a classic description of AD/HD, but not every ADD child is hyperactive.
The problem is there are many – and conflicting – signs of ADD. This is where the variants come into play.
Dr. Amen lists symptoms for all six of his types of ADD. Here are some examples:
Classic ADD: Easily distracted, has difficulty sustaining attention span, has difficulty keeping an organized area, makes careless mistakes, is impulsive, acts as if “driven by a motor”.
Inattentive ADD: Core symptoms, plus is forgetful, daydreams excessively, appears apathetic or unmotivated, is tired or sluggish.
Overfocused ADD: Core symptoms, plus worries excessively or senselessly, is oppositional and argumentative, has tendency toward compulsive behaviors, has difficulty seeing options, needs to have things done a certain way.
Temporal Lobe ADD: Core symptoms, plus quick temper or rages with little provocation, misinterprets comments as negative when they are not, periods of panic and/or fear for no specific reason, has history of head injury or family history of violence, has dark thoughts that may involve suicidal or homicidal ideas.
Limbic ADD: Core symptoms, plus moodiness, negativity, low energy, frequent irritability, frequent feelings of hopelessness, helplessness, or excessive guilt, sleep changes, chronic low self-esteem.
“Ring of Fire” ADD: Core symptoms, plus is angry or aggressive, is sensitive to noise, light, clothes, or touch, has frequent or cyclic mood swings, is inflexible, periods of mean or insensitive behavior, periods of excessive talkativeness.
So what is a teacher to do? Based on the information I found, here are my conclusions:
1. Be alert to the symptoms. With estimates of affected children ranging anywhere from three to ten percent, I know I will have ADD children in my classroom. It’s not a question of if, but when.
2. Don’t self-diagnose. I have heard the suspicions that teachers simply want to drug normally active children. And in some cases that criticism is probably justified. Teachers must not fall into that trap. Do what my neighbor did. Even though she’s a mental-health professional herself, she had her children tested by another psychologist.
3. Use the system. A description of how to refer and assess students for special needs and develop Individualized Education Programs is beyond the scope of this essay. But the system does exist; don’t be afraid to use it.
For the record, there are actually advantages to having ADD, including creativity, resourcefulness, tenacity, and flexibility. But not all people with ADD exhibit all these qualities. Further, the problem is the negatives can overwhelm whatever positives the child may possess. Once the proper treatment is found, the positives can come to the forefront.
Meanwhile, research continues. Much has been learned about ADD since the early 1900s. The details that have emerged have shown just how challenging it is to educate all children to their full potential. As a new teacher, I just hope we can learn at least as much in the next hundred years as we have to date.
Amen, D. G. (2001). Healing ADD. New York: G. P. Putnam’s Sons.
Amen, D. G. (video). Windows into the A.D.D. Mind. Fairfield, CA: Mindworks Press.
Meisenbach Boylan, K. (2003). Born to be Wild. New York: Perigee Books.
Parker, H. C. (1999). Put Yourself in Their Shoes. Plantation, FL: Specialty Press.
Sousa, D. A. (2001). How the Special Needs Brain Learns. Thousand Oaks, CA: Corwin Press.
U. S. Department of Education (Feb. 2004). Teaching children with attention deficit hyperactivity disorder: instructional strategies and practices. Report under contract no. HS97017002 with American Institutes for Research.