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distractible, willful, irritable, irresponsible, forgetful, undependable,
impulsive, uncontrollable or random (basically I’m-not-paying-
attention-to-what-you-say). Therefore, ADHD children have been
shamed, punished, and called stupid or rotten. But since they lack
hindsight and foresight--due to a physiological disorder--they can
hardly be held fully responsible for their short attention span,
disregard for the rules, and inability to follow directions.
Therefore, ADHD is not considered primarily a psychological
disorder, although behavioral principles can certainly be used to
provide structure for controlling impulsive or inattentive behavior.
Traditionally, there have been two types of ADHD: (1) inattentive
(ADD) and (2) inattentive with hyperactivity (ADHD). However, recent
authoritative texts (Incorvaia, Mark-Goldstein & Tessmer, 1998)
suggest three or maybe five or six sub-types: (1) quiet, (2)
overactive, and (3) overfocused or those three plus (4) depressive, (5)
anxiety, and (6) explosive types. They contend each type needs a
different complex treatment and that Ritalin or longer-lasting Adderall
is not the complete treatment for all types (actually, not for any type).
According to these authors, careful diagnosis is crucial because a
stimulant may be actually harmful when given to inappropriate types.
(Why a stimulant slows an ADHD child is not known.) Anti-depressants
or other medication might work better in some cases, they say. An
estimated 70% to 75% of 5-year-olds to teenagers with ADD or ADHD
benefit from Ritalin/Allerall. The new drug, Allerall, has been on the
market for a year or so. Of interest to parents, Allerall can be taken in
one pill in the morning before school; Ritalin requires a second pill
during the day. Also, it is claimed that Allerall works with some
children who do not benefit from Ritalin. Stimulants are not a total
cure and have side-effects but usually they help (for the down side,
see deGrandpre, 1998). This means that an ADD patient must see an
informed MD. But with or without medication, most people with this
diagnosis need psychological treatment, behavioral control training,
and, as children, special teaching-parenting methods.
It may not be surprising that 90% of children and adolescents who
are given the rare diagnosis of bipolar are also diagnosed as ADHD.
ADHD is a much more common diagnosis than bipolar at that age, so
the classification as ADHD is not a good predictor of becoming bipolar
as an adult. Only very aggressive, anxious or depressed ADHD children
are more likely to become bipolar as adults. Half or more of ADHD
children are also diagnosed Oppositional Defiant Disorder (with the
subtle implication that there is more than a brain disorder here) or
Conduct Disorder. Follow-ups as adults confirm that ADHD in childhood
is somewhat associated with a diagnosis of Antisocial Personality or
Substance Abuse as an adult (but the connection is not so high that
parents should despair). Moreover, learning problems are found in
15% to 30% of children and teens with ADHD, so tests for learning
disorders are needed. In the other direction, however, about 50% of
learning disabled children have ADHD. All of this indicates that this
diagnosis is very complex, requiring very sophisticated investigation of
several areas, both biological and psychological. ADHD and ADD
certainly vary in severity--some are “out of control,” others are only
