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Attention Deficit Disorder: Schools
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The primary signs were hyperactivity, short attention span, and poor impulse control. According to her parents and school teacher, Patient A had a first grade reading level (1.5) at the beginning of the third grade. Her printing was illegible, and spelling was a problem. The parents stated that Patient A has never been able to sit still and relax and has never taken naps. She ... woke up crying at least twice every night. A school psychologist had suggested that Patient A be evaluated by a pediatrician and then given Ritalin to control the ADD symptoms.
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All signs do not have to be present for a diagnosis of attention deficit/hyperactivity disorder (ADHD). However, signs of inattention must always be present for a diagnosis. Signs must be present in two or more situations (for example, home and school) and must interfere with social or academic functioning.
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Many parents see signs of an attention deficit in toddlers long before the child enters school. For example, as a 3-year-old, Henry's son already displayed some signs of hyperactivity. He seemed to lose interest and dart off even during his favorite TV shows or while playing games. Once, during a game of "catch," he left the game before the ball even reached him!
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At the end of the eight years, 80% continued to have the ADD symptoms, while 60% had advanced to Opposition Defiant Disorder (ODD) and Conduct Disorder (CD) diagnoses. (Barkley R., Fischer M, et al:The adolescent outcome of hyperactive children diagnosed by research criteria: J Am Acad Child Adoles Psychiatry 29 (4):546-556 July 1990.) These two diagnoses are considered to be much worse than the ADD diagnosis. A literature review dating back to 1971 showed little to be encouraged about. Children with ADD were more likely to fail subjects in school and dropped out of school more frequently. Fewer attended college. And there were NO statistical differences between the long-term results of children treated with medications and those who did not use medications.
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The task used to identify children with deficit of attention is school work. In child's life schools are the most demanding of concentration: hours of sustained attention on cognitively difficult material. So school work becomes the discriminator of who has attentional deficits.
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A diagnosis of one of the attention-deficit/hyperactivity disorders is usually made when children have several of the above symptoms that begin before age 7 and last at least 6 months. Generally, symptoms have to be observed in at least two different settings, such as home and school, before a diagnosis is made.
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