Attention Deficit Hyperactivity Disorder and Learning Disabilities
Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder is a disruptive neurobiological disorder that can arise in early childhood. ADHD is marked by behaviors that are chronic (lasting at least six months) that typically before age seven. Hyperactivity may not be present in all cases. When this happens the diagnosis is ADD rather than ADHD.
Characteristics of children with ADHD can include:
A. Either inattention or hyperactivity/impulsivity
Inattention: At least six of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level
- Often fails to give close attention to detail or makes careless mistakes in schoolwork, work, or other activities
- Often has difficulty sustaining attention in tasks or play activities
- Often does not seem to listen to what is being said to him or her
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
- Often has difficulties organizing tasks and activities
- Often avoids, expresses reluctance about, or has difficulties engaging in tasks that require sustained mental effort (such as schoolwork or homework)
- Often loses things necessary for tasks or activities (e.g. school assignments, pencils, books, tools, or toys)
- Is often easily distracted by extraneous stimuli
- Often forgetful in daily activities
Hyperactivity - Impulsivity: At least five of the following symptoms of hyperactivity - impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level
- Often fidgets with hands or feet or squirms in seat
- Leaves seat in classroom or in other situations in which remaining seated is expected
- Often runs about or climbs excessively in situations where it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- Often has difficulty playing or engaging quietly in leisure activities
- Is always "on the go" or acts as if "driven by a motor"
- Often talks excessively
- Often blurts out answers to questions before the questions have been completed
- Often has difficulty waiting in lines or awaiting turn in games or group situations
- Often interrupts or intrudes on others (e.g., butts into others' conversations or games)
B. The following must also be true
- Some symptoms that caused impairment were present before age seven.
- Some symptoms that cause impairment are present in two or more settings (e.g., at school, work, and at home).
- There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
- Does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia or other Psychotic Disorder, and is not better accounted for by Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder.
How is ADHD diagnosed?
ADHD is often diagnosed by psychological testing together with a careful history of the person's behavior. Because learning disabilities are often associated with ADHD, psychological testing is especially important to assess for the presence of complicating factors. Also, examination by a professional is important to assure that only children (or adults) with truly excessive symptoms are given the diagnosis of ADHD. A typical test battery for ADHD/LD includes a major intelligence test along with tests used to measure achievement in a variety of academic areas. Depending on the thoroughness of the exam, other questionnaires and tests are used to assess behavior and rule out other disorders that can look like ADHD but are not.
What about treatment for ADHD?
Treatment for ADHD is varied, depending on the type of behavioral problems evident. Typically behavioral means are used to help provide structure for impulsive behaviors. Social skills training techniques are utilized to help the individual learn social skills that have been impaired by the presence of excessive distractibility and impulsiveness. Also, medication is sometimes used to reduce distractibility.
At the present time something neurofeedback is holding out new promise to people with ADHD. Neurofeedback is a form of biofeedback that directly trains the brain to work in a stable way that decreases many ADHD symptoms. Some people find that they do not need medication. Neurofeedback can also help with learning disabilities, discussed below.
Our understanding of learning disabilites has also made many advances during the last ten years or so. Learning disabilities have to do with specific impairments in the process of learning new material or utilizing previously learned material. The categories are not simple and it can be difficult to test directly for a specific ability because usually a combination of abilities are utilized for any one task.
A sample of commonly recognized learning disabilities includes:
- auditory comprehension (spoken material)
- visual comprehension (written material)
- the ability to utilize numbers and sequences
- the ability to produce spoken language on demand (as the result of questions, rather than spontaneous conversation)
Again, psychological testing is important in diagnosing learning disabilities to isolate as much as possible the abilities that are affected. The individual is then instructed how to use strengths to compensate for the affected abilities and how to make adjustments to minimize the negative impact of the disability on their daily functioning.
Like ADD, learning disabilities are not a sign of an impaired intelligence. Both occur among some of the most intellectually gifted individuals.