ADHD: What It Is, What It Isn’t

ADHD. The term rolls off the tongues of anxious parents, doctors and educators with practiced ease, yet its meaning and effect on children is widely misunderstood. That’s partly because research is still homing in on the disorder—really a big basket of symptoms. Some researchers think this basket contains several different disorders. Adding to the misunderstanding, ADHD (Attention Deficit / Hyperactivity Disorder) is often blamed when anxiety, depression, family turmoil, or the frustration of a learning disorder is what’s really wrong.

Because educators and doctors may share in the confusion, warns Larry B. Silver, psychiatrist and author of Dr. Larry Silver's Advice to Parents on ADHD, parents have to be strong advocates for their kids. “You have to go in knowledgeable enough to educate your family doctor.”

What to look for

Estimates on the numbers of school age children with the disorder range from 3% to 9%. Is your child one of them? The first step in finding out is to educate yourself about ADHD (ADD is an outdated term). Russell A. Barkley, a psychologist and author of Taking Charge of ADHD: The Complete, Authoritative Guide for Parents, describes the three hallmark symptoms of ADHD; however not every person with ADHD displays all the symptoms:

• Hyperactivity, impulsiveness: Think of kids popping out of classroom seats or fidgeting, constantly tapping their fingers and toes—constantly subject to more motor activity than normal. Impulsiveness means they lack the ability to think before acting or speaking.
  
  
• Distractibility: Kids who have trouble ignoring unimportant sights or sounds. Any noise—birdsong or a car motor outside, what have you—distracts. Some kids over-respond to visual distractions. Say you tell Julie to get dressed, but when you check on her 15 minutes later she’s moved on to something else and has forgotten all about needing to get dressed. These kids can’t follow through from minute to minute.
  
  
• Trouble focusing: These kids can’t process information quickly. They’re confused by complexity, day dream, can’t attend to the task at hand, are spacey or foggy.

The types—and a big exception

To make a diagnosis, professionals follow the Diagnostic and Statistical Manual for Mental Disorders, which defines three broad types of ADHD:

• Combined hyperactive and attention deficit—most ADHD kids are in this category
  
  
• Predominately inattentive (without significant hyperactivity)
  
  
• Predominately hyperactive-impulsive (without, at least at this stage of their development, an attention deficit)

These categories weren’t developed by scientists, but were created to help organize symptoms for diagnosis and insurance reimbursement, says Barkley. That’s why there’s a lot of similarity. For the most part, the differences among these types are in the degree or number of symptoms—often because of the age or developmental stage of the child. Kids usually outgrow hyperactivity, but may still be inattentive in school or at home.

There is one big exception. Researchers found that some ADHD children in the “predominately inattentive” category are quite different from all others. In Barkley’s opinion, these kids don’t really have ADHD, but another little-explored disorder. It’s called “sluggish cognitive tempo disorder,” or SCT (sometimes referred to as “ADHD without much hyperactivity: predominantly inattentive type”), though this type still falls under the ADHD umbrella.