Attention Deficit/Hyperactivity Disorder (AD/HD), once called hyperkinesis (e.g., super active) or minimal brain dysfunction, has a very strong neurological basis and is one of the most common disorders of childhood and adolescence is characterized by hyperactive or impulsive behaviors and attention-deficit problems that cannot be explained by any other psychiatric condition and are not in keeping with the individual’s intellectual ability or stage of development. test

AD/HD is often confused for LD and vice-versa. AD/HD is not a form of LD, each is a distinctive neurologically-based disability-recognized, diagnosed, and treated differently; however, approximately 30 to 40 percent of individuals with LD also have AD/HD.

WHAT CAUSES AD/HD?

No definitive cause for AD/HD has been determined but its biological basis is becoming more understood.  Based on numerous studies of neurological brain scans, it has been determined that there are three structures within the brain that are believed to be responsible for AD/HD; the orbital prefrontal cortex, striatum, and caudate. Studies show these brain structures to be underdeveloped and located more on the right side than the left, suggesting a possibility that AD/HD could be a result of brain asymmetry. The size of those regions is directly correlated with how uninhibited an individual is.

Researchers are also searching for other differences between those who have and do not have AD/HD. Some of the factors they are studying include drug use during pregnancy, toxins, infection, head trauma, and genetics.

UNDERSTANDING AD/HD

AD/HD is present at birth and is characterized by a history of chronic and pervasive symptoms and problems with hyperactivity, distractivity, and impulsivity. Of course, there can be other causes for such symptoms (e.g., anxiety, depression), thus requiring the diagnosing professional to take care in reviewing an individual's entire case history including input obtained from relatives, teachers, the individual, and other healthcare professionals before assigning a diagnosis of AD/HD. If the symptoms only occur in certain situations or in specific settings, it is not likely that a diagnosis of AD/HD would be given.

Subtypes of AD/HD

The DSM-IV TR describes three subtypes of AD/HD:

1. Inattentive—Cannot seem to get focused or stay focused on a task or activity

2. Hyperactive/Impulsive—Very active and often acts without thinking

3. Combined—Inattentive, impulsive, and too active

Inattentive—Individuals who are inattentive have a hard time keeping their mind on any one thing and may get bored with a task after only a few minutes. They may give effortless and automatic attention to activities and things they enjoy, but have difficulty focusing deliberate, conscious attention to organizing and completing a task or learning something new.

Hyperactivity—Individuals who are hyperactive always seem to be in motion, unable to sit still or constantly dashing around and talking incessantly. Sitting still through a lesson or assignment in class can be an impossible task. Hyperactive teens and adults may feel intensely restless. They may be fidgety or try to do several things at once, bouncing around from one activity to the next.

Individuals with AD/HD exhibit degrees of hyperactivity, distractibility, and/or impulsivity that are abnormal for their age potentially resulting in serious problems with social and family relationships and impaired academic success or other life endeavors.

Although young people with AD/HD do improve their degree of inhibition, gain greater self-control, and improve their ability to successfully manage themselves, they always lag behind developmentally. As they are improving so are the non-AD/HD youth and the gap tends to remain intact. This developmental lag is roughly 30 to 40 percent, which is significant and provides valuable insight to determining appropriate expectations for these individuals.

Positive Attributes of Individuals with AD/HD

There are certain positive attributes that typically are ascribed to individuals with AD/HD. There are no absolutes here and each individual's unique needs and abilities must always be considered in developing a successful program and work-related experiences. Knowing these attributes can be particularly helpful during the career preparation phase of the program. Assisting an individual with AD/HD in finding a career match that is more conducive to his/her wiring often leads to better outcomes. Of course, students may select the career path of their choosing; however, it is important that they understand the nature of their disability and how it personally impacts them. Armed with this knowledge, the student can then make better career choices suited both to his/her skills and abilities.

An individual with AD/HD typically:

• Has better expressive language skills than their receptive abilities-meaning they are better talkers than listeners (e.g., sales, announcers, etc.)

• Enjoys and has strengths in physically stimulating and creative tasks (e.g., painting, drawing, sports, construction, etc.)

Neurological Deficits Associated with AD/HD

• Motor Coordination Deficits—AD/HD appears to interfere with fine motor sequencing and often results in increased clumsiness.

• Internalization of Speech Delay—AD/HD delays the internalization of speech (e.g., where verbal thought originates) by approximately 30 to 40 percent.
• Delay in Moral Development—Individuals with AD/HD experience a harder time with socialization and are more prone to antisocial behavior and delays in the development of "moral" behaviors.

All animals respond to stimuli in their environment. Humans, more so than other species, build in a pause between the stimulus and the decision to respond. Thus, inhibition (e.g., the ability to wait and not respond to the world around us) is not just another mental ability; it is the foundation upon which the human executive system (e.g., self-control, self-regulation) is built. Executive functions are what give you self-control and the executive system is built on the inhibitory system. If inhibition fails, so does the executive system.

As children we develop inhibition and during those moments of waiting or pausing before responding to the world around us, four executive functions began to develop and emerge. Each function provides a form of self-control not provided by the other, and by adulthood, these functions work in concert to manage our behavior.

As the executive functions begin to appear, we move from:

1. External to internal thought
2. Other's control to self-management
3. Control by the moment to anticipating the future
4. Immediate gratification to deferred gratification

Individuals with AD/HD fail to have one or all of these executive functions appear which can wreck havoc in the individual's environment.

SYMPTOMS OF AD/HD

AD/HD tends to occur comorbidly with other disorders such as LD or other conduct disorders. Only a qualified professional who has gathered a variety of historical and current data on the student can diagnose AD/HD. According to the DSM-IV TR, there must be some impairment from the symptoms present in two or more settings (such as in school or work and at home) and there must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. Typically AD/HD is not diagnosed when a person is depressed, anxious or when the person has another disorder that can explain the AD/HD-like behaviors.

Possible symptoms of AD/HD include the following:

Inattention

• Often fails to give close attention to details or makes careless mistakes in school work, work, or other activities
• Often has difficulty sustaining attention in tasks or play activities
• Often does not seem to listen when spoken to directly
• 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 difficulty organizing tasks and activities
• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as homework)
• Often loses things necessary for tasks or activities (toys, school assignments, pencils, books, or tools)
• Often easily distracted by extraneous stimuli
• Often forgetful in daily activities

Organization

• Avoidance of dull, repetitious tasks or tasks requiring sustained mental effort, such as homework
• Difficulty organizing tasks and activities
• Distracted by external stimuli or own thoughts
• Forgetfulness
• Tendency to lose things

Hyperactive

• Often fidgets with hands or feet or squirms in seat
• Often leaves seat in classroom or in other situations in which remaining seated is expected
• Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
• Often has difficulty playing or engaging in leisure activities quietly
• Is often "on the go" or often acts as if "driven by a motor"
• Often talks excessively

Impulsive

• Often blurts out answers before questions have been completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others (such as butting into conversations or games)

According to the DSM-IV TR:

1. AD/HD inattention applies to individuals with at least six (6) of the symptoms of inattention. These symptoms must have persisted for over 6 months. These symptoms must be maladaptive; that is, they will seem immature for a person's age.
2. AD/HD hyperactive applies to individuals with at least six of the symptoms from the hyperactive-impulsive list.
3. AD/HD combined type applies to individuals who have six symptoms in both of the categories of inattention and hyperactive-impulsive symptoms.

MEDICATION MANAGEMENT

Any student that is using medication for the management of attention deficit/ hyperactivity symptoms is monitored and managed by on site health and wellness center staff in accordance with standard medication management policies in the PRH. Click here for information on AD/HD medications. (pdf file, Click here to download Adobe Acrobat Reader)

Vocational Training

Students diagnosed with AD/HD who are taking prescribed medication for the management of the disorder cannot be prohibited from entering or be removed from any program without the recommendation and approval of the center's physician or mental health consultant.

Medication Recommendations

Non-medical staff should not suggest or recommend the use of medication as a treatment option for students with AD/HD. Concerns about a student's behavior, performance, or noncompliance with medication should be well documented and attached to a referral to the center's mental health consultant for review.

AD/HD INTO ADULTHOOD

AD/HD is a lifelong disorder-it does not disappear with age. That does not mean that individuals with AD/HD cannot be highly successful individuals in their youth and as adults. It does mean, however, that most individuals with AD/HD will need to learn and use lifelong compensatory strategies; particularly those that build on the person's strengths, and/or medication to effectively manage the disorder.

Problems with inattention (e.g., executive functions, etc.) are often more difficult to detect than the more overt behaviors often associated with hyperactive and impulsive behaviors, increasing the likelihood that adults "who were not previously diagnosed as children, will continue to go undiagnosed and untreated.