Attention Defecit Disorder
By Jim Jacob
In 1902 a doctor named Still describe children who had behavioral
problem which he termed "defects in moral control" and he recoginzed
that the condition occurred more commonly in boys. He described the
childern as having conduct disorders and poor attention.
The discovery of the "paradxivcal quietening effect" and marked
behavioral and school improvement of hyperactive childern treated with
Benzedrine in 1937. This find may have influenced the selection of
the term of "Minimal Brain Dysfunction."
In 1959 Knobloch and Pasamanick, who compared birth history of
500 childern referred for behavior problem with a matched control
groups of 350 children from the same socioeconomic group and found
that the behavoir disordered children had significantly more
complications of pregnancy and that most common behavioral syndrone
Below is a brief historical highlights:
1. The discription of the syndrome is not new in
the medical literature and appeared as early as
2. The interaction between organic factors and
the environment in the perpetuation of the
behavioral syndrome was recognized in the 1930's.
3. The terminology of the syndrome has changed
over time from MBD to Attention Deficit Disorder.
(Hyperactive Childern Grown Up, Grabrille Weiss
and Lily Trokenberg Hechtman).
Within the past 20 years the condtion has become the most-
researched and best known of the childhood behavior disorders. It is
the most common single condition referred to child psychiatry clinics.
The condition is severe enough to be very distressing to teachers and
parents. In 1960's the use of stimulants drugs began to help
behavior. In 1970's discovery that hyperactive child syndrome was not
limited to childhood, and that children do not necessarily outgrow
this condition. The fact of psychiatric and social impairment and
continuing into adolescence and adulthood was established.
Finally, attention deficit disorder (ADD), has become the
established, current name.
It can take a long time to diagnose attention-deficit
hyperactivity disorder. It effects one in five school age childern.
In the past it was assumed that after puberty it would disappear,
which in today's research is not necessarily true. Three things are
giving hope to adults with attention-deficit hyperactivity disorder:
1. Early intervention
2. More of the population becoming aware
3. Researchers are beginning to focus on the
underlying causes of this disorder.
Identifying the child with attention-deficit hyperactivity
disorder has become easier. These are inability to sustain attention,
impatient, impulsive, and nonreflective. There often is a lack of
social skills. Other disabilities may be present, including conduct
The American Psychiatric Association states the
essential features of ADD as:
ADD With Hyperactivity
Does not finish tasks
Does not seem to listen
Has diffculty concentrating on tasks
Has difficulty sticking to play
Acts before thinking
Shifts from one activity to another
Has difficulty organizing work
Needs much supervision
Often calls out in class
Has difficulty awaiting turn
Is restless during sleep
Is always "On the go"
Onset: Before 7 years of age
(Usually by 3 years)
ADD Without Hyperactivity
As above, except for the absence of
There are many approaches to therapy with a child showing ADD.
It is geared to a a child's particular needs. Almost always, the
child with ADD is treated through educational management. The more
individualized education and positve approach is best for the child.
Having least amount of distraction in class by sitting near the
teacher can be of great help. Short sessions of work with regular
breaks seems to work well for the child.
Medical management is often a essential part of ADD treatment.
It should not be the only treatment. Treatment with drungs such as
dextroamphitamine, methylphenidate, or pemoline depends on the degree
of ADD in academic and social activities. The drugs should be given
only after extensive discussion with the child's parents and school.
Medical history, findings on examination, or the results of
laboratory testing will not show the child's reaction to medication.
An appoved questionaire for parents and teachers should be used to
determine a child's behavior. This can assist the health care
professional in determining whether to treat a patient with
medication. Follow-up reports are important to keep track of the
Beacause some ADD childern have poor motor control, they can be
helped through physical education. If a child is gifted in sports,
running most common, it should be encouraged by professionals. This
is a socially accepted form of self-expression with no limits and
builds good self-esteem.
Psychotherapy is widely used with medical treatment in children
with ADD. The child should be shown that medical treatment cannot
correct all problems but to increase personal control of behavior help
along with medication. In this situation parents need to have
counseling as well.
There is a strong genetic infulence in attention-deficit
hyperactivity disorder. In recent years several studies have been
done with family and twins to suggest this disorder is hereditary.
One of the studies was done by David Comings, M.D., director of the
Department of Medical Genetics at the City of Hope Medical Center.
New research attached to genetics include theories about children
with attention-deficit hyperactivity disorder will have more genetic
problems. Research also shows systems play a central role in ADD.
This research was done by Bennett and Sally Shaywita.
Reports of reduced concentrations of homovanillic acid (HVA) in
the cerebrospinal fluid of children with ADD suggest adnormalities
in central dopaminergic system. This new research seems to not
support the other theory call lag theory. This theory states children
with attention-deficit hyperactivity disorder (ADD) are behind their
peer but not different in any important ways.
Whatever the causes, today about at 3% worldwide if the average
amount of children with the desease.
In the past 15 years more and more interest in ADD has taken
place. Whatever the location, it is likely this interest will
continue, so research can go forward to find the best ways to treat
this common problem.