ADHD in Toddlers

"I never diagnosed a child under the age of five with ADHD," says our clinical director Dr. Doug Cowan.

"You see, everyone who has a genetically based ADHD was born with it, and they act like it when they are two, three, four, five years old. They have characteristics of ADD from very young. But there are also a lot of kids, particularly boys, who develop a bit more slowly than their peers, and may be more active than their peers, who can look like they have ADD, but by the time they are eight years old they are fine."

The "neurological wiring" in a child's brain is not completely "plugged in" until a child is about eight years old, but according to Cowan, "a eight or nine, what you see is what you get." So many kids who appear to have ADHD at four or five will have developed more self-control and focus by age seven, eight, or nine.

"Also, the younger the child is, the more difficult it is to make a good diagnosis. It is hard to be certain with a six or seven year old child, and it is not much better than a guess with a four or five year old child. The good, objective, diagnostic tools like the TOVA are only normed for kids down to age five, and the norm groups for five year olds are very much smaller than for eight or ten or twelve year olds. You just cannot be as certain with younger children."

"Since about five percent of children have ADHD, that five percent includes two year olds, three year olds, and four year olds too. But the problem is that about twenty percent of two, three, and four year old boys look like they are ADD. Most of them will out grow it and mature into more self-control, but five percent won't. But which five percent? Without the right tools, you really are just guessing."

Which brings us to the discussion in the medical field today on the use of stimulant medications with very young pre-school aged children. See the press release on a recent study of pre-schoolers with ADHD responding to stimulant medication. See our comments on the study of pre-schoolers with ADHD here.

In making the diagnosis of Attention Deficit Disorder in a person of any age, first there must be a problem. Second, they must meet certain diagnostic criteria. Third, other possible causes must be ruled out.

In pre-school children, or even younger toddlers, to establish even that there is a problem one has to compare the child to other children his or her age, and not compare the child to older children.

How many toddlers can pay attention to a task for very long? How many can practice self-control? How many can just sit still and pay attention to a teacher talking? The answer is "not many."

It is normal for a toddler, or a pre-schooler, to want to move, run, explore, and play.

It is not normal for adults to want to make them sit still in a classroom setting. Doing this to three, four, and even some five year olds, will make them look ADHD when they want to get up, move around, play, and not pay attention to the teacher. But these behaviors would be normal for a young child.

Study: ADHD Preschoolers Improve with Low Doses of Medication

The first long-term, large-scale study designed to determine the safety and effectiveness of treating preschoolers who have attention deficit/hyperactivity disorder (ADHD) with methylphenidate (Ritalin) has found that overall, low doses of this medication are effective and safe.

ADHD, Preschool, and Medication

Brave New World

However, the study found that children this age are more sensitive than older children to the medication's side effects and therefore should be closely monitored. The 70-week, six-site study was funded by the National Institutes of Health's National Institute of Mental Health (NIMH) and was described in several articles in the November 2006 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"The Preschool ADHD Treatment Study, or PATS, provides us with the best information to date about treating very young children diagnosed with ADHD," said NIMH Director Thomas R. Insel, MD. "The results show that preschoolers may benefit from low doses of medication when it is closely monitored, but the positive effects are less evident and side-effects are somewhat greater than previous reports in older children."

Methylphenidate is the most commonly prescribed medication to treat children diagnosed with ADHD. But its use for children younger than 6 years has not been approved by the Food and Drug Administration. And until PATS, very few studies—and no large-scale ones—have been conducted to collect reliable, consistent data to help guide practitioners treating preschoolers with ADHD.

Design of Preschool ADHD Study

The 303 preschoolers enrolled in the study ranged in age from 3 to 5 years. The children and their parents participated in a pre-trial, 10-week behavioral therapy and training course. Only those children with the most extreme ADHD symptoms who did not improve after the behavioral therapy course and whose parents agreed to have them treated with medication were included in the medication study. In the first part of the medication study, the children took a range of doses from a very low amount of 3.75 mg daily of methylphenidate, administered in three equal doses, up to 22.5 mg/day. By comparison, doses for school-aged children usually range from 15 to 50 mg total daily.

The study then compared the effectiveness of methylphenidate to placebo. It found that the children taking methylphenidate had a more marked reduction of their ADHD symptoms compared to children taking a placebo, and that different children responded best to different doses.

"The best dose to reduce ADHD symptoms varied substantially among the children, but the average across the whole group was as low as 14 mg per day," said lead author Laurence Greenhill, M.D., of Columbia University/New York State Psychiatric Institute. "Preschoolers with ADHD may need only a low dose of methylphenidate initially, but they may need to take a higher dose later on to maintain the drug's effectiveness."

To ensure the safety of the very young children involved, the study was governed by a strict set of ethical standards and additional review boards. The children's health was monitored carefully and repeatedly throughout the study's duration. Their parents were repeatedly consulted for consent prior to every step of the program. The researchers also reviewed the teacher ratings of the children who attended preschool at various stages in the study.

Similar to 1999 results found in NIMH's Multimodal Treatment Study of Children with ADHD (MTA study), and other studies on school-aged children, the medication did appear to slow the preschoolers' growth rates. Throughout the duration of the study, the children grew about half an inch less in height and weighed about 3 pounds less than expected, based on average growth rates established prior to the study.

Currently, no data exist that track long-term growth rate changes among preschoolers with ADHD who are medicated with methylphenidate. However, a five-year-long follow-up study is underway to track the children's physical, cognitive, and behavioral development, as well as health care services the family is using to care for the child. Those data will be available in two to three years.

Preschoolers, ADHD Medications, Results

Eighty-nine percent (89%) of the children tolerated the drug well.

But 11 percent—about 1 in 10 children—had to drop out of the study as a result of intolerable side effects.

For example, while some children lost weight, weight loss of 10 percent or more of the child's baseline weight was considered a severe enough side effect for the investigators to discontinue the medication. Other side effects included insomnia, loss of appetite, mood disturbances such as feeling nervous or worried, and skin-picking behaviors. Despite concerns that stimulants may increase blood pressure or pulse, any changes seen in the children's blood pressure or pulse were minimal.

"The study shows that preschoolers with severe ADHD symptoms can benefit from the medication, but doctors should weigh that benefit against the potential for these very young children to be more sensitive than older children to the medication's side effects, and monitor use closely," concluded Dr. Greenhill.

PATS was conducted by researchers at Columbia/New York State Psychiatric Institute, Duke University, Johns Hopkins University, New York University, the University of California Los Angeles, and the University of California Irvine, in collaboration with NIMH staff under a cooperative agreement.

The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website.

The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit NIH.gov.

Greenhill L, Kollins S, Abikoff H, McCracken J, Riddle M, Swanson J, McGough J, Wigal S, Wigal T, Vitiello B, Skrobala A, Posner K, Ghuman J, Cunningham C, Davies M, Chuang S, Cooper T. Efficacy and Safety of Immediate-Release Methylphenidate Treatment for Preschoolers With ADHD. J Am Acad Child Adolesc Psychiatry. 2006 Oct 4; [Epub ahead of print]

Wigal T, Greenhill L, Chuang S, McGough J, Vitiello B, Skrobala A, Swanson J, Wigal S, Abikoff H, Kollins S, McCracken J, Riddle M, Posner K, Ghuman J, Davies M, Thorp B, Stehli A. Safety and Tolerability of Methylphenidate in Preschool Children With ADHD. J Am Acad Child Adolesc Psychiatry. 2006 Oct 4; [Epub ahead of print]

McGough J, McCracken J, Swanson J, Riddle M, Kollins S, Greenhill L, Abikoff H, Davies M, Chuang S, Wigal T, Wigal S, Posner K, Skrobala A, Kastelic E, Ghuman J, Cunningham C, Shigawa S, Moyzis R, Vitiello B. Pharmacogenetics of Methylphenidate Response in Preschoolers With ADHD. J Am Acad Child Adolesc Psychiatry. 2006 Oct 4; [Epub ahead of print]

Kollins S, Greenhill L, Swanson J, Wigal S, Abikoff H, McCracken J, Riddle M, McGough J, Vitiello B, Wigal T, Skrobala A, Posner K, Ghuman J, Davies M, Cunningham C, Bauzo A. Rationale, Design, and Methods of the Preschool ADHD Treatment Study (PATS). J Am Acad Child Adolesc Psychiatry. 2006 Oct 4; [Epub ahead of print]

Swanson J, Greenhill L, Wigal T, Kollins S, Stehli A, Davies M, Chuang S, Vitiello B, Skrobala A, Posner K, Abikoff H, Oatis M, McCracken J, McGough J, Riddle M, Ghuman J, Cunningham C, Wigal S. Stimulant-Related Reductions of Growth Rates in the PATS. Stimulant-Related Reductions of Growth Rates in the PATS. J Am Acad Child Adolesc Psychiatry. 2006 Oct 4; [Epub ahead of print]

This story's web page.

NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health (NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated.

Our Response to NIMH Study on Preschoolers with ADHD and Low Doses of Medication

Grant has just turned six years old. That's his picture on his fourth birthday. I simply cannot imagine giving him Ritalin at six, or at five, or at four years old. But here is a study from the National Institute of Mental Health that says it might be a good idea.

If this is all the farther that you read, read this: You can accomplish the same thing as can be accomplished by the small dose of Ritalin used on these children with a protein shake and some coffee mixed together. See our diet recommendations.

Preschoolers, ADHD, and Medication

Brave New World

Here's the report on the study:

Recently the National Institute of Mental Health reported on “the first long-term, large-scale study designed to determine the safety and effectiveness of treating preschoolers who have attention deficit/hyperactivity disorder (ADHD) with methylphenidate (Ritalin).” The study was published in the Journal of the American Academy of Child and Adolescent Psychiatry.

The study looked at 300 preschoolers, ages 3-5. According to the study's authors, the children had been diagnosed with ADHD and their families had all been in a 10-week behavior modification program first.

How exactly the children had been diagnoses with Attention Deficit Hyperactivity Disorder is beyond us. There are few, if any, valid tools used to diagnose ADHD in children that young. We do not recommend diagnosing a child with ADHD under the age of five, as there are too many variables, and no good diagnostic tools for this age group.

But the story continues...

"The Preschool ADHD Treatment Study, or PATS, provides us with the best information to date about treating very young children diagnosed with ADHD," said NIMH Director Thomas R. Insel, MD.

"The results show that preschoolers may benefit from low doses of medication when it is closely monitored, but the positive effects are less evident and side-effects are somewhat greater than previous reports in older children."

There are three key points to Dr. Insel’s quote:

1. Preschoolers may benefit somewhat – from low doses – if closely monitored;
2. But there aren’t a lot of positive benefits, and
3. The side-effects are worse than in older children.

11% Drop Out of Study from Severe Side-Effects

In fact, 11 percent of the children had side-effects that were so severe that they had to drop out of the study. The side-effects included weight loss of more than 10 percent of body weight, insomnia, loss of appetite, anxiety and worry, and tics.

Some of these side-effects are due to the nature of the medication: they are stimulants, and stimulants decrease appetite, increase anxiety, and keep you awake.

Others of these side-effects are most likely due to mis-diagnosis of these children. Children with anxiety disorders, when given stimulants, get anxiety. Children with Tourettes Syndrome, when given stimulants, get tics.

The medication also seemed to slow the children’s growth rate during the study. But we have noted elsewhere (at the ADHD Information Library) that initially stimulant medications inhibit the release of growth hormone in children, but over time stimulant medication will actually enhance release of growth hormone. So initially growth rate is slowed, but about a year later it is accelerated, and if a child is treated for three years or more, it all evens out.

But it is not a good things to risk with preschoolers.

The amount of Ritalin administered to the children were, on the low end, roughly equivalent to the caffeine in one cup of coffee all day, and on the high end to three cups of coffee per day.

So why give the kids Ritalin?

The bottom line is that small doses of stimulants like Ritalin improve brain performance. But there are side-effects to deal with.

But giving many of these kids a protein shake with a spoon of instant coffee once, twice, or if needed, three times per day, is superior to giving them Ritalin, because they won’t experience the severe side-effects.

We strongly recommend that families try our eating program, or someone else’s eating program, before trying stimulant medications.

100 mg of caffeine is roughly equivalent to 5 mg of Ritalin.

You can read about the NIMH study here.

You can see our ADHD diet and eating recommendations here.

Interventions for Children with ADHD

Here is a brief summary of our thoughts on the treatment of attention deficit hyperactivity disorder, or ADHD, in children.

Most of these treatment interventions are discussed in far more detail elsewhere on this website. Please look especially at our "books" on

• the Different Types of ADHD, and Specific Treatment Strategies for each types;
• Medical management of ADHD, Medications for ADHD;
• Alternative Treatments for ADHD;
• ATTEND for ADHD;
• Our ADHD Diet recommendations.

Each of these "books" will have great information for you!

Here is our list of treatment interventions for children with ADHD:

• Parenting Classes - this is our first choice, as you, the parents, will have the most influence, contact, and responsibility with and for the ADHD child. Raising an child with ADHD will not be easy, and will present a wide assortment of challenges throughout the years. So we recommend whatever specialized training you can get on parenting skills, behavioral interventions, developing patience and endurance, and etc. We will try to help you our as much as we can here on this site, and through our free newsletter. Be sure to sign up for it!
• ATTEND - Attend is an amino acid based homeopathic nutraceutical medicine for the symptoms of ADHD. Whew! That's a lot of words. Back in 1996 we helped the manufacturer, VAXA International, to develop this product by providing the clinical studies on the effectiveness of the product. For a "natural alternative" for ADHD, it actually works pretty well. Using objective testing we discovered that about 70% of the subjects made significant improvements with 30 days of Attend. So we recommend that whenever possible parents try Attend before trying medications. If the Attend doesn't work, then try the meds. The downside to Attend is that the capsules are large and must be swallowed. The company offers a great money back guarantee if it doesn't help.
• Our ADHD Diet Recommendations - The Diet goes along nicely with the Attend. Its a "higher" protein, "lower" carbohydrate approach to try to optimize brain performance. We also try to help families to be more aware of foods that they may be allergic to, such as cow's milk (30% of children are allergic to cow's milk). We don't think that all ADHD kids will have a "day and night" improvement just from our diet recommendations, but our experience was that about 25% of kids did improve significantly.
• Medications - If the diet doesn't help enough, and the Attend doesn't help enough, then it's time to consider medications for ADHD. In general there are two types: stimulants and anti-depressants. The stimulants are the most common (Ritalin, Adderall, Concerta, etc). The reason that so many kids take medication is that it works. They have to be carefully prescribed, monitored, and administered, but they do work for 70% to 80% of ADHD kids.
• Counseling - the purpose of counseling is to teach the child with ADHD the skills that he or she needs in order to be successful at school, with friends, and in life. Academic skills, problem solving skills, and social skills should be more important in counseling than "how did that make you feel?" conversation.

Again, these are discussed in much more detail in other "books". Please take the time to visit them to investigate further.

ADHD Helpful Hints for Classroom Teachers

ADHD in the Classroom: Hints for Teachers

1. Make clear rules and post them, with logical consequences and with rewards.

2. Look for patterns of behavior in the child. Are there better times than others? Does the child do better in structured activities than at recess? Does the child do most poorly between 11:30 a.m. and 12:30 p.m. when medication might be wearing off?

3. Promote time on task, never time off task. Give a minute timer to keep on his desk. Ask the child how long he thinks it would take to perform a certain task. Let him set his own time and race against the timer.

4. Stress accuracy instead of quantity of work. This is really what you want as a teacher anyway. The child is easily overwhelmed and discouraged. Reduce the quantity of work on a page. Instead of giving 30 problems on a page, give only five or six. Then the child won't be overwhelmed, and successes will build up his self-esteem.

5. Smile.

INTERVENTIONS TO CONSIDER

6. Computers are great for 1-to-1 work and immediate feedback.

7. Use peer tutoring whenever possible. Older children to help him, and perhaps allowing him to tutor a younger child.

8. Organize the child's environment. Use dividers and folders in his desk so he can easily find things. Teach him how to organize himself better.

9. Move his desk to where there are fewer distractions. Close to the teacher to monitor and encourage, or near a well-focused child.

10. Privacy boards can work well, but should never embarrass the child.

11 .The more exciting a subject is to a child, the better he will learn.

CLASSROOM ENVIRONMENT

12. Establish routines and notify the child well ahead of time if there are to be changes in the daily routine. This will help the child to focus better.

13. Help the child to organize his written work or numbers. Allow the child to move a pencil or his finger across the page while reading. If he's writing, allow him to use one or two fingers for spacing between words. During math, graph paper may be very helpful to organize his numbers and columns.

14. Provide a safe environment for the child. Make sure the child knows you are his friend and you are there to help him. Treat him with respect. Never belittle him in front of his peers. Both he and the other children know that he stands out, and if the teacher belittles the child, then the rest of the children will see that as permission from the teacher to belittle the child as well.

15. Listen to the child. They want to be heard too.

16. Be alert to how much movement they may need. Allow for some extra trips to the restroom, or to run some errands. You may want to allow him to run around in a designated spot in the play yard.

17. Give him a break once in a while. Know the difference between big things and little things, and don't confront him on each little thing. It is hard for these children to control themselves all of the time.

18. Help the child find his areas of strength so that he can build his self-esteem.

19. Report any significant changes in behavior or school performance to parents, school administrators, or school psychologist.

20. Be the child's advocate.

For 500 great ADHD classroom interventions visit ADDinSchool.com

ADHD in More Boys? Biological Reasons

Boys have biological reason to be troublesome

Published: 25 September 2007
The University of Queensland News Online

Children with ADHD have less activity in parietal brain areas while performing attention-demanding problem-solving tasks.

A team of researchers working with UQ's Queensland Brain Institute (QBI) has discovered more compelling evidence that attention-deficit disorder in young boys is substantially attributable to brain development.

UQ neuroscientist, Dr Ross Cunnington said there appeared to be a biological difference in young boys that made them more susceptible to attention deficit hyperactivity disorder, combined type (ADHD-CT).

“ADHD affects about three-to-five per cent of primary school aged children,” Dr Cunnington said. “It is the most common neurodevelopmental disorder in children and causes significant delay in educational and social development.”

In a study of boys aged eight-to-twelve, Dr Cunnington and a team of scientists from The University of Queensland and research centres in Victoria used functional magnetic resonance imaging (fMRI) to map the brain activity of each of the boys as they performed a mental rotation task.

The study focused on imaging the parietal lobe, a region of the brain known to become active when something distracts a person from performing or completing a given task.

“We're looking at the interaction that occurs in the brain between the pre-frontal and parietal lobes,” Dr Cunnington said. “Interactions between these brain areas are crucial for maintaining and focusing attention.

“ADHD can be a problem for young boys because it means they don't do well at school, and there are often serious social consequences as well. Severe ADHD could at times lead to a young person becoming alienated from their friends and classmates – which can lead to low self-esteem and further disruptive behaviour.

“Overall, there is strengthening evidence that ADHD has a biological cause. It's not all bad parenting.”

The good news for parents is that most cases of ADHD reduce with age and there are already several effective therapeutic treatments which help control the condition's symptoms.

The Cunnington group's research "Right parietal dysfunction in children with attention deficit hyperactivity disorder, combined type: a functional MRI study" was published in a recent edition of Molecular Psychiatry.

Dr Cunnington established his laboratory at The University of Queensland in January 2007, where he is a Principal Research Fellow and works jointly in the School of Psychology and the Queensland Brain Institute.

Dr Cunnington says that his research "focuses on Action and Attention in the human brain. I use methods of functional MRI and EEG event-related potentials to measure neural activity underlying the preparation and control of action, as well as the perception of others' actions."

He says that he "began research examining cortical activity underlying movement preparation in patients with Parkinson’s disease during my PhD at Monash University, Melbourne. In 1998, I moved to Vienna as an NHMRC post-doctoral research fellow at the Centre of Excellence in High Field MR, Medical University of Vienna, where I developed functional MRI methods to examine neural activity during the preparation and readiness for action. I then returned to Australia in 2001 as an NHMRC RD Wright Fellow to establish the Cognitive Neuroscience group at the Howard Florey Institute, Melbourne, where my research examined attention, the preparation for action, and spatial working memory, including studies of normal brain function as well as clinical disorders such as Parkinson's disease, Huntington's disease, Autism, and Attention Deficit Hyperactivity Disorder. In January 2007, I established my lab at the University of Queensland where I am currently appointed as Principal Research Fellow jointly in the School of Psychology and the Queensland Brain Institute."

ADHD Kids "Hitting the Wall" at School

By "hitting the wall" we mean that the child simply cannot keep up with the demands of his classes, and their teacher is going to do something about the problem. This something might be getting help, calling the parent's attention to the situation, or complaining, but at least the problem is no longer being ignored.

What do you imagine the most difficult environment for a child who had difficulty sitting still, difficulty paying attention, and loved to talk to other children might be?

Imagine that this child had to go into this situation every day, and was expected to perform successfully in this environment. In fact, this child had to perform at the same level as peers who did not have the same set of problems. How difficult would this be?

For ADHD kids, it is the classroom setting that is this difficult setting.

There are a lot of distractions, yet they are told to sit still, don't move, don't talk, to pay attention to boring worksheets, and keep on task until the work is finished. None of these things come easily to Attention Deficit Hyperactivity Disorder kids. But day by day, off to school they go.

Many Attention Deficit Hyperactivity Disorder kids "hit a wall" in school as the school year progresses.

Every week they just get a little farther and farther behind, until they're so far behind that it's impossible to catch up. They lose their homework assignments, even after they have spent hours working on them. And they study hard for tests only to perform poorly the next day. They just slip farther and farther behind with each passing week.

The disorder is most often recognized and referred for treatment in third grade.This is when kids most often hit the "academic wall." In third grade they are expected to do more and more work on their own, and they are given more homework to do as well.

We also see many referrals in seventh grade, or when the child leaves Elementary School for Junior High School, with several classes and several teachers. Many Attention Deficit Hyperactivity Disorder kids who found ways to compensate in Elementary School are totally lost in Junior High School.

How can we help these children to be more successful in school?

One thing that you can do is to visit the outstanding resource of ADDinSchool.com . This site has over five hundred classroom interventions to help ADHD students in elementary school or high school classes. It is a great resource for both parents and teachers working with ADHD students.

ADHD Overview

Inattention, Impulsivity, Hyperactivity = ADHD?

When we talk about attention, we are talking about two different kinds of abilities:

The ability to focus on a specific task put in front of us to do, such as school work, and the ability to pay attention in a more global sense to the world around us, to be able to pay attention to the buzz of the lights overhead, and the touch of the clothes on your skin, and the children playing outside of the classroom. These are two different kinds of attention.

One Definition of "Paying Attention" is - “Sustaining and selecting to the right cue.”

One part of that definition is that the child has to pick the right thing to pay attention to. That's the “selecting” part of the definition.

A better word might be "Filtering." The brain is supposed to filter out distractions, or stimuli which compete for our attention, but might not be important at that moment.

Many children with attention problems pay attention to everything in the world around them equally, such as giving equal time to the touch of the clothes on their skin, the buzz of the lights overhead, the kids outside the classroom, and the math worksheet in front of them. This, of course, is a problem if he needs to be paying attention to only the math worksheet.
Many Children with Attention Disorders have trouble concentrating on the specific task in front of them, especially if they are working on something like school work or chores that are only moderately interesting, or not interesting at all. These kids have to be very motivated, very excited, very interested in what they're doing in order to pay attention.

What are Inattention, Impulsivity, Hyperactivity, and Boredom in ADHD?
adhd in school addThis Is NOT My Child…

Now, you might be thinking,

"This is not my kid. I have a kid who could play Nintendo, and be so focused that the house could burn down around him, and he'd never notice."

Well, that could be. A lot of these kids could do just exactly that. Nintendo is interesting, its challenging, and its fun. Kids get immediate feedback, they could play Nintendo for hours.

But just put a math worksheet in front of them and see how different it is. They have a terrible time paying attention to something that's not interesting or that's not motivating, which accounts for about 85% of school work, and about 100% of chores.
add adhd school
Lack of Flexibility with Attention

Part of the problem with Attention Deficit Hyperactivity Disorder – ADHD - is a lack of FLEXIBILITY with attention.

A person without ADHD has the ability to shift from attention that is focused on a specific task at hand to the kind of attention that is global many times in just a few seconds. At will those without ADHD can shift from reading a book, to scanning the room to know where our kids are and what they are doing, and then very quickly returning to focus on our reading.

Without ADHD we have Flexibility in our ability to Focus. We can shift from specific focus to global focus at will and very quickly.

Individuals with ADHD do not have this same Flexibility of focus. Those with Attention Deficit Hyperactivity Disorder – ADHD – have a very difficult time shifting from a global focus, such as they might have at recess or lunch break, to a specific focus that would be required when they return to the classroom to study math and work on the math worksheet in front of them.

This is why kids with Attention Deficit Hyperactivity Disorder – ADHD – could play Nintendo, be really focused on that task, and not notice the house burning down around them. Or you telling them to talk out the trash.
Paying Attention to the Right Thing

A second type of problem with Attention Deficit Hyperactivity Disorder – ADHD – is sustaining attention to the task long enough to finish the task. We may call this “attention span.”

Many children with Attention Deficit Hyperactivity Disorder – ADHD – may be able to focus attention to the correct task for a while, but then can't sustain it for very long. Their “attention span” is very short for their age. Unless kept highly motivated, these children have a very hard time staying focused long enough to finish the work that they start.

They are often seen as fidgety, easily distracted, and “day-dreamers.” These are the people who may start five different projects, but fail to finish any of them. They may begin to clean their rooms, but after a short time become distracted by their toys or baseball cards and forget all about the job that they are supposed to be working on.

A note about children with this type of Attention Deficit Hyperactivity Disorder – ADHD > Inattentive Type: Often children as described above are not impulsive or hyperactive. They just appear to be “space-cadets,” unfocused, or lazy.

Children with only the Inattentive Type of Attention Deficit Hyperactivity Disorder – ADHD – tend to be females (60% females to 40% males). They are the least likely Attention Deficit Disorder subgroup to receive any help for their condition, especially the boys with Inattentive ADHD.

Kids who are just ADHD Inattentive Type are like space-cadets. They are in a brain fog. They are like Winnie the Pooh.

They are often seen failing to pay close attention to details, or having trouble keeping their minds focused on a task, especially with school work or chores. They often don't seem to be listening. They are often disorganized.

They often will try to get out of doing their homework because it is just such a boring task. They are the kids that will spend two hours to complete a 20 minute homework assignment, and then fail to turn it in to the teacher the next day because they have lost it in their back pack or sent it to the Bermuda triangle of homework assignments.
IMPULSIVITY

Impulsivity is found in two areas:

Behaviorally and Cognitively.

Behavioral impulsivity would include what you do.

ADHD er's with behavioral impulsivity don't stop and think first before they act. No matter how many times you tell this kid, "stop and think first," the next time the situation comes up, he may well do the same impulsive thing again.

Kids with ADHD often aren't learning from their past mistakes. Their learning threshold is very high, and if you don't excite them, or motivate them enough to get them above that learning threshold, they don't learn, and they make the same the same mistake again and again.

ADHD er's with behavioral impulsivity act without thinking first, cut in line, can't wait their turn in line or in a game, blurt out answers in class, speak when they're supposed to be quiet, maybe show aggressive behaviors, are often a little too loud, and sometimes fights.

They often have poor social skills, which of course is the death socially for teenagers with ADHD. They impulsively say the wrong thing at the wrong time. They can get one date, but they can't get the second date because they might impulsively blurt out something and then say, "Why did I say that?" The other teens are asking, "Who is this guy?" and often begin to avoid him.

Also, sometimes these kids fail to learn those subtle social cues that everybody else has learned, and so they're socially awkward and often don't know why.

Cognitive impulsivity means that they guess a lot. Guessing is their problem solving method of choice.

Cognitively impulsive ADHD kids will make a multiple number of guesses in a short period of time. On a matching task, or if you give them multiple choices orally, you'll see them guess for the right answer very quickly, "it's this one, no, its this one, no, wait, its this one," until finally you step in and, when he guesses right, you'll say, "That's it!" Of course this just reinforces his guessing.

These cognitively impulsive ADHD kids have very limited problem solving strategies. They don't stop and look and the problem and then say, "Well, I could do it this way first, then do that, then I'll be done." They don't approach problem solving that way. They usually just guess and let trial and error take its course.
Being Fast is NOT a Problem

Now remember, being fast is not a problem. Some have pointed out that “being fast and accurate is good." It's fast and inaccurate that is a problem.

Impulsive kids are often seen interrupting others in conversations, or blurting out answers in class. They often have trouble waiting their turn in games, or have trouble lining up at school. They just don't wait... or think...before they act.
HYPERACTIVITY

First of all, not all of the kids with Attention Deficit Hyperactivity Disorder are hyperactive. Perhaps as many as two out of three are, but perhaps as few as only 50%.

So, that means that as many as 35% to 50% of kids with ADHD are not hyperactive.

Most of the ADHD kids that we see in our private practice setting are hyperactive kids, because they get in the most trouble. Their parents are usually pulling their hair out and saying, "We've got to get this child some help." The sad truth is that if a parent is going to spring for money to get treatment for his kid, that kid's usually got to get in trouble. So that's why we see the hyperactive kids the most in treatment.
What is “Hyperactivity”?

If you have a child who is hyperactive, you need no explanation. He's the one running across the ceiling. But for the rest of you, this is what I mean.

These are kids that act as if they are driven by a motor. They "go." You wind them up in the morning and they "go" until they're finally exhausted, and then they go to sleep, maybe. Some of these sleep pretty well during the night, and some of them hardly need sleep at all. Three hours of sleep and they're up and ready to go.

Each child is different, each child is unique. Remember that there are several different types of Attention Deficit Hyperactivity Disorder – ADHD.

One definition of hyperactivity is "high levels of non-goal directed motor activity."

A child with high levels of motor activity that is always directed at a goal may not be clinically hyperactive. He may be a future professional athlete or rocket scientist. It's the kid who bounces from one activity to another, in a manner inappropriate for their age, which is our concern.

Hyperactivity is often thought of as the child being “over aroused.”

There is a part of your brain that is constantly scanning the environment to see if there are any changes in that environment. If anything has changed, then that part of the brain asks the question, “Is this new thing in the environment good or bad? Is it something good to eat, or is it going to eat me? How should I feel about this new thing? Should I like it, or be afraid or it?”

In many ADHD kids who are hyperactive this part of the brain is overly sensitive, and the kids are seen as being easily startled or scared, overreacting to things, touching everything around them, and being very edgy.

They never seem to be able to just relax.

Some of these kids also have a very quick temper, a short fuse. They are sometimes explosive. They often lose friends because of their intensity and temper, and they often seem to run over people like a tornado.

But as we have said, a lot of ADHD kids are not hyperactive. And the kids who are not hyperactive tend to be girls, and they tend to sit in the back of the classroom and just quietly get C's and D's when everyone knows they should be getting A's and B's.

These kids with ADHD without hyperactivity are the one's being labeled as "lazy" and at the parent conferences the parents are told, "He or she could do better if they'd just try harder."
EASILY BORED

Also as we've said, these kids with ADHD are easily bored, especially at school and with chores.

If the subject is interesting, then he's OK. If the subject or task is only moderately interesting, or not interesting at all, then he can't sustain his motivation levels, or his attention to task long enough to get the job done.

Although it's not in the literature, nor in the diagnostic criteria, this aspect of being easily bored is the most common element that I've seen with these children.

Since most of the work from school is boring, and since everything to do with chores at home is boring, these kids can have a very difficult time growing up.

ADHD Information

Attention Deficit Hyperactivity Disorder in the Classroom

ADHD in the Classroom

Often the ADHD child has special educational needs, though not always. Most Attention Deficit Hyperactivity Disorder kids can be successful in the regular classroom with some help.

Identifying Attention Deficit Hyperactivity Disorder – ADHD – in the Classroom

Attention Deficit Hyperactivity Disorder (ADHD) is the phrase that is used to describe children who have significant problems with high levels of distractibility or inattention, impulsiveness, and often with excessive motor activity levels.

There may be deficits in attention and impulse control without hyperactivity being present. In fact, recent studies indicate that as many as 40% of the ADHD kids may not be hyperactive.

Research shows that there are several things happening in the brain of the ADHD child which causes the disorder. The main problem is that certain parts of the Central Nervous System are under-stimulated, while others may be over-stimulated. In some hyperactive kids there is also an uneven flow of blood in the brain, with some parts of the brain getting too much blood flow, and other centers not getting as much.

Certain medications, or other forms of treatment can be used to address these problems.

Classroom Teachers

As a teacher, ask yourself these questions:

1. Can the child pay attention in class?

Some ADHD kids can pay attention for a while, but typically can't sustain it, unless they are really interested in the topic.

Other ADHD kids cannot pay attention to just one thing at a time, such as not being able to pay attention to just you when you are trying to teach them something.

There are many different aspects to "attention," and the ADHD child would have a deficit in at least one aspect of it.

2. Is the child impulsive? Does he call out in class? Does he bother other kids with his impulsivity?

These kids often cannot stop and think before they act, and they rarely think of the consequences of their actions first.

Impulsivity tends to hurt peer relationships, especially in junior high school years.

3. Does he have trouble staying in his seat when he's supposed to?

How is he on the playground? Can he wait in line, or does he run ahead of the rest of the class? Does he get in fights often?

4. Can he wait?

Emotionally, these children often cannot delay gratification, and they typically cannot wait their turns.

5. Is he calm?

ADHD kids are constantly looking for clues as to how they are doing. They may display a wide range of moods, which are often on the extremes: they act too sad, too angry, too excited, too whatever.

6. Is the child working at grade level? Is he working at his potential? Does he/she stay on task well? Does he fidget a lot? Does he have poor handwriting?

Most ADHD kids have trouble staying on task, staying seated, and many have terrible handwriting.

7. Does he have difficulty with rhythm? Or the use of his time?

Both awareness of time and the rhythm of music often escape ADHD children.

8. Does he lack awareness about “personal space” and what is appropriate regarding touching others?

ADHD children are often overly touchy with others, and are often prompted to keep their hands to themselves.

9. Does he seem unable to read facial expressions and know their meanings?

ADHD children have often missed the subtle social cues that they need to be successful in social relationships.

10. Does the child seem to be immature developmentally, educationally, or socially?

It has been suggested by research that children and teens with Attention Deficit Hyperactivity Disorder may developmentally lag 20% to 40% behind children without ADHD.

In other words, a ten year old with ADHD may behave, or learn, as you would expect a seven year old to behave or learn. A fifteen year old with ADHD may behave, or learn, as you would expect a ten year old to behave, or learn.

Sensory Integration Dysfunction

Many children with ADHD also have Sensory Integration Dysfunctions (as many as 10% to 20% of all children might have some degree of Sensory Integration Dysfunction).

SID is simply the ineffective processing of information received through the senses. As a result these children have problems with learning, development, and behavior.

Identifying ADHD in the Classroom: Eight Things Teachers Should Ask Themselves

Identifying Attention Deficit Hyperactivity Disorder in the Classroom:

You see the kids in your classroom. There are two, maybe three of them. They are "space cadets," paying attention to someone or something else when they should be paying attention to you. Or they are always out of their seat, sharpening their pencil or wanting a drink. They cannot sit still for very long, and they are disturbing others. Or worse.

Are these kids ADHD? Or are they just undisciplined? Here are some questions to ask yourself, and a bit of background information for you to consider.

Eight Things Teachers Should Ask Themselves

Attention Deficit Hyperactivity Disorder (ADHD) is the phrase that is used to describe children who have significant problems with high levels of distractibility or inattention, impulsiveness, and often with excessive motor activity levels. There may be deficits in attention and impulse control without hyperactivity being present. In fact, recent studies indicate that as many as 40% of the ADHD kids may not be hyperactive.

Research shows that there are several things happening in the brain of the ADHD child which causes the disorder. The main problem is that certain parts of the Central Nervous System are under-stimulated, while others may be over-stimulated. In some hyperactive kids there is also an uneven flow of blood in the brain, with some parts of the brain getting too much blood flow, and other centers not getting as much. Certain medications, or other forms of treatment can be used to address these problems.

Often the Attention Deficit Hyperactivity Disorder child has special educational needs, though not always. Most Attention Deficit Hyperactivity Disorder kids can be successful in the regular classroom with some help. Teachers can find over 500 classroom interventions to help children be successful in school at http://www.ADDinSchool.com.

As a teacher ask yourself these questions:

1. Can the child pay attention in class?

Some ADHD kids can pay attention for a while, but typically can't sustain it, unless they are really interested in the topic. Other ADHD kids cannot pay attention to just one thing at a time, such as not being able to pay attention to just you when you are trying to teach them something. There are many different aspects to "attention," and the ADHD child would have a deficit in at least one aspect of it.

2. Is the child impulsive? Does he call out in class? Does he bother other kids with his impulsivity?

These kids often cannot stop and think before they act, and they rarely think of the consequences of their actions first. Impulsivity tends to hurt peer relationships, especially in junior high school years.

3. Does he have trouble staying in his seat when he's supposed to? How is he on the playground? Can he wait in line, or does he run ahead of the rest of the class? Does he get in fights often?

4. Can he wait?

Emotionally, these children often cannot delay gratification.

5. Is he calm?

They are constantly looking for clues as to how they are doing. They may display a wide range of moods, which are often on the extremes: they act too sad, too angry, too excited, too whatever.

6. Is the child working at grade level? Is he working at his potential? Does he/she stay on task well? Does he fidget a lot? Does he have poor handwriting?

Most ADHD kids have trouble staying on task, staying seated, and many have terrible handwriting.

7. Does he have difficulty with rhythm? Or the use of his time? Does he lack awareness about "personal space" and what is appropriate regarding touching others? Does he seem unable to read facial expressions and know their meanings?

Many children with ADHD also have Sensory Integration Dysfunctions (as many as 10% to 20% of all children might have some degree of Sensory Integration Dysfunction). SID is simply the ineffective processing of information received through the senses. As a result these children have problems with learning, development, and behavior.

8. Does he seem to be immature developmentally, educationally, or socially?

It has been suggested by research that children and teens with Attention Deficit Hyperactivity Disorder may lag 20% to 40% behind children without ADHD developmentally. In other words, a ten year old with ADHD may behave, or learn, as you would expect a seven year old to behave or learn. A fifteen year old with ADHD may behave, or learn, as you would expect a ten year old to behave, or learn.

There is a lot to learn about ADHD. Both teachers and parents can learn more by visiting the ADHD Information Library's family of web sites, beginning with http://www.ADDinSchool.com for hundreds of classroom interventions to help our children succeed in school.

More Classroom Tips for Teachers of ADD ADHD Students

ADHD Checklist for Classroom Teachers

Physical Arrangement of Room:

Use rows for seating arrangements. Avoid tables with groups of students, for this maximizes interpersonal distractions for the ADHD child. Where possible, it may be ideal to provide several tables for group projects and traditional rows for independent work. Some teachers report that arranging desks in a horseshoe shape promotes appropriate discussion while permitting independent work. Whatever arrangement is selected, it is important for the teacher to be able to move about the entire room and have access to all students.

Have ADHD students seated near the teacher, as close as possible without being punitive. Locate the student's desk away from both the hallway and windows to minimize auditory and visual distractions.

Keep a portion of the room free of obvious visual and auditory distractions. For example, have one area of desks that doesn't have interesting objects hanging over it that invite the child to study them rather than her/his work. Use desk dividers and/or study carrels. Be sure to introduce their use as a "privilege" or pair appropriate carrel usage with reinforcement, so these study aids are not perceived as punishment.

Seat appropriate peer models next to ADHD child. Stand near the student when giving directions or presenting the lesson. Use the student's worksheet as an example.

Provide comfortable lighting and room temperature. Use individual headphones to play white noise or soft music to block out other auditory distractions. Be sure the music is not too interesting so that it becomes a distraction. Introduce headphones as a privilege or pair with appropriate use with reinforcement.

Provide a quiet, carpeted space in the room as a special study section for independent reading.

Lesson Presentation:

Provide an outline, key concepts or vocabulary prior to lesson presentation.

Increase the pace of lesson presentation. Include a variety of activities during each lesson. Use multisensory presentation but screen audio-visual aids to be sure that distractions are kept to a minimum. For example, be sure interesting pictures and or sounds relate directly to the material to be learned.

Make lessons brief or break longer presentations into discrete segments.

Actively involve the student during the lesson presentation. Have the ADHD student be the instructional aid who is to write key words or ideas on the board.

Encourage the students to develop mental images of the concepts or information being presented. Ask them about their images to be sure they are visualizing the key material to be learned. Allow the students to make frequent responses throughout the lesson by using choral responding, frequently calling on many individuals, having the class respond with hand signals. Employ role-playing activities to act out key concepts, historical events, etc.

Provide self-correcting materials. Use computer assisted instruction. Use cooperative learning activities, particularly those that assign each child in a group a specific role or piece of information that must be shared with the group.

Develop learning stations and clear signals and procedures for how students transition from one center to another. Use game-like activities, such as "dictionary scavenger hunts," to teach appropriate use of reference/resource materials.

Interact frequently (verbally and physically) with the student. Use the student's name in your lesson presentation. Write personal notes to the student about key elements of the lesson.

Pair students to check work. Provide peer tutoring to help student's review concepts.

Let ADHD students share recently learned concepts with struggling peer.

When presenting a large volume of information on the chalkboard, use colored chalk to emphasize key words or information.

Worksheets and Tests:

Use large type.

Keep page format simple. Include no extraneous pictures or visual destractors that are unrelated to the problems to be solved.

Provide only one or two activities per page. Have white space on each page. Use dark black print. (Avoid handwritten worksheets or tests.)

Use buff-colored paper rather than white if the room's lighting creates a glare on white paper.

Write clear, simple directions. Underline key direction words or vocabulary or have the students underline these words as you read directions with them. Draw borders around parts of the page you want to emphasize.

Divide the page into sections and use a system to cover sections not currently being used. If possible, use different colors on worksheets or tests for emphasis, particularly on those involving rote, potentially boring work. Have the students use colored pens or pencils.

Give frequent short quizzes and avoid long tests. Provide practice tests.

Provide alternative environments with fewer distractions for test taking.

Using a tape recorder, have the student record test answers and assignments or give the student oral examinations.

Shorten assignments. If the child can demonstrate adequate concept mastery in 10 or 20 questions/problems, don't require 30-40 problems.

Organization:

Model an organized classroom and model the strategies you use to cope with disorganization.

Establish a daily classroom routine and schedule. Show that you value organization by following 5 minutes each day for the children to organize their desks, folders, etc. Reinforce organization by having a "desk fairy" that gives a daily award for the most organized row of desks.

Use individual assignment charts or pads that can go home with the child to be signed daily by parents if necessary. Develop a clear system for keeping track of completed and uncompleted work such as having individual hanging files in which each child can place completed work and a special folder for uncompleted work.

Develop a color coding method for your room in which each subject is associated with a certain color that is the that subjects textbook cover and on the folder or workbook for that subject.

Develop a reward system for in-school work and homework completion. One example of a system that reinforces both work quality and work quantity involves translating points earned into "dollars" to be used for silent auction at the end of grading period.

For children needing more immediate reinforcement, each completed assignment could earn the child a "raffle ticket" with her/his name on it. Prizes or special privileges could be awarded on the basis of a random drawing held daily or weekly.

Write schedule and timelines on the board each day. Provide due dates for assignments each day. Divide longer assignments into sections and provide due dates or times for the completion of each section.

Use visual and/or auditory cues as signals prior to changing a task and to announce that the task will be ending.

Tape a checklist to the child's desk or put one in each subject folder/notebook that outlines the steps in following directions or checking to be sure an assignment is complete. Provide study guides or outlines of the content you want the child to learn, or let the child build her/his own study guide with worksheets tat have been positively corrected.

Be clear about when student movement is permitted and when it is discouraged, such as during independent work times.

Behavior:

Keep the classroom behavior rules simple and clear. Have the class agree on what the rules should be. Define and review classroom rules each day. Implement a classroom behavior management system. Actively reinforce desired classroom behaviors.

Use self-monitoring and self-reinforcement on-task behavior during independent work time. Use a kitchen timer to indicate periods of intense independent word and reinforce the class for appropriate behavior during this period. Start with brief periods (5-10 minutes) and gradually increase the period as the class demonstrates success.

When necessary, develop contracts with an individual student and her/his parents to reinforce a few specific behaviors. Set hourly, daily, weekly, or monthly goals depending on the reinforcement needs of the specific student. Provide frequent feedback on the student's progress toward these goals.

Provide a changing array of backup rewards or privileges so that students do not "burn out" on a particular system. For example, students can earn tickets for a daily or weekly raffle for the display of positive behavior.

To improve out-of-the-classroom behavior, allow the class to earn a reward based on he compliments they receive on their behavior from other teachers, lunchroom staff, playground aides and principals.

Avoid giving the whole class negative consequences based on the ADHD child's behavior. The ADHD child, as well as the whole class, can benefit from implementation of social skills curriculum for the entire class.

Modeling and requiring the children to use a systematic method of talking through classroom conflicts and problems can be particularly valuable for the ADHD child to implement this, teachers are referred to the literature on cognitive-behavioral approaches to developing the child's self-talk and problem solving.

Praise specific behaviors. For example, "I like how you wrote down all your assignments correctly," rather than "Good boy!"

Use visual and auditory cues as behavioral reminders. For example, have two large jars at the front of the room, with one filled with marbles or some other object. When the class is behaving appropriately, move some marbles to the other jar and let the students know that when the empty jar is filled they can earn a reward.

Frequently move about the room so that you can maximize you degree of proximity control.

When appropriate, give students choices about several different activities that could choose to work on one at a time.

With students who can be quite volatile and may initially refuse negative consequences (such as refusing to go to time-out), set a kitchen timer for a brief period (1-2 minutes) after refusal has occurred. Explain to the child that the child can use the two minutes to decide if she/he will go to time out on her/his own or if more serious consequence must be imposed. Several experienced teachers insist this method has successfully reduced the extent to which they have had to physically enforce certain negative consequences with students and seems to de-escalate the situation.

Suggestions from 450 surveyed teachers, compiled by Suzanne Cardman of Long Beach State University, "Seminar In Child Language Disorders," Spring 1994. Learn more ADHD classroom interventions at ADDinSchool.com

The ADD ADHD Information Library

Six Tips for the Classroom Teacher

HINTS FOR TEACHERS of ADHD Students

1. Don't buy into the line, "He'd behave if he wanted to."

That may or may not be true. He may behave just fine from time to time, and if you encourage him, he may do well for periods of time. But his problem is not that he does not want to behave, rather his problem has a medical basis as described on this site.

2. Understand that of all kids with ADHD, about 60% or so are hyperactive, and that 40% or so are not hyper at all.

Also know that about 60% are male, and about 40% are female.

Not all kids with ADHD cause problems. And only one out of three with the disorder will ever get help from a professional.

3. Don't dismiss the behaviors as just either poor parenting or poor classroom management.

4. Before talking to the parents get a second opinion from another teacher, the school psychologist, etc.

Make a list of the behaviors that you are concerned about. Don't try to diagnose the child yourself, just report the observed behaviors.

5. Invite the parents to come in to your class and observe their child in a classroom setting.

More than one visit may be required, as often having the parent present the first time creates a "unique" situation which stimulates the child to do better than normal.

6. Be aware that the ADHD child often does very well in unique or novel situations, or in one-to-one situations. This would include a visit to a physician or a therapist to diagnose a problem.

Also be aware that the hardest place for an ADHD child is in the classroom setting. There are dozens of distractions, pressures, and rules that can be difficult for the child.

Good luck with you and your ADHD kids!!!

This material may be reproduced for non-commercial uses. Please cite the author somewhere in the material: "The ADD ADHD Information Library" at www.NewIdeas.Net, by Dr. Doug Cowan.

Why Other Children are Rejecting Your ADHD Child: Guest Author

by guest author Anthony Kane, MD

Developing healthy peer relationships is critical for the normal development of a child. Peer relationships have been found to be an important predictor of positive adult adjustment and behavior. Difficulty in finding friends leads to feelings of low self-esteem and these feelings usually continue into adulthood. Children with poor social skills are at risk for delinquency, academic under-achievement, and school drop out. Even though the inattentiveness, impulsiveness, and restlessness frequently persist into adult life, these problems are of less importance as the child gets older.

Rather, the main difficulty ADHD patients encounter as they reach maturity is their inability to interact appropriately with others. An ADD ADHD child often lacks the social skills that are essential to success in life. These children can be socially inept, and their lack of interpersonal skills may cause them a multitude of difficulties. In addition, positive relationships with friends in childhood provide a critical buffer against stress and help to protect against psychological and psychiatric problems. ADHD children lack these positive interactions and thus are at risk for a number of emotional problems. Probably 60% of ADHD children suffer from peer rejection. ADHD children are less often chosen by peers to be best friends, partners in activities, or seatmates.

As the children grow older, their social problems seem to get worse. Their inappropriate behavior leads to further social rejection and exacerbates their inability to relate to others appropriately. Long term these children are more likely to have difficulty finding and maintaining successful careers. This is not surprising since social aptitude can make or break careers and relationships in the adult world.

Causes of Poor Peer Relationships

ADHD children are frequently disliked or neglected by their peers. It is difficult to determine all the factors that make a child unpopular, but children who frequently display aggressive or negative behavior tend to be rejected by their peers.

Impulsivity and Aggression

ADHD children tend to be more impulsive and aggressive than other children. Teachers observe that the social interactions of ADHD children more often involve fighting and interrupting others. These children are more intense than others and behave inappropriately in social contexts. For example, ADHD children are more likely to yell, run around and talk at unsuitable times.

They also tend to want to dominate play, engage in off task behaviors and engage more in teasing and physical jostling of peers. This sets up a process of peer rejection.

Academic Problems

ADHD children often do not do well in school. Poor school performance by itself does not result in social rejection. However, the way the child responds to his academic difficulties can contribute to inappropriate social behavior.

Children who cannot engage themselves with classroom work assignments often disrupt and irritate their peers.

Inattention

ADHD children have difficulty with sustained attention. Deficit in attention seems to be related to peer rejection independently of the aggressive, impulsive, and hyperactive behaviors of ADHD children. These children become bored more easily than other children. As a result, they are more likely to become disruptive in the classroom.

ADHD children have difficulty in modulating their behavior and changing their conduct as the situation demands. They have apparent social-cognitive deficits that limit their ability to encode and recall rules of social cues. Children with ADHD pay less attention to others verbally in games and other activities. Many ADHD children are aware that they are socially inept. Children who are anxious or fearful about peer relations are unlikely to behave in an effective manner.

These children withdraw from peer interactions and, in this way, limit their ability to gain acceptance and friendship. Children are rejected by peers when they appear to be different. Similarity fosters social acceptance. Because ADHD children do not learn social clues as well as other children, they tend to be viewed as strange.

Bad Behavior

One of the keys to your child's social success is proper behavior. If your ADHD or ODD child frequently misbehaves, it is your obligation as a parent to teach your child how to improve his behavior. If your child is aggressive or defiant, if he does not accept the authority of adults, or if he conducts himself in a such a way that children his age will view him as a behavior problem, then your child will have a difficult time making and maintaining friendships. The friends he will attract are other aggressive problem children, the type of child with whom which you would rather your child not associate. All children need friends. Behavior problem children have trouble making friends with others, so these children tend to congregate together.

They reinforce each other's bad behavior. If you are an aware parent and you have control of your child you can put a stop to friendships with these children. However, you must have control of your child's behavior in order to help him to avoid the trap of bad friends.

Conclusion

Helping children with ADHD build close peer relationships is an important goal to focus on, and is one that often may be overlooked. You, as a parent, have the ability to help your child accomplish this important social goal.

You should make every effort to help your child in this area. His psychological health and his happiness, both now and in the future, are very much dependent upon how successful he is at making and maintaining childhood friendships.

Anthony Kane, MD
ADD ADHD Advances
Anthony Kane, MD is a physician and international lecturer. Get ADD ADHD Child Behavior and Treatment Help for your ADHD child, including child behavior advice and information on the latest ADHD treatment.

Editor: The opinions expressed by out guest authors are not necessarily those of the ADD ADHD Information Library or Dr. Doug Cowan

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ADD ADHD in the Classroom

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Not since we built our giant new web site with powerful interventions for parents and teachers at ADDinSchool.com

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