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Introduction
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School counselors are often
consultants for parents and teachers on problems
that children and adolescents face. Attention
deficit is one such problem. It is frequently
misunderstood, presenting a challenge for parents
and teachers alike. The counselor is a resource for
initial identification and interventions at home
and in the classroom. The counselor must have at
least a working knowledge of typical symptoms and
likely responses to environmental demands in order
to be an effective resource on attention deficit.
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ETIOLOGY
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Attention Deficit Disorder
without Hyperactivity (ADD) or with Hyperactivity
(ADHD) continues to be a misunderstood diagnosis by
many. Some parents and teachers still hold a
perception that the label simply provides an excuse
for disruptive behavior; however, studies continue
to support a biochemical or organic basis to the
disorder.
Presentation of symptoms can
be affected by family interactions, school
expectations, and other demands placed on the
individual child. Part of the reason that attention
deficit is usually diagnosed in school age children
(e.g., first to third grade) is attributable to the
demands placed on the child when beginning school
(American Psychiatric Association [APA],
2000). The structure at school differs from that in
the home or preschool environment.
Typical predisposing factors
within the individual, as well as in the family
history, are being identified in the literature
(Chi and Hinshaw, 2002). For example, a history of
alcoholism, smoking, or depression in parents can
be predisposing factors (Mick, Biederman, Faroane,
Sayer, and Kleinman, 2002). Certain physiological
markers, such as frequent early ear infections
(Combs, 2002), have also been associated with the
presentation of attention deficit. Physical
complications can be a factor in the development of
language and reading disabilities that are
associated with attention deficit for between 45%
and 60% of those diagnosed (Lloyd, Hallahan,
Kauffman, and Keller, 1998).
Attention Deficit Disorder
presents in a slightly different way for each
individual, partially due to the factors noted
above. Although there is a cluster of symptoms
usually associated with the disorder, the
individual presentation can be just as varied as
the predisposing factors.
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SYMPTOMS AND DIAGNOSIS
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Diagnosis in
children and adults is usually made by history,
self- report, and observation from significant
others in the person's life. Central to diagnosis
in children are the symptoms in the general areas
of inattention, impulsivity, and hyperactivity
(APA, 2000). In adults, the most prominent symptom
is inattention (Stern, Garg, and Stern, 2002).
Symptoms of
attention deficit can be mimicked by emotional
disorders, e.g., reaction to abuse, depression or
anxiety (APA, 2000). If therapy is not successful
in addressing underlying emotional concerns,
medication may be used with positive results just
as in the case of more classic symptoms of ADHD. In
those cases where early abuse or neglect has been
instrumental in affecting the neurology of the
individual, the actual outcome, and thus treatment,
may not differ significantly from other cases of
ADHD. Difficulty sleeping is often seen with
attention deficit, particularly for those with
hyperactivity (Stein, Pat-Horenczyk, Blank, Dagan,
Barak, and Gumpel, 2002). Sleep problems can also
be exacerbated by medication use.
Other
disorders may co-occur with Attention Deficit
Disorder. Those commonly observed include:
Tourette's, Obsessive-Compulsive Disorder,
Depression, Autism, Oppositional Defiant Disorder
(ODD), or Conduct Disorder (CD) (Burns and Walsh,
2002). The relationship between ADHD, ODD, and CD
is often presented on a continuum or as a
progressive relationship. Symptoms of ADHD often
present initially, followed by ODD, and ultimately
CD for a small percentage of those with initial
attention problems. Individual characteristics,
family factors, and life experiences all interact
to push some individuals through this continuum to
more serious behavioral concerns. The comorbidity
of other disorders or symptoms often makes
successful treatment more difficult. Other features
of ADHD include differences in level of executive
functioning between those who present with
hyperactivity and those who do not (Klorman,
Hazel-Fernandez, Shaywitz, Fletcher, Marchione,
Holahan, Stuebing, and Shaywitz, 1999). Deficits in
executive functioning are associated with greater
hyperactivity and impulsivity. These differences in
executive functioning include an inability to
self-monitor and self-control.
Prevalence
estimates for ADHD and ADD are between 3 to 7% of
school age children (American Psychiatric
Association, 2000).
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TREATMENT
OPTIONS
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Effective treatment usually
combines medication and therapy, including
behavioral interventions aimed at increasing
structure at home and school. Parents and teachers
are active participants in successful treatment
efforts. Stimulants are the most commonly used
medications, with some use of anti-depressants, for
co-morbid conditions of depression and anxiety
(Shatin and Drinkard, 2002). Other interventions
include parent training and family therapy,
individual therapy, support groups, and social
skills training. Providing structure for these
individuals, and helping children learn to provide
structure for themselves, are at the core of
successful interventions (Shapiro, DuPaul and
Bradley-Klug, 1998).
Although medication is often
part of a successful treatment approach, school
personnel are usually not directly involved in
recommending a prescription. Diagnoses and
prescriptions can only be provided by the family
physician, pediatrician, or psychiatrist. Even the
process of referral can expose a school to
liability for financial responsibility, so the
counselor needs to be aware of the manner in which
any conversation about medication or referral takes
place.
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Tourette
Syndrome "Plus" © Copyright 1998 - 2005 Leslie
E. Packer, PhD. except as noted.
All rights reserved
This page last updated January 7, 2005.
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