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Common Youth Diagnosis
- Attention Deficit/Hyperactivity Disorder / ADHD
- Oppositional Defiant Disorder / ODD / Conduct Disorder
Much of the information from this site comes from SAMHSA's National Mental Health Information Center.
What Is Attention-Deficit/Hyperactivity Disorder?
Young people with Attention-Deficit/Hyperactivity Disorder typically are overactive, unable to pay attention, and impulsive. They also tend to be prone to accidents. Children or adolescents with Attention-Deficit/Hyperactivity Disorder may not do well in school, or even fail, despite normal or above-normal intelligence. Attention-Deficit/Hyperactivity Disorder is sometimes referred to as ADHD.
What Are the Signs of Attention-Deficit/Hyperactivity Disorder?
There are actually three different types of
Attention-Deficit/Hyperactivity Disorder, each with different
symptoms.
The types are referred to as inattentive,
hyperactive-impulsive, and
combined Attention-Deficit/Hyperactivity
Disorder.
Children with the inattentive type:
· Have short attention spans;
· Are easily distracted;
· Do not pay attention to details;
· Make lots of mistakes;
· Fail to finish things;
· Are forgetful;
· Don't seem to listen; and
· Cannot stay organized.
Children with the hyperactive-impulsive type:
· Fidget and squirm;
· Are unable to stay seated or play quietly;
· Run or climb too much or when they should not;
· Talk too much or when they should not;
· Blurt out answers before questions are completed;
· Have trouble taking turns; and
· Interrupt others.
Combined Attention-Deficit/Hyperactivity Disorder, the most common type, is a combination of the inattentive and the hyperactive-impulsive types.
A diagnosis of one of the Attention-Deficit/Hyperactivity Disorders is made when a child has a number of the above symptoms, and the symptoms began before the age of 7 and lasted at least 6 months. Generally, symptoms have to be seen in at least two different settings (for example, at home and at school) before a diagnosis is made.
How Common Is Attention-Deficit/Hyperactivity Disorder?
Attention-Deficit/Hyperactivity Disorder is found in as many as 1 in every 20 children. Studies have shown that boys with ADHD outnumber girls with the disorder by about three to one. Children and adolescents with Attention-Deficit/Hyperactivity Disorder are at risk for many other disorders. About half of all young people with ADHD also have oppositional or Conduct Disorder, and about a fourth have an anxiety disorder. As many as one-third of these young people have a depression problem, and about one-fifth have a learning disability. Sometimes a child or adolescent will have two or more of these disorders in addition to Attention-Deficit/Hyperactivity Disorder. Also, children with Attention-Deficit/Hyperactivity Disorder are at risk for developing personality disorders and substance abuse disorders when they are adolescents or adults.
Attention-Deficit/Hyperactivity Disorder is a major reason why children are referred for mental health care. Boys are more likely to be referred for treatment than girls, in part because many boys with Attention-Deficit/Hyperactivity Disorder also have Conduct Disorder. The mental health services and special education required by children and adolescents with Attention-Deficit/Hyperactivity Disorder cost millions of dollars each year. Underachievement and lost productivity can cost these young people and their families even more.
What Causes Attention-Deficit/Hyperactivity Disorder?
Many causes of Attention-Deficit/Hyperactivity Disorder have been studied, but no one cause seems to apply to all young people with the disorder. There is strong evidence that genetic factors are important. But other factors such as viruses, harmful chemicals in the environment, problems during pregnancy or delivery, or other things that impair brain development may play a role as well.
What Help Is Available for Families?
Many treatments - some with good scientific basis, some without - have been recommended for children and adolescents with Attention-Deficit/Hyperactivity Disorder. Medication and behavior treatments have proven to give the best results. Options for parents also include placement in specialty schools for defiant teens, boot camps, residential treatment centers, and military type schools.
The most widely used drugs for treating Attention-Deficit/Hyperactivity Disorder are stimulants, such as amphetamine (Dexedrine, Dextrostat, Desoxyn), methylphenidate (Ritalin), and pemoline (Cylert). Stimulants increase the activity in parts of the brain that are underactive in children and adolescents with Attention-Deficit/Hyperactivity Disorder. Experts believe that this is why stimulants improve attention and reduce impulsive, hyperactive, or aggressive behavior. Individuals may respond better to one medication than to another. For example, clonidine (Catapres) is often used, although its effectiveness has not been clearly shown. A few antidepressants may also work for some patients. Tranquilizers like thioridazine (Mellaril) have also been shown to work for some young people. Care must be used in prescribing and monitoring all medication.
Like most medications, those used to treat Attention-Deficit/Hyperactivity Disorder have side effects. When taking these medications, some children may lose weight, have a smaller appetite, and temporarily grow more slowly. Others may have trouble falling asleep. However, many doctors believe the benefits of medication outweigh the possible side effects. Side effects that do occur can often be handled by reducing the dosage.
· Teaching parents and
teachers how to manage and modify the child's or adolescent's behavior,
such as rewarding good behavior;
· A daily report card to
link the home and school efforts (where the parent rewards the child
or adolescent for good school performance and behavior);
· Summer and Saturday programs;
· Special classrooms that use intensive behavior
modification; and
· Specially trained classroom aides.
It is clear that both stimulants and behavior treatment can be helpful in the short run (a few weeks or months). However, it is not clear how long the benefit lasts. The Federal Government's National Institute of Mental Health is supporting research on the long-term benefits of various treatments as well as research to find out whether medication and behavior treatment are more effective when combined. There is also research on new medicines and other new treatments. Other Federal agencies carrying out research on Attention-Deficit/Hyperactivity Disorder include the Center for Mental Health Services and the Department of Education.
A child or adolescent in need of treatment or services, and his or her family, may need a plan of care based on the severity and duration of symptoms. Optimally, this plan is developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions.
Can Attention-Deficit/Hyperactivity Disorder Be Prevented?
Because there are so many suspected causes of
Attention-Deficit/Hyperactivity Disorder, prevention may be difficult.
However, it is always wise to obtain good prenatal care and stay away
from alcohol, tobacco, and other harmful chemicals during pregnancy, as
well as to get good general health care for the child. These
recommendations may be particularly important if
Attention-Deficit/Hyperactivity Disorder is suspected in other family
members. Knowing that Attention-Deficit/Hyperactivity Disorder is in
the family can alert parents to take early action to prevent bigger
problems.
What Else Can Parents Do?
When it comes to Attention-Deficit/Hyperactivity Disorder, parents and other caregivers should be careful not to jump to conclusions. A high energy level alone in a child or adolescent does not mean that he or she has Attention-Deficit/Hyperactivity Disorder. The diagnosis depends on whether the child or adolescent can focus well enough to complete tasks that suit his or her age and intelligence. This ability is most likely to be noticed by a teacher. Therefore, input from teachers should be taken seriously.
If parents or other caregivers suspect Attention-Deficit/Hyperactivity Disorder, they should:
· Make an appointment with a psychiatrist, psychologist, child
neurologist, or behavioral pediatrician for an evaluation. (Check with
the child's doctor for a referral.)
· If the young person is diagnosed with
Attention-Deficit/Hyperactivity Disorder, be patient. The disorder may
take a long time to improve.
· Instill a sense of competence in the child or adolescent.
Promote his or her strengths, talents, and feelings of
self-worth.
· Remember that failure, frustration, discouragement, low
self-esteem, and depression, in many cases, cause more problems than
the disorder itself.
· Get accurate information from libraries, hotlines, or other
sources.
· Ask questions about treatments and services.
· Talk with other families in the community.
· Find family network organizations.
Help for children with the above diagnosis may also be sought in specialty type schools, boot camps, and behavior modification type programs.
ODD
Oppositional Defiant Disorder
Conduct Disorder
What Is Conduct Disorder?
Children with Conduct Disorder repeatedly violate the personal or property rights of others and the basic expectations of society. A diagnosis of Conduct Disorder is likely if the behavior continues for a period of 6 months or longer. Because of the impact Conduct Disorder has on the child and his or her family, neighbors, and adjustment at school, Conduct Disorder is known as a "disruptive behavior disorder." Another disruptive disorder, called Oppositional Defiant Disorder, often occurs before Conduct Disorder and may be an early sign of Conduct Disorder.
Oppositional Defiant Disorder is diagnosed when a child's behavior is hostile and defiant for 6 months or longer. Oppositional Defiant Disorder can start in the preschool years, whereas Conduct Disorder generally appears when children are somewhat older. Oppositional Defiant Disorder is not diagnosed if Conduct Disorder is present. What Are the Signs of Conduct Disorder?
Some symptoms of Conduct Disorder include:
· Aggressive behavior that harms or threatens to harm other
people or animals;
· Destructive behavior that damages or destroys property;
· Lying or theft; and
· Skipping school or other serious violations of rules.
Children with Oppositional Defiant Disorder or Conduct Disorder may have other problems as well, including:
· Hyperactivity;
· Anxiety;
· Depression;
· Academic difficulties; and
· Problems with peer relationships.
How Common is Conduct Disorder?
· As many as 1 in 10 children and adolescents may have Conduct
Disorder.
· Most children and adolescents with Conduct Disorder do not
have lifelong patterns of conduct problems and antisocial behavior.
Years of research show that the most troubling cases of Conduct Disorder begin in early childhood, often by the preschool years. In fact, some infants who are especially "fussy" are at risk for developing Conduct Disorder. Other factors that may make a child more likely to develop Conduct Disorder include:
· Inconsistent rules and harsh discipline;
· Lack of enough supervision or guidance;
· Frequent change in caregivers;
· Poverty;
· Neglect or abuse; and
· A delinquent peer group.
What Help Is Available for Families?
Conduct Disorder is one of the most difficult behavior disorders of childhood and adolescence to treat successfully. However, young people with Conduct Disorder often benefit from a range of services, which might include:
· Parent training on how to handle their child's or
adolescent's behavior;
· Family therapy;
· Training in problem-solving skills for children or
adolescents; and
· Community-based services that focus on the young person
within the context of family and community influences.
A child or adolescent in need of treatment or services, and his
or her family, may need a plan of care based on the severity and
duration of symptoms. Optimally, this plan is developed with the
family, service providers, and a service coordinator, who is referred
to as a case manager. Whenever possible, the child or adolescent
is involved in decisions.
What Can Parents Do?
Antisocial behavior in children and adolescents is very hard to change after it has become ingrained. Therefore, the earlier the problem is identified and treated, the better. Some recent studies have focused on promising ways to prevent Conduct Disorder among children and adolescents who are at risk for developing the disorder. Most children or adolescents with Conduct Disorder are probably reacting to events and situations in their lives. More research is needed to determine if biology is a factor in Conduct Disorder.
Parents should:
· Pay careful attention when a child or adolescent shows signs
of Oppositional Defiant Disorder or Conduct Disorder and try to
understand the reasons behind it. Then parents can try to improve the
situation or their own reactions.
· Talk with a mental health or social service professional,
such as a teacher, counselor, psychiatrist, or psychologist
specializing in childhood and adolescent disorders (if parents
cannot reduce
their child's or adolescent's antisocial behavior on their own).
· Get accurate information from libraries, hotlines, or other
sources.
· Talk to other families in their community.
· Find family network organizations.
Options for parents also include placement in specialty schools for defiant teens, boot camps, residential treatment centers, and military type schools. Call toll free 800 507 5535 and we will help you find your way through the myriad of options available to you.