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In 1998, the National Institutes of Mental Health agreed that attention-deficit hyperactivity disorder (ADHD) is indeed a legitimate psychologic condition even though its definition has not been fully pinned down. ADHD is a syndrome generally characterized by the following symptoms that first occur before the age of seven:

Inattention, Distractibility, Impulsivity, Hyperactivity.

Some experts further categorize ADHD into three subtypes:

Behavior marked by hyperactivity and impulsivity, but not inattentiveness.

Behavior that is marked by inattentiveness, but not hyperactivity and impulsivity.

A mixed type.

There are some issues with these criteria, and arguments exist for both an over- and underdiagnosis of this problem. Defining ADHD is made particularly difficult because one-third of the cases are accompanied by learning disabilities and other neurologic or emotional problems. It is likely that the term attention-deficit hyperactivity disorder will eventually give way to subgroups of problems that include some of these general symptoms. [For more details, see How is Attention-Deficit Hyperactivity Diagnosed? below.]

General Description of a Child with ADHD

Studies now indicate that ADHD can be diagnosed in children by age four. Parents may notice symptoms even earlier. (One mother reported that three days after delivery, nurses were referring to her ADHD son as "Wild Willie.") The classic ADHD symptoms, inattention, distractibility, impulsivity, and hyperactivity often do not adequately describe the child's behavior, nor do they describe what is actually happening in the child's mind. Other behaviors also often coincide with the classic symptoms.

Some experts are focusing on deficits in so-called "executive functions" in the brain as the key to understanding all ADHD behaviors. Such impaired executive functions may include the following:

Inability to hold information in short-term memory.

Impaired organization and planning skills.

Difficulty in establishing and using these goals to guide behavior, such as selecting strategies and monitoring tasks.

Inability to keep emotions from becoming overpowering.

Inability to shift efficiently from one mental activity to another.

Hyperactivity. The term hyperactive is often confusing for those who expect to observe a child racing unceasingly about. A boy with ADHD playing a game, for instance, may have the same level of activity as the other children without the syndrome. If a high demand is placed on the ADHD child's attention, however, then his motor activity intensifies beyond the levels of the other children. In a busy environment, such as a classroom or a crowded store, for example, ADHD children often become distracted and react by pulling items off the shelves, hitting people, or spinning out of control into erratic, silly, or strange behavior.

Impulsivity and Temper Explosions. Even before the "terrible two's," impulsive behavior is often apparent; the toddler may gleefully exhibit erratic and aggressive gestures, such as hair pulling, pinching, and hitting. Temper tantrums, normal in children after two, are usually exaggerated and not necessarily linked to a specific negative event in the life of an ADHD child. One of the most painful events a parent may experience is an abrupt and aggressive attack that may occur after cuddling a young ADHD child. Often this reaction seems to be caused not by anger, but by the child's apparent inability to endure overstimulation or displays of physical affection.

Attention and Concentration. ADHD children are usually distracted and made inattentive by an



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