Most of us find ourselves a little “scattered” at moments. Who hasn’t zoned out during a meeting or while listening to a speech? Or found their attention wandering during conversations with friends or co-workers? Forgetting where we put the car keys or why we dropped by the supermarket are experiences we can all relate to.
For many people, however, absent-mindedness, “scattered” thinking and disorganization are not merely occasional lapses. They are chronic and persistent, to the point of impairing a person’s functioning. When attention deficit is present to this degree, it can indicate the presence of a neurological disorder.
Until just recently, the term Attention Deficit Disorder (ADD) was virtually unheard of. Remarkably, in less than two decades, it has gone from an obscure medical footnote to a household word.
ADD and ADHD (attention deficit with hyperactivity) are among the most prevalent chronic conditions plaguing school children in the United States, experts say. In a majority of cases, left untreated, the symptoms – and their emotional fallout – continue through adulthood.
What Exactly Is ADD?
ADD is a neurological disorder characterized by inappropriate levels of inattention, over-activity, and impulsivity. Symptoms arise in early childhood but are not always identified correctly. Signs of inattention include:
- Difficulty following instructions
- Difficulty sustaining attention
- Loses things necessary for tasks
- Poor attention to details
- Disorganized, surrounded by clutter
- Makes careless mistakes
- Appears sluggish/drowsy
- Forgetful
- Chronic daydreaming
- Appears apathetic, unmotivated to complete tasks
- Appears “spacey,” preoccupied
- Appears confused, lost in thought
- Difficulty complying with rules
- Signs of hyperactivity and impulsivity include:
- Difficulty awaiting turn
- Interrupts/intrudes
- Blurts out answers
- Difficulty playing quietly
- Difficulty remaining seated
- Excessive writhing, squirming, playing with objects
- Fidgeting
- Excessive talking
Despite a flood of research in recent years, ADD is still not well understood. It is often mistaken for other neurological or behavioral conditions such as bipolar disorder; oppositional defiant disorder; anxiety; learning disabilities or depression. This has led to many children being misdiagnosed, and in some cases, incorrectly medicated.
On the other end of the spectrum, many children struggling with ADD but lacking some of ADD’s more glaring features, such as hyperactivity and impulsivity, have fallen through the cracks at school. Left untreated, they struggle through school, have difficulty making and keeping friends, and enter the workplace at a serious disadvantage.
“If Only My Symptoms Had Been Recognized”
Consider the case of Penina, 22. She was diagnosed with attention deficit disorder just recently, after years of underachievement in school followed by failure at her first nursing job.
Unlike the stereotypical ADD/ADHD child, Penina wasn’t disruptive, fidgety or prone to oppositional behavior or outbursts. She was shy and creative, even showing streaks of brilliance. In first and second grades, she performed extremely well. But by fourth grade, there were clear signs of an attention disorder.
She recalls frequent embarrassing moments when she’d be staring out the window during class and a teacher’s sharp inquiry would snap her out of her reverie.
“Earth to Penina – are you with us, Penina?”
She would jerk to attention, face on fire, as classmates snickered. But moments later, she’d be swept away again by her daydreams.
She habitually missed deadlines for reports and failed to complete tests and classwork. She took a spectator role in classroom discussions and usually spent recess drifting about the schoolyard by herself.
Penina’s mother, Bracha, remembers one of the first signs of something more serious than forgetfulness when Penina was in fourth grade. “She wrote two beautiful book reports, each with a cover that took her hours of painstaking work. But she never turned them in. They were in her knapsack.”
Bracha says that’s when her daughter got her first flunking grade.
When questioned as to why she failed to hand in the reports, Penina said she had no idea where they were. She had searched her bedroom but the room was filled with such clutter, she had despaired of finding them.
“Why didn’t you think of checking your knapsack? Why didn’t you ask for help?” her mother probed in disbelief.
Penina shrugged. The massive mess in her room was an ongoing sore point with her parents. The last thing she wanted was her mother and father sifting through her piles of clothing, shoes, books, papers and miscellaneous junk strewn about the floor.
Bracha remembers that when she had to be out of the house and needed Penina, the eldest of five children, to keep an eye on things at home, she was never secure that her daughter would remember to feed the baby or turn the oven off at a pre-arranged time.
Bracha admits that she and her husband often lost patience with Penina. “I’d come down hard on her for being irresponsible, for not keeping track of her belongings. I was frustrated that I couldn’t depend on her. I tried rewards, incentives. Nothing seemed to make a difference.”
Penina’s teachers consistently gave her low marks for effort. Because she was seen as extremely bright with a reading level that far surpassed the class level, her teachers attributed her failure to finish assignments and participate in class as laziness and lack of motivation.
“All my report cards said the same thing: ‘doesn’t work to potential;’ ‘not motivated;’ ‘needs to apply herself,’ Penina recalled.
“After high school, I took up nursing, wanting to make a difference in others’ lives. I dreamed that I’d somehow be able to reverse a lifetime of underachievement. My parents cheered me on. We all had such high hopes. In retrospect, if only someone had picked up on my symptoms, I’d never have gone that route.”
Penina said her experiences as a nurse in the post-operative recovery ward taught her more about herself than she could ever have imagined. The lessons were excruciatingly painful.
“All my attention issues stood out glaringly in this pressure-cooker environment: the tendency to space out, the disorganization, lack of thoroughness … It took me twice as long as anyone else to do routine tasks and the results always seemed to fall short. I’d keep myself awake at night agonizing over my mistakes. My self-confidence was totally shaken.”
“One day, after a serious oversight regarding patient care, my nursing supervisor took me aside. ‘Penina,” she said, ‘We can’t go on like this. I’m concerned about you. No one who is trying as hard as you are trying keeps dropping the ball – unless something is very wrong… Have you ever checked out the possibility that you may have an attention disorder?’
“I was shocked speechless. ‘She thinks I’m not normal!’ I cried in my heart. Despair and humiliation, bottled up over so many years, came spilling out with my tears.
As searing as it was, this confrontation was also a gift. It led to some intense searching for answers… and a major turning point in my life.”
Early Detection And Intervention
Would earlier detection of Penina’s ADD symptoms have made a significant difference in her life?
The current research indicates so. “The emotional insight and empowerment that comes with early detection of ADD can transform a child’s world,” says Dr. Edward Hallowel, a Harvard-based psychiatrist who treats ADD children and has authored many books on the subject.
Instead of facing a steady barrage of criticism that destroys self-worth, a child whose ADD is detected in the early grades is helped to learn about his special neurological challenges, and to master specific strategies to stay on top of them, he explains. Early intervention “can transform a victim into a victor.”
Ironically, the vast increase in ADD/ADHD diagnoses across the country has given rise to skepticism in some quarters about the disorder. Teachers who try to make parents aware of their child’s attention issues often encounter opposition. They find that some parents brush aside the suggestion that ADD might be present, and are quick to put the onus on the teacher.
The child is “bored,” the parents argues, or lacking stimulation. “He has no problem concentrating at home. Perhaps if you made the lessons more interesting, he would pay better attention.”
This reaction underscores one of the key misconceptions about attention deficit disorder. An ADD child often has no trouble focusing on an activity he or she finds enjoyable. One can find such children engaged in games, crafts or other projects in which they have natural skill or interest.
However, as soon as the subject matter becomes more abstract or requires sustained mental effort, the ADD child typically loses interest. She begins either to fidget and become disruptive, or to “space out.”
Parents who do not see their child in a classroom context obviously have no frame of reference with which to gauge attention issues, hyperactivity or impulsivity. Only when these behaviors are measured against those of his peers, and combined with a parent’s observations of behavior at home, can a valid diagnosis be made—and then only by a professional.
Since there is no blood test, x-ray or sonogram that can identify ADD, a specialist arrives at a diagnosis through skilled interviewing of both the child, parents and teachers, as well as careful observation and weighing of data and anecdotal evidence over a period of time.
Socially Immature
Current research shows that ADD children are often socially immature. Their interactions with others often appear unfriendly, awkward, remote, abrasive, domineering or insensitive. They tend not to be able to read social cues and to be rebuffed by peers for inappropriate behavior.
Social rejection provokes negative behavior that triggers more rejection, which in turn, reinforces the child’s social isolation.
“ADD children may become demoralized, believing they are little more than a nuisance,” notes an article in Eye on Education. “Feelings of low-self esteem begin to emerge. These children tend to compare themselves unfavorably with their siblings and peers. They may believe that their families are disappointed in them, and begin to feel unloved and unappreciated.”
Although medication has been used for years to improve control over behavior and to stimulate and increase attention, medication does not erase the negative feelings and low-self esteem. It does not reverse ingrained habits and behavior in ADD children that tend to alienate their peers.
Many experts believe that helping ADD children to rebuild self-esteem and to master social skills should precede – or at the very least accompany – the use of medication. Only when ADD kids can truly believe that they are important and worthwhile, and can exercise control over their lives, will they be able to succeed.
Current research shows that up to half of children with ADD will continue to have difficulties with inattention, distractibility, and impulsivity for the rest of their lives. The best way to insure long-term success and compliance with treatment is to get ADD children personally involved in the process early.
ADD Coaching
Many people have found ADD coaching a highly effective and more affordable alternative to counseling. An ADD “coach” works with a child often on her own turf, to analyze what specifically is contributing to her social difficulties, and to generate behavioral strategies to improve social interactions.
ADD coaching also helps children to
- Understand that the source of many of their challenges is ADD, not personal shortcomings.
- Safely examine areas of failure for clues as to how to implement change.
- Heighten self-awareness and self-observation skills, and use those skills to improve decision-making and performance.
- Change perspective when “stuck” (i.e. learning new ways to work with procrastination, staying on task, or being more productive).
- Become aware of their own learning and processing styles so they can enhance their ability to comprehend information and situations.
Classroom Modifications for ADD and ADHD
The following suggestions may be of help in the classroom for children with ADD.
Seat students in rows. Having children sit in groups increases distractions for the ADHD child.
Seat ADD student near teacher’s desk, up front with her back to the rest of the class, but include as part of regular class seating.
Surround ADD student with “good role models,” preferably students whom the ADD child views favorably. Encourage buddying up during class time, whenever appropriate.
Do not place the ADD/ADHD student near air conditioners, heaters, high traffic areas, doors or windows. Keep the classroom door closed. Keep the room free of clutter. Distracting posters, signs, and hanging pictures should relate to the lesson being presented.
ADD children do not handle change very well so whenever possible, avoid transitions, changes in schedule, physical relocation and disruptions.
Lesson Modifications
Maintain eye contact with the ADD student during verbal instruction. Make directions clear and concise. Simplify complex directions. Avoid multiple commands.
All children will benefit from receiving an outline of the day’s lesson on the board prior to beginning the lesson. Use colored chalk to emphasize important words or ideas in the lesson.
Anything that spices up the lesson such as role-playing, stories, learning games and other activities will help children with ADD focus and pay attention.
ADD children often benefit from a daily assignment notebook in which they record homework assignments and dates due. Parents sign the notebook daily to signify completion of homework assignments. Parents and teachers can also use the notebook for daily communication.
Worksheet, workbook, and test layout may need to be modified for children with ADD or visual perceptual problems. It may help to use large type without distracting pictures. Underlining, highlighting, or drawing boxes around parts of the child’s worksheets may also help.
During tests or quizzes, allow the ADD child to demonstrate mastery of the curriculum by answering oral questions if writing for extended periods of time is too difficult. ADD children may also benefit from being given extra time for certain tasks. The ADD student may work more slowly. Don’t penalize for needed extra time.
Never Too Late
Returning to Penina, ADD coaching helped her to discover the reasons behind years of underachievement and the difficulty she had with organization and time-management. She learned that she needed to avoid stressful and high-pressured environments that magnified her ADD vulnerabilities.
Leaving her job at the hospital was difficult. It made her feel like a failure. But then she joined a home-health agency, and discovered an outlet for talents she never knew she possessed.
She found she loved getting to know the patients to whom she was assigned. In the relaxed environment of their homes, she was far more efficient and attentive. She had the opportunity to relate to the people in her care as human beings, not merely names on a hospital chart. Her natural sensitivity and compassion won their hearts and she found herself in great demand.
“I love my job. I feel so lucky to be in a profession that’s helped me to believe in myself,” she said. “I still struggle with time-management, and the paperwork for home-health nursing can be overwhelming for someone who hates detail and tends to procrastinate. But I’ve learned to break down tasks into small chunks. I’m getting better at it all the time. I wish this kind of breakthrough on all ‘ADDers’—hopefully earlier in life!”
