What causes AD/HD?

Research has demonstrated that AD/HD has a very strong neurobiological basis. Although precise causes have not yet been identified, there is little question that heredity makes the largest contribution to the expression of the disorder in the population.

In instances where heredity does not seem to be a factor, difficulties during pregnancy, prenatal exposure to alcohol and tobacco, premature delivery, significantly low birth weight, excessively high body lead levels, and postnatal injury to the prefrontal regions of the brain have all been found to contribute to the risk for AD/HD to varying degrees.

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If your child is having trouble in school, where do you start?

Students diagnosed with ADHD may be entitled to classroom accommodations or services if the disorder has a negative impact on academic, social, or behavioral performance at school. A diagnosis does not automatically entitle a student to services or accommodations, however. The resources listed below will provide you with a good background in the services and/or accommodations that may be available to your child. Every public school should also provide parents with information about local procedures and policies governing ADHD and support available through the school.

If you have placed your child in a private school, or if your child's school receives no federal funding, you may not have access to many of the services and accommodations offered in public school. But you can still use many of the suggestions in the resources below to develop a plan with your child's teacher and school to provide a more supportive education environment.

Tip of the day - Classroom Seating

Parents of children with AD/HD might want to request that their child with AD/HD sit closer to the front of the classroom or to the teacher to help maintain focus; this way, teachers can remind the child to pay attention when it is clear that he or she is “zoning out” or paying attention to other things (e.g. the fly buzzing around the room).

Multimodal Treatment Approach of AD/HD

Children and Teens
Effective treatment of AD/HD in children and teens requires a comprehensive approach that professionals call multimodal. This means that the best outcomes are achieved when multiple interventions work together as part of a comprehensive treatment plan. The elements of a multimodal treatment approach include:

• Parent training
• Behavioral intervention strategies
• An appropriate educational program
• Education regarding AD/HD
• Medication, when necessary

Positive behavior intervention can be critical. The most important techniques are consistency and positive reinforcement, in which the child is rewarded for desired behavior. Classroom success may require a range of interventions, from making minor adjustments in the regular classroom to requiring special education programs. For many children with AD/HD, medication may be an integral part of treatment. Both stimulant and nonstimulant medications are now available to physicians and parents.

Adults
Treatment for adults with AD/HD also involves a comprehensive approach. This usually means a team approach works best. The team includes not only the adult with AD/HD, but also healthcare professionals, a spouse/significant other, and others in the adult’s immediate family. Adults can benefit from learning to structure their environment as well as from vocational counseling. Short or long-term psychotherapy can also help. Medication may also be part of the treatment to improve the symptoms of AD/HD, as many adults report that this helps them gain more control and organization in their lives.

Read more about Diagnosis and Treatment by visiting CHADD’s National Resource Center on AD/HD.

Hands-On Classes for AD/HD Students

Since AD/HD is largely characterized by inattention, many students find it easier to focus in more exciting, hands-on classes. Think about this when considering your major, minor or even elective classes. I personally found speech classes to be particularly interesting because they were more interactive.

Active Classes

Hyperactivity is a component of two out of the three subtypes of AD/HD (Predominantly Inattentive, Predominantly Hyperactive-Impulsive and Combined). Taking active classes such as aerobics or jogging may help expend some of that excess energy during the day so you can better focus on homework or study sessions in the evenings.

Tip of the Day-Classroom Sizes

Many students with AD/HD find it easier to focus in smaller, as opposed to larger class sizes. When registering for fall classes, try to schedule smaller classes to help maintain focus and minimize distractions.

Tips on Handling Homework Headaches

INTERVENTIONS THAT BUILD LIFELONG HABITS
by Maureen A. McQuiggan, EdD

Tips and tricks for surviving the homework wars fill volumes. Strategies intended to “help” with homework often leave both parent and child feeling like they are just adding to the workload. The real key to success with homework rests in identifying strategies that work for all homework all the time. Here are three basic interventions that get the job done and build valuable lifelong habits:

	Process is more important than product. In recent years, educators have perfected the art of outlining explicitly the product they expect from students. Rubrics and assignment contracts spell out clearly what teachers expect to see handed in. The missing link often rests with the process. Help your child get from “I haven’t even thought about the assignment” to handing in a quality product by creating process cards. Together with your child, outline clear and simple steps to completing the task. Cards for tasks such as learning new vocabulary and outlining reading materials can be used repeatedly to build both confidence and good work habits. Start each step with a motivational check box that can be ticked off for a sense of accomplishment.
	All reading assignments must be active. Asking a child with ADHD to simply read a chapter for homework is like asking him or her to watch grass grow—many will comply, but in the end the grass and child remain unchanged. If reading assignments are not active, the brain is not engaged, attention wanders, and learning does not take place. Active reading strategies can involve asking students to locate key ideas in the reading, color coding answers to the end-of-chapter questions, or creating questions based on the reading.
	Build basic skills. Basic skills are the gifts that keep on giving. Devoting a chunk of time in the summer to targeted basic skills practice such as increasing reading fluency, improving written language skills, or committing math facts to memory will help build your child’s automaticity. Students who read more fluently, compute with speed and accuracy, and write with ease will realize the benefits across all academic tasks.

Maureen A. McQuiggan, EdD, is the Literacy Coordinator for the Radnor Township School District in Radnor, Pennsylvania, and an adjunct professor in special education at Immaculata University. She is a member of the professional advisory board for Chester County/Main Line CHADD and the parent of two children affected by ADHD.

African Americans and AD/HD

"African American parents may perceive that providers are not interested or are culturally incompetent to address parental concerns sensitively." *

"More African Americans than Hispanics and others, indicated a concern that racial background could be a factor that might serve as a barrier to ADHD treatment." **

Although individuals with ADHD can be very successful in life, untreated ADHD may have serious consequences. These may include school failure, family stress and disruption, depression, problems with relationships, substance abuse, delinquency, risk for accidental injuries and job failure. To minimize these consequences, early identification and treatment for ADHD is essential. This is especially true for African-American children and others from communities historically underserved by the medical and mental health systems.

Dr. Janice L. Cooper, PhD, a health services researcher who has focused on quality of care for children and youth with ADHD, will be answering questions from those affected by the barriers that African Americans face when seeking treatment for ADHD. This chat is for parents, family members, school teachers, health care professionals and friends who are concerned about overcoming the challenges of receiving quality care for African-American children with ADHD. Dr. Cooper will be answering questions about:

• How African American families may access appropriate interventions
• How individuals can confront stigma and misunderstandings about ADHD in their communities
• What roles African American families can play in increasing early identification and interventions for their children
• How to overcome other ADHD related obstacles having to do with quality of care, ethnicity, and cultural competence

African American Children with ADHD: Overcoming Stigmas and Barriers will take place Friday, August 20th at 1:30 to 3:00 pm (Eastern time). See Ask the Expert for more information about our future chats and how to participate.

About Janice Cooper:

Dr. Janice L. Cooper directs the National Center for Children in Poverty (NCCP). She is a health services researcher who specializes in children's mental health. She received her PhD in Health Policy from Harvard University. Her research has focused on quality of care for children and youth with attention-deficit/hyperactivity disorder (ADHD), cultural and linguistic competence and mental health financing. Since 2005, she has led NCCP's work on Children's Mental Health. She was the lead author on Unclaimed Children Revisited. She also teaches Child Health Policy at the Mailman School of Public Health of Columbia University.

Dr. Cooper has served as an Associate for Abt Associates, Director of the Children's Mental Health Division in the State of Minnesota, Director of the New York State Coalition for School-Based Primary Care, and as Coordinator for the Christian Health Association of Liberia's AIDS and Family Life Education program. She is an appointee to the New York State Mental Health Services Council and a member of the Multicultural Advisory Committee of the New York State Office of Mental Health. She is also a former board member of the American College of Mental Health Administration (ACMHA).

* Improving Advocacy for African American Children with AD/HD, Attention, October 2005, v12, n5, p 32-37 / Gary, Faye A.; Bussing, Regina.

** AD/HD: Cultural Attitudes & Perceptions, Attention, June 2003, v9, n6, p 38-41,45 / Taylor-Crawford, Karen; Richardson, Jerome; Madison-Boyd, Sybil.

Academic Accommodations

Many students might qualify for academic accommodations (a note-taker, longer time on tests, a separate room to take exams, etc.) and not even realize it. If you feel that you have AD/HD or a learning disability that hinders your ability to succeed at a collegiate level, contact the Neuropsychology Clinic for testing at (205) 344-6169 or visit our website at http://www.npclinic.com. Using our Full Evaluation, we can diagnose AD/HD, learning disabilities and other difficulties that can prevent you from reaching your potential. In addition, the testing provides sufficient documentation for academic accommodations, where appropriate.

Starting the School Year Right

This is the time of year when we begin to see summer drawing to an end and school days coming soon. To give our students with ADHD the best possible start to the year, there are things you can do now that can make a significant difference. Whether you have a child in elementary school, middle school or high school; don't wait until there are problems before you begin to work with your student's teachers. Starting from the very beginning of the year is a far more effective strategy. With just a few hours of time, you can make a significant difference for both your child and his or her teachers.

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Finding a Professional to Treat ADHD in Adults

"I think I have ADHD, what do I do now?" This question may be the first that comes to mind for many adults who may have symptoms of ADHD. Because of the long-standing myth that ADHD is a disorder affecting only children (see myth #2 on the NRC's webpage on Myths and Misunderstandings), finding treatment for adults may be more difficult than finding treatment for children. Due to the mistaken belief that ADHD symptoms would usually be outgrown, most ADHD research and treatment was focused on children for much of the 20th century.
This trend has changed over the last two decades, with more researchers and treatment providers focusing on ADHD in adults. The next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), due out in the next several years, is expected to contain guidelines for ADHD in adults, whereas the current fourth edition only classifies ADHD as a disorder among those "Usually First Diagnosed in Infancy, Childhood, or Adolescence."

With this in mind, it is easier for adults to find information and treatment for ADHD than it has been in the past, but there are still many questions to answer. In addition to the opening question posed above, others may include:

How do I find a provider who can treat ADHD in adults?

Will my family doctor be able to work with me on ADHD?

Will I need to see a specialist, like a psychologist or psychiatrist?

What kind of treatment will I need?

Will I need to take medication?

How much will treatment cost?

Will my health insurance cover the costs?

A good first step is to speak with a family practitioner. The NRC's information sheet, What We Know #9: Diagnosis of ADHD in Adults, advises adults to ask their primary care physician for a referral to a health care professional in the community who is qualified to evaluate and treat ADHD in adults. In some cases, family physicians may be familiar with diagnosing adults with ADHD and the treatment options available. CHADD maintains an online professional directory as well, allowing adults with ADHD to search for local providers. Another option is to contact a local university-based hospital, medical school or graduate school in psychology. The NRC maintains a listing of Hospitals and University Centers on its website.

Another way to find a qualified professional is to attend a local ADHD support group. Having experience with ADHD treatment providers, the people who attend the group are likely to have worked with healthcare professionals and may be willing to share their experiences and other information. CHADD has a number of such support groups around the country. For a searchable list of CHADD chapters, visit the CHADD Chapter locator on the CHADD website.
ADHD treatment or supporting services can be provided by a number of different types of professionals depending on the severity of symptoms and the nature of treatment or services needed. Some professionals who can help adults with ADHD are:

Physicians, including Psychiatrists and Neurologists
Nurse Practitioners
Physician's Assistant
Psychologists, especially Clinical Psychologists
Clinical Social Workers
Licensed mental health therapists
ADHD Coaches
Professional Organizers

In most situations, adults consult with more than one type of professional, sometimes having a team rather than an individual provide treatment. If medication is needed as part of the treatment, it is usually necessary to have a physician (i.e. someone with an M.D. or O.D. degree) or other qualified medical professional write the prescription (although one state, New Mexico, also allows clinical psychologists with advanced training in pharmacology to write certain prescriptions in certain circumstances). Medication may be, but is not necessarily, part of ADHD treatment for adults. If medication is not part of the plan, a psychologist, social worker or other mental health provider can be the primary professional involved, and some adults will be able to manage their ADHD with help from those "emerging professions" such as ADHD Coaching or Professional Organizing.

Information on medication for adults with ADHD can be found in What We Know #10: Managing Medication for Adults with ADHD. Information on coaching can be found in What We Know #18: Coaching for Adults with ADHD. Treatment options for adults do vary, especially as there is a portion of the adult population with ADHD that does not respond to medication treatment. Some treatment options that go beyond medication are discussed in the May 2010 NRC News article Beyond Medication: Treating ADHD in Adults.

Cost of treatment can vary greatly depending on the kind of treatment plan needed and the type of insurance coverage available. In years past, many insurance companies did not cover mental health treatment to the same extent as physical health treatment. However, in fall 2008, Congress enacted the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, which limited the ability of insurance companies to provide different levels of coverage for mental and physical conditions. According to the CHADD fact sheet on Mental Health Parity, "The law makes it illegal for health insurance plans sponsored by businesses with fifty or more employees to impose day and visit limits that are more restrictive than physical illness coverage. It also prohibits applying different deductibles, copayments, out-of-network charges, and other financial requirements for mental health treatment compared to physical health treatment covered in a plan."

One thing noted in the fact sheet regarding adult ADHD is that, "Health plans have discretion on which conditions to cover. Until the published science is as sound for adult ADHD as it is for childhood ADHD, there will be plans that will not cover adults." So adults will have to check with their insurance providers to see what services are covered. Adults who are privately insured or work for companies with fewer than 50 employees will also have to check with their plan to see what is covered and what is not.

Finding the right provider or team can be challenging, but it can sometimes be as simple as talking to a family physician. If the physician does not know of anyone who can treat ADHD in adults, there are other options to consider as outlined above. Finding the right providers and enacting the right plan is a vital step in the process of living a meaningful life as discussed in CHADD's Professional Advisory Board's statement on ADHD and Recovery. Although adults with ADHD may feel their lives are in a state of constant chaos, finding the right professionals to work with can go a long way towards empowerment and taking control of one's own life.

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