Out of Focus: ADHD Forces Families to Look for Answers

When they were raising their two older children, Lee and Kathy Wilson of Eau Claire would bask in praise for how well behaved their kids were. Then along came their third, Philip.

He had difficulty sleeping. He wouldn’t eat. He learned late how to walk.

When Philip learned to talk, he wore down the family with tantrums and arguments. He pestered his older siblings so much, they avoided bringing friends to the house. Philip didn’t get along any better with children his own age. In baseball games, if he didn’t get the position he wanted, he’d lie down and throw a tantrum, then roll over and pick flowers.

It’s not like Philip enjoyed being disruptive and in constant motion. He told his mom he “felt like he had a motor he couldn’t turn off.”

Finding a way to help him eat and control his impulsive behavior had the Wilsons frantic. They consulted an allergist who recommended acupuncture and put Philip on a diet of potatoes, beef and soy plus expensive exotic fruits. They researched eating and behavior problems on the Internet, consulted with pediatricians, psychologists and psychiatrists, read advice books and tried strict discipline at home and school.

Nothing worked.

Then last December, Philip, now 8, became violent and aggressive at school. A psychiatrist finally diagnosed Philip as having a high level of attention-deficit hyperactivity disorder, Wilson said. Philip started taking a low dosage of Adderall, a drug that has improved his behavior.

Still, there were harrowing times as doctors experimented with the dosage. When a doctor added a sedative to help Philip sleep, he had nightmares and heard nonexistent voices. In the middle of the night, he got up and went to the bedrooms of the other family members to say his bed was “yelping.”

The Wilsons aren’t alone in their confusion and trauma. ADHD is the most commonly diagnosed neurobehavioral disorder in childhood, affecting about 1.6 million school-age children, according to Children and Adults With Attention Deficit Hyperactivity Disorder. Still, questions of how to treat it — and whether it exists at all — spark debate. And controversy.

Attention-deficit hyperactivity disorder is a family of related chronic disorders that hinder a person’s capacity to maintain normal activity levels, control impulsive behavior and focus on tasks, according to the National Institute of Mental Health. Because it’s a neurobiological disorder, ADHD affects brain functions: thinking, learning, memory and behavior.

Scientists, however, have not yet identified a definitive cause.

Restless, unable to focus

Children with ADHD have a hard time concentrating on a task, so they become bored after just a few minutes, have difficulty organizing tasks and often make careless mistakes in schoolwork. They can’t sit still, tend to squirm in their seat and may run around or talk constantly.

Children with ADHD have trouble curbing their impulses or considering consequences, so they may blurt out answers in class, grab a toy away from another child, hit others or even run out into traffic without looking. They can have quick mood changes and temper outbursts and may cry easily.

In girls and women, the symptoms can look different, which may make ADHD harder to spot: Many girls don’t appear hyperactive like boys and may appear daydreamy, shy and withdrawn.

Some doctors prescribe antidepressants, but psychostimulant medications are most commonly used to treat the symptoms and have been for decades. Common stimulants in use today include Ritalin, Adderall and Concerta.

Research suggests the areas of the brain involved in planning, foresight and considering consequences are understimulated in people with ADHD. Psychostimulant drugs help the patient focus better by increasing brain activity to more normal levels, according to the National Institute of Mental Health.

ADHD has had different names over the years. In the 1970s, it was known as hyperactivity; in the 1980s, attention deficit disorder, or ADD. Because people with ADHD often have the symptom of hyperactivity, the official name was changed to ADHD in 1987.

ADHD is estimated to affect 3 percent to 5 percent of school-age children, occurring three times more often in boys than girls, according to the National Institute of Mental Health.

In Indiana, the estimated number of students who required special education as a result of ADHD soared from 685 in 1996 to 2,180 in 2001, according to the Indiana Department of Education.

No definitive medical or psychological test exists for ADHD. Interviews with the child, parent and teacher are used to diagnose children. Children are diagnosed with the disorder if they display at least six of about 18 behaviors before age 7 in two or more settings, such as home, school and play, and when the behaviors significantly interfere with social or school performance.

The list of behaviors include having trouble focusing on one activity at a time, fidgeting and squirming constantly, having trouble waiting for a turn and seeming not to listen even when directly addressed.

This means that symptoms of ADHD fall on a continuum. “Everybody is inattentive or hyperactive sometimes. The question is, what is the cutoff?” said William Kronenberger, co-chief of the ADHD clinic at Riley Hospital for Children in Indianapolis.

Expectations for behavior

Philip Wilson eats a graham cracker while relaxing with his mom, Kathy Wilson. Before Philip went on a medication to treat attention-deficit hyperactivity disorder, just asking for and settling on an afternoon snack would have involved a long argument, she said.

One author theorizes that ADHD is not a disorder; rather it is a set of “hunter” traits that don’t fit into today’s more mundane “farmer” world. Being easily distracted and a quick thinker — qualities that are helpful for stalking a deer — are less desirable for people expected to sit at length and read or do paperwork, according to psychotherapist Thom Hartmann, author of “Attention Deficit Disorder: A Different Perception.”

It’s true that expectations for behavior change over time, and our diagnoses come from what society says is acceptable or unacceptable, said Catherine Pittman, chairwoman of the psychology department at Saint Mary’s College in South Bend. But whatever the cause, she said, these are very real problems people have: maintaining attention and impulse control.

For kids with ADHD, being “different” means they can have a rough time at home and that schoolmates often reject or taunt them. They can suffer from low self-esteem.

As they grow older, children with untreated ADHD along with conduct disorders are at higher risk for drug abuse, antisocial behavior and injuries, Kronenberger said.

Adults suffer, too

ADHD isn’t limited to children. Up to 70 percent of children diagnosed with ADHD will continue to have symptoms into adulthood. Their symptoms include trouble managing time, memory problems, disorganization, impulsivity and restlessness.

Experts say ADHD is treated most effectively with drugs and behavior modification: parents and teachers setting up an environment in which the child is rewarded for appropriate behaviors, Kronenberger said.

But the subject is hardly black and white. Experts agree much more research is needed. And there remains debate in several areas: Is ADHD really a medical problem, or is it merely the result of bad parenting? Are stimulant drugs a godsend or a mistake?

For parents of children with ADHD, it’s an ongoing process with no easy answers. As the Wilsons raise their three children, they continue to sort things out, trying their best to ensure their kids’ success.

After trying so many methods to help Philip, they are content with their decision to put him on medication. He does better in school, behaves better at home and his siblings enjoy playing with him.

“He feels good about himself now,” Kathy Wilson said. “We feel like medicine is God’s gift to him.”