ADD and ADHD are chronic medical conditions of childhood that have been well studied and are usually amenable to treatment. They are conditions that seem to be relatively common among children in foster care, perhaps in part due to the fact that they are often associated with other conditions in which early trauma and loss play a role, such as attachment disorder, post-traumatic stress disorder bipolar disorder and depression. Parents should be careful in jumping to the conclusion that their child has, or is developing ADD or ADHD. The symptoms of depression, anxiety, and bipolar disorder can mirror those associated with ADD/ADHD. A thorough evaluation by a physician (and especially a psychiatrist) is the only way to make the correct diagnosis. The cause of ADD/ADHD remains unknown, although there are some theories and speculation. In about a third of children the symptoms begin to disappear in adolescence or adulthood. For others they may lessen, or in some cases deteriorate. Most adults with ADD/ADHD live successful lives, and even turn their symptoms into assets as they progress through life.

Causes:
Although the cause is unknown studies have shown that ADHD is genetically linked and others in the extended family may have experienced the condition. Theories about causes range from toxic exposure, sugar, food allergies, complications of birth and brain damage. Even today, many parents are convinced that sugars, and especially artificial sweeteners in junk food, either cause or exacerbate hyperactivity, despite research that has consistently failed to demonstrate the link. Psychiatrists have reported significant differences in the activity level of the brain, as measured by PET scan between those with and without ADHD, confirming thoughts expressed by many parents that "my child's brain seems to work differently". It is for this reason that medication is an important part of the treatment plan.

Symptoms and Treatment:
Physicians use a symptom checklist to make an ADD or ADHD diagnosis. The major signs are examples of distractibility (an inability to focus on a single activity, or doing any activity for a reasonable period of time), hyperactivity (seemingly having too much energy, such as always being in motion, difficulty staying sitting down, short periods of sleep and excessive talking), and impulsivity (acting without thinking about consequences, such as dashing into the street, doing what he or she wants in the immediate moment, or saying things without assessing the impact on others or how it will be perceived). The symptoms will differ somewhat depending on whether the child is an infant, toddler, preschooler or in elementary school. Because this is a complex condition two children with the same diagnosis may show quite different symptoms. You may find the condition divided into three specific types; predominantly inattentive (distractible but not very impulsive or hyperactive), predominantly hyperactive-impulsive (hyperactive and impulsive but not inattentive) and combined type (distractible, hyperactive and impulsive, and the most common of the three).

Because the symptoms are behavioral in nature adults will often assume that it is bad behavior they are experiencing rather than something that is beyond the child's ability to control. ADD/ADHD children can easily come to think of themselves as bad because that is often the response that they receive from others, including peers, parents and teachers. These feelings may frequently lead to reduced self-esteem, which itself can effect the child's willingness to "put himself out there" and emotionally attach. As children have told me, "I'm not worth anything because look how I mess up all the time. Nobody really wants me."

Recently revised treatment guidelines (2001) from the American Academy of Pediatrics emphasize five major aspects for treatment, once the condition has been properly diagnosed by a thorough evaluation, summarized as follows;

1. Counseling and support for the parents and family of the child.
2. The treating clinician, parents and school personnel, should specify appropriate target outcomes (3-6 desired changes) to guide management.
3. The clinician should recommend simulant medication and/or behavior therapy as appropriate to improve target outcomes in children with ADHD.
4. When the selected management for a child with ADHD has not met target outcomes, clinicians should evaluate the original diagnosis and review the plan and any coexisting conditions, and
5. Provide periodic follow-up to review outcomes and any adverse effects.

Adoption Issues and Implication:
Adopting a child with ADD/ADHD calls for some extra commitment on the family's part because the behaviors associated with ADD/ADHD can affect the adoptive parent's willingness to emotionally connect with the child in positive ways. The "difficulty" of living with the symptoms may easily make family life more stressful than was originally planned. This may be especially true if there are already other children living at home. Parents considering the placement of a child with the condition should educate themselves fully about issues that are likely to arise such as; behavioral issues at school, the possible need for some degree of special education services, the child's frustration and disappointment at not performing up to everyone's expectations in life, and possibly difficulties maintaining friends or participating on a team. Parents must be prepared to maintain effective dialogue with school personnel and advocate for necessary services and adjustments by participating actively in the child's I.E.P. (Individualized Educational Plan). Adoption agencies will want to be assured that prospective parents will also support the medication regime, and be prepared for adjustments and changes to it over time. Holistic approaches simply won't do the job alone. Last, and certainly not least, the family must be willing to learn about, and then help design, implement and maintain a behavior modification plan as an essential part of the treatment process.

© Copyright 2003 Placenet Solutions in Child PlacementPlacenet

Credits: Graham