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|Quick reference medical handouts used
by Pediatric offices
Attention Deficit Disorder (Short Attention Span)
Also called ADD, ADHD, or hyperactivity, a short attention span occurs
in 3% to 5% of children, most of them males.
A normal attention span is 3 to 5 minutes per year of a child's age.
Therefore, a 2-year-old should be able to concentrate on a particular task
for at least 6 minutes, and a child entering kindergarten should be able
to concentrate for at least 15 minutes. (Note: A child's attention span while
watching TV is not an accurate measure of his or her attention span.)
If you suspect that your child has a short attention span, ask another
adult (a teacher or day care provider, for example) if they have observed
A child hasn't learned to listen when someone talks, wait his turn,
complete a task, or return to a task if interrupted. (These can be normal
characteristics of children less than 3 or 4 years old.)
80% of boys and 50% of girls are also hyperactive. A child who has
symptoms of hyperactivity is restless, impulsive, and in a hurry.
50% of children also have a learning disability. The most common learning
disability is an auditory processing deficit (that is, they have difficulty
remembering verbal directions). However, the intelligence of most children
with ADD is usually normal.
Disruptive children, children who don't mind, and aggressive children
are sometimes included under the broad category of hyperactivity. Many problem
2-year-olds are considered "hyperactive." These children should be looked
upon as children with behavior problems and approached with appropriate
Attention deficit disorder (ADD) is the most common developmental
disability. "Developmental" means that the disability is caused by delayed
brain development (immaturity). This delay results in poor self-control,
requiring external controls by the parents for a longer period of time. Often
this type of temperament and short attention span is hereditary. A small
percentage of children with ADD are reacting to chaotic home environments,
but in most cases the parents' style of child-rearing has not caused the
disability. Minor brain damage has not been proven to be a cause of ADD but
scientists are conducting research into this area.
Children with ADD on a developmental basis can improve significantly
if parents and teachers provide understanding and direction and preserve
the child's self-esteem. When these children become adults, many of them
have good attention spans but remain restless, have to keep busy, and, in
a sense, have not entirely outgrown the problem. However, not only does society
learn to tolerate such traits in adults, but in some settings the person
with endless energy is prized. Children with severe ADD may need vocational
counseling as adults.
Call Your Child's Physician for Referral to a Child Psychiatrist or
Your child shows unprovoked aggression and destructiveness.
Your child has repeated accidents.
Your child has been suspended or expelled from school.
Your child can't make or keep any friends.
You have "given up" hope of improving your child.
You can't stop using physical punishment on your child.
You are at your wit's end.
Living with a Child Who Has Attention Deficit Disorder
Attention deficit disorder is a chronic condition that needs special
parenting and school intervention. If your child seems to have a poor attention
span and is over 3 years of age, these recommendations may assist you in
helping your child. Your main obligations involve organizing your child's
home life and improving discipline. Only after your child's behavior has
improved will you know for certain if your child also has a short attention
span. If he does, specific interventions to help him learn to listen and
complete tasks ("stretch" his attention span) can be initiated. Even though
you can't be sure about poor attention span until your child is 3 or 4 years
of age, you can detect and improve behavior problems at any time after 8
months of age.
Accept your child's limitations.
Accept the fact that your child is intrinsically active and energetic
and possibly always will be. The hyperactivity is not intentional. Don't
expect to eliminate the hyperactivity but merely to bring it under reasonable
control. Any criticism or other attempt to change an energetic child into
a quiet or model child will cause more harm than good. Nothing helps a
hyperactive child more than having a tolerant, patient, low-keyed
Provide an outlet for the release of excess energy.
This energy can't be bottled up and stored. Daily outdoor activities
such as running, sports, and long walks are good outlets. A fenced yard helps.
In bad weather your child needs a recreational room where he can play as
he pleases with minimal restrictions and supervision. If no large room is
available, a garage will sometimes suffice. Your child should not have too
many toys, for this can cause him to be more easily distracted from playing
with any one toy. The toys should be safe and relatively unbreakable. Encourage
your child to play with one toy at a time.
Although the expression of hyperactivity is allowed in these ways,
it should not be needlessly encouraged. Don't initiate roughhousing with
your child. Forbid siblings to say, "Chase me, chase me," or to instigate
other noisy play. Encouraging hyperactive behavior can lead to its becoming
your child's main style of interacting with people.
Keep your home well organized.
Household routines help the hyperactive child to accept order. Keep
the times for wake-up, meals, snacks, chores, naps, and bed as regular as
possible. Try to keep your environment relatively quiet because this encourages
thinking, listening, and reading at home. In general, leave the radio and
TV off. Predictable daily events help your child's responses become more
predictable. ADD symptoms are made worse by sleep deprivation and hunger.
Be sure your child has an early bedtime and a big breakfast on school
Try not to let your child become fatigued.
When a hyperactive child becomes exhausted, his self-control often
breaks down and the hyperactivity becomes worse. Try to have your child sleep
or rest when he is fatigued. If he can't seem to "turn off his motor," hold
and rock him in a rocking chair.
Avoid taking your child to formal gatherings.
Except for special occasions, avoid places where hyperactivity would
be extremely inappropriate and embarrassing (such as churches or restaurants).
You also may wish to reduce the number of times your child goes with you
to stores and supermarkets. After your child develops adequate self-control
at home, he can gradually be introduced to these situations. Be sure to praise
your child when he plays independently rather than interrupting you when
you are talking to guests or are on the telephone.
Maintain firm discipline.
These children are unquestionably difficult to manage. They need
more carefully planned discipline than the average child. Rules should be
formulated mainly to prevent harm to your child and to others. Aggressive
behavior, such as biting, hitting, and pushing, should be no more accepted
in the hyperactive child than in the normal child. Try to eliminate such
aggressive behaviors, but avoid unnecessary or unattainable rules; that is,
don't expect your child to keep his hands and feet still. Hyperactive children
tolerate fewer rules than the normal child. Enforce a few clear, consistent,
important rules and add other rules at your child's pace. Avoid constant
negative comments like "Don't do this," and "Stop that."
Enforce rules with nonphysical punishment.
Physical punishment suggests to your child that physically aggressive
behavior is OK. We want to teach hyperactive children to be less aggressive.
Your child needs adult models of control and calmness. Try to use a friendly,
matter-of-fact tone of voice when you discipline your child. If you yell,
your child will be quick to imitate you.
Punish your child for misbehavior immediately. When your child breaks
a rule, isolate him in a chair or time-out room if a show of disapproval
doesn't work. The time-out should last about 1 minute per year of your child's
age. Without a time-out system, overall success is unlikely.
Stretch your child's attention span.
Encouraging attentive (nonhyperactive) behavior is the key to preparing
your child for school. Increased attention span and persistence with tasks
can be taught at home. Don't wait until your child is of school age and expect
the teacher to change him. By age 5 he needs at least a 25-minute attention
span to perform adequately in school.
Set aside several brief periods each day to teach your child listening
skills by reading to him. Start with picture books, and gradually progress
to reading stories. Coloring pictures can be encouraged and praised. Teach
games to your child, gradually increasing the difficulty by starting with
building blocks and progressing to puzzles, dominoes, card games, and dice
games. Matching pictures is an excellent way to build your child's memory
and concentration span. Later, consequence games such as checkers or tic-tac-toe
can be introduced. When your child becomes restless, stop and return for
another session later. Praise your child for attentive behavior. This process
is slow but invaluable in preparing your child for school.
Buffer your child against any overreaction by neighbors.
Ask neighbors with whom your child has contact to be helpers. If
your child is labeled by some adults as a "bad" kid, it is important that
this image of your child doesn't carry over into your home life. At home
the attitude that must prevail is that your child is a good child with excess
energy. It is extremely important that you not give up on him. Your child
must always feel loved and accepted within the family. As long as a child
has this acceptance, his self-esteem will survive. If your child has trouble
doing well in school, help him gain a sense of success through a hobby in
an area of strength.
From time to time, get away from it all.
Exposure to some of these children for 24 hours a day would make
anyone a wreck. Periodic breaks help parents to tolerate hyperactive behavior.
If just the father works outside the home, he should try to look after the
child when he comes home, not only to give his wife a deserved break but
also to understand better what she must contend with during the day. A baby
sitter one afternoon each week and an occasional evening out can provide
much-needed breaks for an exhausted mother. Preschool is another helpful
option. Parents need a chance to rejuvenate themselves so that they can continue
to meet their child's extra needs.
Utilize special programs at school.
Try to start your child in preschool by age 3 to help him learn to
organize his thoughts and develop his ability to focus. However, you should
consider enrolling your child in kindergarten a year late (that is, at age
6 rather than 5) because the added maturity may help him fit in better with
Once your child enters grade school, the school is responsible for
providing appropriate programs for your child's attention deficit disorder
and any learning disability he might have. Some standard approaches that
teachers use to help children with ADD are smaller class size, isolated study
space, spaced learning techniques, and inclusion of the child in tasks like
erasing the blackboard or passing out books (as outlets for excessive energy).
Many of these children spend part of their day with a teacher specializing
in learning disabilities who helps improve their skills and confidence.
If you think your child has ADD and he has not been tested by the
school's special education team, you can request an evaluation. Usually you
can obtain the help your child needs with schoolwork by working closely with
the school staff through parent-teacher conferences and special meetings.
Your main job is to continue to help your child improve his attention span,
self-discipline, and friendships at home.
Medications are sometimes helpful.
Some stimulant drugs can improve a child's ability to concentrate.
You may want to discuss the use of drugs with your child's physician. In
general, medications should not be prescribed before school age. They should
also not be prescribed until after your child has been evaluated by a doctor
and a school psychologist or special education teacher, an individualized
educational plan (I.E.P.) is in effect at school, and you have followed the
suggestions in this handout. Medications without special education and home
management programs have no long-term benefit. They need to be part of a
broader treatment program.
Written by B.D. Schmitt, M.D., author of "Your Child's Health,"
Bantam Books. Copyright 1999 Clinical Reference Systems
As a reminder, this information should not be relied on as
medical advice and is not intended to replace the advice of your childs pediatrician.
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