ADD In Children

Excerpted from
Answers to Distraction
By Edward M. Hallowell, M.D., John J. Ratey, M.D.

Q: My son is a first-grader who was recently diagnosed with ADD. I am finding it very difficult to live with this diagnosis. I am embarrassed to say this, but I just can't accept that he has something like this wrong with him. Do you have any advice?

A: My hat is off to you for being so honest. First grade is the age when most parents have to come to terms with their children's imperfections; this leads most parents to have secret thoughts like the one you just acknowledged.

It can be traumatic for a parent to learn that his or her child has ADD or any learning disability. It might be the first evidence that the child isn't perfect. As parents, we all like to imagine our children are perfect. We want for them to suffer none of the pain in life that we had to suffer. We want them to have all the good, none of the bad. We forget, all parents do, that no one is perfect. We forget that having a hard time now and then is a necessary part of being alive. We forget what we all know, at least in our heads-that mistakes are part of learning, that suffering can be formative, that learning how to deal with adversity is an essential part of growing up.

We parents forget these things. In our devotion to our children we sometimes champion them as if they were gods-immortal, perfect, beyond criticism. We take any hint that our child might have a problem as a direct attack on us, and the most precious part of us at that.

If a doctor tells us that our child has a problem such as a learning disability or ADD, we might fire the doctor. If several doctors tell us the same thing, we might go into mourning. Dr. Michael Jellinck, a child psychiatrist at the Massachusetts General Hospital in Boston, has described receiving this diagnosis of a child as a "near-death experience" for many parents. They take it almost as hard as if their child had died.

As a parent, don't be ashamed of such a reaction. A part of your child really has died. It is the part that dies usually about the first grade. For some unfortunate children it lives longer. For a lucky few it dies much younger. But for most, it dies at first grade. It is the unreal, perfect part. It is the version of the child that can do no wrong and have no flaws.

Once the perfect part dies, you can love your child as he or she really is. This is the love your child needs. Your child needs this love much more than your love of the illusion of the perfect child, the child that never was and never will be. It is a cause for celebration when you let the perfect child die and accept the child you have.

Q: At how early an age can ADD be diagnosed:

A: Theoretically, ADD can be diagnosed at any age. In practice, people differ as to when the earliest cutoff point is. I myself do not diagnose ADD in children younger than five. This is because I think it's so hard to differentiate ADD from normal toddler behavior. In children under five who present with symptoms suggestive of ADD, I recommend nonmedication treatments like increased structure, consistent limits, predictable schedules, plenty of play and exercise, and increased parental presence, if possible.

However, many responsible practitioners do diagnose ADD - and treat it with medication-in children younger than live, even as young as two. Their reasoning is that since the medication is safe, even in very young children, and since the behavior associated with severe ADD is often quite unsafe, then it makes good medical sense to give the medication a try. The choice of treatment ultimately is made by doctor and parent working together.

Q: How is ADD diagnosed in the very young?

A: The younger the child, the more the diagnosis rests upon physical behaviors. Even children who do not have ADD do not sustain attention very long. The younger the child, the shorter the attention span.

Q: Are there any risks to having a young child diagnosed and "labeled" by the school bureaucracy?

A: There are always risks, but I think the greater risk is in the school not knowing. Only if the school knows can it participate creatively in the child's treatment program.

Telling the school is usually not the hard part, though. Education is. I hope you live in an enlightened school district, but if you do not, you take on the sometimes gargantuan task of trying to educate the school about ADD. You cannot do this by yourself! You need the help of parent groups like CH.A.D.D., books, professionals-and a few guardian angels.