Active or Hyperactive?

You probably are reading this book because you have a very active child or you know one. All children can be very active occasionally or can make more than enough noise. However, some children attract notice because they are so difficult to control, exhibit overactive behavior, or talk all the time. It is difficult for these children to control their behavior, even though they can be very agreeable at times. They can be funny, full of energy, and well behaved when you deal with them one-on-one.

Dealing with these children is often a challenge, even though they can be charming, creative, and happy little people. When everything is going well, their refreshing point of view can make life exciting. However, when they have problems, they may camouflage them by playing “the clown,” for example. Many children at school enjoy seeing these children play the clown or do deliberately silly things, and the teacher may even laugh at them, despite knowing this is not appropriate behavior. A child displaying this type of behavior temporarily avoids attending to academic material.

Two diagnostic categories are used for highly active children: attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD). These disorders, their relationship with SI, and factors that can cause hyperactivity are discussed in this chapter.

Attention Deficit Hyperactivity Disorder

Hyperactivity is the chief symptom of ADHD. This disorder is recognizable through its display of inattention and incessant movement. Children with ADHD have a problem with self-regulation and cannot organize behavior in a way that is appropriate to the situation.

ADHD has also been termed a performance problem.2 Children who have ADHD cannot seem to find the right behavior to plan or finish a specific task in a set timeframe. ADHD as a continuing problem may be less evident in older children and adults because they may have learned to compensate for these shortcomings. Nevertheless, many of these individuals continue to have great difficulty in their jobs and home life due to ADHD.

Doctors, psychiatrists, and other health-care givers make the diagnosis of ADHD on the basis of observing a certain number of behaviors performed by the child or the adult. For some time it was thought that many doctors and psychiatrists in both America and the Netherlands were diagnosing many, many children—perhaps too many—as having ADHD and consequently prescribing Ritalin for them. To determine if this was the case, we evaluated the diagnoses of the children attending a public Amsterdam outpatient center between 2000 and 2006. This small group of 26 children had been evaluated by the full team. They were referred to an occupational therapist specializing in SI, as well as to other medical and family intervention practitioners. We evaluated the primary symptoms of the child and then compared the diagnoses. This led us to conclude that the percentage of children receiving a diagnosis of ADHD had actually declined in relationship to the percentage of other groups (e.g., children with conduct disorders, with problems dealing with divorce, or with problematic living conditions due to immigration, etc.). The reason for this is not clear, but we suspect it is related to the refinement of the diagnostic criteria, which emphasize other aspects of the child’s life. So it appeared that the doctors in this clinic had become more selective with their primary diagnosis, frequently using the “ADHD/ADD” as a secondary diagnosis.

Attention Deficit Disorder

Attention deficit disorder (ADD) is a different diagnosis from ADHD. For children with ADD, the problem is inattention without hyperactivity. Such children are not hyperactive. The DSM-IV includes a precise description of the symptoms that must be present for such a diagnosis. As with ADHD, the goal is for all medical personnel to arrive at the same diagnosis.