attention deficit hyperactivity disorder (ADHD)
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Attention-Deficit Hyperactivity Disorder (ADHD) in Children:
Theories About the Causes of ADHD, Diagnosis, and Alternative Treatments for ADHD/ADD

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Introduction and General Information: What is ADHD?

» Skip Introduction and Jump to Quick Index of the Diagnosis and Theories of the Causes of ADHD »

Attention-Deficit/Hyperactivity Disorder - ADHD - is usually first diagnosed in children and adolescents. It is characterized by inappropriate degrees of inattention, impulsivity and/or hyperactivity. Children with ADHD - Attention-Deficit/Hyperactivity Disorder - are typically:

These characteristics appear in early childhood, are relatively chronic in nature, and are not due to other physical, mental or emotional causes. From time to time, all children will be inattentive, impulsive and/or exhibit high activity levels. However, for children with ADHD, the persistence, pattern, and frequency of this behavior is much greater. These behaviors are the rule, not the exception. Performance variability is also common among children with ADHD. For instance, it is difficult for teachers to understand why a child can remember homework assignments on Monday and Tuesday but forget them on Wednesday.

When ADHD is left unidentified or untreated a child is at great risk for:

ADHD is not new, though our understanding of the disorder is still developing. Medical science first noticed children exhibiting inattentiveness, impulsivity, and hyperactivity in 1902. Since that time, the disorder has been given numerous names, including Minimal Brain Dysfunction, or Minimal Brain Damage, and Hyperkinesis, the Hyperkinetic Reaction of Childhood or Hyperactivity. In 1980, the diagnosis of Attention Deficit Disorder was formally recognized in the Diagnostic and Statistical Manual, 3rd edition (DSM III), the official diagnostic manual of the American Psychiatric Association (APA).

It is estimated that ADHD affects 3-5% of the school-age population, which means as many as 3.5 million children.

ADHD: Diagnosis and Theories About What Causes ADHD

Quick Index to the Diagnoses and Theories of ADHD

Diagnosis of ADHD

There is no concrete medical test to diagnose ADHD, which often makes the diagnosis of ADHD subjective. This is the reason why it is imperative that the diagnosis is done properly and by an appropriate and qualified person. The Diagnostic and Statistical Manual (1997), lists six essential steps in diagnosing ADHD. These are only suggested steps and are not universally followed. Professionals who can diagnose include psychiatrists, psychologists, pediatricians or physicians, and neurologists. Parents, teachers, and professionals may provide important information to help in the diagnosis. The diagnosing professionals should always consider other possibilities and rule them out before diagnosis of ADHD (DSM-IV, 1997).

[Return to the "Quick-Index" of the Diagnosis of ADHD and the Theories About the Causes of ADHD]

How is ADHD Diagnosed?

As above, the diagnosis must be based on a number of observations, since ADHD is not a defined biological entity, but a collection of symptoms and behaviors. Typically, to diagnose ADHD, parents and teachers complete questionnaires, children are observed at home and at school, psychological tests are administered, and a clinical interview of the child and the family is conducted.

One assessment tool is the use of behavioral rating scales in the identification of ADHD. The Conners' Teacher Rating Scale (CTRS), developed in 1969, has been used extensively since its publication (Grumpel, Wilson, & Shalev, 1998). This instrument (CTRS) is important because of its wide acceptance. The CTRS has been in use for about 25 years.

Although our understanding of ADHD has changed over the years, the preference for the scale has continued stable (Grumpel, et al., 1998). The Conners' Teacher Rating Scale uses a 4-point scale. It includes the following ratings: Not at all present, Just a little present, Pretty much present, and Very much present. There are 28 items in the scale with several questions that collect demographic information from the respondent (Grumpel, et al., 1998). Both the child's teacher and a parent complete the scale. A discrepancy score should be determined from the two completed questionnaires and a determination made as to whether the child is exhibiting symptoms proportionate with ADHD.

Another rating scale used widely is the Conners' Abbreviated Symptoms Questionnaire (ASQ). It is often referred to as the Hyperactivity Index. This 10-item scale is used for screening purposes to identify hyperactive children (Erford, Peyrot & Siska, 1998). The utility of the ASQ has chiefly been in diagnosing children as hyperactive and in assessing changes in hyperactive and conduct problems behaviors after interventions particularly stimulant drug therapy (Erford, et al., 1998). The results of the Analysis of Teacher Responses To The Conners Abbreviated Symptoms (Erford, et al., 1998) concluded that the ASQ over-identifies normal children and disproportionately identifies children who are hyperactive and aggressive, and under-identifies distractible children (Erford, et al., 1998). This rating scale is also known as the Conners' Abbreviated Parent-Teacher Questionnaire (APTQ).

Attention Deficit Hyperactivity Disorder, Predominantly Inattentive Type (formerly often called simply Attention Deficit Disorder or ADD) is particularly difficult to diagnose. Clinicians only correctly diagnose this subtype 50% of the time 6. Diagnostic tools include those of Barkley (1990) and BAADS (Boatwright-Bracken Adult Attention Deficit Disorder Scale) (1992). Brown (1993) uses the BAADS in combination with a careful clinical history of the individual and family, school reports, and an analysis of WISC/WAIS subtest scores using the Bannatyne method (since over 60% of ADHD adolescents show statistically significant differences between their verbal conceptualization and sequential scores on WISC/WAIS).

Clearly, an evaluation should integrate multiple informants and look at the child in a comprehensive manner since no single test can effectively diagnose the disorder.

[Return to the "Quick-Index" of the Diagnosis of ADHD and the Theories About the Causes of ADHD]

ADD vs. ADHD: Diagnostic Subtypes

Originally, as in the DSM-III, the term Attention Deficit Disorder (ADD) was used and less attention was given to those with had this disorder without the hyperactivity that often, but not always accompanies it. The DSM-IV now uses only the term Attention Deficit / Hyperactivity Disorder (ADHD), but classifies it into three different subtypes, of which Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type is one.

Dr. Thomas Brown 1  of Yale University has championed the recognition of children who have ADHD without hyperactivity. These children are underdiagnosed, since they rarely display the restless, intrusive, "driven by a motor," "Dennis the Menace" traits which most people, including many professionals, associate with ADHD. Brown notes that these children more closely resemble the stereotypes of "space cadet" or "couch potato" than the "whirling dervish" of ADHD. They are frequently overlooked by teachers, scapegoated by parents, and misdiagnosed by clinicians. Often they are seen as"just lazy" or "unmotivated" and are not given the support and treatment which could help them become markedly less frustrated and more productive. While ADHD is present in girls, it is more often the inattentive type without hyperactivity.

Brown tells us how even publications about ADHD offer little guidance about this disorder without hyperactivity. Most popular books and articles discuss just children who are chronically hyperactive, not those who are quiet or withdrawn. Some publications for professionals acknowledge that ADHD without hyperactivity is seen, but even in current journals for physicians, educators, and psychologists, there is rarely information about how to recognize and provide treatment for those whose ADHD do not include hyperactivity. Until recently, not much has been known about ADHD without hyperactivity.

[Return to the "Quick-Index" of the Diagnosis of ADHD and the Theories About the Causes of ADHD]

Formal Diagnosis of ADHD (DSM-IV and International Classification of Diseases)

The formal diagnostic criteria for ADHD/ADD used in most North and South America is the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV), 4th Edition 5. Europe, Asia, and Africa use the International Classification of Diseases, 10th edition (or the International Statistical Classification of Diseases and Health Related Problems (The) ICD-10, Second Edition). Each of these tools organizes the diagnosis slightly differently, but in both, the three major categories of symptoms are:
  1. Hyperactivity
  2. Problems with attention
  3. Problems with conduct

The Diagnostic criteria for Attention-Deficit/Hyperactivity Disorder (ADHD) from the DSM-IV are:

Criteria A - either (1) or (2):

(1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with the child's developmental level:

  1. often fails to give close attention to details or makes careless mistakes in
    1. school
    2. work
    3. other activities.
  2. often has difficulty sustaining attention in tasks or play activities.
  3. often does not seem to listen when spoken to directly.
  4. often does not follow through on instructions and fails to
    1. finish schoolwork
    2. chores
    3. duties in the workplace (not due to oppositional behavior)
    4. failure to understand instructions
  5. often has difficulty organizing tasks and activities
  6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
  7. often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
  8. is often easily distracted by extraneous stimuli
  9. is often forgetful in daily activities

(2) six (or more) of the following symptoms of hyperactivity/impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with the child's developmental level:


  1. often fidgets with hands or feet or squirms in seat
  2. often leaves seat in classroom or in other situations in which remaining seated is expected
  3. often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings or restlessness).
  4. often has difficulty playing or engaging in leisure activities quietly
  5. is often "on the go" or often acts as if "driven by a motor."
  6. often talks excessively
  7. Impulsivity
    1. often blurts out answers before questions have been completed
    2. often has difficulty awaiting turn
    3. often interrupts or intrudes on others (e.g., butts into conversations or games).

Criterion B: Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

Criterion C: Some impairment from the symptoms is present in at least two or more settings (e.g., at school [or work] and at home).

Criterion D: There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

Criterion E: The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

The diagnosis is coded as:

314.01 ( Attention-Deficit/Hyperactivity Disorder, Combined Type) if both Criteria A1 and A2 are met for the past 6 months

314.00 (Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type): if Criterion A1 is met but not Criterion A2 is not met for during the past 6 months

314.01 ( Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type): if Criterion A2 is met but not Criterion A1 is not met for during the past 6 months

[Return to the "Quick-Index" of the Diagnosis of ADHD and the Theories About the Causes of ADHD]

Additional Reflections on ADHD, Prominently Inattentive Type

Lahey & Carlson (1991) reviewed the research literature and concluded that was then called formerly called ADD (Attention-Deficit Disorder) was found in two independent dimensions:
  1. one consisting of motor hyperactivity and impulsive behavior
  2. the other consisting of inattention disorganization, and difficulty completing tasks
They concluded "it no longer seems doubtful that Attention-Deficit Disorder without Hyperactivity (ADD/WO) "exists," and that ADD without hyperactivity differs from ADD with hyperactivity (ADD/H) in clinically important ways."

Brown & Gammon (1992, 1993) at Yale suggest that more is involved in ADHD without hyperactivity than just inattention. Such is not just a mild case of ADHD, but can be a debilitating disorder in which even bright and talented people are unable to activate themselves and sustain their efforts for productive work. What is called apathy or lack of motivation is a chronic problem with activation, which may be central to understanding this type of ADHD.

Many of those with non-hyperactive ADHD report chronic problems with "getting cranked up" to do tasks, even tasks they recognize as urgent and important for their own welfare. Often this activation problem in ADHD extends to sustaining energy for tasks. Many patients report great difficulty keeping up their energy to read or write or do a task. They speak of feeling drowsy even after a good night's sleep. Some almost meet the diagnostic category for narcolepsy, reporting problems with dozing at long stoplights and difficulty fighting off drowsiness while studying, listening to lectures, or attending meetings. There appears to be chronic difficulty not only in activating to work, but in sustaining energy for tasks.

Chronic problems in activating and sustaining arousal make life difficult for high-IQ people, who are seen by themselves, parents, teachers, and employers as extremely bright, with great promise for successful achievement. The symptoms of chronic inattention, lethargy, failure to follow through, brings oscillating achievement, poor grades and frequent reminders that "you could do much better if only you'd be more consistent." The wide gap between their potential and actual achievement can make these patients vulnerable to demoralization and resignation to failure.

About 30% of children meet diagnostic criteria for both inattention and hyperactivity 2. Depending upon the study, 30-70% of children with ADHD continue to exhibit symptoms of ADHD in adulthood. ADHD crosses all socioeconomic, cultural, and racial backgrounds.

Some current researchers believe that the inattention seen in children with ADHD, predominantly inattentive (PI) type - also known as ADD without hyperactivity or ADD/WO - may actually be a qualitatively different problem than the type of inattention seen in ADHD, HI or combined types: a problem with focused/selective attention versus one of poor goal-directed persistence and interference control or inhibiting distraction. (Barkley, in press; Barkley and colleagues; Goodyear and Hynd; Lahey and Carlson).

All of this leads to interesting implications for the nature of ADHD, chief among which is that we have possibly two separate and qualitatively distinct disorders on our hands. The PI type may be the true attention disorder while the other two types are simply different developmental stages of the same disorder, one that involves behavioral disinhibition that ultimately results in poor goal-directed persistence and defective resistance to distraction (Barkley, in press).

For additional information, please see:

[Return to the "Quick-Index" of the Diagnosis of ADHD and the Theories About the Causes of ADHD]

School-Based Assessments for ADHD Children

Often, concerns about a child's attention and activity levels are first noted in the context of school. This occurs because school places greater demands for attention and self-regulation on the child.

Recent recognition of ADHD as a disability to be served under existing education laws (IDEA, Other Health Impaired category, and Section 504 of the Rehabilitation Act of 1973, United States Department of Health & Human Services), has generated the need for assessment protocols for school-based evaluation teams. In keeping with these requirements, the school has a legal responsibility to provide assessment services for students who are suspected of having ADHD.

In the event that the assessment procedure indicates that ADHD exists, the school should determine if the ADHD is placing an adverse effect on educational performance. The process for these determinations generally involves the use of a school-based multidisciplinary team. At least one member of the team should be knowledgeable about the disability.

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PGARD Two-Tiered Assessment Protocol

The Professional Group for ADD and Related Disorders (PGARD) suggests school-based personnel follow a two-tier approach to evaluate children suspected of having ADD. The guiding principle underlying both tiers of assessment is to use multiple sources of information. The assessment protocol recommended by PGARD is sufficient to determine the presence of ADHD behaviors and adverse affects on educational performance.

Tier I:

Prior diagnosis by physician or psychologist can be used in lieu of Tier I

Tier II:

For further information:

What Other Behaviors Can Mimic ADHD?

A number of other conditions and disorders can mimic ADHD or have similar symptoms:

Please see our section on Related Mental Disorders and Comorbidity for more information on some of these factors.

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Related Mental Disorders and Comorbidity

Over 50% of persons diagnosed with ADHD also have another psychiatric disorder, which may mask or complicate their diagnosis and treatment (Haleperin, Newcorn & Sharma, 1991). Depressive disorders, learning disorders, anxiety disorders, substance abuse, aggression and behavior disorders, and sleep disorders, have all been reported to occur in persons with ADD significantly more than in people without ADD (Biederman, 1991b; Wilens, 1994). Biederman and colleagues (1991a) demonstrated that close biological relatives of children with ADHD are far more likely to have ADHD, major depressive disorder, multiple anxiety disorders, conduct disorder, anti-social personality disorder, and/or substance abuse than are relatives of children without ADHD. All of these disorders tend to run in families and may be inherited in various combinations by some, though not all, family members.

Comorbidity may also be a reaction to living with ADHD. From their earliest years, many people with ADHD experience intense and sustained frustration in their efforts to learn, to work, and to get along with other people. Often, they suffer ongoing criticism from teachers, parents, siblings, and peers. Years of chronic, sustained frustration and criticism, especially if the ADHD has not been diagnosed and the individual feels, "It's all my fault," may produce dysthymia, a chronic, low-grade depression, comorbid to the ADHD. Other disorders may similarly develop reactively.

Jensen (1993) recently reported on a group of 47 school-aged children diagnosed as having Attention Deficit Hyperactivity Disorder (using DSM III-R) where 49% also received diagnoses of either depression alone (n=10), anxiety disorder alone (n=5), or both depression and anxiety (n=8).

People who are depressed often report difficulties with concentration and sustaining energy just over the course of their depression; those with ADHD generally report lifelong difficulties with symptoms of inattention and problems of activation, upon which depressive symptoms may be superimposed.

ADHD of the combined type is more often associated with oppositional defiant disorder (ODD), where a child is hostile and negativistic, chronically arguing and defying parents and other authorities. When a child with ADHD is severely oppositional, that child may meet ODD diagnostic criteria and need treatment for both ODD and ADHD.

About 35% of those with ODD also demonstrate the more severe behavior problems classified as conduct disorder (CD); these may include truancy, physical cruelty to animals or people, and criminal activities. Children whose ADHD is comorbid with just ODD are likely to get into trouble in school and community, but they do not carry the same high risk for poor long-term adult outcomes as do those with comorbid CD (Barkely, 1990).

Longitudinal studies indicate that among persons with ADHD who do not have conduct disorder (CD), the incidence of substance abuse is no higher than in the general population. However, for those with ADHD and comorbid CD, risk of substance abuse is greatly increased; among adults diagnosed as substance abusers, over 70% are estimated to have ADHD (Wilens, in press). This overlap raises the question as to whether persons who have ADHD and are recovering from addiction might increase their chances of abstinence if their ADHD is pharmacologically treated. There are certainly risks in treating recovering persons with medications for ADHD, but there are also risks in not treating ADHD in recovering persons.

Cantwell and Baker (1991) reported that in a sample of 600 children with impairments of speech and/or language, 30% had comorbid ADHD, while in a matched group who also had learning disorders, 63% had comorbid ADHD. Persons with ADHD who are impaired in their ability to communicate with others or whose ability to read, write, and/or do arithmetic is compromised are at significant risk for academic underachievement and for problems in social interaction and fragile self-esteem.

[Return to the "Quick-Index" of the Diagnosis of ADHD and the Theories About the Causes of ADHD]

The Theories of the Causes of ADHD

The exact cause of ADHD remains undetermined, but the prevailing theories include genetic and hereditary factors, neurobiological conditions and pathologies, prenatal influences, nutritional factors and deficiencies and environmental/toxin influences. We have grouped these theories into three section below. As additional studies are made and as part of the development of this site, we will be elaborating on these theories and exploring them in greater depth.

A good resource for information on current and new research is:

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Neurobiological Theories: Pathophysiological Views

While the exact cause of ADHD remains undetermined, frontal lobe lesions, anterior and medial to the pre-central motor cortex are considered the most likely neuroanatomic sources of ADHD. Cerebral blood flow studies have found central hypoperfusion in the frontal lobe and decreased blood flow to the caudate nucleus. (See Treatments: Methylphenidate [Ritalin])

Positron emission tomography scans of parents of ADHD children who also have symptoms of ADHD have shown decreased glucose metabolism in left frontal and parietal regions 8. These findings suggest the prefrontal cortex, which governs auditory attention, is less active among those with ADHD. Neurostimulants such as Ritalin are thought to increase the activity of these brain regions 9. Electroencephalographic studies of ADHD patients reveal abnormal reaction potentials in response to novel stimula after the subject has habituated to the test procedure 10.

Persons with ADHD have an unusually low rate of activity in brain areas responsible for motor control and attentiveness.

Please also see our new article, "Imaging Children with ADHD: MRI Technology Reveals Differences in Neuro-signaling". In this report, it was found that children with attention deficit-hyperactivity disorder (ADHD) may have significantly altered levels of important neurotransmitters in the frontal region of the brain, according to a study published in the December 2003 issue of the Journal of Neuropsychiatry and Clinical Neurosciences. "Our data show children with ADHD had a two-and-half-fold increased level of glutamate, an excitatory brain chemical that can be toxic to nerve cells," said lead author Helen Courvoisie, M.D., assistant professor, division of child and adolescent psychiatry, department of psychiatry and behavioral sciences at the Johns Hopkins Medical Institutions, Baltimore. "The data also suggest a decreased level of GABA, a neuro-inhibitor. This combination may explain the behavior of children with poor impulse control."

[Return to the "Quick-Index" of the Diagnosis of ADHD and the Theories About the Causes of ADHD]

Genetic Theories of ADHD

Persons with ADHD have an unusually low rate of activity in parts of the brain areas responsible for motor control and attentiveness. However, the source of these neurological defects remain uncertain. Defects in the metabolism of dopamine, and, to a lesser degree, norepinephrine are postulated (Baren, 1995).

Molecular Studies have shown a link between ADHD and the Dopamine transporter gene and the Dopamine DR D4 receptor gene. The latter showed an increased frequency of the "7-repeat allele" in ADHD subjects.

Familial studies:

Adoption studies:

Twin Studies:

Additional Reading:

[Return to the "Quick-Index" of the Diagnosis of ADHD and the Theories About the Causes of ADHD]

Environmental & Other Possible Factors as Causes for ADHD

Pregnancy and birth insults may affect the developing brain. Fetal exposure to alcohol has been linked to ADHD. Some argue that stress and poor nutrition during pregnancy can cause babies to have more allergic reactions that may cause developmental problems.

A variety of environmental factors, such as other pre- and perinatal abnormalities, central nervous system infections and reactions to sugar and food additives, are beginning to be evaluated with controlled studies.

Toxicity from lead and thyroid dysfunction should be considered is assessing ADHD as well.

Nutritional deficiencies (e.g., see: Purdue University Study: Deficiency in Omega-3 Fatty Acids Tied to ADHD in Boys) may also play a role.

Some of the most promising theories to date include exposure to various agents that can lead to brain injury (e.g., trauma, disease, fetal exposure to environmental toxins) and diminished brain activity.

ADD does occur in known biological syndromes, such as the fragile X and fetal alcohol syndrome. Psychosocial factors do not appear to play a primary etiologic role for the core symptoms, but certain types of parent/child interaction may be involved in the development of comorbid, oppositional and conduct disorder. Research also suggests that some predisposed children may become symptomatic after stressful or traumatic life events.

Environmental factors associated with ADHD include low birth weight, hypozia (too little oxygen) at birth, and exposure in utero to a number of toxins including alcohol, cocaine, and nicotine. Other studies have found correlations between certain toxic agents / nutrient deficiencies and learning disabilities. These include:

For additional reading see also:

A study done by researchers from Cornell University and the University of Kentucky suggests that cocaine use during pregnancy may be a cause of ADHD in children. The study is to be released in August, 2000.

Researchers from Yale University, Harvard and the Addiction Research Foundation have also observed a link between ADHD and addiction. In a Yale study of 298 cocaine addicts, 35 percent had a childhood history of ADHD and Harvard Medical School reports that adults with ADHD are three times more likely to abuse drugs and alcohol than those without the disorder.

An NIH conference scheduled for November is to examine possibilities that the drug Ritalin may mimic cocaine and may be the reason that those with ADHD are more likely to become addicted to cocaine.

Please see the following articles for more information:

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Creativity and ADHD

The "Theory of Disintegration", formulated by Dabrowski in 1960, asserts that persons born with 'overexcitabilities' have greater developmental potential than others. These individuals are hyperreactive to the environment in the following areas:
  1. Psychomotor
  2. Sensuality
  3. Imagination
  4. Intellectual behavior
  5. Emotionality, including deep relationships, concern with death, feelings of compassion and responsibility, depression, the need for security, self-evaluation, shyness, and concern for others

These signs are common in creative people. People diagnosed with ADHD score higher on measures of creativity, and highly creative people are more active than the norm. Do the underlying neurological processes associated with ADHD also foster creativity? Supportive of this hypothesis is the fact that the brains of creative persons and ADHDers show similarities.

Studies have shown that the following personality traits associated with ADHD are also associated with highly creative people:

For more information, please see the following:

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Left-Brain/Right-Brain Theory of ADHD

Dr. Mary Ann Block, author of the book, No More Ritalin: Treating ADHD without Drugs, believes children with ADHD are usually right-brain dominant in their information processing and learning styles, as well as being more creative than those with left-brain dominant styles. They also show a tendency to be kinesthetic learners, which means that they learn best while using their hands. Most conventional schools accommodate left brain dominant information processors, who are typically logical thinkers and auditory and visual learners. The right brain dominant child is not as well accommodated.

The right brain dominant child may also be diagnosed as learning disabled even though often bright. These children are typically able to compensate in the early years of school, yet struggle when the classroom orientation shifts towards lecturing and writing assignments. Because these children are tactile learners they may spontaneously attempt to engage their sense of touch by picking up a pencil, touching the person in front of them, or by putting their hands in their pockets. Frequently these children are misinterpreted as being trouble makers, presumably because their style of learning has been frustrated.

Block suggests simple aids such as providing a squeezing ball for the child to use to engage the sense of touch while listening, reading, or writing. She asserts that doing so may enhance visual and auditory learning, as well as reduce unacceptable behavior in the classroom. She suggests that parents call their child's name first, prior to any directive statements.

ADHD children, being tactile learners, may not readily process auditory information or a parent's call. She suggests then that a parent should ground information by touching the child on the arm of shoulder once s/he has responded, and then giving verbal directions, in order to assist the child to process the information adequately.

More useful suggestions like this will be found under Educational and Behavioral Treatments for ADHD Children. You may also find this webpage interesting:

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Evolutionary Aspects of ADHD

Thom Hartman 3 says the traits of ADD/ADHD were actually beneficial to our hunter ancestors. These highly adaptive "hunters" were better suited to notice the subtle differences in their environment. Their more impulsive nature gave them bravery, their thirst for excitement sent them off better equipped for the hunt than their brother "farmers."

Today, we want our schools and offices full of farmers — patient, methodical, more passive. Though truth be told, our world is dependent on both hunters and farmers. Hartman's book, Beyond ADD : Hunting for Reasons in the Past & Present - which discusses brain chemistry and physiology and examines the pros and cons of the controversial drug Ritalin, is an excellent addition to the literature on this subject.

Some parents believe that their ADHD children would not be deemed deficient or disordered if they were allowed to follow their nature. They believe that the modern school classroom — over-crowded, based on boring busy work and visual learning, forces children to comply or fail. It forces children into a label that assumes their nature is a fault. Some parents believe that the "increase" in ADHD and some other learning disabilities is actually an increase in the labeling of children.

These parents believe that society wants these children labeled, boxed and compliant - even if it means drugging them. They say, "Whatever happened to kids being kids? Of course they don't want to sit in a classroom 8 hours a day! Of course they want to explore their world - to touch it, to taste it, to manipulate it, they want to run and play and fidget. Of course they are easily distracted, impatient, impulsive! Those are hallmarks of childhood. The problem comes when we expect our children to be compliant little robots who are willing to let others define their reality."

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1.   Brown TE, Gammon GD, Attention-Activation Disorder in Hi-IQ Underachievers, ABS, Proceedings of American Psychiatric Association 145th Annual Meeting. Washington, D.C., May, 1992.

2.   Barkley RA, DuPaul GJ, McMurray MB, Comprehensive Evaluation of ADD With & Without Hyperactivity as Defined by Research Criteria J. Consulting & Clinical Psychology, 1990; 58:775-789.

3.   Subj: [RMA]: Re: ADHD Visits Rise 90%, Date: 12/26/99 6:30:31 PM EST, From: / To:

4.   American Psychiatric Association (1994), Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition, Washington, D.C., American Psychiatric Association.

5.   American Psychiatric Association (1994), Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition, Washington, D.C., American Psychiatric Association.

6.   Epstein MA, Shaywitz SE, Shaywitz BL, Woolston JL, Boundaries of Attention Deficit Disorder J. Learning Disabilities, 1991; 24: 110-120.

7.   Rating Scale, printed with permission, Patient Care [December 15, 1995].

Article consultant: Martin Baren, M.D. practices behavioral and developmental pediatrics in Orange, California. He is Clinical Professor of Pediatrics, University of California, Irvine, College of Medicine.

8.   Zametkin A, Rapaport JL, Neurobiology of Attention Deficit Disorder with Hyperactivity: Where Have We Come in 50 Years?, J Am Acad Child Adol Psychiatry 26:676-686, 1987.

9.   Angier, Natalie, (August 4 1991) Kids Who Can't Sit Still, New York Times newspaper, Education Section.

10.   Conners, CK, Overview of Electrophysiological Findings with ADHD Children, Programs and Abstracts of the 37th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, Chicago, 1990.

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alternative medicine treatment for children with attention-deficit hyperactivity disorder (ADHD)

You may also return to these sections:

ADHD research


Written and overseen by Lewis Mehl-Madrona, M.D., Ph.D.

Associate Professor of Family Medicine and Psychiatry
Department of Family Medicine / University of Saskatchewan College of Medicine


Coordinator for Integrative Psychiatry and System Medicine
Program in Integrative Medicine / University of Arizona College of Medicine

Clinical Program Director, Continuum Center for Health and Healing,
Beth Israel Hospital / Albert Einstein School of Medicine

Medical Director
Center for Complementary Medicine / University of Pittsburgh Medical Center

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