General Description of a Child with ADHD
Studies now indicate that ADHD can be diagnosed in children by age four. Parents may notice symptoms even earlier. (One mother reported that three days after delivery, nurses were referring to her ADHD son as "Wild Willie.") Even before the "terrible two's," impulsive behavior is often apparent; the toddler may gleefully exhibit erratic and aggressive gestures, hair pulling, pinching, hitting. Temper tantrums, normal in children after two, are usually exaggerated and not necessarily linked to a specific negative event in the life of an ADHD child. One of the most painful events a parent may experience is an abrupt and aggressive attack that may occur after cuddling a young ADHD child. Often this reaction seems to be caused not by anger, but by the child's apparent inability to endure overstimulation, even displays of physical affection. In a busy environment, such as a class room or a crowded store, ADHD children often become distracted and react by pulling items off the shelves, hitting people, or spinning out of control into erratic, silly, or strange behavior. As ADHD children grow and develop, parents discover that these children have a very difficult time adapting to even minor changes in routines, such as getting up in the morning, putting on shoes, eating new foods, or going to bed. Any shift in a situation can precipitate a strong and noisy negative response. ADHD children are often hypersensitive to sights, sounds, and touch and complain excessively about stimuli that seem low key or bland to others. Sleeping problems usually occur well after the point at which most small children sleep through the night. In one study, 63% of children with ADHD had trouble sleeping.
The classic ADHD symptoms, inattention, distractibility, impulsivity, and hyperactivity, often do not adequately describe the child's behavior nor do they describe what is actually happening in the child's mind. The term hyperactive, for example, is often confusing for those who expect to observe a child racing unceasingly about. A boy with ADHD playing a game, for instance, may have the same level of activity as the other children without the syndrome. If a high demand is placed on the ADHD child's attention, however, then his motor activity intensifies beyond the levels of the other children, and he becomes suddenly impulsive, perhaps hitting another child or behaving in a giddy silly manner. The symptom of inattention may also be misleading. Because ADHD children are usually distracted by over-stimulating situations, some learn to compensate by developing a kind of "super concentration.." Such children become over-attentive, so absorbed in a project that they cannot modify or change the direction of their attention. In one experiment, ADHD children were able to closely anchor their attention when they were directly cued to a specific location but they had difficulty shifting their attention to an alternative location. Many experts now believe that an essential feature in ADHD, as well as in learning disabilities, is impaired working, or short-term, memory. People with ADHD are unable to "hold" groups of sentences and images in their mind until they can extract organized thoughts from them. Such people then may not necessarily be inattentive so much as be unable to remember a full explanation (such as a homework assignment) or are unable to complete processes that require remembering sequences, such as model building. In general, children with ADHD are often attracted to activities that do not tax this working memory or produce distractions, television, computer games, or active individual sports. Children with ADHD have no differences in long-term memory compared with other children.
The ADHD child's relationship with others is volatile, and he or she is often unhappy from a very young age. A best friend can turn into an enemy overnight when, for example, an ADHD boy does not perceive his friend's fearful response to over-aggressive roughhousing and fails to let up. The next day the ADHD child has forgotten the event; the ex-friend hasn't. This is a classic situation repeated time and again. The ADHD child hurts someone; he either may go into a state of denial because he can't accept his lack of self-control or he may blame himself excessively. As ostracism, fear, and ridicule from his peers persist from year to year, the unstable behavior, originally neurologic, becomes emotionally based as well. Unless this cycle is broken, serious adult disorders can evolve.