DOCTOR'S HOUSE CALL

"Attention Deficit / Hyperactivity Disorder" - February, 2005

Dr. Mark Lerner is a clinical psychologist who focuses on helping people during and in the aftermath of traumatic events. Since a significant number of adoptive children have been exposed to traumatic experiences, Dr. Lerner has a special interest in understanding the psychosocial and behavioral needs of these children. He is the President of the American Academy of Experts in Traumatic Stress, www.AAETS.org
and the originator of the Acute Traumatic Stress Management intervention model, www.ATSM.org.

Dr. Lerner wrote and produced the newly released audio book, Surviving and Thriving: Living Through a Traumatic Experience www.DrMarkLerner.com . He is the Editor and Publisher of Trauma Response and Trauma Response E-News, the Academy’ s official publications, and the author of four books. Dr. Lerner maintains a special interest in helping adoptive parents to meet the unique needs of their children.

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I have heard that Attention Deficit/Hyperactivity Disorder (ADHD) is more common among adoptive children than the general population. Is this true? And, if so, why?

Attention Deficit/Hyperactivity Disorder (ADHD) is the most frequently diagnosed psychiatric disorder of childhood. Children with ADHD have difficulty maintaining attention, are distractible, impulsive and, sometimes, hyperactive. Although these behaviors are observed among all children, the child with ADHD exhibits functional problems at home, with their friends and in school. It is important to note that not all children with ADHD are hyperactive.

The incidence of ADHD is indeed higher among adoptive children than the general population. Why this is the case, is perhaps best understood by looking at the potential causes of ADHD. Although research has not identified a specific cause, ADHD seems to be related to both genetic and environmental factors. Approximately 40% of children with ADHD will have a parent with ADHD, generally the father. Beyond genetic factors, research has found that environmental variables such as prenatal alcohol or drug exposure, prenatal maternal smoking, low birth weight, and lead poisoning can place a child at greater risk.

The adoptive child, who has been living in an orphanage, is potentially at greater risk for ADHD. Malnutrition and inadequate nurturing, in concert with other environmental factors (e.g., prematurity, prenatal alcohol exposure, etc.), contribute to this increased risk.

It is important to refrain from hastily diagnosing, or labeling a young child with ADHD, prior to school age years. Other medical problems should be ruled-out (e.g., hearing and/or visual problems) as well as the presence of learning problems. I frequently explain to parents that traumatic exposure can cause symptoms that suggest the presence of ADHD. For example, institutionalized children who have been neglected, exposed to physical and sexual abuse, and various degrees of abandonment, often evidence problems with concentration, distractibility and impulsivity. These are normal reactions in the face of an abnormal event (e.g., sexual abuse).

ADHD is best treated with a multimodal approach that has medical, behavioral, and educational components. Since approximately 70 to 80 percent of children with ADHD respond positively to medication, with an increase in attention and concentration and a decrease in problematic behavior (e.g., impulsivity and hyperactivity), the use psychotropic medications should be considered in consultation with a physician. Behavioral interventions are a major component to treatment. The utilization of behavioral plans, that emphasize positive reinforcement and consistency, are critical. Additionally, the child with ADHD may benefit from problem-solving, communication and self-advocacy skills training. Finally, the child with ADHD can benefit from educational interventions. The Individuals with Disabilities Education Act mandates that children with ADHD be eligible for special services and the Americans with Disabilities Act stipulates that children with ADHD are entitled to educational accommodations, such as extended time for tests and preferential seating in the classroom setting.

ADHD seems to be related to both genetic and environmental factors. The latter, in particular, may help to explain why ADHD is more common among adoptive children than the general population. Also, I hypothesize that due to nature of adoptive parents, there is a greater likelihood of an adoptive child being evaluated, diagnosed and, ultimately, treated for ADHD. It is important not to hastily diagnose children with an attentional disorder without first considering the potential of other medical problems or the effects of psychological variables, such as traumatic exposure. Most adoptive children will not have ADHD. For those who do, there are effective medical, behavioral and educational interventions that can make a difference in these childrens’ lives.

Addendum: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical exam can a medical diagnosis and treatment plan be made.

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