Children’s & Women's Physicians of Westchester, LLP

ATTENTION DEFICIT DISORDER (ADD) - PAYING ATTENTION IS KEY TO TREATMENT

	Pediatric ADD, or Attention Deficit Disorder, should not be ignored or overlooked. Children who appear absent-minded, unfocused, seem to be daydreaming or have a short attention span may actually have this serious but treatable syndrome. What we know today as ADD, which affects between five and seven percent of children, was first recognized in the 1960s, explains William Levinson, MD, Chief of Developmental Pediatrics at CWPW. Known initially by other clinical labels such as MBD, or Minimal Brain Dysfunction, ADD emerged as an all-encompassing term to describe children with symptoms ranging from short attention span and an inability to focus, to hyperactivity, forgetfulness, and difficulty following directions.
“I prefer to take a functional approach to ADD rather relying on a label,” Dr. Levinson says. “If a child's behavior is getting in the way at school, at home, socially or with his or her peers, and the behavior meets the clinical criteria for ADD, then it's important to consider treatment.” Determining who has ADD is the first step toward treatment. Dr. Levinson says a continuous performance test like the Integrated Visual and Auditory Test (IVA), which gauges visual and auditory responses, or an Electroencephalogram (EEG), a study of brain waves, can help to determine whether a child has ADD. The syndrome is not new, he points out, but it has gained greater recognition and acceptance in recent years. It's difficult to gauge which children will suffer from ADD, and who is most susceptible. Dr. Levinson notes, however, that studies indicate that premature babies are at slightly higher risk, and a family history of ADD might also contribute to a child having ADD. Lead poisoning can be a factor as well, as can certain thyroid conditions. The school setting is crucial in making the ADD diagnosis, Dr. Levinson says, enabling teachers to observe a child's activities and behavior. “Most parents who come to us — usually when the child is in kindergarten or the first grade — tell us the teacher notices that the child is not focusing like the rest of the class,” he explains. “They may have to repeat directions or requests, and they might have trouble with multiple requests.” Treatment for ADD can involve a range of options. “We try to get a multi-faceted treatment plan in place for the child,” Dr. Levinson says. “Medication may be indicated, and we can build in a counseling component for the individual and the family.” The school can be involved as well, he adds, by “modifying the teaching environment,” which can include preferential seating for the ADD child. “The learning environment is probably the most stressful for attention span,” Dr. Levinson says, “so teachers' input is most valuable” in diagnosing and helping the ADD child. Most schools have in-house services to help teachers to recognize ADD and to help the afflicted child.

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