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Faulty filters: Children with ADD can't tune out distractions

Mark Diamond, M.D.

Recently, a parent expressed concern about her son's performance in second grade. Although enjoying school, according to his teacher, John was having problems. He did not listen to directions and was constantly in motion. While lessons were being taught, he seemed to be in his own world. His grades were beginning to suffer.

Alice was a sophomore in high school. Always an honor student, she found her grades deteriorating since beginning high school. She spent more and more time studying and doing homework, yet the results continued to worsen. She found herself distracted, frustrated and disappointed..

These children are having difficulties and may share a common problem. Could they have Attention Deficit Disorder?

What is ADD?

Here is a way to think about ADD; it may not be the most scientifically accurate model, but it allows us to understand what appears to happen. Think of the brain as a computer. And as all computers require input through disks, keyboard or modem, so does our brain receive input for sensory systems such as our eyes, ears, and senses of taste, smell and touch. While we are awake, we are constantly bombarded by many thousands of bits of information. In order to function, our brain has a "filter" that tunes out irrelevant information. For example, will you remember in six months what color shirt you are wearing today? Or will you hear the humming of your air-conditioning system while you read this? We automatically ignore these things in order to concentrate on things at hand.

Children with ADD have "filters" that are immature. Thus they react to things that most of us ignore. The child in the next row drops his pencil and John looks up. Then someone coughs and his attention is again diverted. This inability to prevent distraction is a hallmark of ADD.

It is estimated that three percent to five percent of children in the United States have ADD. This corresponds to roughly 2 million children or one to two children in every class of 25. ADD was first described in 1845. A fidgety child who had trouble paying attention was the subject of that report.

All children with ADD share certain characteristics. The distractibility described above is universal. "But he can sit in front of his PlayStation for hours," I am often told. However, that setting is entirely different from one that includes a lot of people. Children with ADD are also impulsive, acting before considering the consequences. The child jumping up and down, waving his arms, volunteering an answer to a question that has not been asked is demonstrating impulsive behavior. Generally these kids also have trouble with organization. They know the facts, but they have trouble writing a book report. Some kids, but not all, have hyperactive behavior, being unable to sit still. This group is said to have ADHD, Attention Deficit with Hyperactivity Disorder.

ADD is diagnosed only by observational surveys completed by parents, teachers, and others working with a child. A variety of causes have been proposed; these include environmental agents, such as lead or mercury, food additives and sugar. As many as 25 percent of close relatives of children with ADD have ADD themselves, suggesting a strong genetic component. Boys are more affected than girls. Unfortunately, only a very small percentage of children improve when the above conditions are corrected.

Children with ADD are likely to have other accompanying conditions: learning disabilities, depression, oppositional behavior or bipolar disorder. These conditions cannot be ignored when attempting a diagnosis.

Clinical studies have demonstrated that behavioral therapy and medication together are the most effective remedies for ADD. In essence, the medicines work to tune the filter described above, allowing less distraction, better impulse control and improved organization skills. Therapies such as herbal medications and chiropractic have not had proven effects.

Is ADD over-diagnosed? I believe so. BUT it does exist and the consequences can be devastating. Children with ADD often begin to show symptoms as they enter the structure of school settings. I have seen children improve from C and D students to honors students with proper therapy. I've seen social outcasts develop friendships and relationship skills. I've seen depressed children become happy. Properly diagnosed and treated, children with ADD are truly a joy to watch as their lives change for the better.

If questions exist about your child, be concerned without overreacting. Your pediatrician can help you find the right course. Ignoring the situation might dig a hole from which a child will have difficulty escaping. Be educated, be aware and unafraid to find answers if there is a problem. These concerns can only help your child.

Mark Diamond, M.D., has been in pediatric practice for 27 years in the South Hills, PA. You can reach him at

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