Hyperactivity (Attention-Deficit / Hyperactivity Disorder, Hyperkinesis)

After many years of research and debate, hyperactivity is now classified as an aspect of disruptive behavior disorders. The preferred medical term is attention-deficit/hyperactivity disorder, or ADHD. It has previously been called minimal brain dysfunction, hyperkinesis, and hyperactive child syndrome.

The name may have changed, but the characteristics have remained the same. Hyperactive children have an abnormally short attention span, are impulsive, and in constant motion. They often have explosive tempers, but no mood lasts for long. They can go from laughter to tears in an instant. These children are also excessively accident prone. As they grow older, about three-fourths of hyperactive youngsters become unusually defiant and aggressive. Part of their antisocial behavior may reflect low self-esteem.

Now considered the most common developmental disorder among American children, it affects 3 to 5 percent of those in elementary school, and boys outnumber girls about five to one.

Symptoms typically appear before the age of four and always by age seven. Many parents report, however, that their hyperactive children were somehow different from infancy. They may have slept poorly, cried a good deal, moved about more than average, and been hypersensitive to noise, light, and other environmental changes.

In rare cases, hyperactive children exhibit early behavior that fits an opposite extreme. They are unusually placid, sleep a good deal, and develop at a slower than average pace.

No one knows for certain what is the cause of this disorder, but it is presumed to result from an immaturity in brain development. Some researchers believe that an imbalance of brain chemicals is responsible. There may also be a genetic predisposition, since it seems to be more common in children whose parents were themselves hyperactive and who also have various neurological or psychological problems.

Having one child who is hyperactive increases the risk that siblings will also be affected. There is some evidence that exposure during pregnancy to alcohol, cigarette smoking, and certain drugs increases the incidence of hyperactivity. Babies born addicted to crack cocaine suffer from a unique form of hyperactivity, in which they develop a high pitched, mewing cry and cannot tolerate being touched or cuddled.

Diagnostic Studies and Procedures

In many instances, a parent or teacher labels a child as hyperactive, when, in fact, the youngster is simply talkative and rambunctious. Before assuming a child is hyperactive, parents should seek a professional evaluation.

As a first step, the child should be examined for a possible organic disorder. For example, certain brain studies, including CT scans and an electroencephalogram, may be ordered to look for structural brain damage. Ideally, the child should be evaluated by a team of specialists that includes a child psychiatrist, developmental pediatrician, and, if possible, a neuropsychologist. The evaluation will be based on descriptions of the child's behavior at home and in school, an examination to rule out vision and hearing disorders, and tests to measure intelligence, memory, and other menial capabilities. After organic disorders and other problems have been eliminated, a diagnosis of hyperactivity requires the presence of specific characteristics.

Medical Treatments

When treatment with medication is recommended, it should be under taken as part of a complete program that includes behavior modification, counseling, and special education. The administering of medication is usually postponed until the child starts school. Ironically, the drugs that are the most effective are stimulants, such as methyiphenidate (Ritalin), pemoline (Cylert), and dextroamphetamine (Dexedrine). About 80 percent of all hyperactive children benefit from these medicines, showing an increased ability to focus their attention on learning and a reduction in compulsive movement.

Ritalin, given in small daily doses, is the most frequently prescribed drug because it has fewer side effects than Dexedrine and Cyiert. Although its side effects differ among children, a major drawback is possible suppression of growth. It can also cause headaches, stomach pain, sleep disturbances, loss of appetite, and depression. Many doctors recommend that Ritalin be taken only on school days, with weekends, school holidays, and summer vacations considered drug holidays. Unfortunately, when the effects of Ritalin wear off, hyperactive symptoms return.

If stimulants do not work, an antidepressant, imipramine (Tofranil), may be prescribed. It works by blocking the action of catecholamines, body chemicals related to adrenaline. However, this drug is usually not given before age six, and because it can damage the heart, it requires careful physician monitoring.

Alternative Therapies

Although controversial, several alternative therapies appear to help some children who are hyperactive, and have the added benefit of avoiding the adverse effects of drugs.

Music Therapy. Regular exposure to music is likely to be part of the special education program for a hyperactive child because of its calming effects. Parents can ask a qualified music therapist to suggest kinds of music to be played at home. Also, having a child make music on his own may help him to expand his attention span.

Naturopathy and Nutrition Therapy. Although they concede that other (actors may be involved, numerous naturopaths and nutritionists believe that food sensitivities, sugar, and chemical food additives play a role in many cases of hyperactivity, a theory first put forth in 1973 by Dr. Benjamin Feingold, an allergist. But carefully controlled studies have shown no connection between diet and hyperactivity. Some nutritionists believe that eliminating sugar helps. Others think that hyperactivity comes from specific food allergies. Parents who wish to test this approach should consult a qualified nutritionist for a plan that eliminates suspected foods while providing essential nutrients. Some naturopaths treat hyperactivity with high doses of vitamins. Not only are the benefits unproven, but the supplements can also cause nutritional imbalances.

Pet Therapy. Supervised contact with and caring for an animal can have a calming effect and also foster improved self-esteem and a sense of responsibility. A hyperactive child is likely to benefit more from being around a docile animal, such as an older cat, than a frisky dog or kitten. A bowl of goldfish may be an even better choice.

Self-Treatment

Parents need all the help they can get in meeting the challenge of a hyperactive child. Since parental understanding and an orderly home environment play a critical role in helping a child overcome hyperactivity, it is doubly important that parents keep calm. Here are some guidelines to follow:

• Accept the fact that hyperactivity is a chronic condition that needs special attention. Don't blame yourself for your child's problems, but do seek help.
• Join a support group to obtain practical advice and information.
• Accustom the child to a consistent daily routine with specific times for meals, naps, play, snacks, and going to bed.
• Be alert to fatigue. Hyperactivity increases when a child is tired. Suggest a rest and a quiet story or warm bath.
• Make simple rules and enforce them without physical punishment. Discipline should be prompt and matter-of-fact, relying heavily on sending the child to a quiet place for "time out."
• For a preschool child, provide simple, safe, unbreakable toys to be played with one at a lime.
• Keep the TV off except for carefully chosen nonviolent programs.
• Allocate an open space for active play to get rid of excess energy. Do not allow roughhousing, especially indoors, with siblings or friends.
• Always be quick to praise the child for obeying or playing quietly.
• Do what you can to increase the child's attention span before he enters school. Choose age-appropriate games, picture books, and puzzles. As soon as the child begins to fidget, switch to a physical activity.
• Investigate preschool programs that cater to children with special needs. Find out what provisions your public school has for children with learning disabilities. Ask that your child be tested by the special education team, and as soon as he is enrolled in school, request regular conferences with teachers and the school psychologist.

Other Causes of Hyperactivity

Hyperactive behavior is a component of some types of mental retardation and genetic neurological syndromes.