Attention Deficit Hyperactivity Disorder:
Overview with Implications for Residential Treatment and
Therapeutic Schools

Jay J. Jones
Fresno, California

Features

Features characteristic of ADHD are many and varied. One complication is that not all ADHD children have the same features, and the features that individual children do have are not always present across different situations. Additionally, features directly connected to the ADHD syndrome are frequently made worse by the associated features of CD, ODD, or other disorders. There are volumes of references in the recent literature detailing this point. But it must be sufficient to say here that the multiplied effects of additional and associated features can make the effects of disability both chronic and severe.

The cardinal features of ADHD are inattention, impulsivity, and hyperactivity (APA, 1987; Barkley, 1981; Coker & Thyer, 1990; Garfinkel & Wender, 1989; Gueuremont, et al. 1990; Hallahan & Kauffman, 1988; Quay & Werry, 1986; Ross & Ross, 1976; Wender, 1987). Although there are other features directly related to these, and many associated features less directly related, these three symptoms--inattention, impulsivity, and hyperactivity--comprise the cardinal symptoms of what we now call Attention Deficit Hyperactivity Disorder.

Inattention

Inattention can be described in various ways, and the effects of inattentiveness are manifested in various forms. Garfinkel and Wender (1989) describe inattention as difficulty concentrating, limited attention span, and distractibility. Inattentiveness is often less obvious to detectt than some of the other features of ADHD, but inattentiveness is considered the most disabling of the ADHD features (Wender, 1987). Limited attention span interferes with a child's ability to stay focused on a task long enough to complete it. Distractibility also makes it difficult for a child to sustain attention because the attention can be easily drawn away by irrelevant stimuli. These features compound learning difficulties, and taken in combined form, can present a serious learning problem.

Inattention is one area where serious disability can exist even when the ADHD child does not suffer from CD or ODD. Halprin, et al. (1987) report that pure ADHD children, as compared to "mixed" (ADHD/CD/ODD) have the most severe learning problems. This is particularly important given that it is unlikely that a child with ADHD alone will be identified as needing learning help (Hallahan " Kauffman, 1988).

Impulsivity

Impulsivity can be defined as the tendency of the child to act before thinking. Especially problematic is the tendency to act before fully considering the consequences of behavior (Garfinkel & Wender, 1989). The excessively impulsive child may give answers before fully considering questions, which accounts for educational performance problems. Behavioral disruptiveness manifests itself in numerous forms including calling out in class out of turn, interrupting the work of other children during quiet periods (APA, 1987), or rushing into dangerous situations, such as running into the street without considering the consequences (Wender, 1987).

Draeger, Prior & Sanson (1986) believe that it is largely impulsivity that accounts for performance deficits in ADHD children. They suggest that this contradicts the often held notions that ADHD children suffer from frank inability to accomplish tasks because of inherent deficiencies in processing and cognition. Draeger et al. (1986) believe that ADHD children have the capacity to perform the same tasks as other children, but deficient inner controls prevent them from doing so.

Hyperactivity

Hyperactivity is often the most noticeable of the features of ADHD children. In fact it has been only recently that clinicians and educators have realized that hyperactivity is not the central feature--nor is it the most disabling feature--of ADHD (Barkley, 1981; Garfinkel & Wender, 1989; Hallahan & Kauffman, 1988). Hallahan and Kauffman (1988) report that the most disabling of the ADHD symptoms lie in the area of attention rather than the area of excessive motor activity. Motoric overactivity is one feature of hyperactivity, and is manifested by fidgetiness, restlessness, and general motor activity in excess of normal children (Garfinkel & Wender, 1989). Hyperactivity can be seen as excessive talking, especially at inappropriate times (Barkley, 1981). It can appear in other types of vocal excesses, such as inappropriately loud or frequent calling out in class (APA, 1987; Barkley, 1981; Roberts, 1990).

Hyperactivity that manifests itself in the form of physical aggressiveness is common, and is of great concern. Although verbal aggressiveness is a common manifestation of hyperactivity, physical aggressiveness presents a greater concern (Barkley, 1981; Cantwell, 1989; Hallahan & Kauffman, 1988; Halperin, O'Brien, Newcorn & Healy, 1990; Werry & Reeves, 1987). Physical aggression is a feature of CD, and ADHD children who manifest this dimension of hyperactivity also may qualify for the CD diagnosis. This is so much the case that Halperin, et al. (1990) have indicated that most ADHD children are aggressive. Although such a statement may be an exaggeration, the frequency of ADHD and physical aggressiveness is so common (Cantwell, 1989; Hamden, et al. 1989; Lambert, 1988; Lambert, Hartsough, Sassone, & Sandoval, 1987; Reeves & Werry, 1987; Roberts, 1990), and so worsens the prognosis for these children (Barkley, 1981; Garfinkel & Wender, 1989; Gittelman & Manuzza, 1985; Goldstein, 1987; Hamden, et al. 1989; Kaplan, Busner, & Kupietz, 1990; Nichamin & Windell, 1984; Roberts, 1990; Wallander, 1988; Werry & Reeves, 1987) that the issue of ADHD and CD (especially physical aggressiveness) has dominated much of the recent literature on ADHD.

Last Modified: Thursday, October 02, 1997 9:34:45 PM