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Med Travelers - December 2019

APD, ADD, ADHD and AD/HD: Personal and Scientific Reflections

APD, ADD, ADHD and AD/HD: Personal and Scientific Reflections
Katherine A. O'Neill, PhD
March 21, 2005
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Introduction:

I'm not a stranger to research or behavioral conditions based in physiology. I am the mother of a 9 year old child with an auditory processing disorder, and I have a Ph.D. in Physiological Psychology.

As a mom, I wanted to educate myself to better understand my 9 year old son's auditory processing disorder, to better provide him with helpful treatments and activities. However, prior to arriving at his diagnosis, one of the steps along the way was to "rule out" attention deficit disorder/attention deficit hyperactivity disorder. The term "rule out" is common in medicine. It is used by physicians and others while trying to establish a differential diagnosis while eliminating other possibilities. Hence, things to be "ruled out" are often similar to, or indeed are the actual diagnosis, but are as of yet undetermined.

Our experience while "ruling out" took us through an enormous amount of information regarding the prevalence, diagnosis and treatment of neuropsychological conditions, many of which potentially cause us to medicate children who are physically and emotionally developing. This is a significant issue for all parents, professionals, and children too.

Many diagnostic terms and acronyms used in 2005, which describe specific patterns of behavior, were unheard of twenty or thirty years ago. Of course, that doesn't mean these problems didn't exist previously, maybe they did...but these terms were strangers to most moms, dads, teachers, and professionals!

I believe decisions regarding the management and treatment of children should be based on solid scientific evidence, good clinical judgment and excellent parenting skills, none of which can be assumed.

Definitions:

  1. Auditory Processing Disorders (APD) is a term used to describe what happens when your brain recognizes and interprets sound. It has been said that auditory processing is "What you do with what you hear." The "disorder" part of APD indicates something is adversely affecting the processing of sound. APD is typically more apparent and more of a problem in noisy environments or while listening to complex or difficult information. APD is also referred to as central auditory processing disorders (CAPD).

    Symptoms of APD:

    Children with APD often have difficulty paying attention to and remembering information presented to them verbally. Children with APD often have difficulty executing multi-step directions, they have poor listening skills and may need more time to process information. Children with APD may have low academic performance and may have behavior problems. They may demonstrate language difficulties and they often have difficulty with reading, comprehension, spelling, and vocabulary (adapted from www.nidcd.nih.gov/health/voice/auditory.asp).


  2. Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD), and ADD/ADHD, and Attention Deficit/Hyperactivity Disorder (AD/HD).

    While many people use these diagnostic terms rather loosely, it is important to note that there are in fact, specific diagnostic criteria and guidelines for making a diagnosis. ADD is the more general term, referring to Attention Deficit Disorder. ADD can be present with or without hyperactivity, hence the terms ADHD ADD/ADHD and AD/HD.

    It has been estimated that about 5 percent of the U.S. population (children and adults) has AD/HD.

    Symptoms of AD/HD behaviors include:

    • distractibility (poor sustained attention to tasks)

    • impulsivity (impaired impulse control and delay of gratification)

    • hyperactivity (excessive activity and physical restlessness)

    Of course, at one time or another, virtually everyone experiences some of these behaviors. However, specific diagnostic criteria (below) identifies AD/HD from "normal" distractibility and/or occasional impulsive behavior of childhood (adapted from www.add.org/).

    Therefore, to be diagnosed with AD/HD, symptomatic behaviors must be present prior to age 7 years and have lasted more than 6 months. The behaviors must create a significant handicap in at least two areas of a person's life, such as school, home, work, or social settings. We tend to associate hyperactivity with attention deficits, but they are not always present in tandem.

Katherine A. O'Neill, PhD



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