Joel P. Sussman, M.D. FAAP
Clinical Director; Palmetto Associates for Scholastic Success (P.A.S.S.)
245 Business Park Boulevard                  Columbia, SC 29203           Phone:  (803) 462-1234


ADHD: What is it?
ADHD:  Clearing Up The Confusion 

ADHD:  What is it? What it is NOT is simple. ADHD is a condition characterized by a deficit in the ability to be attentive and a tendency to be impulsive. There are also problems in executive function, which is the ability to organize oneself. Finally, people with ADHD are either hyperactive or under-active. The hyperactive, aggressive behaviors are predominately found in males while under-active presentations are usually female.

Attention Problems: Not Only From ADHD
Many people assume that ADHD is the diagnosis for any person with attention issues.  While some people with attention problems do have ADHD, there are many other conditions that they could have.  Or, they may have ADHD, but also have a combination of other conditions.

Other Conditions Causing Attention Issues
1. Educational Issues - Educational issues often cloud the diagnosis of ADHD. If a child has a problem understanding the concepts of reading, writing and math, the child will be inattentive and will often be a behavioral problem. The child feels incapable of getting positive attention, so therefore becomes the class clown. It is often said that it is "...better to be wanted by the police than not be wanted at all...."

2. Medical Issues - There are also medical issues that influence attention. ADHD is a metabolic problem in the glucose metabolism in the pre-frontal part of the brain. There are, however, many other medical issues that can influence attention.  A person might have an iron deficiency, with or without anemia, that can cause inattention and either hyperactivity or under-activity.  Similarly, some adolescent girls start to function at a lower level due to an iron deficiency from their menstrual periods. Another medical issue is the thyroid.  Thyroid dysfunction will cause under-activity if the thyroid is low, and hyperactivity if the thyroid level is high.

3. Sensory Issues - Many sensory issues will cause problems in school. Obviously, if a child does not see the board or does not hear the teacher, that child will not do well in school. More subtly, the problems of Central Auditory Processing Deficiencies will both accompany ADHD and will masquerade as ADHD. These deficiencies will cause a student to incorrectly hear the words of the teacher or they will not be able to filter out unimportant sounds while trying to listen to the teacher. These deficiencies stem either from an inherited tendency or from an early history of fluid in the ears or chronic ear infections. This will affect the student's ability to read while young and will affect the ability to take notes in class as the child gets older.

4. Specific Syndromes - There are several  syndromes that also create problems in attention that may look like ADHD. The three most prominent are the Autistic Spectrum Disorders, including Asperger's Syndrome, Sensory Integration Dysfunction and Tourette's Syndrome. Autistic  Spectrum Disorders hinder children in their ability to use language appropriately, to socialize and to inhibit repetitive movements. Sensory Integration Dysfunction is a condition wherein sensory stimuli affect people well beyond the effect on most normal people. They are either under-stimulated or over-stimulated by visual, auditory or tactile input and hence react negatively. Tourette's Syndrome is a condition where the patient cannot inhibit the impulse to both use voices and to make movements. It is obvious that these syndromes often overlap one another in many patients.

5. Mood Disorders - Mood disorders also accompany or mimic ADHD. The most important one is a bi-polar disorder. It is thought that 90% of bi-polar patients also have ADHD and that 20% of ADHD have a bi-polar disorder. In adults, there are classically mood swings in which the patient has very high moods alternating with very low moods. In children, however, this presentation is rarely seen. They are generally hypo-manic (just under  the mania of the adult form) and this presents as hyperactivity. The depressed patient could be mistaken for an under-active ADHD patient and will generally not be able to pay attention. The patient with anxiety could be mistaken for a hyperactive ADHD patient and will also not be able to pay attention.

6. Sleep Problems - Sleep disorders often mimic inattention. Tired adults appear to be inattentive, while tired children are often hyperactive. The most common type of sleep disorders are disorders of sleep schedules. People go to bed too late and wake up too late; thus, they are too tired when they get up to be as functional as they need to be. When they do get up, they are often late for school or work and thus skip breakfast ( or eat a quick sugar-laden breakfast.) The two other most common sleep problems are Obstructive Sleep Apnea and Narcolepsy. In children, sleep apnea is caused mostly by enlarged tonsils and adenoids. In adults, Sleep Apnea is caused by the central nervous system and most commonly, by obesity, large necks and by palatal collapse when breathing. There are also people with deviated septa  who have obstructive sleep apnea. Lastly, allergic rhinitis can also contribute to the problem. Because they are increasingly sleepy, both children and adults resort to increased caffeine intake. Excessive caffeine then causes increased insomnia. It is a vicious cycle.

7. Lifestyle Choices - Lifestyle issues have become a very important factor in people being inattentive.  Electronic entertainment has dominated people's lives for a long time; however, since the explosion of the internet and video games, both children and adults have become addicted to these modern inventions. There are children who purposely wake themselves in the middle of the night so they can play video games, Thus, they are falling asleep in school. Video games have been shown to cause boys (much more than girls, who prefer text messaging) to be hyper-aggressive and hostile. Their pulses, blood pressures and pupillary responses are increased. In adult men, the internet poses a problem in the workplace and it often involves pornography addiction. ADHD people are more prone to addictions of all types, when untreated. Video games lead to school failure in children and internet addiction leads to problems at work and in marriages in adults. Though boys play more video games than do girls, both are affflicted with the latest craze of text messaging.  Text messaging has caused many college students (who had been excellent high school students) to fail out of college.  They text all day long, including during lectures.  They have their cell phones on next to their beds when they are trying to get efficient sleep.  This is truly an addiction and not a lifestyle choice.  Most are not willing to admit they are addicted, but until they come to grips with this reality, they will have a very difficult time in getting their education.  Dr. Sussman spends hours every day in telling this story to his patients.  Both children and adults who are addicted to electronic stimulation do not exercise, for the most part. Lack of exercise increases inattention, depression, and anxiety.

8. Outdoor Activity - Children, in days gone by, played outdoors. There is a body of literature that suggests that "Green" time is essential for clear and creative thinking. A good book about this issue is The Last Child In the Woods...Nature Deficit Disorder   by Richard Louv. He makes a compelling case for getting youngsters outdoors to explore their world. Presently, their world is inside, in front of a T.V., a computer or a video game. For those who claim that video games are good for eye-hand coordination, I say, get them a ping-pong table. A few video games would cost the same thing as a ping-pong table.


ADHD is clearly a very complex field. Those that think that one pill will solve all of the problems of childhood are deluding themselves and are short changing their children. The solution is to take an in-depth look at all of the symptoms that a person presents and to come up with a comprehensive plan of action.

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