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Scientists Are Still in the Dark About Causes

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As many teachers know first-hand, the behavior of the hyperactive child--characterized by restlessness, inattention, calling out in class, and other symptoms--can disrupt an entire classroom and impede learning for all students.

Unfortunately, however, the "hyperactivity syndrome" remains poorly understood and is difficult to diagnose and treat, according to the experts who gathered this month at the National Institutes of Health (nih) for a conference on the subject.

Hyperactivity is a "common childhood disorder with different names,'' according to Gabrielle Weiss of Montreal, a child psychiatrist who outlined the history of the syndrome at the conference.

The disorder was first identified in 1902, according to Dr. Weiss, and there was a resurgence of interest among medical researchers in 1918, when increased reports of hyperactivity followed the 1918 pandemic of Spanish influenza. Since then, it has attracted the attention of numerous researchers, none of whom have succeeded in determining the cause. Physiological, psychological, and environmental factors are all among the suspected causes, according to researchers.

There are few statistics on the number of hyperactive children. According to estimates cited, anywhere from one in five to one in 20 children may demonstrate some or all of the signs of hyperactivity. It is found more often in boys than in girls, and most hyperactive children are diagnosed between the ages of 8 and 10, according to Dr. Weiss. The methods of treatment used most commonly now, she said, include medication (amphetamines), behavior modification, restricted diet, and psychotherapy.

Experts agree that the truly hyperactive child is so disruptive that he cannot be characterized as merely unruly. The most current definition of the syndrome, and the one used by the nih panel, comes from the American Psychiatric Association's (apa) Diagnostic and Statistical Manual of Mental Disorders, Third Edition.

The apa refers to the syndrome as the "attention deficit disorder with hyperactivity." According to this definition, "The child displays, for his or her mental and chronological age, signs of developmentally inappropriate inattention, impulsivity, and hyperactivity."

These signs, according to the manual, should be reported by teachers, parents, and other adults who come into contact with the child.

"When the reports of teachers and parents conflict," the manual says, "primary consideration should be given to the teacher reports because of greater familiarity with age-appropriate norms."

Symptoms often grow worse when the child is in a situation--such as the classroom--that requires him to apply himself, notes the apa manual.

The following symptoms characterize the "attention deficit disorder," according to the manual:

A. Inattention. At least three of the following:

(1) often fails to finish things he or she starts

(2) often doesn't seem to listen

(3) easily distracted

(4) has difficulty concentrating on school work or other tasks requiring sustained attention

(5) has difficulty sticking to a play activity

B. Impulsivity. At least three of the following:

(1) often acts before thinking

(2) shifts excessively from one activity to another

(3) has difficulty organizing work (this not being due to cognitive impairment)

(4) needs a lot of supervision

(5) frequently calls out in class

(6) has difficulty awaiting turn in games or group situations

C. Hyperactivity. At least two of the following:

(1) runs about or climbs on things excessively

(2) has difficulty sitting still or fidgets excessively

(3) has difficulty staying seated

(4) moves about excessively during sleep

(5) is always "on the go" or acts as if "driven by a motor"

D. Onset before the age of seven.

E. Duration of at least six months.

F. Not due to schizophrenia, affective disorder, or severe or profound mental retardation.--S.W.

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