The following patterns have been found in Attention-Deficit Hyperactivity Disorder (ADHD) children and adults. The patterns are identified through a combination of professional research and twenty-seven years of clinical experience with ADHD.

Difficulty Understanding Sequence
Life moves in a series of sequences, one event connected to another and to another as our activities continue. ADHD children/adults have difficulty with understanding sequences, creating a variety of problems. For example, if you have an appointment in your hometown, you anticipate the amount of time needed to prepare, drive to the office, park the car, and register - perhaps 60 minutes. For ADHD Johnny, the short attention span makes understanding sequences very difficult. Getting ready for school is a nightmare as ADHD children don't understand that time is involved in every activity. They somehow figure you can get out of bed at 7:45 am, shower, eat breakfast, brush their teeth, gather their books, and get dressed -all before the bus arrives at 8:00 am.

The inability to understand sequences is the cause for the amazing ability of ADHD children/adults to always get caught when doing something wrong. ADHD children/adults are unable to be "sneaky" due to this trait. As a parent, you can watch the ADHD child grab a cola from the refrigerator and sit in the next room to watch television. You walk in, notice the cola is spilled, and question them about the spill - to which they reply "I didn't do it!" ADHD children can't figure out how you know the sequence of events that allows adults to figure out who did what. They can't project sequence forward or backward.

This inability to understand sequence and time creates many problems for the ADHD teenager. Told to be home at 7:00 pm, the ADHD teenager leaves at 6:00 pm to visit a friend. They walk to the local video store where they meet a friend with a new game. They follow the friend home to check out the game. A contest follows and the friend's mother provides soda and snacks so the ADHD teenager doesn't get hungry. Eventually, the friend's family bluntly tells the ADHD teenager to go home - it's 10:00 pm! Upon returning home, the ADHD teenager is at a loss to explain why he's three hours late, didn't call, and was rude to stay too long at the friend's home. Despite grounding, the same behavior is repeated within a few days.

"I don't know"
When confronted with a misbehavior and asked "Why did you do that?", the number one response from an ADHD child is "I don't know!" This response is a combination of two behaviors in ADHD children, the lack of sequence understanding and the presence of tangential behavior. In geometry, a tangent is the single point at which two separate objects touch. Due to a short attention span, ADHD children jump from one activity to another, the two activities often linked together by a glance. If asked to clean the top of their desk, they wipe a bit, examine the lamp, read a comic, staple a few things, pull tape from the dispenser, and reprogram the phone - one behavior leading to another as they look around the desk. Asked why the desk isn't cleaned off or why the phone is now reprogrammed to call only video stores - "I don't know" is the reply. ADHD children can't remember the sequence of events that ended with a reprogrammed phone. It's not unusual to send an ADHD student to the garage for a hammer, finding him/her 45 minutes later in the process of disassembling the lawn mower. Asked why - "I don't know!"

Hyperfocus and Outbursts
ADHD Children have very low levels of attention, focus, and concentration. Normal concentration/attention allows us to listen to conversation or watch a television program with extra attention to spare - to monitor the environment, listen for the oven buzzer or others in the house. ADHD Children may only have half the concentration of non-ADHD individuals. For this reason, if they intensely focus on a television program or play a computer game, they have no extra attention with which to monitor their environment. When playing a game, they don't hear calls for lunch because all 50% of their attention is on the game.

Both research and clinical experience tells us that ADHD Children can exhibit a type of "hyperfocus" - intense concentration and single-minded focus when the activity is very interesting. This situation is most often found when ADHD Children play computer games. ADHD Children may have an amazing ability to hyperfocus on a computer game, one of the few things that moves fast enough to maintain their attention, unlike homework or routine chores.

The hyperfocus found in ADHD Children is not a normal type of concentration or focus. Remembering the neurochemical aspects of Attention-Deficit Hyperactivity Disorder (ADHD), hyperfocus requires the child to use the maximum attention and sustained concentration available. For parents and teachers, imagine trying to thread a needle, in low light, while sitting in a row boat in the ocean - the waves tossing and rolling all the time. The amount of concentration required to thread that needle makes us anxious, tense, and irritable - as if somebody were asking us questions while we were trying to thread that needle. This is way ADHD Johnny is so fidgety while trying to listen to your conversation or correction.

In ADHD Children, hyperfocus allows them to participate in computer games or watch high-action movies - but at a cost. The amount of energy being used makes them very irritable. If a parent interrupts the computer game or movie with a question, a call for lunch, or a request - the ADHD Children is likely to explode in a burst of verbal or physical aggression. His or her concentration has been broken and that neurochemical activity spills out into the room, or is directed at the interrupting source. It's not uncommon for ADHD Children, upon losing a computer game, to throw controllers or objects, stomp, scream, or behave in a way that tells us they are very upset. As a parent or teacher, we are shocked at their overreaction to such a minor situation. To see it from the viewpoint of an ADHD Children - imaging trying to thread that needle for 30 minutes - then accidentally dropping the needle overboard. We'd have a few choice words or a bit of behavior problem as well.

Dealing with hyperfocus requires patience and a minimal reaction to their overreaction. Interrupting ADHD Children who are hyperfocusing will always bring an inappropriate reaction, typically a verbal outburst. Parents are advised to not focus on their overreaction but remain on the topic. For example, interrupting ADHD Johnny's videogame to ask for help in the kitchen is likely to prompt a loud reaction such as "Why do I have to help! Sally never does anything! It's always me!" and so on for about five minutes. After the outburst, the parent might address the comments superficially but stick to the request as in "If you think I treat you unfairly, we can get together in an hour after lunch and discuss it. But right now, I need you to help me set the table."

"I think my child is possessed!" - Neurochemical Excitability
Of all Attention-Deficit Hyperactivity Disorder (ADHD) behaviors that bring ADHD Children to the attention of professionals, severe behavioral outbursts must be ranked in the top three complaints. One parent described the wild look in her son's eyes, the aggressiveness, kicking holes in the wall, and the physically threatening behavior with the summary "I think my child is possessed!" ADHD Children are normally more aggressive, pushy, argumentative and talkative. When upset, as when confronted or in a heated discussion, their neurochemical system explodes in a burst of energy and aggression that is far in excess to the situation.

Let's review what happens in a routine discussion or argument, as if it were being videotaped. If adults are in a discussion, the issue is first reviewed. If a disagreement is present, both sides present their opinion, normally at first, then more aggressively. As the discussion continues, we notice signs of neurochemical excitement - loud voice, an aggressive or resistive posture, name calling, references to past arguments, and often what I call the "adrenalin finger" - that pointed forefinger shaken at the other person. In healthy adults, as the neurochemical excitement increases, there is a sense that the discussion or argument is getting out of hand. Often a truce is offered as "We don't need to be yelling at each other. Let's take a break, get a cup of coffee, and talk about this later."

ADHD Children are already more excited and excitable than most children and adults. When upset or angry, the neurochemical excitement of anger or distress is added to the already-present high level of aggression and excitability. Imagine being very angry or upset, then suddenly receiving an injection of stimulants. At that point, you'd be out of control, talking and yelling nonstop, posturing, and physically aggressive. The upset ADHD Child rapidly goes from "hyper" to out of control. Parents often find that normal "rough-housing" with the child or between siblings, prompts the ADHD child to become very aggressive and unable to settle down after the event.

Signs of neurochemical excitement and outburst:

- Verbally loud, threatening, screaming, and talking excessively. In psychiatry, we use the term "pressured speech" to describe an aggressive, nonstop talking that is difficult to interrupt. The ADHD Children are almost totally unreasonable at this point.

- Physical aggression is strong. The neurochemical excitement becomes so strong at times that arms wave, feet stomp, objects are thrown, furniture/walls are hit, and the ADHD Child closes the physical range and may be intimidating or "in your face". Repeated cautions to calm down have no effect.

- Aggressive pursuit is often present. Recognizing that the situation is out of control, a parent typically offers a truce or attempts to disengage from the argument. The enraged ADHD Child suddenly can't break off their attack. If you walk away, they pursue you - following the parent through the house - still yelling, intimidating, and hitting the walls as they go.

- A major component of an Attention-Deficit Hyperactivity Disorder (ADHD) is impulsivity, acting before thinking. ADHD Children have difficulty understanding consequences of their behavior, a component related to their problems understanding sequences. For this reason, enraged ADHD Children can be very dangerous and threaten or engage in high-risk behavior. They may destroy their favorite possessions, run out the door, strike at parents/teachers, curse, or threaten suicide. Amazingly, all those behaviors can surface simply because you've asked the ADHD Child to take out the garbage.

- Normal parenting techniques used for discipline or behavior are totally ineffective during these episodes. After the outburst is over and the ADHD Child does settle down, they are always remorseful and apologetic but the parents are traumatized.


Dealing with this excessive chemical reaction involves several components.

1. Address the ADHD Child in a calm manner. A loud voice will only increase their reaction to being interrupted or addressed.
2. Expect a verbal reaction. Attention-Deficit Hyperactivity Disorder (ADHD) children have "quick-draw mouth" - a verbal reaction and reflex anytime they are addressed or interrupted. I often encourage parents of ADHD children to become deaf for ninety seconds after asking the ADHD child a question. A simple comment such as "Jimmy, can you take your glass into the kitchen for me" produces an aggressive "Why!? Jennifer leaves her glass in here all the time! I'm not the only one with an empty glass around here! You never tell Dad to take his glass to the kitchen! He can do anything!" Expect an overreaction to your comments or requests.
3. Don't take the verbal reaction personally. Parental focus on the ADHD Child's overreaction will often prompt an emotional and behavioral explosion. When the comments include such gems as "I wish I didn't live here!" or "Jennifer is the favorite around here!", the natural tendency is to defend yourself or address the comments. Addressing their reaction only side-tracts the original discussion and raises their agitation.
4. Ignore the reaction and stay on your original topic. Often a comment such as "I'm sure there are times you don't like our family rules. If you want to talk about that, we can get together after you take your glass into the kitchen."

When are ADHD Children Identified
ADHD Children are often diagnosed as being "hyperactive type" or "inattentive type" - or the combined version. There is difference in identification with these two types. The obviously hyperactive child is often identified within the first week of kindergarten or first grade. Parents arrive at a professional office with a note from the school principal, often demanding that the child be seen by a psychologist or pediatrician. These hyperactive children have been running around the room for three days at that point.

The inattentive type of Attention-Deficit Hyperactivity Disorder (ADHD) is more difficult to detect. The inattentive child is often labeled a "dreamer", "immature", "in a world of his/her own", or parents are told the child should be held back. As all six year old children are somewhat flighty at times, the inattentive child is typically advanced in school with the understanding that they will probably mature as they age. For this reason, inattentive ADHD Children often aren't identified until they are discovered to be one or two grades behind (see Academic Problems).

Academic Problems
ADHD Children typically have many academic problems. Despite being intelligent, academic performance is often below grade level. The best way to visualize the difficulty is to image an automobile with a Rolls Royce engine (the IQ/ability) and a go-cart transmission (attention/concentration system). The power of the engine is not getting to the wheels due to a difference in the transmission capability. Engine performance is only as powerful and efficient as the transmission system. If a child's intellectual ability (IQ) is measured at 115 and his/her concentration "IQ" is 75 - academic performance will most likely be at the "75" level - with hyperfocus bursts of sheer genius at times. In this situation we find very bright children often performing one or two grades behind despite amazing abilities to reprogram the school computers.

Without treatment, ADHD Children rapidly lose ground in school. Imagine an ADHD Child with only 75% concentration. For each grade completed, he/she retains 75% despite the IQ level. After four grades in school, the ADHD Child has retained only three grades and is now one grade behind. At this point, the child begins failing and lacks the foundation to understand some more complex math concepts.

Attitude Problems
Parents often asked about the risks involved in both medication treatment and not treating Attention-Deficit Hyperactivity Disorder (ADHD). Untreated ADHD Children can experience academic failure and behavior problems but more importantly, they often sustain damage to their self-confidence and self-esteem. Years of untreated ADHD gradually wear down the self-esteem of the child, creating a commonly found "ADHD attitude".

The "ADHD attitude" forms as a direct result of lots of adult attention. ADHD Children receives lots of attention but when we monitor that attention with a camcorder, we find that the attention received is about 90% negative. Adults are constantly attending to the ADHD Child with comments like "don't touch that", "sit still please", "stop that singing/drumming/moving", or "leave your sister alone". The ADHD Child finds the same type of attention at school, the teacher commenting "sit down", "please pay attention", "your work is too sloppy", and "leave your neighbor alone". As time passes, the student develops a negative view of himself or herself. Comments we often hear from hyperactive youngsters are "I can't do anything right", "they're always on my case", "they never say anything to my sister", or "no matter what I do I get into trouble." ADHD Children often describe themselves as "stupid" or a troublemaker. Personality development can be permanently altered or damaged by the presence of an ADHD attitude. With proper treatment of the hyperactivity, this self-view can gradually change to a more positive self-image. If the change does not appear in time, counseling in this area might be needed. One child recently treated at the office, when asked how his school situation had changed since medication treatment, replied "Now I got three friends!" It's important to remember that untreated ADHD often prevents the ADHD Children from obtaining and keeping friends. Like an octopus, the hyperactive student is constantly touching, hitting, poking, slapping, and irritating anyone who enters their body zone/range. For that reason, other students keep their physical distance from the hyperactive octopus.

Parents of ADHD Children: Issues
Parents of ADHD Children often develop difficulties of their own due to the constant supervision and effort required by the ADHD son or daughter. Commonly encountered parental issues:

"I can't take it anymore!" Many parents arrive exhausted and overwhelmed by the constant stress involved in rearing ADHD Children. Single parents are particularly vulnerable to being gradually overwhelmed by the night and day coping required with ADHD Children. At times, parents may require treatment for stress, anxiety, or depressive reactions.

"They say he's all boy." As the infant grows and the symptoms of ADHD surface, parents begin to question the activity level of their child. As they compare their child with other children, they ask the opinions of relatives, friends, and others. Initially, parents are often told "He's just all boy". While many later stick to their original assessment as "all boy", you'll notice that nobody volunteers to baby-sit that "all boy" child.

"We're both crying by the time homework is over!" Homework time, labeled "homework hell" by some parents of ADHD children, is often so stressful that both child and parent are traumatized by the experience. If the child is receiving medication treatment, it is not unusual for the child to experience a period of "emotional instability" after school, as the school-time medication loses effectiveness. Homework during that time would involving crying, yelling, temper tantrums, frustration, etc.

"I must be a bad parent!" With ADHD Children, normal parental discipline and educational techniques don't work. Your neighbor offers "I did this (technique) and Billy hasn't repeated it since!" If your child has ADHD, use of that technique will have little or no effect. After trying various recommendations and reading parenting books, and still nothing works, parents become demoralized and feel they are at fault. In reality, a completely different approach is often needed for ADHD Children.

"Dealing with this is ruining our marriage!" Selecting a coping style to deal with ADHD Children often places parents at odds. One parent may come from the "All he needs is a good spanking" school of discipline (totally ineffective by the way) and the other desires to protect and understand the condition. Parents also argue over issues of medication, who does homework, and who deals with the school. Parents of ADHD Children often receive daily notes from teachers/principals - the record at my office being 37 discipline slips in a two week period. When the marriage is troubled in this manner, marital counseling and support is often needed.

Treatment of Attention-Deficit Hyperactivity Disorder (ADHD)
Treatment of ADHD often involves a multidisciplinary approach and includes physicians, therapists, educators, and families. Children and adults with mild ADHD may require minimal professional intervention while severe ADHD may require multiple medications and professional interventions.

Medication Medication for Attention-Deficit Hyperactivity Disorder (ADHD) has been the treatment of choice for many years. Three groups of medications have been utilized: stimulants, antidepressants, and tranquilizers. Stimulants have the best track record, working very well in 65 - 75 percent of cases. Children with the inattentive type of ADHD frequently require a low dose to obtain a favorable response. Antidepressants can be of help, especially when bed-wetting is also part of the ADHD symptom picture. Tranquilizers have been used although typically in special cases, as when the ADHD features are related to neurological damage or head trauma.

Counseling for ADHD Counseling can help both the ADHD child and his family understand and cope with the disorder. Cognitive approaches often assist the ADHD student with developing coping skills and decreasing impulsivity. Counseling often focuses on self-control, respecting others, and decreasing negative self-concept that often accompanies ADHD.

Home/Classroom Management Techniques A variety of home and classroom management techniques are found in ADHD research and literature. Recommendations abound and several are listed in this paper. Clinical experience also provides "tricks of the trade" that are shared via the internet or in literature. Perhaps one of the best discovered by this author deals with the "withdrawals" experienced by some ADHD children after school, as the Ritalin medication leaves the system and the child becomes grouchy and hypersensitive. One pediatrician recommends a 12 oz. Mountain Dew which serves to "flatten out" the angle of the withdrawal. Thousands of internet sites are devoted to Attention-Deficit Hyperactivity Disorder (ADHD) and offer these and other suggestions for family and school management.