Glossary of Terms and Definitions

The following is a continuation of the glossary of terms used frequently when dealing with the mental health needs of children. This page contains:

• specific definitions of
  • attention-deficit/hyperactivity disorder
  • emotional disturbance
• list of national organizations

Attention-Deficit/Hyperactivity Disorder

Definition

Attention-Deficit/Hyperactivity Disorder (AD/HD) is a neurobiological disorder. Typically children with AD/HD have developmentally inappropriate behavior, including poor attention skills, impulsivity, and hyperactivity. These characteristics arise in early childhood, typically before age 7, are chronic, and last at least six months. Children with AD/HD may also experience problems in the areas of social skills and self - esteem.

Incidence

AD/HD is estimated to affect from 3 to 5 percent of the school-age population. Even though the exact cause of AD/HD remains unknown, it is known that AD/HD is a neurobiologically based disorder. Scientific evidence suggests that AD/HD is genetically transmitted and in many cases results from a chemical imbalance or deficiency in certain neurotransmitters, which are chemicals that help the brain regulate behavior.

Characteristics

AD/HD is diagnosed according to certain characteristics described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (APA, 1994), known as DSM-IV. A child with AD/HD is often described as having a short attention span and as being easily distracted. The child will have difficulty with one or all parts of the attention process: focusing (picking something on which to pay attention), sustaining focus (paying attention for as long as is needed), and shifting focus (moving attention from one thing to another).

According to DSM-IV some symptoms of inattention are: failing to give close attention to details; making careless mistakes in schoolwork or other activities; having difficulty sustaining attention in tasks or play activities; appearing to not be listening when spoken to directly; having difficulty following through on instructions; failing to finish schoolwork, chores, or duties (not due to oppositional behavior or failure to understand instructions); having difficulty organizing tasks and activities; often avoiding, disliking, or being reluctant to engage in tasks that require sustained mental effort (schoolwork and homework); losing things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools); easily distracted by extraneous stimuli; and often forgetful in daily activities.

According to DSM-IV, some symptoms of hyperactivity are: often fidgeting with hands or feet or squirming in seat, often leaving seat in classroom or in other situations in which remaining seated is expected, often running about or climbing excessively in situations in which this is inappropriate, having difficulty playing or engaging in leisure activities quietly. Often "on the go" or acting as if "driven by a motor" and often talking excessively.

Impulsiveness with AD/HD appears when children act before thinking. According to DSM-IV, some symptoms of impulsivity are: often blurting out answers before questions have been completed, having difficulty awaiting turns, and often interrupting or intruding on others (during conversations or games).

From time to time, all children will be inattentive, impulsive, and overly active. In the case of AD/HD, these behaviors are the rule, not the exception.

Educational Implications

Planning for education needs begins with an accurate diagnosis. Children suspected of having AD/HD must be appropriately diagnosed by a knowledgeable, well-trained clinician (usually a developmental pediatrician, child psychologist, or pediatric neurologist). Treatment plans may include behavioral and educational interventions and sometimes medication. Parents suspecting a problem may seek the services of the local school district or an outside private professional to conduct an evaluation. For children under age five, families may want to contact early childhood programs specialized in serving the needs of youngsters with disabilities. Call the local public school system and ask about services for children with disabilities.

Many children with AD/HD experience great difficulty in school, where attention and impulse and motor control are virtual requirements for success. Children with AD/HD tend to overeact to changes in their environment. Whether at home or in school, children with AD/HD respond best in a structured, predictable environment. Here, rules and expectations are clear and consistent, and consequences are set forth ahead of time and delivered immediately. By establishing structure and routines, parents and teachers can cultivate an environment that encourages the child to control his or her behavior and succeed at learning.

Adaptations that might be helpful (but will not cure AD/HD) are: posting daily schedules and assignments, calling attention to schedule changes, setting specific times for specific tasks, designing a quiet work space for use upon request, providing regularly scheduled and frequent breaks, using computerized learning activities, teaching organization and study skills, supplementing verbal instructions with visual instructions, and modifying test delivery.

Further information regarding helpful strategies can be found in the NICHCY's Briefing Paper Attention-Deficit/Hyperactivity Disorder.

Resources

Alexander-Roberts, C. (1994). ADHD parenting handbook: - Practical advice for parents from parents: Proven techniques for raising hyperactive children without losing your temper. Dallas, TX: Taylor Publishing. Call 1-800-677-2800.)

Fowler, M.(1994). Attention Deficit/Hyper-activity Disorder. NICHCY Briefing Paper, 1-16. (Available from NICHCY. Call 1-800-695-0285.)

Fowler, M. (1996). Maybe you know my kid: A parent's guide to identifying, understanding, and helping your child with ADHD (3rd ed.). New York: Birch Lane Press. (Call 1-800-447-2665.)

Fowler, M. (1992). CH.A.D.D. educators manual: An in-depth look at attention deficit disorders from an educational perspective. Plantation, FL: CH.A.D.D. (Available from Caset Associates. Call 1-800-545-5583.)

Goldstein, S. & Goldstein, M. (1992). Hyperactivity - Why won't my child pay attention? A complete guide to ADD for parents, teachers, and community agencies. New York: Wiley. (Call 1-800-225-5945.) ISBN#0471533076.

Wodrich, D.L. (1994). Attention deficit hyperactivity disorder: What every parent wants to know. Baltimore, MD: Paul H. Brookes. (Call 1-800-638-3775.) Stock # 1413.

Emotional Disturbance

Definition

Many terms are used to describe emotional, behavioral, or mental disorders. Currently, students with such conditions are categorized as having a serious emotional disturbance, which is defined under the Individuals with Disabilities Education Act (IDEA), Public Law 101-476, as follows:

"...a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects educational performance:

• An inability to learn that cannot be explained by intellectual, sensory, or health factors;
• An inability to build or maintain satis-factory interpersonal relationships with peers and teachers;
• Inappropriate types of behavior or feelings under normal circumstances;
• A generally pervasive mood of unhap-piness or depression; or
• A tendency to develop physical symptoms or fears associated with personal or school problems." [Code of Federal Regulations, Title 34, &#sect;300.7(b)(9)]

As defined by IDEA, serious emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have a serious emotional disturbance.

It is important to know that the federal government is currently reviewing the way in which serious emotional disturbance is defined and that the definition may be revised.

Incidence

For the 1994-95 school year, 428,168 children and youth with a serious emotional disturbance were provided services in the public schools (Eighteenth Annual Report to Congress, U.S. Department of Education, 1996).

Characteristics

The causes of emotional disturbance have not been adequately determined. Although various factors such as heredity, brain disorder, diet, stress, and family functioning have been suggested as possible causes, research has not shown any of these factors to be the direct cause of behaviors seen in children who have emotional disturbances. These behaviors include:

• Hyperactivity (short attention span, impulsiveness);
• Aggression/self-injurious behavior (acting out, fighting);
• Withdrawal (failure to initiate interaction with others, retreat from exchanges or social interaction, excessive fear, or anxiety);
• Immaturity (inappropriate crying, temper tantrums, poor coping skills); and Learning difficulties (academically performing below grade level).

Children with the most serious emotional disturbances may display some of these same behaviors at various times during their development. However, when children have a serious emotional disturbance, these behaviors continue over long periods of time. Their behavior signals that they are not coping with their environment or peers.

Educational Implications

The educational programs for children with a serious emotional disturbance need to include attention to mastering academics, developing social skills, and increasing self-awareness, self-control, and self - esteem. Career education (both vocational and academic) is also a major part of secondary education and should be a part of the transition plan included in every adolescent's Individualized Education Program (IEP).

Behavior modification is one of the most widely used approaches to helping children with serious emotional disturbance. However, there are many other techniques that are also successful and may be used in conjunction with behavior modification. Life Space Intervention and Conflict Resolution are two such techniques.

Students eligible for special education services under the category of serious emotional disturbance may have IEPs that include psychological or counseling services. These are important related services that are available under the law and are to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.

There is growing recognition that families, as well as their children, need support, respite care, intensive case management services, and a multi-agency treatment plan. Many communities are working toward providing these wraparound services, and there are a growing number of agencies and organizations actively involved in establishing support services in the community. Parent support groups are also important, and organizations such as the Federation of Families for Children's Mental Health and the Alliance for the Mentally Ill - Children and Adolescent Network (NAMICAN) have parent representatives and groups in every state. Both of these organizations are listed under the resources section of this fact sheet.

Other Considerations

Families of children with emotional disturbances may need help in understanding their children's condition and in learning how to work effectively with them. Help is available from psychiatrists, psychologists, or other mental health professionals in public or private mental health settings. Children should be provided services based on their individual needs, and all persons who are involved with these children should be aware of the care they are receiving. It is important to coordinate all services between home, school, and therapeutic community with open communication.

National Organizations

American Academy of Child & Adolescent Psychiatry
Public Information Office
3615 Wisconsin Avenue, NW
Washington, DC 20016
202-966-7300; 800-333-7636
Email: mbel@cap.org

ERIC Clearinghouse on Disabilities and Gifted Education
Council for Exceptional Children
1920 Association Drive
Reston, VA 22091-1589
703-264-9449 (TTY); 800-328-0272
Email: ericec@cec.sped.org

Federation of Families for Children's Mental Health 1021 Prince Street Alexandria, VA 22314-2981 703-684-7710 Email: ffcmh@ffcmh.org

National Alliance for the Mentally Ill
200 N. Glebe Road, Suite 1015
Arlington, VA 22203-3754
703-524-7600; 800-950-6264

Research & Training Center on Family Support and Children's Mental Health
Portland State University
P. O. Box 751
Portland, OR 97207-0751
503.725.4040; 800-628-1696

National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
703-684-7722; 800-969-6642