Attention Deficit/Hyperactivity Disorder (ADHD) is a condition in which a child has difficulty controlling some aspects of his or her behaviour leading to three major symptoms, inattention, hyperactivity, and impulsivity.
If you are a parent, you know that:
However, the words sometimes and occasionally don't apply to children with ADHD. They have these problems all the time. And, the behaviours are so intense that they interfere with the child's ability to function in the classroom and with his or her ability to get along with other children.
ADHD is not related to intelligence. It occurs in children with average intelligence and in children with superior intelligence.
The three major symptoms of ADHD are inattention, hyperactivity, and impulsivity.
Children who are inattentive
Children who are hyperactive
Children who are impulsive
Another symptom of ADHD is inconsistency. One day a child with ADHD can 'do it,' the next day he can't.
Yes. There are four different kinds of ADHD
Sometimes a child will have many of the symptoms of ADHD, when the true cause of these symptoms is something else such as:
To make sure that your child has ADHD rather than some other condition, it is important that he/she is evaluated by a doctor or psychologist with experience in evaluating children with these conditions.
Yes, most children with ADHD have another condition as well, and this has to be considered in making the diagnosis.
Specific learning disorders are common in children with ADHD. These include:
Though ADHD itself is not a learning disorder, the combination of a learning disorder and difficulty paying attention can make it doubly hard for a child to learn.
Language difficulties may occur. A child might have:
Other conditions include:
Some children initially thought to have ADHD will in fact have Asperger's Disorder or Tourette's Disorder.
To make sure that your child has ADHD rather than some other condition, it is important that (s)he is evaluated by a doctor or psychologist with experience in evaluating children with these conditions.
No, it is not. But the diagnosis is being made more frequently than in the past, and is receiving increasing attention in the medical press and in the popular media.
The first description of ADHD in a medical journal came in 1902, when Dr. George Still, an English paediatrician, described 43 children who were aggressive, defiant, very emotional, and uninhibited. These children had difficulty paying attention and following rules.
However, while ADHD received a lot of attention in America, it didn't receive much attention in Europe until relatively recently, and most European doctors are not familiar with it.
The study of ADHD and related disorders began with children who suffered from encephalitis (an inflammation of the brain) during the influenza pandemic of 1919. Some of the children who survived encephalitis were found to have severe behavior disorders, and were presumed to have suffered some brain damage.
When it became clear that children could have a behavior disorder without demonstrable brain damage, the term 'Minimal Brain Damage' came into use. This term was used to indicate that brain damage could not be demonstrated by available tests and must therefore be minimal. Later, the term 'Minimal Brain Dysfunction' came into use, indicating dysfunction rather than damage.
Over the past 20 or 30 years Americans and Europeans used different classifications for ADHD and related disorders. Europeans used the term 'Hyperkinetic Disorder of Childhood.' Americans called it 'Attention Deficit Disorder' (ADD) with or without an 'H' (ADHD/ADD) to indicate the presence or absence of hyperactivity.
ADHD has been shown to occur in 4-5% of children in the United States and Canada. A prominent British paediatrician has said that ADHD is 'under-diagnosed and under-treated' in Britain. The prevalence of ADHD in Ireland is not known.
But remember, for every child who meets the criteria for the diagnosis of ADHD, there is another child who does not meet the criteria but still struggles in school and needs help.
ADHD is 3 to 4 times commoner in boys than in girls. However, girls often present with different difficulties. They are usually less hyperactive, less aggressive, and less likely to lose their tempers. At the same time, they are often more anxious and more likely to have a learning disability. But, because girls are less disruptive in a classroom, they are less likely to be referred for an evaluation.
70-80% of children with ADHD still have difficulty during adolescence, and 30-40% still have difficulty in adult life. However, as children mature the symptoms change somewhat. Whereas the primary complaint in a child might be hyperactivity, in an adult this becomes restlessness, disorganisation, and impatience.
ADHD is a real disorder. There is no doubt about that. However, the diagnosis of ADHD is being made more and more frequently. As a result, ADHD has attracted a lot of attention from the media.
The precise cause of ADHD is not known. But we do know that the root of the problem is in the child's genetic make up, and that several other factors play a role in the development of ADHD.
Genetics
Just as children inherit their looks (the structure of their face, colour of hair, color of eyes, etc.) from their parents, they also inherit behaviour.
These kinds of studies suggest that a child is born with an inherited tendency to develop ADHD. Why some children develop ADHD and some don't depends on other factors.
Biology
Brain damage
If the developing brain is exposed to toxins, it does not develop normally.
Diet, medications, and various environmental influences have been said to cause ADHD, but there is no real proof of these claims.
It is clear that ADHD is not caused by
though each of these may act as an environmental factor which contributes to the expression of the condition.
The theory of difficulty with inhibition seems best to explain the problems experienced by people with ADHD.
Most people concentrate on important stimuli and ignore unimportant stimuli by inhibiting their response to less important stimuli. This processing of stimuli, and either allowing or inhibiting a response, is controlled by the brain's 'executive control centre.'
But, children with ADHD do not process these stimuli properly:
Thus, a child with ADHD does not inhibit his responses to distractions, and spend hours 'working' on homework without getting it finished.
Children with ADHD require instant gratification. They cannot inhibit or delay their response to a stimulus. They cannot forego a pleasure right now for a greater pleasure sometime in the future.
This failure to inhibit responses probably occurs because the brain circuits that do this processing are not properly developed.
There is no blood test or X-ray or brain test that can be used to diagnose ADHD. The diagnosis is made by obtaining information from parents and teachers (often using questionnaires) and determining if the child's attention span, activity level, and impulse control are appropriate for his/her age.
Sometimes, a neuropsychological test or a computerised Continuous Performance Test is given.
In order to make the diagnosis
The evaluation process includes a determination as to which kind of ADHD a child has.
It is important that children are evaluated by a qualified professional with experience in evaluating children with ADHD.
Children with ADHD often describe themselves as being dumb or stupid. Important adults, such as parents and teachers, may tell them that they are not trying hard enough in school.
As a result, some children become aggressive and may lash out at other children and get into fights. Other children may internalise their feelings, and become depressed and withdrawn.
The appropriate management of these problems requires that the paediatrician and psychologist work together with parents and teachers.
ADHD interferes with much more than just reading, writing, and other academic subjects. It affects the child's participation in sports, relationships with other children at school, and relationships within the family.
Children with ADHD often have difficulty with social skills and social relationships. They often act inappropriately or seem to be immature, or may appear to be bossy or in need of being in control. These behaviours may alienate other children.
The treatment of these problems requires a team approach. The paediatrician, psychologist, parents, and teachers must work together.
When a child has ADHD, it affects the whole family. The child's frustrations and failures may cause the parents to be frustrated, and to feel that they have failed as parents. Parents might deny that their child has a problem, might be angry that this happened to them, or feel guilty that somehow they are responsible. Dealing with these feelings takes time.
Parents may disagree about the best way to raise children. One might be firm and strict, the other understanding and permissive. Such differences of opinion can stress the parents and the marriage. Parents need each other to deal with these problems. Single parents may have more difficulty. They do not have another person to share the problems with.
Brothers and sisters may have difficulties too. They may not understand their sibling's problems. They might wonder if the problem is their fault and feel guilty. Some siblings will be angry at a perceived double standard.
Family therapy may be needed to resolve these problems.
You should discuss the problem with your child's teacher, and collect all the information about the problem(s) your child is having.
Then discuss the problem with your family doctor and ask for a referral to a specialist. It is important that your child is evaluated by a specialist with experience in attentional and learning problems. This would usually be a paediatrician with expertise in development and behaviour, a child psychiatrist, or a child psychologist.
Several lists of people who have or had ADHD have been published. These generally include the following people.
Getting your child to research these individuals is a good way for him/her to learn that people with ADHD can be successful.
Current research efforts are examining the following questions.
The paediatrician or child psychologist who makes a diagnosis of ADHD is responsible for educating the child and the parents about the disorder, and the various treatment options available. This includes a discussion of the side-effects of the various medications which might be prescribed.
The goal of behavioural (or psychosocial) therapy in a child with ADHD is for parents and teachers working together to help the child with all of his or her problems, academic, social, and psychological. Of the treatments that have been studied, some have been more successful than others.
Cognitive behavioral treatment which involves teaching self-monitoring, problem solving strategies, and self reinforcement has not proven successful.
Treatments which have been successful include
Principles of behaviour therapy.
For most children, stimulant medications are both safe and effective. Children who take stimulants seem better able to focus their thoughts and resist distractions, and are 'more available' for learning.
Several stimulant medications are available. Ritalin, perhaps the best known, has been widely used since its release in 1954. Dexedrine, an amphetamine, has been used even longer. Stimulants are regarded as the medications of choice in ADHD.
Several antidepressant medications and Clonidine have also been shown to be beneficial for some children. These are regarded as second line drugs.
Some children will respond to one drug but not to another. Determining which drug is best for an individual child, therefore requires communication among the parents, the teacher and the doctor.
It should be noted, however, that
Parent and teacher should develop strategies which work for your child. The following techniques may be helpful.
This is the name given to combination treatments; usually a combination of behaviour techniques and medication.
Parents and teachers have generally judged multimodal treatment to be superior to either one alone; especially in improving social skills.
Ongoing monitoring of your child's behaviour and learning is essential to a successful outcome. There is no 'quick fix' for ADHD. The management of children with ADHD requires long-term cooperation and communication among the parents, the teacher, and the doctor. For example, sharing behaviour checklists and reports.
Medication schedules can be complicated. Behaviour therapy requires commitment, education, and patience. But, your effort as a teacher or parent has a significant effect on your child's future.
When ADHD is discussed in the media, various non-traditional treatments are often mentioned. Sometimes, these are advertised as cures. The following methods have been shown in scientific studies to be of no value in treating ADHD.