Attention Deficit Hyperactive Disorder (ADHD)
From time to time, in the normal course of their explorations and interaction in the world, most children bubble over with restlessness. They dash from here to there, squirm, twist, and jiggle, with so much to do and to explore there is neither time nor the reason to sit still. While such activity is normal during early childhood, some children continue within this high speed as been driven by a motor and might be the diagnosed as ADHD.
Any child may show inattention, distractibility, impulsivity, or hyperactivity at times, but the child with ADHD shows these symptoms and behaviors more frequently and severely than other children of the same age or developmental level. ADHD must begin before the age of 7, it can continue into adulthood and it runs in families with about 25% of biological parents also having this medical condition.
Causes and Consequences:
Despite years of research, the cause of ADHD is still not fully understood. Evidence to date indicates that there are many factors underlying ADHD, among them genetic and neurobiological vulnerabilities. The basic problem is thought to be in the area of the brain that inhibits responses which leads to the inattention, impulsiveness, and physical over activity seen in ADHD. A child’s environment may also contribute to the development of the disorder or worsen the symptoms.
In some cases, the cause of hyperactive behavior is not ADHD but high levels of lead in the blood; fetal alcohol syndrome (in which excessive alcohol consumed during pregnancy has a range of effects on the unborn child); exposure to other drugs in utero, the result of a serious head injury, or a consequence of an infection of the central nervous system. In the 1970s, attention focused on food additives, although later it was concluded that additives were not a cause of the syndrome and in the 1980s, public attention turned to sugar in its search for an explanation for ADHD, many parents still limit sugar and foods rich in sugars but controlled studies have discounted the sugar theory as a cause for ADHD.
The symptoms of ADHD in these children make parenting more challenging. Dealing with ADHD symptoms and the inevitable frustration that result may cause many parents to doubt their parenting skills and they report greater social isolation, self blame, and depression than other parents. When these factors translate into a more intrusive, controlling, and disapproving parenting style the child’s emotional development, competence, and self esteem can be adversely affected.
This vicious cycle of negative interaction, stress, and sense of failure for both child and adult are also seen in the classroom between teacher and child and especially in a school or classroom setting that is unstructured and disorganized can intensify ADHD symptoms.
SIGNS & SYMPTOMS:
In general, children with ADHD look normal physically and at times their behavior is normal, too. However for children with this disorder, fidgety, restless, and distracted behavior is not just a temporary reaction to stress, but the difference is how frequent the behavior occurs. The behaviors must have been present for longer than six months and must have begun before age 7. The behaviors usually begin at 3 or 4 but are not detected until the child enters some type of an educational program.
The following is a checklist of behaviors that are commonly seen in children with ADHD. The child must exhibit eight or more of the behaviors to be considered a possible ADHD child:
1. Does the child have difficulty staying in one place when asked to?
2. Is the child "squirmy" or wiggly, fidgeting with hands, feet, hair?
3. Is the child distracted by noises?
4. Does the child have trouble following directions?
5. Does the child begin to do as you have asked but cannot follow through with a chore?
6. Does the child have trouble waiting for his/her turn?
7. Does the child have trouble paying attention even when the activity is enjoyable?
8. Does the child interrupt a speaker by answering or commenting before it is appropriate
9. Does the child change activities without completing the first?
10. Does the child have trouble playing quietly?
11. Does the child talk too much?
12. Does the child appear not to be listening when you talk?
13. Does the child lose things easily?
14. Does the child do things that will endanger him/herself or others without concern about the consequences?
Identifying the signs:
Although signs of this disorder are often evident during toddler hood or even earlier, most parents do not seek their pediatricians or mental health professionals until their children start school. Like other behavioral disorders, ADHD is most often identified by adult people, not by the child and adults have varying tolerances for excessive activity, some parents do not know what level of activity, concentration, and compliance to expect from their children at different ages, in addition problems may be present at school but not at home, or at home but not at school.
A young child with ADHD may be prone to:
1. Intense temper tantrums.
2. Some are very aggressive.
3. Great difficulties in entertaining himself and in playing cooperatively with others.
4. Unstructured activities
5. Independent work is difficult.
6. Focused activities like painting, drawing, or games are also problematic because of the difficulties in being able to concentrate and remain seated, making completion of the task unlikely.
7. Clumsy and accident prone.
8. For many, delayed fine motor coordination and language ability.
9. Sleeping problems can continue into the school age years.
School Challenges:
Parents get so distressed when they receive a note from school saying that their child won’t listen to the teacher or causes trouble in class, they know that the child is misbehaving or is different but they may not be able to tell exactly what is wrong. Although the child with ADHD often wants to be a good student the impulsive behavior and difficulty paying attention in class frequently interferes and causes problems.
Once the child enters elementary school he is expected to be able sit still and complete tasks for longer and longer periods of time. The more concentration required, the greater the likelihood that ADHD symptoms will interfere.
In addition to the child’s conduct in class, his schoolwork will show the effects of the disorder in the form of:
· Inability to give close attention to details.
· Prone to making careless mistakes.
· It might appear that the child does not listen when spoken to directly.
· Does not follow through on instructions.
· Does not finish schoolwork.
As a result, homework and schoolwork often go unfinished, especially when it is boring, repetitive, or difficult and in addition they often don’t finish chores at home.
Children with ADHD tend to underachieve at school, failing to reach their potential and functioning below their grade level in reading, spelling, and/or arithmetic as they have trouble paying attention, processing and remembering information. In addition, they may have difficulty remembering things in order (sequential memory). They may also have trouble controlling their pencils required for handwriting and drawing, the result of poor fine motor skills. Even when they are clearly intelligent, such children seem unable to discipline their thinking so that they can focus on or follow a particular line of thinking.
The less success ADHD children have with schoolwork, the less motivated they are to pursue academics, as with many of these children even their most concentrated efforts seem to bring little success. A sense of failure may also permeate the social relationships of children with ADHD, their impulsive behavior bothers other children, in addition to getting into trouble themselves these children tend to get others into trouble. Consequently, they often find themselves unpopular with peers, and long-term friendships are rare. Sometimes, the only other children who are willing to play with a child with ADHD are those who are younger or have similar problems.
On the playground, they might push into games and conversations without being invited, they might run into other children pushing, hitting, shoving while there may be no particular anger, hostility, or malicious intent in this intrusive physical contact, it often results in quarrels and fights with other children. At other times, school age children with ADHD may be oppositional and argumentative, that can become habitual as the child’s personality develops.
TYPES OF ADHD:
ADHD is a chronic disorder and symptoms can be mild, moderate, or more severe, and there are three different types of ADHD. The least common one includes children who are predominantly fidgety and hyperactive, tending to blurt out answers in the classroom, but maintain adequate concentration. A child with the second type of ADHD is characteristically inattentive, easily distracted, and disorganized, but not hyperactive. These children daydream, forget, or lose things, procrastinate, and fail to complete their work. Children with the third type of ADHD have a combination of the symptoms and behaviors of the other two types. This third variety of ADHD is the most common and the most severe form.
MANAGEMENT:
A child presenting with ADHD symptoms should have a comprehensive evaluation. Parents should seek professional medical advice to diagnose and treat this medical condition as the child with ADHD may also have other co- morbid disorders such as conduct disorder, anxiety disorder, depressive disorder and learning disabilities. Without proper treatment, the child will experience more failure than success and criticism by teachers and family who do not recognize a health problem.
The good news about ADHD is that it is a treatable condition, recent years have had numerous studies concerning management of this condition. Research clearly demonstrates that medications can help improve attention, focus, goal directed behavior, and organizational skills. Medications most likely to be helpful include the stimulants (various methylphenidate and amphetamine preparations) and the non-stimulant, atomoxetine. Other medications such as some antidepressants may also be helpful
While medications have been the focus of many studies, other treatment approaches, singly or in combination, have very promising results, these approaches include:
1. Cognitive Behavioral Therapy: Behavioral therapy can help children control their aggression, modulate their social behavior, and regulate their attention and physical movements. Parents and teachers will identify positive behaviors, for which the children are rewarded and encouraged. Cognitive therapy can teach older hyperactive children self control, self guidance, and more thoughtful and efficient problem solving strategies.
2. Social Skills Training: When coupled with other therapies, social skill training has been effective in helping children smooth out their difficult social behaviors. Through such training, children can learn to evaluate social situations and adjust their behavior accordingly. The most successful therapies are those that provide training in the child’s natural environments such as the classroom or in social groups as this may help the child apply the lessons learned directly to his life. Parents participate in their children’s social skills groups and provide opportunities outside the group to practice the skills the child has learned.
3. Parent Training Programs: Some parents are helped through parent training programs. In these sessions, parents learn strategies for managing their children’s behavior, they learn to increase structure in the child’s life and can help the child work toward successful experiences, they are taught negotiating skills, positive reinforcement techniques.
4. Family Therapy: This approach addresses the family stress normally generated by living with ADHD. Using a variety of techniques, families can change patterns of communication or interactions in order to help their child sometimes, in the course of treatment, it may be discovered that a parent also has the disorder and treatment of that parent may be helpful since the adult’s behavior can affect the child’s response to treatment.
It is important to remember that If ADHD goes unrecognized and untreated, a child can experience a lifetime of emotional pain, frustration, academic underachievement, failure, and social isolation, but for those diagnosed and treated early the condition can be effectively managed and their lives can indeed be productive, successful, and fulfilling. Most of these children develop greater control over their behavior and become less impulsive as they grow and mature.
