Children with attention deficit /hyperactivity disorder (ADHD) are constantly distractible, impulsive and unusually active. They may also have other serious behavioural, emotional and learning problems which can get them into an awful lot of trouble if ADHD is not recognised and treated.
Children with ADHD often have poor self-esteem as a result of being constantly criticised by families, whanau and teachers who have not recognised their behaviour as a health problem. It is heartbreaking to hear such children refer to themselves as dumb, stupid or naughty.
Since the 1940s, ADHD has been given several names, including Minimal Brain Damage. Researchers knew that these were otherwise normal children whose brains received and processed information differently from others and resulted in the behaviour associated with ADHD.
By 1980 they agreed on the name Attention Deficit Disorder (ADD). This emphasised that attention was the major problem. A few years later the name was again changed to include hyperactivity – recognising that as an equally significant problem.
Nowadays most people talk about attention deficit hyperactivity disorder or ADHD (although you will also hear it being called ADD). This can still be confusing, because some children with extreme attention problems, may not be hyperactive. They are the more dreamy types who seem often to be away with the fairies. In a classroom these children are in danger of being overlooked because the children who have the ‘H’ in ADHD cannot fail to get noticed!
There is no absolute test for ADHD. The diagnosis needs to be made by expert doctors or specialists, such as child psychiatrists or paediatricians (doctors who specialise in child health) who have experience in treating ADHD. A medical check-up should be part of any assessment for ADHD.
There has been a huge increase in interest in ADHD recently and a lot of conflicting information being reported. It is therefore important that you get advice from your GP or specialist child and family service if you are concerned that your child may have ADHD.
Parents and teachers may be asked to fill out separate questionnaires on the child’s behaviour to see if there is overall agreement on the symptoms. Sometimes it may be suggested that the child do some psychological tests to find out if there are any specific problems with learning. There are two main errors in diagnosing ADHD: making the diagnosis too often, and missing it.
Signs of attention deficit / hyperactivity disorder
Children with ADHD have a characteristic pattern of development right from the time they are toddlers – this is one of the key indicators of the problem. Another clear sign of ADHD is that the child’s behaviour patterns are similar at home, school (or pre-school) and in all other situations. In addition, the signs of ADHD must be severe enough to cause major problems for the child in all of these places.
A child with ADHD will have several or all of the following difficulties.
• As babies they may be colicky, restless, hard to cuddle or hold and poor sleepers.
• They may have crawled or walked earlier than other children.
• They talk a lot, interrupt others and can’t seem to wait their turn.
• They have lots of energy and are constantly on the go. They seem unable to sit still even if they are enjoying doing something.
• They have a short attention span and often don’t follow through what they set out to do.
• They may tune out or appear to be daydreaming, especially when being given instructions.
• At school they have trouble with the work and often give the impression they have not heard the teacher’s instructions.
• They may frequently call out in class or a group and may be known as the class clown.
• They do dangerous and impulsive things, like jumping from heights or running out onto the road without looking out for traffic.
• They act before they think.
• They are often easily upset.
• They get angry and ‘explode’ quite easily.
• They find it hard to make and keep friends, usually because of their exuberance and bossiness rather than any nastiness.
These symptoms must have been present for at least the last six months, for a diagnosis of ADHD.
Children who are affected by ADHD
ADHD affects between three and five percent of school-aged children (one percent are affected quite severely). Some will have milder symptoms than others (about one in 20). ADHD is more common in boys than girls. Sometimes it is not diagnosed until the teenage years.
There is no cure for ADHD although there is a belief that many children seem to grow out of it before adolescence. Recently there has been an increasing awareness that ADHD can progress into adulthood. It is really important that children with ADHD get help early in life so that they can learn to manage their problems and develop the skills and confidence they will need to lead a successful adult life.
Myths
NOT TRUE Children with ADHD are deliberately naughty or bad children.
NOT TRUE ADHD is just youthful high spirits.
NOT TRUE Every child who displays some symptoms of ADHD has it.
There may be other reasons for children having symptoms which mimic ADHD. For example, children who have been abused either sexually or physically, or whose parents have recently separated often display some of the above behaviour. That’s why it is extremely important for the assessment and diagnosis to be thorough and done by qualified professionals who, as much as possible, try to rule out any other causes for a child’s symptoms
NOT TRUE Children with ADHD are incapable of concentrating at all.
Most children with ADHD are often able to concentrate for quite long periods of time on specific activities or hobbies – for example, watching videos they enjoy. In some, this ability to hyperfocus is extraordinary and has led some experts to comment that attention deficit might more accurately be called attention inconsistency.
NOT TRUE Everything that is wrong with the child is ADHD (e.g., all learning and behaviour problems are part of the ADHD).
NOT TRUE If you have ADHD you are not responsible for your behaviour and therefore can be excused for it (i.e., don’t have to face the consequences).
Causes of ADHD
Even though a lot of research into ADHD has gone on around the world, its exact cause is still unknown. It is likely that there are not one, but several causes, which, when they occur together, become ADHD.
Studies of computerised tomography or CT brain scans show that children with ADHD seem to have brain circuits which are wired a little differently from other people’s. This results in the brain having trouble processing the messages it receives – a little bit like a telephone exchange which gets overloaded with calls. This may happen to the infant’s brain in pregnancy, in babyhood, or it may just be an individual variation which has received more notice in the last 40 years. It does not seem to be caused just by a poor diet, yeast infections, allergies or food colourings as some people have thought, although these may be factors in the overall ADHD picture. It is also not caused by bad parenting although often a child’s behaviour will have earned plenty of negative attention in and outside of the family or whanau by the time ADHD is recognised.
Risks factors for developing ADHD
There is thought to be a genetic element to most ADHD, that is, it runs in families. Studies have shown that brothers or sisters of children with ADHD have two to three times the risk of having it as well.
ADHD often occurs with other child mental health problems. These may exist alongside or develop as a result of ADHD. For example, some children with ADHD will have Oppositional Defiant Disorder, Conduct Disorder or experience anxiety or depression. Learning difficulties which are unrecognised also present a risk for serious mental health problems, as they affect progress at school and self-esteem.
ADHD and its associated problems are serious if untreated because they can put young people at risk for accidents, drug or alcohol abuse problems, or suicide.
Living with Attention Deficit / Hyperactivity Disorder
The most important thing to remember about having a child with ADHD is that, like all children, they need love, affection, nurturing and clear rules. Sometimes this is hard to remember when whole days of nagging seem to be the rule rather than the exception at home and everywhere else.
A child with ADHD may have chalked up quite a lot of frustrations and failures before his/her problem is recognised. Some parents worry about the label ADHD and wonder if they have caused it to happen, or failed their child in some way. They may feel anger that this has happened to their family or whanau, or upset that other family or whanau members have dismissed the child’s behaviour as being normal. Others will be relieved that the problem they’ve lived with over a number of years finally has a name.
For the child, knowing he/she has ADHD can be a relief. Often though, children feel there is something really wrong with them. ADHD needs to be carefully explained to them in a way that they can understand and learn to handle. Brothers, sisters and friends, too, may need an explanation that can help them to stop teasing or provoking the child with ADHD.
Some children who have to take medicine to help their symptoms say it is like admitting that something scary is wrong with them and worry that they are retarded or crazy – labels they’ve probably heard before.
In two-parent homes it is important for parents to support each other with managing their child’s behaviour. Consistency is essential. Often one parent will say that the child is “perfectly all right when he is with me.” This can be infuriating for the other parent. For single parents, having a child with ADHD is even more difficult. Have at least one supportive friend outside the family or whanau that you can confide in.
Treatment of Attention Deficit / Hyperactivity Disorder
Summary of treatment options
There is no magic pill to make ADHD disappear, and medication should not be used as a substitute for other appropriate interventions, including educational and psychosocial. It is a complicated condition generally best managed by a mixed treatment programme which may include the following components.
Medication
The main kind of medication are used in the treatment of ADHD are stimulants; antidepressants are only very occasionally prescribed. The same medications are used for both children and adults. It is important that the progress of a child on medication for ADHD is checked and the treatment reviewed regularly with regular weight and height checks if stimulants are taken. You are entitled to know the names of any medicines prescribed; what symptoms they are supposed to treat; how long it will be before they take effect; how long they will have to be taken for and what their side effects (short and long-term) are.
Psychosocial treatments
Psychosocial treatments are non-medical treatments which look at the child or young person’s thinking, behaviour, relationships and environment, including their culture. The main psychosocial treatments for ADHD include behaviour management and social skills training to ensure encouragement and support for the child at home and at school. Other psychosocial treatments may include individual psychological therapy or family therapy to help young people and their families and whanau understand the condition and to make positive changes in their lives and relationships.
All types of therapy/counselling should be provided to children, adolescents and their families and whanau in a manner which is respectful of them, and with which they feel comfortable and free to ask questions. It should be consistent with and incorporate their cultural beliefs and practices.
Complementary therapies
Complementary therapies that enhance the young person’s life may be used in addition to psychosocial treatments and prescription medicines.
This article is an excerpt from www.mentalhealth.org.nz
