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Attention Deficit Hyperactivity Disorder is real, it’s fairly common, and it can cause much distress in the children who have it and great turmoil in the family.
This is not a new disorder; such children were described in the medical literature over a hundred years ago. The hyperactive child has also been described in children’s literature (“Fidgety Phil/He won’t sit still”). However the terminology used to describe these children has changed a good deal through the years (minimal brain dysfunction, the hyperkinetic child, etc.) The term used today is Attention Deficit Hyperactivity Disorder (ADHD).
How common is ADHD? Somewhere between three and six percent of the children in the US have this disorder. Although the prevalence varies from study to study and country to country, all studies show that boys are more commonly involved than girls with a boy/girl ratio of about 6:1.
What are we talking about when we use the term attention deficit? When we attend to a task, our brain filters out other stimuli so that we CAN pay attention. The brains of people with ADHD can’t do this filtering job very well.
A child with ADHD demonstrates excessive activity, poor sustained attention, problems with impulse control, and difficulty getting along with others.
Not all children with excessive activity have ADHD. In order that everybody defines ADHD the same way, a list of fourteen criteria is used. Because all children may show one or more of these behaviors at some time in their life, a child must have at least eight of the symptoms for at least six months in order for the diagnosis of ADHD to be made And, as with every other symptom complex, the problem may be mild, moderate, or severe.
Children with ADHD :
o are restless or fidgety
o have difficulty staying in their seat
o are easily distracted
o have difficulty waiting their turn
o blurt out answers to questions before they have been completed
o have difficulty following instructions
o have difficulty sustaining attention in tasks or play
o often shift from one activity to another
o have trouble playing quietly
o may talk excessively
o interrupt others frequently
o don’t seem to listen to what is being said
o often lose things
o may engage in dangerous activities without thinking of the consequences (run into the street without looking).
It is pretty obvious that EVERY CHILD will exhibit at least one of these behaviors at one time. Further, many of these behaviors are common in preschoolers. I stress this to underline the importance of NOT LABELLING A CHILD. Don’t, even in a joke, refer to your child as “hyperactive” unless the diagnosis has been made.
The problems of ADHD start early in life. But most toddlers are distractable and impulsive at least some of the time so that parents may be unaware that the child has a problem. By the time the child goes to school, everybody knows there is a problem. Looking at the above list, it’s easy to see how much difficulty such a child would have learning–and how much difficulty the teacher would have teaching.
Thus poor school achievement, with or without concomitant learning disabilities, is a hallmark of the school age child with ADHD. Also, some children with ADHD may exhibit conduct problems like destructiveness, aggression, oppositional behavior, or lying and stealing. Many ADHD children have difficulties relating to their peers because they tend to be self-centered, emotionally immature, and unaware of consequences. And, of course, poor self esteem results from under-achievement and poor peer relationships. (“I can’t do it and nobody likes me!”)
What causes ADHD? Nobody knows for sure. However there is a good deal of evidence that this problem has a biological basis. Twenty to thirty percent of parents and siblings also have symptoms of ADHD. One quarter of the biological parents of ADHD children have similar symptoms compared to four percent of adoptive parents.
Other evidence for a biological basis comes from studies of brain function indicating underactivity in certain parts of the brain. A recent study showed that brain glucose metabolism was significantly reduced in adults who had been hyperactive since childhood, especially in those regions of the brain involved in controlling attention and movement. There is no question that ADHD is due to an abnormality in the way the brain functions. Although the child with ADHD can develop compensatory strategies to improve behavior and learning, the child can’t control the way his or her brain works.
Can ADHD be caused by “wrong” parenting? The answer is an emphatic NO! There are studies that show mothers of ADHD children are more negative and directive toward the hyperactive child but it is much more likely that the mother’s behavior results from having to deal with such a child rather than causes the ADHD.
Can anything be done for these children? YES. First of all the child needs an ACCURATE DIAGNOSIS which means the child needs a COMPREHENSIVE DIAGNOSTIC EVALUATION including psychological and educational evaluations.
A pediatrician knowledgeable about, and interested in, behavior problems in children is the best person to coordinate this diagnostic evaluation and make treatment recommendations to the school and family.
MEDICATION can help many of these children. Ritalin, a stimulant, works on the brain to improve attention span and decrease impulsivity. Although there are some side effects, I favor a trial of Ritalin for every child diagnosed with ADHD. The dosage must be carefully regulated and the medication carefully monitored. If the medication is helping, both parents and teachers will notice an improvement in the child’s behavior and performance. Other medications such as antidepressants, can also be tried if Ritalin does not help.
Medication alone is NEVER the answer. The treatment spectrum must include EDUCATIONAL STRATEGIES, BEHAVIOR MODIFICATION, and COUNSELLING therapy for the child and parents.
Parents must learn SPECIAL MANAGEMENT SKILLS AND STRATEGIES. Parents must put this disorder into perspective, learn management strategies and techniques, and establish a parent/school partnership to maximize the child’s performance.
Support groups and classes or workshops about managing ADHD are useful to parents.
What happens to these children when they grow up? The hyperactivity often “calms down” in late adolescence. But many teens with ADHD still have difficulties with school and exhibit impulsive behavior. They may also develop antisocial behaviors probably related to poor self esteem, school failures, and difficulty in making friends. Loss of motivation (“giving up”) occurs in some and may lead to dropping out of school.
In many cases medication is stopped in adolescence but it should be continued even in adulthood if the doctor and patient feel it is helping.
If the educational strategies keep the child in school and the therapy helps the child realize he or she is DIFFERENT BUT NOT BAD OR DUMB, there can be a very favorable outcome.
Although adults with ADHD still have abnormalities in brain activity and some behavioral difficulties, many are able to compensate for their “differences”. They also can develop and exhibit what one author calls “redemptive features”. For example, inattention to detail can be associated with greater ability to see the big picture. A study of ADHD adults showed they were rated by their employers the same as the control adults without ADHD on six out of seven questions about their performance.
So the picture is not hopeless. Parenting an ADHD child is tough but with knowledge and support you can do it.
o REPEAT AFTER ME: PARENTING DOES NOT CAUSE ADHD.
o IF YOU OR TEACHER SUSPECT ADHD GET THE CHILD TO A SPECIALIST IN BEHAVIORAL PEDIATRICS–FAST.
o DON’T BE AFRAID TO USE MEDICATION IF INDICATED.
o LEARN STRATEGIES FOR MANAGING CHILD AT HOME AND IN PUBLIC.
o WORK AS A TEAM: PARENTS, DOCTOR, SCHOOL, CHILD
o DISCOVER AND NURTURE CHILD’S COMPENSATORY STRENGTHS AND BELIEVE IN YOUR CHILD.
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