ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
ABOUT Attention Deficit Hyperactivity Disorder (ADHD)
ADHD can manifest with or without hyperactivity or Behaviour Disorders. Most children with ADHD can be well behaved and polite and are beautiful children of normal intelligence and many have above average intelligence. However, they can often be overly inattentive and be easily distracted, they can be fidgety and may tend to make impulsive mistakes. The media often concentrates on presenting mostly the hyperactive children with associated behaviour disorders as representative of ADHD. Consequently, parents with the more inattentive subtype are understandably unwilling to accept that their child may have ADHD.
SYMPTOMS OF ADHD
The principal characteristics of ADHD are inattention, hyperactivity, and impulsivity. These symptoms appear early in a child’s life. Because many normal children may have these symptoms, but at a low level, or the symptoms may be caused by another disorder, it is important that the child receive a thorough examination and appropriate diagnosis by a well-qualified professional.
Symptoms of ADHD will appear over the course of many months, often with the symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more. Different symptoms may appear in different settings, depending on the demands the situation may pose for the child’s self-control. A child who “can’t sit still” or is otherwise disruptive will be noticeable in school, but the inattentive daydreamer may be overlooked. The impulsive child who acts before thinking may be considered just a “discipline problem,” while the child who is passive or sluggish may be viewed as merely unmotivated. Yet both may have different types of ADHD. All children are sometimes restless, sometimes act without thinking, sometimes daydream the time away. When the child’s hyperactivity, distractibility, poor concentration, or impulsivity begin to affect performance in school, social relationships with other children, or behavior at home, ADHD may be suspected. But because the symptoms vary so much across settings, ADHD is not easy to diagnose. This is especially true when inattentiveness is the primary symptom.
According to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders2 (DSM-IV-TR), there are three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive far more than others of their age. Or they may show all three types of behavior. This means that there are three subtypes of ADHD recognized by professionals. These are the predominantly hyperactive-impulsive type (that does not show significant inattention); the predominantly inattentive type (that does not show significant hyperactive-impulsive behavior) sometimes called ADD—an outdated term for this entire disorder; and the combined type (that displays both inattentive and hyperactive-impulsive symptoms).
Hyperactive children always seem to be “on the go” or constantly in motion. They dash around touching or playing with whatever is in sight, or talk incessantly. Sitting still at dinner or during a school lesson or story can be a difficult task. They squirm and fidget in their seats or roam around the room. Or they may wiggle their feet, touch everything, or noisily tap their pencil. Hyperactive teenagers or adults may feel internally restless. They often report needing to stay busy and may try to do several things at once.
Impulsive children seem unable to curb their immediate reactions or think before they act. They will often blurt out inappropriate comments, display their emotions without restraint, and act without regard for the later consequences of their conduct. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they’re upset. Even as teenagers or adults, they may impulsively choose to do things that have an immediate but small payoff rather than engage in activities that may take more effort yet provide much greater but delayed rewards.
Some signs of hyperactivity-impulsivity are:
Children who are inattentive have a hard time keeping their minds on any one thing and may get bored with a task after only a few minutes. If they are doing something they really enjoy, they have no trouble paying attention. But focusing deliberate, conscious attention to organizing and completing a task or learning something new is difficult.
Homework is particularly hard for these children. They will forget to write down an assignment, or leave it at school. They will forget to bring a book home, or bring the wrong one. The homework, if finally finished, is full of errors and erasures. Homework is often accompanied by frustration for both parent and child.
The DSM-IV-TR gives these signs of inattention:
Children diagnosed with the Predominantly Inattentive Type of ADHD are seldom impulsive or hyperactive, yet they have significant problems paying attention. They appear to be daydreaming, “spacey,” easily confused, slow moving, and lethargic. They may have difficulty processing information as quickly and accurately as other children. When the teacher gives oral or even written instructions, this child has a hard time understanding what he or she is supposed to do and makes frequent mistakes. Yet the child may sit quietly, unobtrusively, and even appear to be working but not fully attending to or understanding the task and the instructions.
These children don’t show significant problems with impulsivity and overactivity in the classroom, on the school ground, or at home. They may get along better with other children than the more impulsive and hyperactive types of ADHD, and they may not have the same sorts of social problems so common with the combined type of ADHD. So often their problems with inattention are overlooked. But they need help just as much as children with other types of ADHD, who cause more obvious problems in the classroom.
DIAGNOSIS OF ADHD
ADHD requires a medical diagnosis by a doctor, usually a child or adolescent psychiatrist, a paediatrician or paediatric neurologist or a GP.
It will often be appropriate for other professionals such as psychologists, speech therapists, teachers and health visitors to contribute their observations to the assessment of a child with possible ADHD. There is no single diagnostic test for ADHD so different sorts of information needs to be gathered, such as the following:
History of symptoms
The precise nature of the difficulties, when they were first noticed, in what situations they occur, factors that exacerbate or relieve them.
Risk factors that could predispose the child to ADHD include difficulties and risks in pregnancy and during birth, for example if the mother was in poor health, very young or drank alcohol or smoked or had an extended or complicated labour.
Several medical conditions are known to be associated with ADHD. These include fragile-X syndrome, fetal alcohol syndrome, G6PD deficiency, phenylketonuria and generalised resistance to thyroid hormone.
Accidents, operations and chronic medical conditions such as epilepsy, asthma and heart, liver and kidney disorders all need to be taken in to account. Also of possible relevance is any medication the child is taking, as well as any adverse reactions they have had to medication in the past.
Past psychiatric history
Enquiring about any mental health problems the child has had can help rule out depression or anxiety being behind the symptoms.
This means the level of their ability and what specific difficulties they have, how they function within their peer group and get on with teachers, and any behaviour difficulties such as suspensions or exclusions. A more detailed evaluation of the child's learning by a psychologist may be necessary.
Evaluation of the child's temperament and personality
The child's temperament and personality, those of other family members and the nature of relationships within the family may need to be assessed. This will include discussion of the methods used by the parents to manage the child's behaviour and how successful they have been. Although this seems intrusive, the assessor will remain neutral and parents should not feel the disorder is 'their fault'.
The mental and physical health of the child's parents and other family members can be relevant, particularly regarding the incidence of ADHD or depression.
The family's social circumstances, such as housing, poverty, and social support may all have an impact on the child's behaviour.
WHAT CAUSES ADHD?
Children who have ADHD do not make enough chemicals in key areas in the brain that are responsible for organizing thought. Without enough of these chemicals, the organizing centers of the brain don't work well. This causes the symptoms in children who have ADHD. Research shows that ADHD is more common in children who have close relatives with the disorder. Recent research also links smoking and other substance abuse during pregnancy to ADHD.
Things that don't cause ADHD:
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