Is It Really Attention Deficit Hyperactivity Disorder?
|ASEHA Leaflet Series - ADHD|
What is ADHD?
ADHD is a disorder that primarily affects a child’s behaviour (as interpreted by parents and teachers) and refers to a combination of symptoms in the general area of inattention, impulsivity and hyperactivity. The child is unable to remain at rest while awake, has less total sleep time and has difficulty concentrating on a particular activity.Studies estimate between 2 to 9.5% of all school age children worldwide has ADHD. Males are 4 – 9 times more likely than females to have the disorder although the disorder is increasing amongst girls. Some 20 to 25 % of children with ADHD will also have severe learning disabilities. Learning disabilities do not necessarily mean that the child has ADHD but the two can co-exist.
What are the Signs and symptoms of ADHD?
There is marked variability in signs and symptoms over time, across situations and even within the same child in a similar situation. The ADHD symptoms can be mild, moderate, or severe, depending on the child and their situation. During times of stress, these behaviours may become more exaggerated.
ADHD is characterised by the inability to Focus on tasks and individuals will display either
• Hyperactive and impulsive - fidgety, restless behaviour, the tendency to blurt out answers and interrupt others or
• Lethargic inattentive, distractible, and disorganised, but not particularly hyperactive - dreamy, forgetful, and careless or
• Both Impulsive behaviour and lethargic inattention. This is the most common and most severe.
How is ADHD Diagnosed?
Behaviour patterns that are typical of ADHD usually arise at age 3 to 5 years, but a diagnosis is not usually made until problems with lack of concentration become apparent at school, typically in the first or second grades (ages 7 to 8). ADHD must be diagnosed by a doctor on the basis of observed and reported symptoms over at least a six month period.
What causes ADHD?
The cause/s of ADHD is currently under investigation and many theories have evolved.
Genetic/ Inherited characteristic:
Evidence of an inherited characteristic comes from family and studies.
The disorder may arise from a neurological defect, with abnormalities in the brain tissue and brain neurotransmitter function.
Distinguishing ADHD from other causes of behavioural problems:
At certain ages, specifically with very young children and teenagers, the distinction between ordinary, age-appropriate behaviour and disturbed behaviour is difficult to draw. Diagnosing ADHD in children less than three years is difficult as they naturally have a shorter attention span and impulsive behaviour.
- Emotional trauma can play a large part in behavioural problems and should never be overlooked. Stressful situations such as a new baby in the house, divorces, domestic violence, or a motor car accident can result in ADHD like behaviours.
- Many children who suffer from other conditions such as learning disabilities, Tourette’s Syndrome, autism, anxiety, or depression express their emotional distress through their behaviour.
- When home and school fail to provide the type of environment a child needs, even those without the disorder can become bored, discouraged, restless, and inattentive.
- Some children have problems related to poor vision and poor hearing.
- Children with early puberty may experience more behavioural problems, anxiety disorders, depression and lower cognitive function.
- Metabolic disorders such as hypoglycaemia, diabetes, or thyroid dysfunction can affect behaviour and learning.
- Nutritional deficiencies may also play a part. Nutritional deficiencies such as vitamin B, zinc or iron deficiencies can cause behaviour problems.
- Heavy metal poisoning (eg lead) can cause a variety of symptoms such as headache, fatigue, hyperactive behaviour, poor attention span, and aggressive behaviour.
- Perfumes, fumes and inhalants from non-food items including paints, cosmetics and garden plants may also affect behaviour in susceptible children.
- The issue of foods, food additives and sugar as a cause of ADHD is controversial and there are studies that both confirm and deny this theory. It maybe that some foods may exacerbate some of the symptoms of ADHD or cause some behavioural problems that are not necessarily associated with ADHD.
How is it treated?
The primary treatment for ADHD is stimulant medication but the most successful management appears to come from a combination of therapies that are aimed toward developing self-esteem, effective social skills and good pragmatic language skills. Educational management is an important priority.
Medications commonly prescribed for ADHD
Medications include methylphenidate (Ritalin), dextroamphetamine (Denedrine), and pemoline (Cylert). By prompting an increased production of dopamine and norepinephrine, two of the brain's neurotransmitters (messengers), these medications increase nervous system alertness, enhancing a person's attention while reducing excess restlessness.
Other forms of therapy used alone or in conjunction with medication are
- Cogitive-behavioural therapy: In this type of therapy, children are taught to control their aggression, modulate their social behaviour, regulate their attention and physical movements, and learn more thoughtful and efficient problem-solving strategies.
- Social skills training: Social skills training uses reinforcement strategies and rewards a child as they develop and apply appropriate behaviour to social circumstances.
- Parent and family training programs: In these sessions, parents learn practical strategies for helping the children manage their behaviour and address the normal stresses of living with a child with ADHD.
- Remedial education: Remedial education or special tutoring may be needed to compensate for learning difficulties, reading disorders, or language delays when they exist.
How can the parent, family, and teacher help?
The areas where children with ADHD have difficulties are the mental processes required to complete a task. ADHD children lack the capacity for self-control – the ability to inhibit or delay the initial (and maybe emotional) response to an event.
The mental activities that are deficient in ADHD are those that:
• Help deflect distractions
• Recall the aim of the task – working memory
• Help take the appropriate sequence of events in order to achieve the aim
• Remain emotionally in control
• Maintain motivation and state of arousal
Children with ADHD require special ‘cues’ in order to:
• Remember the aim and objectives of a task
• Achieve the aim by breaking down the steps involved
• Remain motivated and interested in a task
• Remain focused on a task
A more structured and organised environment may help a child with ADHD. This may be achieved by:
• Making the consequences of a child’s actions more frequent and immediate
• Increasing the external use of prompts and cues about rules and time intervals
• Anticipation of events, breaking down tasks into smaller and more immediate steps
• Using artificial and immediate rewards
• Support and stability within the family and sufficient structure and challenge at school can help most children.
Where to go for help
A team approach is essential for success. You will need a sympathetic GP, you may need to see a neurologist, endocrinologist, ENT specialist, eye specialist, behavioural optometrist, psychologist, psychiatrist, speech therapist, occupational therapist, physiotherapist, remedial teacher, guidance officer, immunologist, allergy dietitian/nutritionist, clinical ecologist - to help with the diagnosis. Help can be sought from your local Child Guidance Clinic, Special Education Development Unit and a support group to help you cope.
• National Attention Deficit Disorder Association
• Attention-Deficit/Hyperactivity Disorder. CDC. National Centre for Environmental Health.
• Food Intolerance Network Australia link Food Additives Information
• Royal Prince Alfred Hospital, NSW, Australia Link RPAH Allergy Clinic
• Dietitian Link Joan Breakey site
• The MERCK Manual of Diagnosis and Therapy. 15th Ed. Merck Sharp & Dohme Research Laboratories. Merck & Co Inc. Rahway, NJ, 1987
• Shaywitz BA, Fletcher JM, Shaywitz SE 1997 Attention-deficit/hyperactivity disorder. Adv Pediatr 44 331-67
• Sparke C. 1999. Early puberty linked to disorders. Aust Doc. 26 March 1999
• Heyer JL 1995 The responsibilities of speech-language pathologists toward children with ADHD. Semin Speech Lang Nov 16:4 275-88
• Halperin L. 1999 Giving an ADD in-service for school staff. National ADDA. www.add.org
• Barkley RA. 1998. Attention-Deficit Hyperactivity Disorder. Scientific American. Feature Article September 1998.
• InteliHealth Website. John Hopkins Health Information. Attention-Deficit Hyperactivity Disorder http://intelihealth.com/
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Last Updated (Saturday, 14 November 2009 03:34)