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Attention-Deficit/Hyperactivity Disorder Introduction Children with ADHD are inattentive, impulsive and hyperactive. Although all individuals are at some time restless and inattentive, these qualities are more persistent with children who have ADHD. ADHD is thought to be due to developmental and genetic factors that affect biochemical and metabolic function. Medication is the primary effective treatment, and behavioral management strategies are useful for those who may have behavioral problems. Jake, 9 years old, is starting to avoid school. His teacher reports that he squirms around in his seat, stands up unexpectedly and seldom finishes his work. The kids sitting near him in class say he's always interrupting and shouting out the answers (generally wrong). His desk is in disarray; papers are on the floor and his work is disorganized. He's often not picked for soccer games and then tries to spoil the game for the others. Sarah, l4, chooses to sit in the back of the classroom, and much of the time she's doodling in her notebook or staring out of the window. She seldom completes assignments and often forgets to bring the right books to class. Her desk is a mess and she usually can't find what she's looking for. Then she gets resentful and says that everybody picks on her. Danny, aged 4, attends nursery school. He has an aide assigned specifically to help him comply with the routine of the group. He would prefer to roam around the room, picking up toys here and there but doesn't really get interested in any one activity. During story time he doesn't become involved in the story, but keeps repeating the same questions in a loud tone of voice. Danny's mother states that she avoids family gatherings and celebrations because he gets overly excited and then she can't control him. Sarah, Danny and Jake have all been diagnosed as having ADHD, the most common of the childhood psychiatric disorders. Mental health professionals use this diagnosis to describe a group of behaviors that occur when self-control is not developed appropriately in relation to the child's age. What are the symptoms? ADHD is a behavioral disorder with three major symptoms:
In diagnosing ADHD some questions are critical:
There are three major types of ADHD:
Children with ADHD are at a high risk for other problems. Some experience trouble with learning, such as reading and language processing difficulties, that are not just the result of inattention. Some children with ADHD have difficulty in regulating their behavior to follow rules and can be quite obstinate and resistant to limits and authority. Because children and adolescents with ADHD tend to seek excitement, feel bored more easily and spend little time planning things through, some gravitate toward thrill-seeking behaviors. Anxiety and depression are more common in children with ADHD than in the general population. Some children may be so worried that they find it hard to stay focused on academic work. Similarly, sad children are also less likely to stay focused and to feel motivated to keep up with school demands. If they are irritable, they may resist direction or lash out. Who is likely to have it? Three to five percent of all children have this disorder, with some estimates as high as 15%. That means that more than a million children in the U. S. have ADHD. It is more prevalent in boys than girls, with the ratio estimated at anywhere from 4:1 to 9:1. (The ratio may shift as we come to learn more about how the specific manifestations of ADHD differ between boys and girls.) Although signs of ADHD may be apparent during the preschool years, most families seek help when the child starts is in elementary school and the child's behavior interferes with his adjustment and learning. ADHD is a chronic, not an episodic, illness. It generally starts early and may get worse over time as the demands on the child increase. Early and mid-adolescence are particularly difficult times for children with ADHD. In some children the symptoms diminish or disappear during late adolescence. It is unusual for 12-year-olds to run through stores or jump on furniture, but they may feel restless and avoid situations. They may depend on medication to function to their capacity in academic and social situations. About half of the children with this disorder may outgrow the symptoms by early adulthood; the other half learn strategies for getting work done and getting along with other people. In a small proportion, the disorder will persist through the rest of their lives. Why does it happen? ADHD is not the fault of the parent or the child. Children are born with a vulnerability to this disorder. There is evidence that ADHD is genetic; parents of children diagnosed with ADHD showed symptoms associated with the disorder when they were younger. Among twins, ADHD is more likely to occur in those who are identical than among those who are fraternal. Children with ADHD suffer from a brain-based biological disorder. They have lower levels of dopamine, a neurotransmitter. In addition, brain-imaging studies using PET scanners show that brain metabolism is lower in patients with ADHD than in normal controls, with significantly lower metabolic activity in regions of the brain that control attention, social judgment and movement. Other tests of brain function, such as MRIs, have shown similar patterns. There are more than 200 studies showing that a stimulant called Ritalin (generic name: methylphenidate) which has been used for ADHD for more than 90 years, is effective with the vast majority of ADHD children. The medication increases the child's attention and reduces excess fidgetiness and hyperactivity, thus enabling the child to take advantage of his talents and interests. Children who take Ritalin are less impulsive and more attentive, both in the classroom and in social situations. When Ritalin is not effective or produces side effects, such as reduction in appetite, delay in falling asleep, headaches or tearfulness, other similar medications are routinely prescribed. In many cases, the medication produces marked improvement, to the delight of all those who care about the child. Some children improve a great deal with medication, but they still have problems with self-control or problems with getting along in school or with the family. When this occurs, it makes great sense to help the family and the child through carefully designed behavioral treatments involving the child, family, school personnel, and prescribing physicians. Questions & answers Isn't a lot of activity and running around just part of being a boy? Wouldn't Huck Finn and Tom Sawyer be taking Ritalin today? ADHD is real. There are essential symptoms or criteria that comprise the disorder. The most compelling evidence of how young people with ADHD differ from garden variety "boys will be boys" comes from outcome studies in which adolescent boys diagnosed earlier with ADHD still show higher rates of ADHD symptoms. Does ADHD lead to drug abuse? There is no evidence that this is the case. Untreated ADHD can lead to serious conflicts with authority and with age may turn into a pattern of behavior called Conduct Disorder. This adds significantly to the risk for drug abuse. However, it appears that if ADHD children do not develop a Conduct Disorder they are not more prone to drug abuse than their peers who never had ADHD. Do adults have ADHD? Recent studies show that the children with ADHD continue to have symptoms through adolescence. It is not clear how many continue to have the disorder, but many improve during late adolescence. Adults with ADHD continue to have problems such as disorganization, impulsively saying or doing things that cause problems with others, being chronically late, not following through on assignments, a quick, explosive temper, recklessness, etc. How does medication help ADHD? Medication may affect the brain centers involved in attention. It decreases distractibility, focuses attention, and promotes self-control. Medication often leads to direct improvement in school functioning and to improved behavior and social relationships. Why is behavior therapy important? Behavior therapy involves developing a system of dealing with the child's behavior to curtail problem behaviors and increase self-control and compliance. Two broad sets of techniques are involved. One tries to increase positive behaviors by making the child aware of the circumstances that trigger the behavior, such as giving very clear directions, changing the class seating arrangement, modifying school demands, providing structure during peer interactions. The second set of techniques deals with the way adults react to the child's behavior so that positive consequences follow compliance and mild undesirable consequences following difficult behaviors. Consequences for positive behavior may include rewards; consequences for negative behavior may include loss of rewards and time-out. Collaboration between parents and school by means of a daily or weekly report card is helpful. Source: http://www.aboutourkids.org/aboutour/articles/about_adhd.html Parenting a Child with ADHD - by Alisha Leigh I’m not a medical doctor, psychologist, lawyer or other expert – I'm a mom who struggles to help my ADHD/ADD child. In this regard, I’ve spent a considerable amount of time searching for answers. It’s my hope that by sharing this information it will raise public awareness as well as be instrumental in lending a helping hand toward finding “a place to start.” There's something here for everybody. Perhaps you've just learned your child has ADHD, and you are on an emotional roller coaster ride. Perhaps you've scanned this letter and felt an overwhelming sense of fear, frustration, or what next? -- Maybe felt, "I can't do this." Consider yourself normal. Parenting a special needs child is a challenge, but you can do it. On the up side, it is easier to deal with a problem if you know what you are dealing with. Now you can begin to sort things out and make a plan. Listed below are some tips I've learned along the way: 1. Accept that there is a problem, whether or not you accept the diagnosis. Denial will not help you or your child. 2. Do not expend energy grieving that your child is "labeled." No, it's not fair but grieving will not make things better. Take some time to pull yourself together -- then get on with parenting your child. 3. Be prepared to feel guilty about the time you spend parenting your ADHD child compared to the time you spend with other family members. Be prepared for backlash you may get caught-up in as a result of other family members feeling neglected. 4. You will have to look deep within yourself to find patience. Patience dealing with your child, patience waiting for appointments, patience waiting for test results, patience when working with the school district, patience, patience, patience. 5. In general, all children need structure. ADHD children require more structure, routine and consistency. 6. Behavior management plans do not work overnight -- many times it takes two to three months to see results -- sometimes longer. Many times the "plan" ends up being a little from this one and a little from that one. Make clear, age and developmentally appropriate rules and consequences for infraction of those rules. Your child must know your expectations. 7. It is critical that all caregivers in the household be on the same page when it comes to disciplining your child. If one parent perceives his/her spouse to be very lenient and the other has the opposite perspective, it's time for the parents to compromise. If it requires that you have a family meeting and put rules and consequences on paper -- so be it. Behavioral expectations and consequences for violations should be as consistent as possible between caregivers. Remember "structure, consistency." And yes, this is easier said than done. 8. In my opinion, Attention Deficit Hyperactivity Disorder is somewhat of a misnomer. It's not that ADHD children do not pay attention, it's that they are bombarded with information. Their filtering system does not work correctly. 9. It's not unusual for an ADHD child to do well one day, and not so well the next. If you think your child can perform well in school today because s/he did yesterday, you are mistaken. 10. ADHD children are very sensitive to their environment. The more noise, color, people, clutter, movement, the higher the difficulty level staying focused. Guard against over-stimulus. 11. ADHD children generally do not transition well. I've found it helpful to give my child "lead time." For example, rather than saying "8:00 p.m. -- bedtime," it works better if I give some lead time by saying, "bedtime in 15 minutes…bedtime in 10 minutes…bedtime in 5 minutes." 12. Many people you meet will think they know a lot about ADHD, but actually they know very little. Some people do not believe there is such a thing as ADHD. It is these people that inadvertently add to our burden. They have no concept of the disorder, choose to have no more than a cursory knowledge of ADHD, yet tend to shout the loudest and have the strongest opinion that "it's the parenting. I could straighten him out in a week." It would be so wonderful if that was the case, but it is not. If your efforts to educate them fall on deaf ears, print a copy of this letter and give it to them. If that doesn't work "maverickmom" has some excellent advice in my opinion: Tell them to blow it out their socks. 13. It is our job as parents to teach our children to function in this world to the best of their ability. In this respect, do not let the ADHD "label" cripple them. Keep your expectations high and teach them to adapt the best they can. As a parent, it's difficult to walk the centerline of teaching responsibility while addressing potential limitations. 14. This day in time everyday living is a challenge. Throw in an ADHD child, the extra time required to parent a special needs child, problems with health insurance, the extra financial strain, perhaps an uncooperative school district, the additional stress within the family unit and you have a formula for a full-blown crisis. Do not forget to take care of you. You can't adequately care for your child(ren) if you're mentally and physically falling apart. Do something special for yourself from time to time. Join a support group, call a crisis hotline when necessary, go see a movie, go shopping, and/or see a counselor. 15. There is still much that is unknown about ADHD, but treatment has come a long way by comparison to yesteryears. There is reason to believe that ADHD treatment will improve as research advances. 16. Unfortunately ADHD/ADD rarely travels alone -- it appears to be the norm rather than the exception when there are no accompanying disorders such as an auditory processing disorder, learning disorder, bi-polar, non-verbal learning disorder, sensory integration disorder, etc. And just because your child makes good grades in school doesn't mean the child does not have a co-existing disorder. 17. Trust you instincts. No one knows your child better than you. Source: http://www.keepkidshealthy.com/parenting_tips/parenting_child_adhd.html |
