ADHD
What is ADHD
ADHD stands for Attention Deficit Hyperactivity Disorder
ADHD is not a new problem or condition but over the years it has been called many things. In the 1930’s it was a brain-injured child, in the 1950’s hyperactive child syndrome, in the 1960’s minimal brain dysfunction and in 1965 it changed again to hyperkinetic child syndrome. By 1975 it was being termed ADD and in 1987 it changed to the familiar name of ADHD.
The current clinical definition of ADHD is that the child is developmentally excessive in areas such as inattention, impulsivity and over activity.
This is the technical bit; the brain basically works in 3 parts; receiving cells, transmitters and sending cells.
The receiving cells enable the action, which is then passed onto the transmitters, which are the bridging gap between receiving and sending out information, or an action, to the body. The information or action is then sent out the message via sending cells.
In the case of ADHD there is a problem with the receiving cells -Like a chip in a plate or glass. In situations where medication might help, the medication provides more transmitters, which help the message continue on its path.
The causes of ADHD.
Many of us sit and wonder why our child has ADHD or what have we done to cause it but it is not an uncommon condition. There is a list of known causes that have been linked to people having ADHD. In 75% of cases it’s genetic (this doesn’t have to be immediate family member like a parent but it could be a distant relative like a great uncle). It’s twice as common in boys as girls. Smoking can be a factor as can alcohol use in pregnancy, Prematurity, a brain injury or pregnancy complications.
ADHD is not caused by bad parenting, diet or food additives.
Some people have noticed that children with ADHD cannot tolerate food additives which can heighten the ADHD symptoms, but it is not the cause of ADHD.
When ADHD is likely to appear
Onset of ADHD is normally before 7 years of age, although it is rarely diagnosed before a child is reaches 3 years of age. This is due to the fact that the natural tendencies of a preschool child can make it hard to differentiate between normal behaviour and traits of ADHD. Also health care professionals like it to be present for at least 6 months, and not linked to, or in response to, a particular event. It must also be present both in the school and home environments, and causing a significant impairment for the child, to make them intervene and offer support. In some cases it has been known to be diagnosed at an earlier age, but this is uncommon.
The 3 main types of ADHD
Hyperactivity and Impulsive traits
A Child with the Hyperactivity and Impulsive traits often fidgets or squirms, leaves there seat in a classroom situation, runs about or climbs excessively or has feelings of restlessness. They have difficulties in engaging in activities quietly and can act as if they are ‘driven by a motor’. They talk excessively and blurt out answers as they have difficulty in waiting their turn (even apparent in games). They also can interrupt or intrude on others.
Inattentive
A child with the Inattentive trait often has difficulty with sustained attention. They often fail to give close attention to details and don’t seem to listen. They don’t follow through on instructions and have difficulty in organising tasks and activities. They often avoid tasks involving sustained mental effort (for example; homework). They can even loose things that are needed to do tasks and activities. They are easily distracted by things such as a butterfly or a dot being put on top of the letter ‘i’ and they are often forgetful.
Combined Hyperactivity-Impulsive-Inattentive
Is all of the above which is why; it can be such a testing but rewarding time having a child with ADHD.
Many children who have ADHD only have this condition, but for some children ADHD is often diagnosed alongside other conditions, giving the child multiple problems to face. This means that there is co-morbidity occurring. There are 7 common co-morbidity groups which can be found along side ADHD, these are:-
- Oppositional defiant disorder
- Mood disorder
- Social Skills
- Anxiety
- Conduct disorder
- Dyslexia
- TICS
ADHD is difficult enough and unmanaged it can give rise to increasing complications. By this an example is: When you first receive the diagnosis around the age of 5/6yrs it’s just plain ADHD, but over time the child picks up traits such as low self-esteem, disruptive behaviour, poor social skills and learning delay. All these traits are picked up from how the child is perceived at school and home by friends and family. I.e. if your given the label of being a class clown and people like you because of it you’ll act up to it to have friends but the same goes if someone is called stupid enough then it will stick and they start to believe it and can easily give up. If these problems aren’t picked up on and the support provided it can lead to problems later on in life such as oppositional defiant disorder, challenging behaviour and in extreme cases complex learning difficulties, lack of motivation, substance abuse and conduct disorder.
The Lifecycle of ADHD
ADHD can persist into adult life. The proportion of children that still have it as adults is normally termed as mild ADHD. Mild ADHD doesn’t need treatment, but the techniques and coping strategies learnt as a child will aid everyday tasks and a routine is helpful. However it isn’t always a hindrance, being impulsive in later life can be seen as being a risk taker. Below are some Geniuses record breakers, celebrities and role models that have or had ADHD:-
- Thomas Edison
- Alexander Graham Bell
- Picasso
- Whoppi Goldberg
- Jim Carey
- Lewis Carroll
- Richard Branson
- Albert Einstein
- Isaac Newton
- Handel
- Napoleon
- Alfred Hitchcock
- Michael Jordon
- Carl Lewis
- Winston Churchill
Treatment
When treating ADHD health professionals take a multimodal approach, targeting 3 areas:-
- The child by educating about ADHD (to each child’s own level), medication if they have severe ADHD and therapy.
- The school by educating about ADHD, behaviour management and educational support and last but not least;
- The parent, by educating about ADHD, behaviour management and by offering family support.
Many health care practitioners are reluctant to prescribe medication and prefer to help in other ways. I.e. help with parenting, setting and sticking to boundaries, rewards etc and try to avoid medication at all if possible. However where medication is needed, which is only the case with 1-2% of children with severe ADHD, there are 2 main forms - short-acting medication and slow-release medication. The short acting medication works soon after being taken and only has to be taken by the child on school days. Normally in the morning and often at lunch time to keep the added transmitters in place for the school day, it is also not uncommon, where after school clubs take place, to take 3 tablets a day. However as the child grows older and is more aware of the medication, the longer lasting medication has to be taken, a bit like anti depressants, on a daily basis. It takes a while to build up in the system but it gives the child a less tablet strict regime.
Medication isn’t without side effects and will need constant observation where height, weight and blood pressure are monitored on a regular basis. Although medication is often seen as a tool to help everything but it unfortunately doesn’t. It can help poor concentration and unstructured behaviour, giving the child an increased ability to pay attention, focus on tasks, listen to what is being said and for them to follow through on tasks. They can also help by decreasing the child’s level of forgetfulness. However it may only slightly alter impulsivity, hyperactivity and frustration outbursts.
Things it’s unlikely to change are things that are classed as learned behaviour: Attention seeking, defiance, severe aggression and spitefulness, destructiveness, verbal abuse, anti social behaviour and temper tantrums.
Common questions about children
- How can they concentrate on reading when the TV is on?
- Why do they always seem to be chewing something?
- Why do they shake a foot all the time?
- Why can’t they sit still?
- Why do they seem restless when standing up?
This all depends on a child’s ability to receive and register the information they see, hear, touch etc. For a child with ADHD we have to consider and put ourselves in their shoes; - Is the world overwhelming or underwhelming?
When we try to get a child with ADHD to sit still and not do more than one thing at a time we don’t always realise that might be almost impossible for that individual child, especially if they see it as underwhelming, as to them fidgeting is a natural way for their bodies to try and help them focus. Their restlessness is not an expression their boredom or them trying to ignore you, they fidget in order to become more focused on the main job at hand. The distractibility is really attractability to interesting things around them. By constantly spilling over all the time by drumming their fingers, the tapping of feet, humming a tune, doodling, looking here and there, scratching and stretching people may thing they’re not interested but so that they can pay attention.
However, fidgeting does need to be respectful. In today’s society where children are expected to sit at a desk and learn, sit still and quietly in assemblies and sit at the table to eat, we need to find respectful and acceptable ways to help them fidget to keep their concentration, whilst not distracting those around us.
Some ways which might be able to be adapted to suit your child are:-
- By movement/Touch:
- Rhythmic, repetitive actions – Like twiddling the thumbs, with fingers interlinked.
- Fine motor movements – Doodling, fiddle toys, twirl hair, lick pen, fiddle jewellery, stroke textures and if brave and you can live with it, pen tapping.
- Mouth movements – chewing (straw or gum), sucking or biting.
- Sight:
- Visually stimulating TV
- Noticing peripheral things – like time: - break things down? Work under pressure, race against clock.
- Sound:
- Music, TV, whistling, humming, reading out loud.
- Smell:
- Fruit smelling marker pens.
There are some exercises you can do if you are over-aroused and alert or if you are feeling sluggish, they can help put our motor and our child’s into a state of calmness.
- Push or pull
- Lift or carry
- Handstands, push-ups, gymnastics
- Backpacking, weighted vest
- Trampoline
- Walking dog (on lead)
- Tug of war
- Crawling through tight space
- Rolling on floor
- Quick heavy work
- Push hands together
- Push down hands on top of head
- Push up from chair with your arms
- Lying down and pushing legs against wall
- Pushing against wall with hands outstretched
- Lying under heavy blankets.
Experiment – Have some fun figuring out what works for you and your child!
What you can do as a parent
There are many times we all wish parenting came with a manual and I thought the red log book you get handed when they are born was one, however this isn’t the case and having a child with ADHD is no exception.
Parenting a child with ADHD and a child without ADHD are surprisingly similar. You have the same parental tasks (security, growth and safety). The child has the same needs as other children. Behaviour techniques are common to all children.
However children with ADHD often have labels attached to them: - attention seeking, violent and aggressive, selfish, unintelligent, badly behaved and thoughtless and this is where the differences occur: - rewards need to be more immediate, instructions need to be simpler, parents need to be calmer and more creative and have different expectations.
Common difficulties that a child with ADHD face are low self esteem, finding it hard to express their feelings, struggling with friendships (as they take things literally, like pull your socks up), they find it hard to control their feelings and emotions and they frequently don’t reach their potential educationally.
Try to separate the child from the ADHD and create an opportunity for the child to share their understanding and hear their voice. ADHD is difficult for children to understand.
One way of looking at it is it’s like a blob on their shoulder feeding on negativity and shouts so loud that they struggle. If it helps the child they can name it. Ask them what makes blob quieter? What makes the blob sit down by their feet so they can’t hear him/her? ADHD (aka blob) is like their bad side, but their good side is better – it’s them.
Helping children whilst managing unwanted behaviour
Try and imagine yourself in your child’s shoes. Children constantly being told no and criticised for imperfection, stop trying and stop listening. So when speaking to the child try and use p words in stead of c words. For example instead of correcting give positives – Look at the time it took you to wash – Well done for washing yourself. Also instead of commanding be empowering, instead of coercing give praise and instead of showing criticism show you are pleased. Give them plenty of eye contact.
Call attention to the child’s competencies and strengths. Have achievable expectations and goals, set the child up to succeed instead of failing. I.e. if they have to go fetch a jumper, go and get yours at the same time. Use visual clues – colour coded items, post-it notes, and dry erase markers on a mirror.
Use simple instructions and do less talking. Say ‘go get your coat’ then ‘can you now put your coat on?’. If you send a child with ADHD to go get there coat and put it on in one go, they are likely to get half way and forget what it is that they are doing.
Choose your battles – Is it necessary to fight them tooth and nail if they don’t want to wear a coat or let them go outside and learn for themselves its cold and they will put it on? Provide a safe and secure environment though boundaries, routines and consistency. Give more positives than negatives. Stick to a few clear rules, if needs be write them out together, or draw pictures together to help them remember.
Praise, praise and praise! You can never praise a child enough. Phrase positively even if it’s not fulfilling the full command. I.e. well done for getting up, or well done for moving towards your coat. Give immediate rewards, if you let the child stay up 15mins later at night they will have forgotten what they had done to get the reward instead give stickers or ‘caught doing good behaviour’ coins (which can be traded in for sweets or a DVD etc. or just plain fun time with play doh). Reward whenever possible, hugs, kisses, smiling, listening, a pat on the back, verbal phrase, stickers or coins.
Try and stay calm and don’t make threats (easier said than done I know!)
Use small, consistent, logical consequences – if they knock a drink over get them a cloth and ask them to help you clean up. If they are being a magpie, take something of theirs and only give it back when the item(s) have been returned.
Play child lead play. What do they want to do? How do they do things? Give lots of positive enhancements – you could comment wow you’ve got a red brick and now a yellow one and you’ve stacked them up (adapting to the child’s age of course).
If you feel yourselves heading in towards a battle walk away from the situation rather than loosing your temper.
Be consistent with the methods you use. There are methods used by professionals such as the 123 magic technique which is similar to the super nanny naughty step/spot method, you give 3 warnings; the 1st time you say ‘please don’t do that, it’s not safe to throw a ball in the house’. The 2nd time you’d say something like ‘Fred that’s 2 warnings now’. The 3rd time you say ‘Ok that’s 3 warnings now; you go to your time out space and chill’. You then go to them and tell them they were put in their time out space as they continued to throw a ball in the house. Try to end by saying something like ‘well done for sitting still’ or ‘well done for coming to your corner with me’. Always finish with a positive.
A child’s self confidence can be likened to that of a piggy bank. If you fill it with positive praise the child will be full and happy, and if they receive the odd negative comment it’s not going to dent there confidence a huge deal but if the piggy is running on reserves and they continually get negatives then they can begin to have self confidence issues and doubt there abilities to be good and can even give up trying.
Parenting techniques for ADHD will also work with other children and their sibling, making them all feel treated the same.
Information learnt from attending an awareness day for parents with children who have ADHD run by Cambridgeshire and Peterborough Child and Adolescent mental health service attended March 2008.
This is a members article written by Zanynut and prepared for the web by Madzwalker
|
Del.icio.us
Digg
Google
Spurl
Blink
Furl
Simpy
Y! MyWeb
