Attention Deficit Hyperactivity Disorder

What is attention deficit hyperactivity disorder?

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Its causes are unknown but it is believed to be neurobiological ie the chemicals in the brain are not working properly (American Academy of Child Adolescent Psychiatry, 2009). Symptoms include inability to sustain focused attention, impulsive behaviour, and hyperactivity (overly-active).

There are 3 subtypes of ADHD:

Predominantly hyperactive-impulsive

Most symptoms (six or more) are in the hyperactivity-impulsivity categories.

Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.

Predominantly inattentive

The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.

Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.

Combined hyperactive-impulsive and inattentive

Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.

Most children have the combined type of ADHD.

Those in the first and third subgroups are easily recognisable. They are loud, always on the go, take risks, engage in dangerous behaviour and would talk back to adults.

The second subgroup, mostly females, are the quiet day dreamers. They loose personal belongings, cannot work alone, do not finish tasks and are lost in their own thoughts.

What are the symptoms of ADHD in children?

The key behaviours of ADHD are

1. Inattention
2. Hyperactivity
3. Impulsivity

It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviours are more severe and occur more often. To be diagnosed with the disorder, a child must exhibit symptoms for 6 or more months and to a degree that is greater than other children of the same age.

Symptoms of inattention:

Easily distracted, miss details, forget things, and frequently switch from one activity to another

Having difficulty focusing on one thing

Becoming bored with a task after only a few minutes, unless they are doing something enjoyable

Having difficulty focusing attention on organizing and completing a task or learning something new

Having trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities

Does not seem to listen when spoken to

Daydreaming, become easily confused, and move slowly

Having difficulty processing information as quickly and accurately as others

Struggling to follow instructions.

Symptoms of hyperactivity:

Fidgeting and squirming in their seats

Talking nonstop

Dashing around, touching or playing with anything and everything in sight

Having trouble sitting still during dinner, school, and story time

Being constantly in motion

Having difficulty doing quiet tasks or activities.

Symptoms of impulsivity:

Being very impatient

Blurting out inappropriate comments, show their emotions without restraint, and act without regard for consequences

Having difficulty waiting for things they want or waiting their turns in games

Often interrupting conversations or others' activities

What causes ADHD?

Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. ADHD could probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.

Genes

Inherited from our parents, genes are the "blueprints" for who we are. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder. Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments.

Environmental factors

Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children. In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, may have a higher risk of developing ADHD.

Brain injuries

Children who have suffered a brain injury may show some behaviours similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury.

Sugar

The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it. In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behaviour or learning capabilities than those who received the sugar substitute. Another study in which children were given higher than average amounts of sugar or sugar substitutes showed similar results.

Food additives

Recent British research indicates a possible link between consumption of certain food additives like artificial colors or preservatives, and an increase in activity.11 Research is under way to confirm the findings and to learn more about how food additives may affect hyperactivity.

What conditions can coexist with ADHD?

Learning disability

A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing himself or herself in words. A school-aged child may struggle with reading, spelling, writing, and math.

Oppositional defiant disorder

Kids with this condition, in which a child is overly stubborn or rebellious, often argue with adults and refuse to obey rules.

Conduct disorder

This condition includes behaviors in which the child may lie, steal, fight, or bully others. He or she may destroy property, break into homes, or carry or use weapons. These children or teens are also at a higher risk of using illegal substances. Kids with conduct disorder are at risk of getting into trouble at school or with the police.

Anxiety and depression

Treating ADHD may help to decrease anxiety or some forms of depression.

Bipolar disorder

Some children with ADHD may also have this condition in which extreme mood swings go from mania (an extremely high elevated mood) to depression in short periods of time.

Tourette syndrome

Very few children have this brain disorder, but among those who do, many also have ADHD. Some people with Tourette syndrome have nervous tics and repetitive mannerisms, such as eye blinks, facial twitches, or grimacing. Others clear their throats, snort, or sniff frequently, or bark out words inappropriately. These behaviors can be controlled with medication.

Problem: ADHD Can be Mistaken for Other Problems

Parents and teachers can miss the fact that children with symptoms of inattention have the disorder because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, compared with those with the other subtypes, who tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive subtypes just have emotional or disciplinary problems.

What Is Not ADHD? (American Academy of Child Adolescent Psychiatry, 2009)

Many children and adults are easily distracted at times or have trouble finishing tasks.To be ADHD, however, the behaviours must appear before age 7 and continue for at least six months. The symptoms must also create a real handicap in at least two areas of the child’s life—in the classroom, at the playground, at home, in the community, or in social settings.

If a child seems too active on the playground but not elsewhere, the problem might not be ADHD. It might also not be ADHD if the behaviors occur in the classroom but nowhere else. A child who shows some symptoms would not be diagnosed with ADHD if his or her schoolwork or friendships are not impaired by the behaviors.

Even if a child’s behavior seems like ADHD, it might not actually be ADHD. Many other conditions and situations can trigger behavior that resembles ADHD. For example, a child might show ADHD symptoms when experiencing

• A death or divorce in the family, a parent’s job loss, or other sudden change.
• Undetected seizures.
• An ear infection that causes temporary hearing problems.
• Problems with schoolwork caused by a learning disability.
• Anxiety or depression.

What can be done?

*Evaluation and assessment

A comprehensive evaluation is necessary to establish the diagnosis, rule out other causes, and determine the presence or absence of coexisting conditions. Early intervention helps the child and family to understand the condition and learn to cope and manage it better. Assessment and evaluation may be sought at clinics, KKH, NUH, IMH.

*Multimodal Treatment Approach

- parent training

- behavioural intervention strategies such as training a child to concentrate and focus

- appropriate educational system

- medication, where necessary

- education regarding ADHD

Ideas for Teaching Students with ADHD

1. Develop a relationship with the student that shows caring, respect, and understanding.
2. Form effective partnerships with parents and other professionals helping the child with ADHD.
3. Keep classroom highly structured with clear rules and expectations about performance.
4. Develop routines for repetitive activities.
5. Make organization a priority and provide help to students with ADHD who have trouble staying organized.
6. State directions clearly and follow up to make sure the student is on task.
7. Arrange classroom seating so that you can teach most effectively. Seat students with ADHD in distraction-free areas of the classroom and in close proximity of you.
8. Design your classroom and your teaching style with motivation in mind.
9. Use computers to motivate learning.
10. Gear assignments to attention span as well as ability level.
11. Plan ahead for transitions.
12. Help the student set realistic goals for work.
13. Provide frequent praise.
14. Use teacher attention to motivate.
15. Use prudent reprimands when correcting misbehavior.
16. Recognize that students with motor coordination problems may have difficulty with writing.
17. Teach study strategies
18. Give the student with ADHD responsibility.
19. Treat the student with ADHD as a whole child, not just a label.
20. Collaborate with other professionals in your school to get ideas for teaching and discipline.

Resources:

American Academy of Child Adolescent Psychiatry. (2009). ADHD - A Guide for Families. Retrieved December 28, 2009, from http://www.aacap.org/cs/adhd_a_guide_for_families/what_is_adhd

National Institutes of Health. (2009, June 15). Attention Deficit Hyperactivity Disorder (ADHD). Retrieved December 28, 2009, from National Institute of Mental Health: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml

Children and Adult with Attention Deficit/Hyperactivity Disorder (N.D. Retrieved 5 January, 2010, from http://www.chadd.com

Society for the Promotion of ADHD Research and Knowledge. (ND). Retrieved 5 January, 2010, from http://www.spark.org.sg

Parker, H. (2005). The ADHD Handbook for School. Florida: Specialty Press.

Videos

ADHD: A Child's Diagnosis - http://www.youtube.com/watch?v=NTnVYGWWiWU&feature=related

Brad's Story: A 12 year-old with ADHD - http://www.youtube.com/watch?v=z2hLa5kDRCA&feature=channel