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ADHD OR JUST PLAIN NAUGHTY?

Jonathan is a bright, outgoing, six-year-old. He is always on the move and busy with something. Getting dressed for school is a nightmare. He has trouble following instructions; he takes ages to complete tasks, is constantly fidgeting and is easily distracted. He lashes out impulsively, can’t look after his things and gets into trouble often. The children at school get irritated by him and tittle-tale to the teacher – often blaming him for things he didn’t even do. Jonathan feels like the teacher and the children don’t like him. He struggles to sit still and even tried to glue himself to the chair. He wants to please the teacher but just can’t help shouting out, fidgeting and irritating the other children. He dislikes school, even though he can cope with the academic demands of school learning. His parents are at the end of their tether. They want to know does Jonathan have an Attention Deficit Hyperactivity Disorder or is he just plain naughty?

Jonathan has an Attention Deficit Hyperactivity Disorder (ADHD), the technical term for what is commonly called hyperactivity. What is ADHD?

What is ADHD?

ADHD is a behaviour disorder where there is a consistent pattern of inattention and impulsivity that is more frequent and more severe than is typically observed in children at a comparable level of development (DSM IV). There are three areas to look at when making this diagnosis:

1. Inattention
2. Impulsivity
3. Hyperactivity

There are also three different categories in the diagnosis of ADHD.

1. If a child is inattentive, impulsive and hyperactive then he would be described as ADHD –combined type. This is the child who is always on the go and behaves as if he is driven by a motor.

2. If a child were inattentive and impulsive (but NOT hyperactive), then he would be described as ADHD – Inattentive type. This is the child one might describe as a “space cadets”

3. If he were hyperactive and impulsive, but NOT inattentive, then he would be described as the ADHD – Hyperactive-inattentive type.

The consistent feature in all of the above is the presence of a significant amount of impulsivity. But parents often ask: “but aren’t all children impulsive?”
All children are impulsive. But as they grow and develop, so they become more able to inhibit their impulsivity. This means that by six, they can wait a few minutes to ask a question or to answer one. This means that at six, they are beginning to use words more than actions to express their anger and frustration. ADHD kids often blurt out answers before questions have been completed, often have difficulty waiting a turn and often interrupt or interfere with others.
You might say that this typically describes your two year old. And that is the case. This is why few professionals will make a firm diagnosis of ADHD in two-year-old children. One might observe them and hypothesize about a possible behaviour disorder, but one would give them time and maturity before jumping into a diagnosis at this young age. It is important to note, however, that retrospectively, parents who have an ADHD child look back and often say: “he was always like this. He was always on the go and busy and impulsive”.


What ADHD is not?

Many parents are confused by the diagnosis of ADHD if their children do well at school. They wander: ”but if he is so distractible and inattentive, then how come his work is so good?” It is important to note that ADHD is a behaviour disorder not a learning disability. Some children are bright enough to compensate for their poor attention with their good academic abilities. But at some level, the workload increases and then they are unable to do so anymore. This is why ADHD can often cause or contribute to learning difficulties.

ADHD can also be over-diagnosed. Some children, for example, might have a slow processing speed. This means that they are still busy answering question one when the teacher has moved onto answering questions two. This might not meant that she is inattentive; it means that she is slow to apply herself to the task at hand. What can be done? Creative use of clocks and timers might help her to work more quickly. Or perhaps some difficulties with using a pencil (fine-motor coordination) are inhibiting her ability to work quickly and accurately. Then an occupational therapy assessment would be needed.

A chaotic family home environment can also contribute to children being inattentive, disorganized, impulsive and distractible. Children need predictability and consistency in order to feel in control of their world. This is a difficult one since studies show that there is a strong genetic component to ADHD. Which means that if a parent experiences /experienced signs of ADHD then there is a chance that their children will also. Adults with ADHD can be chaotic and disorganized, and impulsive and inattentive. This contributes to a chaotic home environment. Perhaps this only highlights for us as parents that what we have to help our children with in life is what we have to work on in ourselves also.

 

If you do have an ADHD child, how can you as parents help?

There was a study where a group of parents were videotaped at home, with their ADHD child. They were then rated on a scale. They all performed poorly. They were ineffective in getting their children to cooperate or to stop inappropriate behaviour. There was lots of shouting, hitting, hurting and alienating. Neither the child nor the parents felt good about themselves and their behaviour. These children were then medicated (Ritalin) and videotaped again. The parents scored well! They were able to contain their children’s inappropriate behaviors, they were able to get them to cooperate and there was a general improvement in the relationship between parent and child.

When the diagnosis for ADHD is correct, then the treatment of choice is medication. Why? Because ADHD appears to be a medical condition, where the neurotransmitters do not carry the messages to different centers of the brain accurately. These are not naughty children. They can’t help it. This child needs your support rather than your criticism.

But medication is not the only area to address. Helping your child with his difficult behaviour, his social functioning and his self-esteem is also important. Parenting an ADHD child is a challenge to say the very least. Here are some suggestions to help you along the way:

1. Create habits. ADHD kids can then rely on these habits to look after their things, to be responsible, to be organized and to gain a sense of control over their world.

2. Make use of specific reminders like lists, schedules, alarm clocks and the like.

3. Use incentives. Don’t think of them as bribes. These children need goals to focus on. When they are working towards a goal they are also learning to inhibit their impulsivity.

4. Give frequent feedback. Kids with ADHD often don’t see the consequences of their behaviour. “When you grab from your brother without asking, he gets angry. Do you want to live with an angry brother or would you rather ask him for a chance?”

5. Give him responsibility where appropriate. Don’t let your ADHD child get into the role of “irresponsible and destructive”. If he can use an alarm clock to get up – let him. If he misses the ride to school, let him learn from the consequences (as long as they are not too punitive).

6. Negotiate – don’t struggle. Come up with specific remedies for specific problems. Ask your ADHD child to help with this. If he comes up with solutions, he is more likely to stick to them.

7. Remember his feelings. He needs lots of understanding. Acknowledge his feelings. This does not mean that you condone his inappropriate behaviour, but understand his feelings.

8. Give lots of praise and encouragement for his appropriate behaviour.
Be specific. “Thanks for helping. You put all the balls in the basket, the pens in the draw and the books on the shelf. It’s a pleasure to walk into this room”

9. Prepare, prepare and prepare. Tell them what is happening today and everyday.

10. Physical devices such as timers and buzzers are helpful for self-monitoring. For example: if a child cannot remember when to take his medication, a wrist alarm clock might help him. If he is taking too long to complete homework because he is inattentive, a timer might help him. He has to complete the exercise before the bell goes.


Looking ahead?

Children with ADHD might continue to have difficulties in adolescence and adulthood. It has been observed that fewer adults are on Ritalin than children with ADHD. Perhaps this is because ADHD adults can choose their environment accordingly. They might work in a job, which requires a high level of energy as well as moving around a lot. But there are also those adults who benefit from medication since they still experience the signs of ADHD. There are also those who self-medicate (e.g.: drugs) since the signs and symptoms have gone undiagnosed.

Ritalin has received a bad name. When it is indicated it is effective. Remember there is no pill for a low self-esteem, which can be the consequence of ADHD not to mention learning difficulties, social problems and the like.

 
 
 
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