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ADHD/ADD Hand Out for Parents and Teachers
M.G. Lazarus Ph.D.
Attention Deficit Hyperactivity Disorder (ADHD) is one of the serious psychiatric
conditions found in children in the preschool and early school years. It is characterized
by inappropriate level of inattention, hyperactivity and impulsivity that is present
before the age of seven. A child with ADHD faces lots of difficulties at home and
school. It is hard for the young person to control his/her behavior and impulsivity
and pay attention. The helpless child might express his/her problems to parents
like ‘why am I different?’, ‘why am I called a troublemaker and headcase?’, ‘why
don’t I understand lots of things at school which are not difficult to other children?’
and so on. When to suspect ADHD? All children, to a certain degree, will demonstrate
restlessness, impulsivity (acting without thinking), or day dreaming. These may
not be typical ADHD. However, it is worth suspecting ADHD/ADD if such behaviors
begin to affect academic performance or social relationships, or in the circumstance
that the child’s behavior becomes disruptive, challenging or beyond control. The
signs of ADHD could be listed in two different categories. The most common hyperactive-impulsive
signs include:
- Feeling restless, often fidgeting with hands or feet, or squirming while seated
- Running, climbing, or leaving a seat in situations where sitting or quiet behavior
is expected
- Blurting out answers before hearing the whole question
- Having difficulty waiting in queue or taking turns.
The inattention signs are the following:
- Often becoming easily distracted by irrelevant sights and sounds
- Often failing to pay attention to details and making careless mistakes
- Rarely following instructions carefully and completely losing or forgetting things
like toys, or pencils, books, and tools needed for a task
- Often skipping from one uncompleted activity to another.
Many parents coming to clinic ask if it is their mistake that causing ADHD to their
child. There are also concerns regarding the intelligence of the child leading to
poor performance at school. ADHD is, in fact, neither caused by lower IQ nor by
poor parenting. Rather, it is a neuro-psychiatric disorder with a genetic risk,
and is influenced by environmental factors. Some other possible reasons might be
alcohol or nicotine abuse by mother while pregnant, low birth weight, and brain
infections, though there are no conclusive evidences to substantiate this. Guidance
and support from counselors, parents, and teachers would help the young person with
ADHD/ADD to achieve his/her full potential in the areas of attention and behavior.
If right intervention is not made at right time the individual will be left with
high risk of increased difficulty in achieving success in life and might develop
the following problems in life:
- Emotional Problems: low self esteem, depression, which might lead to suicide.
- Behavioral Problems: risk taking behavior, oppositional defiant and conduct disorder,
substance misuse, anti-social and criminal behavior.
- Physical health problems: arising from alcohol and drug abuse, accidents due to
inability to see danger and impulsivity, psychosomatic disorders, cardiovascular
diseases and so on.
- Educational Problems: poor academic performance due to lack of attention, suspension
from school due to behavioral problems, leaving school early, etc.
- Relationship Problems: Fights with parents, siblings, and partners, difficulties
with peers, poor social skills, domestic violence, divorce/separation, etc.
- Employment Problems: loss of job due to misbehavior or impulsive behavior, inadequate
performance, etc.
The problems would be endless in any settings including home or social environment
if an early intervention is not made. The individual might cause cost burden to
other individuals and society in the form of accidents, insurance claims, etc. which
might lead to social exclusion, causing further psychological damage to the individual.
It is important to know who the right professional to be contacted if you suspect
ADHD with your young person. The following table might give you an idea about the
health professionals who are trained in this area:
|
Specialty
|
Can
Diagnose |
Can
Prescribe |
Provide
Counseling
|
|
Psychiatrists
|
yes
|
yes
|
yes
|
|
Psychologists
|
yes
|
No
|
yes
|
|
Pediatricians or Family Physicians
|
yes
|
yes
|
no
|
|
Neurologists
|
yes
|
yes
|
no
|
|
Clinical Social Workers
|
yes |
no |
yes |
Assessment
As the symptoms vary so much across settings, assessment of ADHD
is not straight forward, especially when inattentiveness is the primary concern.
Hence, even if a parent or teacher notices only one of the three characteristics
of ADHD namely, inattention, hyperactivity, and impulsivity, it is highly recommended
to make appropriate referrals to the healthcare professionals without delay. It
is not necessary to have all the three characteristics to be present for an ADHD/ADD
diagnosis. Different assessment methods are employed by health professionals to
diagnose ADHD/ADD. A clinician would look at the following aspects to make sure
that none of these are raising the ADHD/ADD concerns:
- A sudden change in the child’s
life—the death of a parent or grandparent; parents’ divorce; a parent’s job loss
- Undetected seizures
- A middle ear infection that causes intermittent hearing
problems
- Medical disorders that may affect brain functioning
- Underachievement
caused by learning disability like dyslexia
- Anxiety or depression.
The clinician
might ask you to fill in a few forms like Conners’, Child Behavior Check List, and
also would seek reports from the school. Careful and comprehensive assessment of
an individual’s history, behavior and symptoms would help a healthcare professional
to make a proper ADHD diagnosis. Hence it is very important to give clear and accurate
information as much as possible to avoid misdiagnosis. The clinician might link
in with your GP and/or school teachers in order to get clear and up to date information
of the case.
Treatment
Effective treatment for ADHD/ADD includes the following:
- Medication
- Behavioral therapy and
- Psycho-education
No single treatment method
is the answer for every child. In most cases a combination approach that involves
medication, behavioral therapy and psycho-education show good result. When a child
is prescribed with medication the parent needs to be fully informed of the side
effects of that particular medication. Each child's needs and personal history must
be carefully considered while planning a treatment package. In any case, it should
be the parent who makes the final decision regarding medication for the child under
his/her care.
©
Copy Right: 2007, M.G. Lazarus PhD.
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