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Helping Children with Attention Deficit Hyperactivity Disorder (ADHD/ADD)


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Attention Deficit Hyperactivity Disorder or Attention Deficit Disorder (ADHD/ADD) is a neurological disorder that makes it difficult for sufferers to concentrate, control impulses, stay focused and limit their activities. It affects about five to ten per cent of children and adolescents.

Both the sufferers and their families feel the deleterious effects of ADHD/ADD. Parents of children with ADHD/ADD feel stressed and find that their usual approaches to dealing with “normal” children do not work well with children who have the disorder. If they are fortunate, they may be able to refer to professionals or friends who have experience with ADHD/ADD to get help. If not, they may succumb to the stress of dealing with the problems this disorder presents.

The characteristics of an ADHD/ADD child or adolescent

The classical triad of ADHD/ADD is distractibility, impulsivity, and overactivity. Sufferers of ADHD/ADD may have one or more of the symptoms from the triad.

Distractibility:

  • Concentration difficulty.
  • Forgetfulness.
  • Disorganisation.
  • Loses things.
  • Inability to complete tasks.

Impulsivity:

  • Calling out and interrupting.
  • Impatient.
  • Does not wait for instructions.
  • Acts before thinking.
  • Inability to stop.

Overactivity:

  • Restless and fidgety.
  • Fiddles with things.
  • Constantly on the move.
  • Hyperactive.
  • Hates being confined to a small space.
  • Difficulty coping with being confined indoors.

Other associated features

Children and adolescents with ADHD/ADD are more likely to have the following problems:

Socialization problems:

  • Difficulty making and maintaining friendships.
  • Does not take turn in games.
  • Bullying behavior.
  • A sore loser in games.
  • Disruptive.
  • Aggressive.

Learning difficulties:

  • Active avoidance of work.
  • Poor handwriting.
  • Poor grammar.
  • Reading difficulty.
  • Writing difficulty.
  • Expressive or receptive language difficulty.

Mood disturbance

  • Major depression with disturbance in sleep, energy levels, eating habits, body weight, concentration, motivation and self-esteem.
  • Chronic low grade depression.

Anxiety

  • Performance anxiety, which may manifest as procrastination and/or active avoidance of work.
  • Social anxiety.

Low self-esteem:

  • Lacking in self-confidence.
  • Learned helplessness (i.e., a constant feeling that one is unable to effect any changes with one’s efforts and that external help is inevitable).

Diagnosing ADHD/ADD

There is no single, foolproof test for diagnosing ADHD/ADD. Psychiatrists, psychologists and doctors use a number of tests, checklists, questionnaires, clinical assessments and investigations to arrive at the diagnosis. A comprehensive examination and assessment will help to confirm the diagnosis and exclude other disorders, such as oppositional defiant disorder, which have a similar presentation to ADHD/ADD.

Seeking professional help

ADHD/ADD is best managed with a combination of complementary treatments including medication and psychological therapies. The two commonly prescribed medications are Methylphenidate and Dexamphetamine. Generally, the impulsive symptoms respond better to medication than the inattention symptoms. For those people who suffer from ADHD/ADD with inattention symptoms, a Tricyclic antidepressant such as Imipramine may be effective.

Cognitive behavioural therapy is useful for ADHD/ADD sufferers, especially when they are young because the problems are not too entrenched. Through the therapy, sufferers learn to deal with and control their impulsiveness and hyperactivity.

It is important to note that ADHD/ADD sufferers have a higher risk of developing an anxiety disorder and depression than the general population. As such, it is useful to include anxiety and stress management in their treatment plan. When their anxiety and depression go untreated, ADHD/ADD sufferers tend to self-medicate with alcohol or other harmful drugs to calm their nerves.

The treatment approaches for anxiety or depression problems in ADHD/ADD sufferers are similar to those recommended for anxious and depressed people who do not have ADHD/ADD.

Helping children with ADHD/ADD

The following are some useful suggestions that work:

Helping your child attend to verbal interactions:

  • Maintain eye contact with your child whenever you talk to him or her.
  • Give short, concrete directions that consist of no more than three separate parts.
  • Get your child to repeat directions back to you if you think he or she has difficulty remembering.
  • As far as possible, use various sensory inputs to help your child to remember information. For example, use cards and drawings to enhance visual inputs in addition to providing the auditory inputs of verbal instructions.

Helping your child to remember:

  • Teach your child to use a personal organiser or diary.
  • Teach your child the art of using mnemonics to cue recall.
  • Use songs, poems or funny stories to enhance recall.
  • Use different colour codes to highlight the content of written notes to improve memory.

Helping your child to overcome impulsiveness:

  • Teach your child the skills of Stop, Think and Do, as represented by the three traffic light colours of Red, Yellow and Green respectively. Before your child does anything, he or she has to Stop (represented by the colour Red), then Think (represented by Yellow) about the consequences of the behaviour to ascertain whether there are any negative consequences. If there are no negative consequences, then your child may proceed to Do whatever he or she wants (represented by the colour Green).
  • Use positive reinforcement to encourage non-impulsive behaviour.

Helping your child to stay on task with study:

  • Remove all distractions from the work area or the study room.
  • Use colour codes to highlight salient points in the school work.
  • Give your child frequent small breaks to overcome mental fatigue.
  • Provide activities that are consistent with the intellectual and developmental level of your child.
  • Initially, alternate short independent tasks with other more difficult tasks that require your input. Then, ease your child into becoming more independent by having him or her attempt more difficult tasks alone before offering your help.

Helping your child to harness excessive energy constructively:

  • Ensure your child has regular sporting activity.
  • Schedule a time for physical exercise before he or she attends to any mental activity, such as homework, as this will enhance concentration ability.
  • If your child is good at sports, provide ample opportunity to develop sporting prowess as this will help to nurture and strengthen your child’s self-esteem.

Helping your child deal with stress:

Helping your child’s self-esteem:

  • Nurture your child’s self-esteem by helping him or her to build up self-confidence.
  • Teach your child self-assertiveness.
  • Teach your child how to deal with negative and irrational beliefs that impact adversely on self-esteem.

If you want to know more about how to build up your child’s self-esteem, refer to the self-help program, Building Your Child’s Self-Esteem, available in the Management Toolkits Section

In conclusion, ADHD/ADD is best managed by a combination of different modalities. Parents should not just leave treatment to the ‘experts’ — the paediatricians, psychologists, social workers and child psychiatrists. You can do a great deal to help your child. Through the combined efforts of professionals and parents, children with ADHD/ADD have a better outcome and better opportunity to achieve their full potential in life.


Spending time with your adolescent child

Spending time together is a good way of building up communication. Here are some suggestions of the “do’s” and “don’ts” when you spend time together:

  1. Set aside some “formal” time that is diarised so that it will not be replaced by other activities or distractions.
  2. Use as much “informal” time as possible, such as the time spent driving together in the car or during mealtimes.
  3. Listen more and talk less.
  4. Engage in the activity that your child prefers.
  5. Avoid an interrogative style of questioning.
  6. Give verbal feedback about their positive behaviour.
  7. Avoid harsh criticism.
  8. Do not bring up past problems constantly.
  9. Express your positive emotions to your child.
  10. Be conscious about building your child’s self-esteem. (Refer to the online product “Building your child’s self-esteem”)

Dealing with your own issues

Depending on your own childhood history, you may have certain unresolved developmental issues that impinge upon your relationship with your child. For example:

A woman, who was brought up in a family where her own parents did not value her, finds that she cannot be positive towards her adolescent daughter. In this case, the woman sees herself in her own daughter. She is projecting her own feeling of unworthiness onto her daughter and finds it difficult to relate to her daughter in a positive fashion.

A man who was brought up by a distant, aloof and harsh father is over permissive towards his son. In this case, the man is over compensating by living his childhood again through his son. He is not enforcing a firm boundary on his son because his father imposed too rigid a boundary on him.

In both the above examples, the respective parents need to deal with their issues before they can foster effective communication with their children.

Sometimes, parents may have their own assumptions about their adolescent children. This is not an uncommon problem. As the child grows from infancy to adolescence, the parents may develop certain ideas into which they pigeonhole the adolescent child. For example, some parents may regard their child to be a lazy, angry, gifted or placid child despite the contrary. The parents continue to relate to the child as though he/she has not changed. This is most unhelpful. It hinders proper communication between the parents and the child.

So, invest in your child’s life by building up the communication between your child and yourself. Learn to enjoy your child and remember to build a relationship with your child. Act now and do something differently!

Both the sufferers and their families feel the deleterious effects of ADHD/ADD. Parents of children with ADHD/ADD feel stressed and find that their usual approaches to dealing with “normal” children do not work well with children who have the disorder. If they are fortunate, they may be able to refer to professionals or friends who have experience with ADHD/ADD to get help. If not, they may succumb to the stress of dealing with the problems this disorder presents.

The characteristics of an ADHD/ADD child or adolescent

The classical triad of ADHD/ADD is distractibility, impulsivity, and overactivity. Sufferers of ADHD/ADD may have one or more of the symptoms from the triad.

Distractibility:

  • Concentration difficulty.
  • Forgetfulness.
  • Disorganisation.
  • Loses things.
  • Inability to complete tasks.

Impulsivity:

  • Calling out and interrupting.
  • Impatient.
  • Does not wait for instructions.
  • Acts before thinking.
  • Inability to stop.

 

Overactivity:

  • Restless and fidgety.
  • Fiddles with things.
  • Constantly on the move.
  • Hyperactive.
  • Hates being confined to a small space.
  • Difficulty coping with being confined indoors.

Other associated features

Children and adolescents with ADHD/ADD are more likely to have the following problems:

Socialization problems:

  • Difficulty making and maintaining friendships.
  • Does not take turn in games.
  • Bullying behavior.
  • A sore loser in games.
  • Disruptive.
  • Aggressive.

Learning difficulties:

  • Active avoidance of work.
  • Poor handwriting.
  • Poor grammar.
  • Reading difficulty.
  • Writing difficulty.
  • Expressive or receptive language difficulty.

Mood disturbance

  • Major depression with disturbance in sleep, energy levels, eating habits, body weight, concentration, motivation and self-esteem.
  • Chronic low grade depression.

Anxiety

  • Performance anxiety, which may manifest as procrastination and/or active avoidance of work.
  • Social anxiety.

Low self-esteem:

  • Lacking in self-confidence.
  • Learned helplessness (i.e., a constant feeling that one is unable to effect any changes with one’s efforts and that external help is inevitable).

Diagnosing ADHD/ADD

There is no single, foolproof test for diagnosing ADHD/ADD. Psychiatrists, psychologists and doctors use a number of tests, checklists, questionnaires, clinical assessments and investigations to arrive at the diagnosis. A comprehensive examination and assessment will help to confirm the diagnosis and exclude other disorders, such as oppositional defiant disorder, which have a similar presentation to ADHD/ADD.

Seeking professional help

ADHD/ADD is best managed with a combination of complementary treatments including medication and psychological therapies. The two commonly prescribed medications are Methylphenidate and Dexamphetamine. Generally, the impulsive symptoms respond better to medication than the inattention symptoms. For those people who suffer from ADHD/ADD with inattention symptoms, a Tricyclic antidepressant such as Imipramine may be effective.

Cognitive behavioural therapy is useful for ADHD/ADD sufferers, especially when they are young because the problems are not too entrenched. Through the therapy, sufferers learn to deal with and control their impulsiveness and hyperactivity.

It is important to note that ADHD/ADD sufferers have a higher risk of developing an anxiety disorder and depression than the general population. As such, it is useful to include anxiety and stress management in their treatment plan. When their anxiety and depression go untreated, ADHD/ADD sufferers tend to self-medicate with alcohol or other harmful drugs to calm their nerves.

The treatment approaches for anxiety or depression problems in ADHD/ADD sufferers are similar to those recommended for anxious and depressed people who do not have ADHD/ADD.

Helping children with ADHD/ADD

The following are some useful suggestions that work:

Helping your child attend to verbal interactions:

  • Maintain eye contact with your child whenever you talk to him or her.
  • Give short, concrete directions that consist of no more than three separate parts.
  • Get your child to repeat directions back to you if you think he or she has difficulty remembering.
  • As far as possible, use various sensory inputs to help your child to remember information. For example, use cards and drawings to enhance visual inputs in addition to providing the auditory inputs of verbal instructions.

Helping your child to remember:

  • Teach your child to use a personal organiser or diary.
  • Teach your child the art of using mnemonics to cue recall.
  • Use songs, poems or funny stories to enhance recall.
  • Use different colour codes to highlight the content of written notes to improve memory.

Helping your child to overcome impulsiveness:

  • Teach your child the skills of Stop, Think and Do, as represented by the three traffic light colours of Red, Yellow and Green respectively. Before your child does anything, he or she has to Stop (represented by the colour Red), then Think (represented by Yellow) about the consequences of the behaviour to ascertain whether there are any negative consequences. If there are no negative consequences, then your child may proceed to Do whatever he or she wants (represented by the colour Green).
  • Use positive reinforcement to encourage non-impulsive behaviour.

Helping your child to stay on task with study:

  • Remove all distractions from the work area or the study room.
  • Use colour codes to highlight salient points in the school work.
  • Give your child frequent small breaks to overcome mental fatigue.
  • Provide activities that are consistent with the intellectual and developmental level of your child.
  • Initially, alternate short independent tasks with other more difficult tasks that require your input. Then, ease your child into becoming more independent by having him or her attempt more difficult tasks alone before offering your help.

Helping your child to harness excessive energy constructively:

  • Ensure your child has regular sporting activity.
  • Schedule a time for physical exercise before he or she attends to any mental activity, such as homework, as this will enhance concentration ability.
  • If your child is good at sports, provide ample opportunity to develop sporting prowess as this will help to nurture and strengthen your child’s self-esteem.

Helping your child deal with stress:

Helping your child’s self-esteem:

  • Nurture your child’s self-esteem by helping him or her to build up self-confidence.
  • Teach your child self-assertiveness.
  • Teach your child how to deal with negative and irrational beliefs that impact adversely on self-esteem.

If you want to know more about how to build up your child’s self-esteem, refer to the self-help program, Building Your Child’s Self-Esteem, available in the Management Toolkits Section

In conclusion, ADHD/ADD is best managed by a combination of different modalities. Parents should not just leave treatment to the ‘experts’ — the paediatricians, psychologists, social workers and child psychiatrists. You can do a great deal to help your child. Through the combined efforts of professionals and parents, children with ADHD/ADD have a better outcome and better opportunity to achieve their full potential in life.


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