by Carol Smit and contributions by Joanna Kleovoulou, Clinical Psychologist, Director of PsychMatters Centre
ADHD is a biological brain based condition that is characterized by persistent difficulty in paying attention and/or hyperactivity. Due to the various ADHD related problems, there may also be difficulty in making friends, low self-esteem, anxiety or depression. Children struggling with ADHD are often fidgeting, unable to remain seated for long, unable to play quietly, easily distracted, unable to sustain attention, always impatient, have difficulty in following instructions, often move from one incomplete task to the next, talk excessively, often interrupt or intrude, do not seem to listen, have poor short-term memory, often lose items and engage in physically dangerous activities. Most are average or above average in intelligence, but due to their genuine inability to pay attention and control their impulsiveness often do not take in all of the information in school. ADHD is a condition listed as a developmental disorder in the classification manual for psychiatric, psychological and mental disorders (DSM-IV). ADHD is viewed as having two factors, inattention and hyperactivity/impulsivity. The two factors compose three subtypes: Predominantly Inattentive, Predominantly Hyperactive/Impulsive and a Combined Type. The problem with defining and identifying ADHD is that the brain has little regard for our attempts to classify it. Symptoms, behaviours and personality patterns ‘leak’ and ‘creep’ across brackets of diagnoses and categories. Though the medical mainstream would like to present a unity about ADHD, this condition eludes easy categorization and cure through medicine.
What causes ADHD?
No one knows exactly what causes ADHD. Scientific evidence suggests that the disorder is genetically transmitted in many cases and results from a chemical imbalance or deficiency in certain neurotransmitters (dopamine), which are chemicals that help the brain regulate behaviour. Without dopamine, neurons in the frontal cortex of the brain, which is responsible for attention, do not communicate properly. Genetics and hereditary are the major risk factors, as ADHD tends to run in families. Brain abnormalities or structural differences have also been found in individuals with ADHD. Early brain injury/trauma or other impediment to normal brain development such as exposure to chronic low levels of lead, prematurity, obstetrical complications and malnourishment can all cause a child to be at greater risk for ADHD. Even though the exact cause of ADHD remains unknown, we do know that it is a neurologically-based medical problem. Parents & Teachers do not cause ADHD. Still there are many things that both can do to help a child manage his or her related difficulties.
Social critics argue that while biological factors play a major role in difficulties with sitting still in class or concentrating in some children, these children could have failed to integrate others’ social expectations of their behaviour for a variety of other reasons. It has been said that ADHD has a link with creativity. As genetic research into ADHD proceeds, it may become possible to integrate this information with the neurobiology in order to distinguish disability from varieties of normal or even exceptional functioning in people along the same spectrum of attention differences.
The diagnosis and treatment of ADHD has been controversial since the 1970’s. Most healthcare practitioners however agree that it is a genuine disorder. Diagnosing ADHD is complicated and no simple test exists. A thorough ADHD diagnostic evaluation includes the following: An in-depth medical & family history; a physical examination; interviews with the parents, the child as well as the child’s teacher; behavior-rating scales completed by both parents and teachers; observation of the child as well as a variety of psychological testing to measure I.Q, social and emotional adjustment as well as indicate if there are any specific learning disabilities. Many other conditions and situations can trigger behaviour that resembles ADHD, for example: A death or divorce in the family, a parents’ 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; insufficient or poor quality sleep. An experienced and knowledgeable diagnostician knows not to make a determination based solely on how the child behaves during their time together.
There is no cure for ADHD however there are many things one can do to help alleviate and significantly decrease the symptoms. No single treatment works for everyone and it is best to approach treatment from a holistic perspective. Stimulant medications, such as Ritalin, Dexedrine, Concerta, Metadata, Focalin & Adderall, have been found to be effective in alleviating symptoms. However much controversy surrounds stimulant medication; for more information on stimulant medication refer to http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder_controversies.
Ones environment can influence symptoms. A setting that is structured, predictable and motivating can greatly help. Many people with ADHD respond well to a reward system with clear consequences for behaviour. This type of treatment is called behaviour modification. ADHD can be exhausting and parents dealing with children with ADHD can benefit from education & training. Parents may also benefit from acknowledgement and support that they are on the right track. Social skills training focuses on helping an individual with ADHD learn appropriate behaviours and ways of interacting with others. In order to process feelings and deal with the effects of ADHD counselling or psychotherapy may be recommended. An ADHD coach works with clients to create structure and organization on a daily basis whilst providing encouragement to set goals and rewards and keep them focused when obstacles occur. Sharing with others who are going through similar difficulties can help and therefore strength, encouragement and education can be found in support groups. ADHASA is the Attention Deficit & Hyperactivity Support Group of Southern Africa. You can contact them on (011) 888-7655 or e-mail them at adhasa@telkomsa.net. Alternatively have a look at the website at www.adhasa.co.za.
Multiple studies have shown Play Attention ® Training to be useful in the treatment of ADHD. According to the low arousal theory, individuals with ADHD have difficulty self-moderating. It indicates that individuals with ADHD need excessive activity as self-stimulation because of their state of abnormally low arousal. Their attention can only be gained by means of environmental stimuli, which results in disrupted attentional capacity and increased hyperactive behaviour. Without stimulation from the environment an individual with ADHD will create it by walking around, fidgeting and talking excessively, etc. Play Attention ® Training is a treatment strategy used for individuals with ADHD. Using an EEG to monitor brain waves and a system of positive reinforcement; individuals learn how to make their brains become more attentive. The result is that there is a significant reduction in ADHD symptoms and improvements in behaviour, relative to how well the individual learns to control their own brain function.
It is useful to have your child fully assessed by a clinical or educational psychologist, whom will be able to provide a comprehensive report of your child’s strengths and academic challenges, as well as emotional blocks that may be impacting on their scholastic performance and psychological well-being. This report will also provide recommendations on which next steps to take for your child.
ADHD is not just a disorder that can disrupt school performance, it is an all-day disorder. ADHD clearly also affects how children get along with friends and family, complete homework assignments and chores, and participate in after-school activities.
Some tips that parents can use to help effectively manage the symptoms of ADHD:
- Work with your child to create a plan & maintain a regular schedule. Be aware of how ADHD can affect your child’s life. Target each event – homework, fun, and family – then work with him or her to stay on track. Work with your child to follow a consistent plan at home, in school, after school, and on weekends. Ease the strain of ADHD. Keep routines fun and take breaks when times get tough to help relieve the stress of ADHD.
- Build a support team that includes parents, teachers, instructors, youth pastors and coaches. Talk with them about how ADHD affects your child’s life. Discuss successes and work together on the challenges. Manage ADHD for the long-term. Consider Play Attention ® Training as a treatment option and/or work with your doctor to develop a total treatment program, which may include long-acting medication that doesn’t require frequent doses. To help your child stay focused all day, use techniques to help him modify his/her behaviour. Understand the challenges of ADHD. Know that ADHD is a medical problem that makes it more difficult to control behaviour and attention.
- Use available resources. Take time to teach your child how to use calendars, organizers, and written reminders to help him or her stay focused all through the day. Encourage participation in after-school activities. Look for structured activities that use energy constructively and build social skills to bring success in and out of school.
- Evaluate your child’s personal strengths and weaknesses. Managing ADHD requires discipline, a positive attitude, and good planning skills. Recognize EVERY win. Review your child’s progress regularly and celebrate accomplishments, small and large.
Talking about & explaining ADHD to your child after he/she has been diagnosed can help remove the mystery surrounding the struggles he/she knows he’s/she’s been having. It can also help a child feel a greater sense of control. It can be hard to take in all the information given during this meeting, and both you and your child may have lots of questions. Learning about ADHD is an ongoing process, and the positive ways in which you communicate and relate with your child will enable him/her to feel free coming to you for support and answers.
When disciplining a child with ADHD try to be consistent in rules and boundaries. Read his/her pre-explosive warning signals. Quietly intervene to avoid explosions by distracting him/her or discussing the conflict calmly. Removal from the battle zone to the sanctuary of his/her room for a few minutes is useful. Tone down your voice when reprimanding your child. Anger is normal but it needs to be controlled. Be mindful to keep your emotions in tact by preparing for expected chaos. Avoid attacking the child’s personality – rather focus on the behaviour. E.g., "I like you, but wasting water is not ok." Recognize and respond to any positive behaviour, however small. Catch your child doing “good”. Avoid a negative approach: "Stop"—"Don’t"—"No." Demonstrate new or difficult tasks, using action accompanied by short, clear, gentle explanations. Repeat the demonstration until learned. The memory traces of a hyperactive child take longer to form. Be patient and repeat. Designate a separate room or a part of a room that is his/her own special area. Simplicity, solid colours, minimal clutter and a worktable facing a blank wall away from distractions assist concentration. A hyperactive child cannot filter out over-stimulation yet. Do one thing at a time: Give him/her one toy from a closed box; clear the table of everything else when colouring; turn off the radio/TV when s/he is doing homework. Multiple stimuli prevent concentration on the primary task. Do not pity, tease, be frightened by, or overindulge this child. S/he has a special condition of the nervous system that is manageable. Know the name and dose of his/her medication. Give it regularly. Watch and remember the effects to report back to your doctor. Openly discuss with your doctor any fears you have about the use of medications. Lock up all medications to avoid accidental misuse. Share your successful "tips" with his/her teacher. The outlined ways to help your hyperactive child are as important to him/her as diet and insulin are to a diabetic child.
It is important to rule out other problems such as allergies, diabetes/hypoglycemia, iron deficiency, lead intoxication and emotional difficulties before a diagnosis of ADHD is made. A combination of dietary intervention, medication (in some instances), necessary supplementation, psychotherapy, play therapy or counselling to learn coping skills and adaptive behaviour is necessary to treat ADHD. In the case of dietary intervention, a low glycemic index (GI) diet is prescribed. The GI classifies carbohydrate containing foods according to how they affect our blood sugar levels. Low GI foods help stabilise blood sugar levels by ensuring a slow release of glucose into the bloodstream, while high GI foods do the opposite. Examples of low GI foods include dairy, legumes, deciduous fruits and brown rice. When a child eats high GI foods, glucose is released very fast into the bloodstream, causing the blood sugar levels to peak – this is usually associated with hyperactivity. The consequent drop in blood sugar levels that follows soon after (10-60 minutes later), shortens the child attention span and is also related to signs of headaches, nausea, tiredness and irritability. Maintaining optimal blood glucose levels reduce restlessness, irritability, poor concentration span, and aggressive and destructive behaviour. This is done by implementing the following guidelines:
- Implement a low GI lifestyle for the whole family
- Eat frequent meals: 4 main meals with 2 snacks in between
- Take essential fatty acid supplementation, specifically omega-3, as well as a good multivitamin
- Avoid additives, preservatives and artificial sweeteners
- Exclude allergens to which your child may be allergic to, or is sensitive to (if any)
- Sugar is fine in moderation. Take in consideration that it is better to have sugar with a main meal.
For more information or to book with a psychologist that is able to assist, contact PsychMatters Centre on 011-4503576 or info@psychmatters.co.za. Visit our website on www.psychmatters.co.za for related articles.