|
ADHD, once called hyperkinesis or minimal brain dysfunction, is
one of the most common mental disorders among children. It affects
3 to 5 percent of all children. Two to three times more boys than
girls are affected. ADHD often continues into adolescence and adulthood,
and can cause a lifetime of frustrated dreams and emotional pain.
These children may not be able to sit still, plan ahead, finish
tasks, or be fully aware of what's going on around them. To their
family, classmates or teachers, they seem to exist in a whirlwind
of disorganized activity. As a result, the disorder can spoil the
person's relationships with others in addition to disrupting their
daily life, consuming energy, and diminishing self- esteem.
Symptoms
of ADHD or Understanding the problem
ADHD is typically
defined as a triad of inattention, impulsivity and hyperactivity.
But for the correct diagnosis of ADHD these behaviours should be
excessive, long term, and pervasive. They should be a continuous
problem and not just a response to a temporary situation.
Signs of inattention
include:
• Becoming
easily distracted by irrelevant sights and sounds.
• Failing
to pay attention to details and making careless mistakes.
• Rarely
following instruction carefully and completely.
• Losing
or forgetting things like toys, pencil, books and tools needed
for a task.
Signs of hyperactivity
and impulsivity are:
• Feeling
restless, often fidgeting with hands or feet, or squirming
• Running,
climbing or leaving a seat in situations where sitting or quiet
behaviour is expected.
• Blurting out answer before hearing the whole question
• Having
difficulty waiting in line of for a turn
Some additional
dysfunction, which are not just incidental symptoms in fact they
are hard to live with; are as follows:
• Lack
of foresight, i.e. lack of ability to predict the results of our
behaviour, which is a major adaptive ability of humans.
• Poor
hindsight, i.e. trouble in learning from mistakes.
• ADHD behaviours are often based on reactions taking only
the present moment into account. It is not that the child with
ADHD doesn't care about failure; it is that the future and past
don't even exist. Such is the nature of the disability.
• Poor
organization
• Trouble
returning to task
• Poor
sense of time
• Poor
ability to utilize "self-talk" to work through a problem
• Poor
sense of self awareness
• Gets
frustrated easily
• Hyper
focused at times
• Frequently
overwhelmed
• Gets
angry frequently and quickly
• Trouble
paying attention to others
• Lying,
cursing, stealing and blaming others become frequent component
of ADHD, especially as the child gets older
Many parents
see signs of an attention deficit in toddlers long before the child
enters school. In many cases the teachers is the first to recognize
that a child is hyperactive or inattentive because teachers work
with many children and they come to know how average children behave
in learning situations that require attention and self control.
In such cases parents/ teachers should consult psychologist to assess
whether the child has an attention disorder or is just immature
has hyperactivity or is just exuberant.
Can
any other conditions produce these symptoms?
There are many
conditions that can produce similar behaviours. Few of them are:
• Underachievement
at school due to a Learning disability.
• Attention lapses caused by seizures.
• A middle ear infection that causes an intermittent hearing
problem
• Disruptive or unresponsive behaviour due to anxiety or
depression.
It's also important
to realize that during certain stages of development, the majority
of children at that stage tend to be inattentive, hyperactive, or
impulsive but do not have ADHD. Preschoolers have lots of energy
and run everywhere they go, but this doesn't mean they are hyperactive.
ADHD is a serious diagnosis that may require long term treatment
with counseling and meditation.
What
causes ADHD?
It has been
found that many different genetic, medical, temperamental and environmental
risks can produce symptoms indistinguishable from ADHD. If extreme
enough, virtually any single factor can, by itself, lead to the
syndrome. However it is quite rare that single risk factor occur;
rather it is not common to see genetic, medical and other risk occur
in combination.
Non-
medical treatment for ADHD
Life can be
hard for children with ADHD. They're the ones who are so often in
trouble at school, can't finish a game, and lose friends. It's not
easy coping with these frustrations day after day. Some children
release their frustration by acting contrary, starting fights, or
destroying property. Some turn the frustration into body ailments,
like the child who gets a stomachache each day before school. Others
hold their needs and fears inside, so that no one sees how badly
they feel.
Medication can
help to control some of the behaviour problem that may have lead
to family turmoil. But more often, there are other aspects of the
problem that medication can't touch. Both parents and their children
may need special help to develop techniques for managing the patterns
of behaviour. In such cases, mental health professionals can counsel
the child and the family, helping them to develop new skills, attitudes,
and ways of relating to each other.
Several intervention
approaches are available such as:
• Psychotherapy
works to help people with ADHD to like and accept themselves despite
their disorder. As they talk, the psychologist tries to help them
understand how they can change.
• Cognitive-behavioural
therapy helps people work on immediate issues. Rather than helping
people understand their feeling and actions, it supports them
directly in changing their behaviour. The support might be practical
assistance or to encourage new behaviours by giving praise or
rewards each time the person acts in the desired way. A psychologist
might use such techniques to help a belligerent child to control
his fighting, or an impulsive teenager to think before she speaks.
• Social
skill training can also help children learn new behaviors. In
social skill training, the therapist discusses and models appropriate
behaviours like waiting for a turn, sharing toys, asking for help,
or responding to teasing, then gives children a chance to practice.
• Parenting
skills training offered by therapist or in special classes gives
parents tools and techniques for managing their child's behaviour.
Parents may also be taught to give the child "quality time"
each day, in which they share a pleasurable or relaxed activity.
In addition,
parents may follow the simple principles of management, which are
given below:
1. Keep a
sense of humor. Seek to enjoy, not to scream.
2. Hate ADHD,
not the person with it.
3. You do
not have a standard child. You can view the issue as a disability.
Or, you can view it as both. The perspective of "standard,"
though, is not an option.
4. Instead
of punishing wrong behaviour, set a reward for the correct behaviour
you would rather replace it with. Rewards should be immediate,
frequent, powerful, clearly defined, and consistent.
5. Plan ahead. Give warning before transition. Discuss in advance
what is expected. Have the child repeat out loud the terms he
just agreed to.
6. Don't argue;
nag; or attempt unsolicited and spontaneous transplants of your
wisdom to your child. Instead, either a) decide that the issue
is aggravating but not significant enough to warrant intervention;
or b) make an appointment with your child to discuss the issue.
7. When temper
of the child flare; allow everyone to cool off. Serious discussion
can only occur during times of composure.
8. Especially
with teens, negotiate, negotiate, and negotiate. Parents need
to model negotiation, not inflexiblity. Don't worry about losing
control: the parent always gets to decide when negotiation is
over and which compromise is accepted.
9. Although
it is not the child's "fault," he will still ultimately
be the one to take the consequences of his behaviour.
10. Forgive
your child and yourself nightly. You didn't ask to live with the
effects of ADHD any more than did your child.
11. This is
not a contest with your child. The winner is not the one with
more points. The winner is the one who's child still loves them
when they graduate high school.
12. May allow
only one or two playmates at a time so that child doesn't get
overstimulated.
13. Help the
child divide a large task into small steps, then praise the child
as each step is completed
14. Learn
to use stress management methods such as relaxation techniques,
meditation etc.
Remember, the
chances for success are good, especially for children with: higher
socio-economic status, higher intelligence, better early peer relations,
less aggression, less psychopathology in the parents, and less conflict
with their parents. We can't solve all of the problems at once.
Stay calm.
Author: Ms. Preeti Gupta, Research Assistant
(Clinical Psychologist), Department of Psychiatry, All India Institute
of Medical Sciences, New Delhi.
|
