Attention Deficit Hyperactivity Disorder (ADHD) is a controversial topic amongst parents, teachers and health care professionals. It sparks passionate debates about the diagnosis and treatment of this condition, with many opinions and beliefs. Some believe that medical intervention alone is sufficient treatment for ADHD, while others feel that medical doctors and psychiatrists over-prescribe and diagnose children with ADHD. Let’s take a closer look at this condition and the various treatment options available to you and your child.
There are four main features of ADHD: Hyperactivity, Impulsivity, Distractibility and Inattention.
Hyperactivity is the most visible and often most noticeable symptom. However, it is important to remember that not all children with attention difficulties present with hyperactivity. Some may be only slightly restless or fidgety and others do not appear to have any of these symptoms but they may talk constantly.
Impulsivity is characterized by shouting out, struggling to wait your turn, pushing in front of others and careless errors in tasks.
Distractibility often results from a difficulty in distinguishing what is important (foreground) from what is not really important (background stimuli). Your child seems to react to all stimuli in their environment and is easily distracted in noisy and busy places, but is also easily distracted by their own internal thoughts and ideas.
Inattention (or lack of concentration) is not as obvious as the other three features but it is by far the most disabling. It is also the most difficult to measure. Your child is usually not aware of the fact that they are unable to concentrate because they have always had the problem.
ADHD occurs when the attention difficulty is due to an imbalance of chemicals in the brain.
There are many factors that cause attention difficulties, but not all of these are as a result of true ADHD. Physical, emotional and cognitive factors need to be investigated before the diagnosis of ADHD is made.
In order to receive a formal diagnosis of ADHD, it is important that you take your child to a trained health professional – Medical Doctor, Paediatric Neurologist, Child/Adolescent Psychiatrist or Educational Psychologist – who can assess their symptoms and behaviours. Early diagnosis and treatment of ADHD is vital, as every year that we wait to treat it, a child’s development can be delayed by as much as three years.
Many people feel that ADHD is over diagnosed in today’s population, and it does sometimes seem as if every second child is being diagnosed with this condition. However, ADHD appears to be more prevalent today as it is one of the most researched childhood disorders. We therefore have much more knowledge of this condition and are more aware of the symptoms and behaviours associated with it. As a result, many children who would have been missed are now being identified and helped.
The name Attention Deficit Hyperactivity Disorder may be confusing, as it tends to indicate that the person diagnosed with this difficulty cannot concentrate at all (i.e. has an attention deficit). And even worse, that it is so bad that they are disordered. However, this is not always the case. In fact, many people with ADHD can concentrate extremely well in certain situations but not very well in others. Very often the priority of focus for someone with an attention difficulty is not the same as that required by their parent and, even more often, not the priority required by their teacher. For example, when a teacher wants a child to focus on a Mathematics worksheet, the child is concentrating on who is walking past the classroom or on sharpening all the pencils in their pencil case. It is not that the child is not concentrating…they are just concentrating on something different!
Perhaps a better and more meaningful label may be to say that the person has attention priority difficulties and not an attention deficit. Needless to say, not being able to prioritise your attention causes a number of problems at home and in the classroom. Many children with attention difficulties are not dysfunctional and manage to cope well in the mainstream schooling system, but almost all of them underachieve whilst at school.
As already mentioned, very few children with ADHD are totally unable to concentrate. Rather, they find it difficult to concentrate on demand and also extremely difficult to sustain their attention unless an activity interests them. If a child perceives something to be novel or interesting, then they can usually concentrate extremely well, often better than a child who does not have an attention difficulty. They go into what is called ‘hyperfocus’ and nothing distracts them from the task at hand. However, if something is boring or repetitive – their brain shuts down or looks for something else to focus on (i.e. gets distracted).
Although this applies to some extent to everyone, children with ADHD are unable to remain focused when a task is repetitive or perceived as boring. No amount of shouting, threatening, pleading or bribing can force their brain to remain focused on the task without becoming distracted.
However, this type of learning environment is not always possible in our traditional mainstream school system. Bells ring and children are expected to focus on one subject for a specified amount of time, usually half an hour to an hour. There is a greater demand for written output, which takes a tremendous amount of effort and sustained focused, something which ADHD children often struggle with.
The treatment of ADHD is aimed at the relief of the symptoms and behaviours – it is not curative. The best treatment involves a holistic and multimodal approach, rather than a purely medical approach. This includes behavioural modification, educational intervention, and medical intervention.
Medication such as Ritalin, Concerta or Straterra are often prescribed by health professionals to treat ADHD. These have been found to be helpful in 70-80% of cases. However, they do come with a range of side effects which need to be carefully monitored by both teacher, parents and doctor.
It is important to remember that the use of stimulant and non-stimulant medication is not a cure for ADHD – but it can be used to reduce some of the symptoms, particularly those symptoms that interfere with learning and optimal school performance. To date, there is little evidence that the use of these medications improves school achievement, relationships, or behavioral issues over the long term for a child with ADHD. And even in the short term, medication will not solve all the problems associated with ADHD or completely eliminate the symptoms.
In addition to medication, studies show that what, and when you eat makes a difference when it comes to managing ADHD. It is recommended that:
Educational interventions are helpful as they address any gaps in your child’s learning that have resulted due to the attention difficulties. These include:
Occupational therapy helps with the improvement of important skills necessary for academic learning (such as fine motor skills, handwriting, perceptual skills, or visual motor integration). It also addresses possible delays that have occurred in your child’s foundational development as a result of their inattention/distractibility or impulsivity.
Research has also found a strong association between sensory processing problems and ADHD. Many children with ADHD exhibit greater difficulties with processing sensory input from their environment. Occupational therapists who are trained in sensory integration can offer sensory integration therapy as well as sensory diets/strategies for the classroom and home environment to help with self-regulation. They can also suggest environmental adaptions in the classroom to assist a child with ADHD maintain focus and attention for longer (such as minimising visual distractions, adjusting the duration and expectation of tasks, pacing of work, as well as regular movement breaks).
Teacher modifications are another way of helping children with ADHD. It is recommended that teachers consider the following modifications in their teaching style and classroom structure:
Learning support from a remedial therapist can be helpful for a child with ADHD as there may be gaps in their literacy and numeracy skills. Therapists can provide additional one-on-one learning opportunities for mathematics and reading.
Cognitive behavioural therapists are skilled in setting up behavioural modification programs for children with ADHD (discussed below). They also offer support and education to parents, so they can have a better understanding of this condition and more realistic expectations of their child. This knowledge helps adapt their parenting style and discipline toward their child. Some cognitive behavioural therapists also offer social skills groups for ADHD children to learn more appropriate ways of interacting and engaging with their peers.
Children with ADHD often struggle with impulse control and their behaviour can be interpreted as rude or inappropriate. Behavioural modification programs help reinforce desired behaviours through rewards and praise, and decreasing problem behaviours by setting limits and consequences. It has been shown to be a very successful treatment for children with ADHD. It is especially beneficial as a co-treatment for children who take stimulant medications.
ADHD is not a disability – it is merely a different learning style. These children are not trying to be difficult. Their learning style is often not being accommodated in the classroom or therapy setting. As a result, they may require extra assistance and far more patience than other children. However, if they can survive 12 years of a schooling system that does not suit the way that their brains work, with their self-esteem intact, they very often turn out to be wonderfully creative and inventive people who improve our world!