What is ADHD?

This month our article focuses on an issue that is quite a contentious subject. ADHD also known as attention deficit hyperactivity disorder. There is a lot of debate about the condition, as it is not yet fully understood. Some people might take the view somewhat erroneously, that it is merely an excuse for bad behaviour. However, having taught for over 25 years, I do believe that it is something that we need to consider seriously, as it can prove to be a significant barrier for some children’s learning. Understanding the condition can lead to a range of effective strategies to ensure that appropriate progress is made.

So, what exactly does attention deficit hyperactivity disorder mean? In short it is a behavioural condition characterised by inattentiveness and hyperactivity and impulsiveness.  It is characterized by difficulties in paying attention, inability to remain still, over activity, or difficulty controlling behaviour which is not always appropriate for a person's age. The symptoms usually appear in early childhood, are present for more than six months, and cause problems in at least two childhood settings, such as school, home, or recreational activities. In children, problems paying attention may result in poor school performance. Although it causes impairment, particularly in modern society, many children with ADHD have a good attention span for tasks they find interesting.

ADHD was first diagnosed by a British paediatrician, Sir George Still, in 1902. He noted that some children were unable to control their behaviour the way that other children could and yet they were still intelligent.  After studying a large cross section of children, Dr Still noted that some children, who were aggressive, defiant, resistant to discipline, excessively emotional or passionate, could not learn from the consequences of their actions; though their intellect was normal. He wrote: "I would point out that a notable feature in many of these cases … is a quite abnormal incapacity for sustained attention.” Dr Still was also the first clinician to pinpoint the impact on a child’s learning of such behaviour,

“…. boy, aged 6 years, …… was unable to keep his attention even to a game for more than a very short time, and as might be expected, the failure of attention was very noticeable at school, with the result that in some cases the child was backward in school attainments, although in manner and ordinary conversation he appeared as bright and intelligent as any child could be.”

More research was conducted and yet, it was not until the Millennium, that a new and final definition emerged. That of ADHD. More recently research has focused on the impact of an ADHD diagnosis in adulthood. This area has once again divided the views of researchers. Some believe that ADHD continues into adulthood. Whilst others consider it is a condition that can be outgrown.

My purpose in citing the research is to show that ADHD is still a recent condition. We do not know enough about it. This also partly explains why gaining a diagnosis is often incredibly difficult, as educationalists and clinicians are uncertain and at time divided, about the nature of the condition.

So, what are the exact symptoms of ADHD and what can be done to ensure that children with the condition still make progress? Symptoms can be divided into two main areas: inattentiveness and hyperactivity or impulsiveness.

Inattentiveness

The main signs of inattentiveness are:

·         having a short attention span and being easily distracted

·         making careless mistakes – for example, in schoolwork

·         appearing forgetful or losing things

·         being unable to stick at tasks that are tedious or time-consuming

·         appearing to be unable to listen to or carry out instructions

·         constantly changing activity or task

·         having difficulty organising tasks

Hyperactivity and impulsiveness

The main signs of hyperactivity and impulsiveness are:

·         being unable to sit still, especially in calm or quiet surroundings

·         constantly fidgeting

·         being unable to concentrate on tasks

·         excessive physical movement

·         excessive talking

·         being unable to wait their turn

·         acting without thinking

·         interrupting conversations

·         little or no sense of danger

These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline. Whilst many people may believe that they experience some of the symptoms, cause for concern only arises when the symptoms are impacting on an individual’s ability to learn. In those cases, it is vital to seek the opinion of a GP and / or a child’s teacher or SENCO.  It might be a good idea to keep a diary of behaviour to use as evidence. 

Children exhibiting symptoms of ADHD also tend to show signs of other conditions.  These include Anxiety disorder, ODD – Oppositional Defiant Disorder (negative behaviour towards authority figures), Conduct disorder (antisocial behaviour), Depression, Autistic Spectrum Disorder, Epilepsy, Tourette’s Syndrome, Dyslexia, Dyspraxia.

GPs can refer children to the child and adolescent mental health service (CAMHS) There is a great deal of demand for this service and the waiting list is long. There is no test for ADHD. Instead, you'll talk to an expert about your concerns, maybe a psychiatrist or specialist paediatrician, to find out the best way to help. Behavioural therapies in ADHD are the recommended first line treatment. There are a wide range of behavioural therapies to treat ADHD. Your child may be offered psychological therapy on a one-to-one basis. Older children may also be offered group sessions to help with their behaviour.     Family therapy, school-based interventions, social skills training, and behavioural peer intervention are also effective.  

In some cases, medication may be prescribed. It is vital that you weigh up all the pros and cons of each medication before you embark on this route. Many of the medications have severe side effects.

Regular physical exercise, particularly aerobic exercise, is an effective add-on treatment for ADHD in children. There have also been some studies which suggest that a change in diet can help alleviate some of the symptoms.  Research in 2013 found that some children see some improvement in symptoms with decreased eating of artificial food colouring. There is evidence of a modest benefit of omega 3 fatty acid supplementation, but it is not recommended in place of traditional medication.

Ensure that you liaise regularly with your child’s school and look at alternative ways to encourage them to learn. The ADHD child will need some adaptations to the curriculum and to the school organisation to help them progress. That is why the Kip McGrath education programme can be very effective for the ADHD child. It is a unique educational programme, tailor made to suit the student with several multi-sensory and short activities to work on. ADHD children will also respond well to short and instant rewards.

FURTHER READING:

Can I Tell You About ADHD?: A Guide for Friends, Family and Professionals Illustrated, 28 Feb 2013 Susan Yarney