Definition
Attention Deficit Hyperactivity Disorder, often called ADD or ADHD, is a diagnostic label that is given to children and adults who have significant problems in four main areas of their lives: Inattention, Impulsivity, Hyperactivity, Boredom In order to qualify for an ADHD diagnosis, the behaviours must create a real handicap in at least two areas of the person’s life such as school, home, work, or social settings. ADHD is manifested as early as 18 months of age but will be more noticeable by age three years. The difficulties usually become more pronounced as the child gets older and more is expected of him or her for example in school.
Features/Characteristics
Attention-Deficit/Hyperactivity Disorder (AD/HD) is a condition that can make it hard for a person to sit still, control behaviour, and pay attention. Doctors do not know just what causes AD/HD. However, researchers who study the brain are coming closer to understanding what may cause AD/HD. They believe that some people with AD/HD do not have enough of certain chemicals (called neurotransmitters) in their brain. These chemicals help the brain control behaviour. For now we will simply report that there is a tremendous amount of research to support the statement that, indeed, Attention Deficit Hyperactivity Disorder is a neurologically based condition. Attention Deficit Hyperactivity Disorder is not the result of "bad parenting" or obnoxious, wilful defiance on the part of the child.
There are four classifications of ADHD:
Inattentive
Hyperactive/Impulsive
Combined
Not Otherwise Specified.Inattentive type: Where the person can’t seem to get focused or stay focused on a task or activity;
Hyperactive-impulsive type: Where the person is very active and often acts without thinking
Combined type: Where the person is inattentive, impulsive, and too active.
Inattentive type: Many children with AD/HD have problems paying attention. Children with the inattentive type of AD/HD often:
do not pay close attention to details;
can’t stay focused on play or school work;
don’t follow through on instructions or finish school work or chores;
can’t seem to organize tasks and activities;
get distracted easily; and
lose things such as toys, school work, and books. (APA, 1994, pp. 83-84)Hyperactive-impulsive type: Being too active is probably the most visible sign of AD/HD. The hyperactive child is “always on the go.” (As he or she gets older, the level of activity may go down.) These children also act before thinking (called impulsivity). For example, they may run across the road without looking or climb to the top of very tall trees. They may be surprised to find themselves in a dangerous situation. They may have no idea of how to get out of the situation.
Hyperactivity and impulsivity tend to go together. Children with the hyperactive-impulsive type of AD/HD often may:
fidget and squirm;
get out of their chairs when they’re not supposed to;
run around or climb constantly;
have trouble playing quietly;
talk too much;
blurt out answers before questions have been completed;
have trouble waiting their turn;
interrupt others when they’re talking; and
butt in on the games others are playing. (APA, 1994, p. 84)Combined type: Children with the combined type of AD/HD have symptoms of both of the types described above. They have problems with paying attention, with hyperactivity, and with controlling their impulses. Of course, from time to time, all children are inattentive, impulsive, and too active. With children who have AD/HD, these behaviors are the rule, not the exception. These behaviors can cause a child to have real problems at home, at school, and with friends. As a result, many children with AD/HD will feel anxious, unsure of themselves, and depressed. These feelings are not symptoms of AD/HD. They come from having problems again and again at home and in school.
Those with Not Otherwise Specified ADHD display some of the characteristics seen in the other types, however, do not have enough of the symptoms to reach a full diagnosis. The symptoms they do have, however, disrupt everyday life. More information about these symptoms is listed in a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association (1994).
How Common is AD/HD?
As many as 5 out of every 100 children in school may have AD/HD. Boys are three times more likely than girls to have AD/HD. About 35% of all children referred to mental health clinics in the USA are referred for Attention Deficit Hyperactivity Disorder. It is one of the most prevalent of all childhood psychiatric disorders.
How Do You Know if a Child Has AD/HD?
There is no single medical test for diagnosing ADHD, however, clear-cut diagnostic criteria have been developed and are listed in the Diagnostic and Statistical Manual of Mental Disorders, which is published by the American Psychiatric Association.
For an individual to be diagnosed with ADHD a complete evaluation must be done involving the following.
Comprehensive evaluations must be administered including ruling out
other possible causes for the child’s
behaviors
A family history
Ability tests/ achievement tests
A collection of observations taken from individuals who are close to the
child.Psychiatrists, psychologists, pediatricians, and neurologists can all diagnose a child with ADHD (Note: psychologists are unable to prescribe medication.).
Differential Diagnosis (Children with antisocial behaviors)
The use of drugs or alcohol are especially dangerous to the developing baby and can often cause neurological problems. When these children enter school, they often display problems with attention, impulse control, temper, learning, and behavior. They are often misdiagnosed as having a genetically based Attention Deficit Hyperactivity Disorder.
The ADHD Child in School
Most children with ADHD can be taught in a regular education classroom with modifications made to the classroom setting, the addition of support personnel, and/or special education programs provided outside of the classroom. For children who are more severely affected by ADHD, a special education classroom may be necessary. Unfortunately, children with ADHD are at risk for school failure, emotional difficulties, and significant negative adult outcomes in comparison to their peers. We tend to see Lower academic achievement for I.Q. If they ought to be A students, they're getting C's instead. If they ought to be B students, they're getting D's instead. In fact, if you think about it, the classroom setting is probably the worst possible setting for these children. There are a lot of distractions, they are told to sit still, don't move, don't talk, to pay attention to boring worksheets, and keep on task until the work is finished.
It is understandable therefore that many Attention Deficit Hyperactivity Disorder children become more frustrated as the school year progresses. Every week they just get a little farther and farther behind, until they're so far behind that it's impossible to catch up. The situation becomes impossible for these children as they leave primary for High School, where they are required to cope with several classes and several teachers. It is important to know that Attention Deficit Hyperactivity Disorder and I.Q. are two different things. In fact, many individuals with ADHD are highly intelligent and are highly creative and intuitive. However, due to their inability to concentrate, their true potential is often times never reached and they may wind up becoming underachievers.
Since the behaviors associated with ADHD can have a substantial impact on the child’s education, experts have identified the following classroom characteristics which best promote educational success for many children with ADHD:
Predictability
Structure
Shorter work periods
Small teacher to pupil ratio
More individualized instruction
Interesting curriculum and
The use of positive reinforcement.Interventions
There is no quick treatment for AD/HD. However, the symptoms of AD/HD can be managed. It’s important that the child’s family and teachers:
find out more about AD/HD;
learn how to help the child manage his or her behavior;
create an educational program that fits the child’s individual needs;
and
provide medication, if parents and the doctor feel this would help the
child.Use of Medications
ADHD is not a disorder than can be cured; it is instead managed and treated over time. Medication is often used to treat ADHD. Stimulant medications, such as Ritalin and Dexedrine, are the most commonly used drugs. Ritalin and Dexedrine have excellent safety records when used and monitored correctly by a physician. These drugs are likely to improve some of the symptoms of ADHD in 90% of the children. Usually, drug treatment is not enough. Often times, teacher and parent training as well as family or individual counseling may be necessary. Behavior therapy is also helpful to help modify inappropriate behaviors and to deal with the emotional effects seen in individuals with ADHD.
In addition to medication and therapeutic measures, other important things can be done to help the child with ADHD such as:
providing a supportive environment
teaching him or her organizational skills
teaching study skills and memory skills
teaching time management skillsMedication will often be helpful if used when the child is trying to learn these skills in that it can decrease the impulsivity/hyperactivity, increase the child’s attention, and reduce aggressive behaviors, allowing the child to better concentrate at the task at hand.
What to expect
Studies indicate that about 50 to 60 percent of Attention Deficit Hyperactivity Disorder children will outgrow most of the symptoms by the time he or she is in their 20's. The old school thinking was that once a child reaches puberty they no longer need any help for ADD ADHD, but this is simply not true. However, there is one final growth spurt of the brain, particularly in the frontal lobes, at about 19 or 20 years old. It is not much, but for those with Attention Deficit Hyperactivity Disorder it just might make a big difference. The Hyperactivity may diminish and may become more of a restlessness or fidgetiness that is considered a more appropriate behavior. The impulsivity may remain, though, and it is often the biggest complaint of adults with the disorder. It causes a variety of problems from often interrupting others in conversations to quitting jobs for little reason and without other employment already lined up. Difficulties with attention may also persist. It is often described as a constant "brain-fog" which makes tasks such as balancing check books very difficult. However, most adults with Attention Deficit Hyperactivity Disorder can find jobs where their strengths can shine, and they can be successful.
Tips for Parents
Learn about AD/HD. The more you know, the more you can help yourself and your child. See the list of
resources and organizations at the end of this publication.
Praise your child when he or she does well. Build your child’s abilities. Talk about and encourage his or her
strengths and talents.
Be clear, be consistent, be positive. Set clear rules for your child. Tell your child what he or she should do,
not just what he shouldn’t do. Be clear about what will happen if your child does not follow the rules.
Have a reward program for good behavior. Praise your child when he or she shows the behaviors you like.
Learn about strategies for managing your child’s behavior. These include valuable techniques such as:
charting, having a reward program, ignoring behaviors, natural consequences, logical consequences, and
time-out. Using these strategies will lead to more positive behaviors and cut down on problem behaviors.
You can read about these techniques in many books. See our “Resources Section”
Talk with your doctor about whether medication will help your child.
Pay attention to your child’s mental health (and your own!). Be open to counseling. It can help you deal
with the challenges of raising a child with AD/HD. It can help your child deal with frustration, feel better
about himself or herself, and learn more about social skills.
Talk to other parents whose children have AD/HD. Parents can share practical advice and emotional
support. Call the McCam Resource Centre to find out how to find parent groups near you.
Meet with the school and develop an educational plan to address your child’s needs. Both you and your
child’s teachers should get a written copy of this plan.
Keep in touch with your child’s teacher. Tell the teacher how your child is doing at home. Ask how your
child is doing in school. Offer support.
Tips for Teachers
Learn more about AD/HD. The resources and organizations at the end of this publication will help you
identify behavior support strategies and effective ways to support the student educationally. Some
strategies are outlined below.
Figure out what specific things are hard for the student. For example, one student with AD/HD may have
trouble starting a task, while another may have trouble ending one task and starting the next.
Each student needs different help.
Post rules, schedules, and assignments. Clear rules and routines will help a student with AD/HD. Have set
times for specific tasks. Call attention to changes in the schedule.
Show the student how to use an assignment book and a daily schedule. Also teach study skills and
learning strategies, and reinforce these regularly.
Help the student channel his or her physical activity (e.g., let the student do some work standing up or at
the board). Provide regularly scheduled breaks.
Make sure directions are given step by step, and that the student is following the directions.
Give directions both verbally and in writing. Many students with AD/HD also benefit from doing the steps
as separate tasks.
Let the student do work on a computer.
Work together with the student’s parents to create and implement an educational plan tailored to meet
the student’s needs. Regularly share information about how the student is doing at home and at school.
Have high expectations for the student, but be willing to try new ways of doing things.
Be patient. Maximize the student’s chances for success.
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