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Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-Deficit/Hyperactivity Disorder (ADHD)

Has your child’s teacher ever mentioned how rowdy and active he or she is in class, and that it is best to consult a psychologist to check for ADHD? Put that thought aside for now. First, you must understand that at some point in life, many children will behave inappropriately in the classroom. Teachers may mistake their immaturity for ADHD, and this is compounded by the fact that most teachers, if not all, are not trained to look out for or diagnose these conditions.

What is ADHD?

ADHD is one of the first things that is speculated when a child’s behavior or performance in school is problematic. A child who cannot sit still for most of the times, who blurts out answers without raising his or her hand, or who daydreams in class – these are established symptoms of ADHD. However, these are also very common behaviors that may have resulted from anxiety or trauma, or as previously mentioned, just being less mature compared to other children in class.

It is certainly true that children with ADHD will have a difficult time concentrating on tasks or paying attention, and it is exactly because of such symptoms which are commonly seen that makes it important for teachers and parents to be aware of what ADHD actually looks like. There is a possibility that ADHD might be confused with other things which are influencing a child’s behavior. We, as adults, should understand that most children are too young to convey what their emotions are and how they feel most of the time. We should also take note that age is also an important factor – it is only appropriate to compare the child’s behavior to other children of the same age and not to all other children in his or her grade. Why is this so? Within any grade, the children’s ages can differ by almost a year, and that difference can make a difference in how a child self-regulates his or her behaviors.

Causes of ADHD

Attention Deficit Hyperactivity Disorder - Adhd

Although the exact cause of this disorder is not fully understood, it has been established that there are a number of risk factors thought to be involved in the development of ADHD. They may include general factors such as genetics, environment and problems with the central nervous system (CNS) during key developmental stages. Examples of other factors include:

  • Blood relatives, such as parents or siblings, with ADHD or another mental health disorder
  • Brain damage
    • either in the womb or after a severe head injury later in life
  • Premature birth
    • before the 37th week of pregnancy, or
    • born with a low birth weight
  • Maternal drug use, alcohol use or smoking during pregnancy
  • Exposure to environmental toxins like lead, which is typically found in paint and pipes of old buildings

With regards to genetic factors, ADHD generally runs in the family and usually, the genes you inherit from your parents are a crucial factor in ADHD development. Studies have shown that parents and siblings of a child with ADHD are more likely to have the disorder themselves. In addition, the way how ADHD is inherited is complicated and not thought to be related to a single genetic fault.

Interestingly, there were claims of sugar being a suspect in causing the hyperactivity presentation in children but there has been no reliable evidence for this case. The same can be said for the inattention portion of ADHD – several other issues experienced during childhood can lead to individuals having difficulty sustaining attention, but that is not the same as having ADHD.

Symptoms of ADHD

The hallmark symptoms of ADHD are inattention, hyperactivity, and impulsivity. However, these symptoms must interfere significantly in multiple settings, such as at school and at home. Moreover, as this is a neurodevelopmental disorder, therefore they symptoms must present themselves before adolescence. Symptoms may also change over time, with young children displaying more issues related to hyperactivity and impulsivity, and inattention being more pronounced among young adults.

There are 3 subtypes of ADHD: predominantly inattentive, predominantly hyperactive/impulsive, and combination of both. In the first one, most symptoms fall under inattention; hyperactive and impulsiveness for the second; and a mix of inattentive and hyperactive/impulsive symptoms for the last.

Moreover, do take note that several symptoms must be present before the age of 12 years, and children should have 6 or more symptoms present, whereas adolescents aged 17 years and above and adults should present at least 5 of the symptoms.

Below are the following presentations for inattention:

  • Failure to pay close attention to details or make careless mistakes
  • Have difficulties sustaining attention in tasks or play
  • Does not appear to listen
  • Have difficulties following through instructions
  • Have difficulties with organisation of tasks and activities
  • Being easily distracted
  • Loses things easily, things that are needed for tasks or activities such as stationeries
  • Is forgetful in daily activities

As for the ADHD predominantly hyperactive-impulsive presentation, children may often:

  • Fidget with hands or squirm in their chairs
  • Has difficulty remaining seated in the class or in other situations
  • Runs around or climbs in situations when it’s inappropriate
  • Has difficulty engaging in activities quietly
  • Often seem to be “driven by a motor”
  • Talks too much
  • Blurts out answers even before a question is completed
  • Difficulties with waiting for their turns

Living with ADHD

Caring for children diagnosed with ADHD can be both physically and mentally draining; the impulsive and chaotic behaviours typical of ADHD can give rise to high stress level and burnout. However, there are a number of effective ways to manage and cope with children with ADHD.

The very first important step is to understand and acknowledge the fact that children with ADHD cannot usually control their behaviours – they do not think of the consequences before they act, and it is very challenging for them to suppress their impulses. You can simply use the following as a guide if you are looking after a child or children with ADHD:

  • Plan the day in advance, so your child knows what to expect.
    • Routines can make a difference to how a child with ADHD copes with everyday life.
  • Set clear and simple boundaries, lay out all enforceable consequences.
    • Remove privileges if boundaries are violated and make sure to stick to it consistently.
  • Provide instructions, try to make sure instructions are specific and concise.
    • Instead of asking your child to tidy his/her bedroom, say something like: “Please put back all your toys into the toybox and the books back onto the shelf.”
  • Be positive, make sure to let the child understand that you are pleased with him/her.
    • Use positive reinforcement such as verbal reinforcement or a reward with a description of the positive behaviour so that the child understands why you are pleased with them.
    • g. You tidied your room very well. Good job, I’m proud of you.
  • Incentive scheme. It would be beneficial if you can set up a reward scheme using stickers or stars, and make sure to involve your child in it – give them an opportunity in deciding what the rewards will be.
    • Try to keep the scheme entertaining by making change regularly lest they become monotonous.
    • Focus only on one or two behaviours at once, and not expect your child to perform well all the time – be realistic.
  • Overall wellbeing – adequate exercise, nutrition, rest
    • Make sure your child gets lots of physical activity during daytime. Being active can help your child expend his/her energy which in turn improves his/her sleep quality, and ensure that he/she is not doing anything too exciting near bedtime
    • As previously mentioned, no reliable evidence has been found for consuming sugar to be a factor. It is usually caffeine or other additives that are the culprits, therefore it is crucial for you to watch what your child eats. However, it is important to limit the sugar intake according to the health guidelines as consuming too much sugar is likely going to lead to other health problems later in life.

Ensure a regular bedtime routine – going to bed around the same time every night and getting up around the same time every morning.

Treatments / Therapies

Most healthy children can be inattentive, hyperactive or impulsive at times, and more so for pre-schoolers as they tend to have shorter attention spans. Moreover, this is compounded by other factors like the level of interest they have in the activities they are engaged in.

ADHD is a brain-based neurodevelopmental disorder. It is not possible to overcome symptoms by simply “focusing harder” or to try and “pay more attention”. Brain imaging studies have evidenced that individuals with ADHD have brain structures that are different than people without ADHD. There are other approaches to managing ADHD in addition to those previously mentioned. There are a wide range of evidence-based therapies that can help relieve some of the symptoms associated with ADHD. Some approaches may combine several therapies to be effective. They include:

  • Behavioural therapy
    • Therapists will teach social skills like waiting for your turn, sharing, and reacting appropriately. Such therapies teach children how to monitor and modify their behaviours and to be aware of their thoughts and emotions as a way of improving focus and attention.
  • Education and training
    • Parents and teachers can learn tools that can help children learn pro-social and positive behaviours. They can also learn how to manage the children’s inappropriate behaviours and encourage positive ones, all of which help to reduce ADHD symptoms.
  • Medication
    • Ritalin and Concerta are the most common prescriptions. Many parents are fearful of trying medication and this is understandable. However, these medications help to stimulate areas of the brain that are usually less stimulated– areas associated with thinking and attention. The main goal of ADHD medication is to reduce hyperactivity/impulsivity and increase focus/attention. It will be important to discuss these options including the pros and cons with the multi-disciplinary team who is managing your child.

In summary, if you are worried about your child exhibiting signs of ADHD, you should visit the paediatrician or family doctor. They may then refer you to the relevant professional such as a psychologist or developmental-behavioural paediatrician. It will be important to have a medical assessment done beforehand so as to rule out other possible medical causes for your child’s behaviours.