“Bringing up lively energetic children can be a taxing business for most people. For parents of hyperactive children the experience can be exhausting, bewildering and often socially isolating.” So writes Judith Treseder, a hospital social work coordinator in the forward to Dr Eric Taylor book The Hyperactive Child. What is Hyperactivity or as most people now refer to it as Attention Deficit Hyperactivity Disorder (ADD or ADHD)? This is not a new disorder; in fact medical science first documented children exhibiting inattentiveness, impulsivity and hyperactivity in 1902.
The name of the disorder has changed over the years to reflect the current thinking and research of the times. It has been known by many names: Minimal Brain Dysfunction (MBD), Hyperkinitic Syndrome, Hyperactive Child Syndrome, Attention Deficit Disorder, Learning Disorder and Conduct disorder and the current Attention Deficit Hyperactivity Disorder.
Most children with ADHD suffer both hyperactivity and attention problems, but some may only have signs of inattention. A number of other conditions could cause symptoms that look similar to some of the symptoms of ADHD. This includes learning disabilities, behaviour, mood or anxiety disorders (e.g. depression, generalized anxiety, obsessive-compulsive disorder, conduct disorder or schizophrenia).
Another variant of ADHD is Hyperkinetic disorder (HKD), which is broadly similar to a severe combined type. Hyperactivity can cause reading problems which can make children restless and inattentive, but the two sorts of problems are essentially separate.
Families of such children are often marred by significantly higher rates of socially aggressive behavior among other family members; more harsh, extreme and unpredictable methods of child discipline; greater strife in marital interactions; and a greater risk of psychiatric disturbance in the parents.
Hyperactivity is not an illness. It can be a problem and when it is severe it can have a major impact on a child’s life. However, it is best to identify it as a behaviour pattern. Several physical illnesses can cause children to lose concentration or behave badly. The most important, and commonest, is probably unrecognized deafness. However, the majority of hyperactive children do not have any known physical diseases. Hyperactivity can certainly go unrecognized if, for example, it is present with another problem that over shadows it.
Early identification and treatment of ADD has a direct impact on the future successes and failures of these children. The home, school and social life of a symptomatic, but undiagnosed, ADHD child can be unfriendly if not downright hostile. During this pre-diagnostic phase, parents and teachers continually ask the ADHD child to diagnose himself. “Why can’t you pay attention? Why can’t you keep your hands to yourself? Why can’t you learn to raise your hand before you talk? Why are you always losing your things? Why are your papers such a mess? Why can’t you ever finish anything? Why can’t you sit still?” The child does not know the answers.
What the child does know and what is constantly reinforced is that he is a big disappointment to others. He learns that he cannot do much of anything right. His self-esteem drops quickly. ADHD children often develop secondary emotional problems that are compounded by a delayed diagnosis.
Before the age of three or four, the normal range of activity and attention is so wide that it is very difficult to detect anything but severe degrees of hyperactivity. If you are having problems in adjusting to your toddler’s increased level of activity, advice can still very very useful.
Many children with ADHD have problems with hyperactive, impulsive behaviour before the age of six. Some mothers even comment that their baby was hyperactive in the womb. Parents often remember their children as having been restive and difficult to quiet down as babies.
ADHD children usually start having problems before they are seven years old. Sometimes the problems begin when they start going to school. Boys are three or four times more likely to be diagnosed as hyperactive and have ADHD more often than girls — but no one knows why. Girls are less vulnerable, but if they do become affected, they are then just as likely to need help as boys with hyperactivity. “ADHD/ADD is inherited. You don’t all of a sudden get ADD/ADHD. You are born with ADHD and it usually goes undiagnosed until the child reaches school age and usually it is the teachers who brings up the possibility of hyperactivity to the parents” (Time Magazine, July 18, 1994).
Many adults were never diagnosed as children or they were told they would outgrow the symptoms, and the disorder, by adolescence. As a result, many other problematic behaviors developed in some people that masked the ADHD like alcohol or drug addiction, depression, inability to find or keep a job, etc. Cases like Saima’s need to be diagnosed at a young age to avoid future complications.
ADHD adults can be highly distracted; they have difficulty sustaining attention or concentration, they may be fidgety and have frequent mood swings. Many experience career problems; they lose jobs due to inconsistent performance, organizational problems, or poor “people skills”. Others experience problems in relationships — they have trouble sustaining it, are prone to divorce, and often have trouble with intimacy.
Salim, was a steno-typist at a multinational firm, who had ADHD and could not control his temper. He was a hard worker who was offered a better position with better fringe benefits but he chose to quit instead. For the last five years, he has been at home. His brothers are well settled in the US and have asked him to come settle with them but he is not ready to. ADHD is a disorder that impairs academic learning—disrupts social and peer relations—and disturbs functioning within the home and at school. Salim’s is another case of a person who was not diagnosed at an early stage and has had to suffer the consequences well into his adult life.
Children who have ADHD are not “bad”, “lazy”, or “stupid.” They have a behaviour disorder; they can also act on impulse — this means doing things without thinking about them first; they may change their friends a lot. When parents and teachers suspect that a child has ADHD the first step is to visit the doctor then he may refer the kids to a specialist like a psychologist, psychiatric or neurologist.
The diagnosis of ADHD is complex and is based on an assessment by a child/adolescent psychiatrist or pediatrician with expertise in the disorder. Doctors make a diagnosis of ADHD by looking at the child’s behaviour, and by obtaining more information about the child from parents, teachers, or other people who are familiar with the child’s behaviour. Confusion is a very common state for parents because ADHD is a complicated condition.
Many contemporary researchers and authors are suggesting that the rise in diagnosis of ADHD is due to several factors. These factors include dietary traits, long-term adverse results of medications and immunizations, and neurological factors from interference to the nervous systems. Smoking and eating a high carbohydrate, high sugar diet during pregnancy may be related to behaviour problems in toddlers.
Research has shown that gifted children are more than twice as introverted as their peers. While involvement in enrichment and gifted and talented programs is one answer, sometimes a child may need some counseling to get on track. Family therapy is often a component of such an intervention, and rightly so, since a gifted child challenges the whole family. Also, when a child is identified as gifted it is likely that others in the family are comparably bright. A child that is suffering from depression, anxiety or has a learning disability, or just made a major move with the family, or their parents are in the middle of a divorce can also show some of the same behaviors of ADD/ADHD. i.e.: attention problems, distractibility and mood changes.
Parents rely on two primary sources in the community to alert them to a developmental problem or disability. The first source is the family physician or pediatrician. Unfortunately, routine and brief visits to the family doctor are not likely to result in early identification of ADHD because such children may not exhibit their symptoms in this novel setting. Instead significant differences between the ADHD child and his peers most commonly come to light when teachers begin to report difficulties in the elementary school years. Teachers and parents sense that the child is not producing school work or grades that reflect the child’s true potential.
Communication between parents and schools is key to the educational success of all students. Regular communication is essential because of the degree of difficulty ADHD children are likely to have in meeting school standards for academic performance and in complying with school discipline codes. Getting parents to feel comfortable is the first step in establishing good communication. Parents of ADHD children are very sensitive to hearing criticism and complaints about their child. One parent lamented at a parent support group meeting that her child’s school once presented her with a five-page report of everything her child had done wrong in the last 48 hours! Her eyes filled with tears as she said, “I would have given anything if they had said just one nice thing about my son, even if it was only to say he has pretty eyes.”
Teachers are in a better position than parents to identify when a child’s behavior is developmentally inappropriate because teachers have a larger pool of same-age children with which to make comparisons. Teachers, however, need the active support of school administrators in order to be proactive in their response to students with attention problems
Educators should be aware of where parents are in the grieving process because it will influence how they communicate with school staff. Parents who are further along will be in a better position to work cooperatively with the school team. Parents respond best to school communications when they are delivered in a non judgmental way and when the school limits their calls or written reports to matters that truly need the attention of parents. Repeated contacts with school staff of the “Please see that your child stops doing this or that right away” variety are very stressful for parents. The reason they are stressful is that parents probably can’t correct the problem overnight. Parents are also in a better position to handle bad news if the news is accompanied by a suggested problem-solving approach. This gives the parent and the school staff something positive on which to focus and the problem seems much more manageable.
Therefore, the first step in the parent-educator partnership is for both to assist in the ADHD diagnosis. Teachers must be alert to the manifestations of ADHD in the classroom so that steps can be taken early to break the pattern of failure. Parents of ADHD children often need encouragement to come to the school and to get involved. Observing their child at school is sometimes an eye opening experience for parents because ADHD children may act quite differently in the home and school settings. This experience gives parents the benefit of seeing their child from the school’s perspective and helps to bridge the gap between their perceptions and those of the school.
Parents may need some coaching to talk about the areas in which their child has the most difficulty because they want the teacher to like their child and are afraid that if they acknowledge problem areas the teacher will form a negative opinion of their child or of their parenting skills. Identifying problem areas in advance allows the parent and the teacher or team of teachers to develop pro-active plans before major problems arise. Parents and teachers must make sure that they are teaching the child how to behave and are not just imply punishing the child for misbehavior. Improvements in behavior can be magnified when they are shared and reinforced by both teachers and parents.
Before any active child is said to have ADHD he must show following symptoms: high level of motor activity, and/or problems paying attention and concentrating. Despite good intentions, they may be unable to listen well, organize work, follow directions, and co-operating in sports and games may be difficult. These problems can be very upsetting to the child, its family, school friends and teachers. A child with ADHD often loses interest in an activity in five minutes or less, and continually moves from one activity to another. Children show some of the signs of hyperactivity in several different settings (in the classroom or the playground; at home watching television). They are often able to keep their attention focused on cartoons and video games, but at the same time they may be fidgeting with their arms and legs. The ADD/ADHD child is attending to his/her complete surroundings all at once and probably missed three quarters of what instructions the teacher has just given.
As aforementioned, ADHD is not a learning disability. Although it affects the child’s performance in school, it can also have a negative impact on a number of other aspects of life. Sometimes a child does not seem to listen when spoken to directly otherwise talks excessively, blurts out answers before questions have been completed and has difficulty awaiting his turn. He may be unsuccessful in arithmetical calculations although he has a good memory but he can be easily fatigued by mental work, becoming confused and averse to it.
In this case, teachers can be very helpful, if they indicate the mistakes to the child. Parents also fear that their child’s grades will suffer because of his poor listening skills, poor organizational skills and poor fine motor coordination. Common problems that ADHD students have in these areas result in comments like, “I didn’t do the correct assignment because I didn’t hear what it was; I didn’t turn in my homework because I left my book at school or I left my assignment at home.” Or, “I was not given full credit on the papers because my handwriting is hard to read.” Checking to see that the ADHD child recorded the correct assignment, letting the child keep an extra set of books at home, and allowing the child with handwriting difficulties to use a computer are no different than allowing a child with a visual impairment to wear glasses to see what’s written on the blackboard.
Teachers who are willing to make accommodations and adjustments so that the ADHD child can be successful create a partnership that is satisfying for everyone involved.
There is no one best way of bringing up hyperactive children, any more than there is one right kind of child-rearing generally. Every family works differently, and general rules are generally wrong. You may have been given broad advice about discipline including ‘always avoid smacking’ or ‘never use bribery’ or ‘never give way to blackmail’. No rule should be followed slavishly. The best guide is simply that works best for you and your child; and on this matter you are the expert
The following are some tips suggested by Dr Dommena Renshaw i n her book The Hyperactive Child.
* Keep your own voice quiet and slow. Anger is normal. Anger can be controlled. Anger does not mean you do not love a child.
* Avoid a ceaselessly negative approach. “Stop” - Don’t. No.”
* Have a very clear routine for this child. Construct a timetable for waking, eating, play, TV, study, chores, and bedtime. Follow it flexibly when he disrupts it. Slowly your structure will reassure him until he develops his own. Supervise their keeping to the routine, which becomes their responsibility. Reward good, appropriate behaviour.
* Get your child’s attention first (before you begin talking). Then make him look at you while you talk. Give clear, concise instructions and be consistent in rules and discipline.
* Allow your child breaks to refresh himself (during homework, studying or chores). They will perform better after a five or 10 minute break. Allow them outlets every day to expand their excess energy e.g. running in playing field or playing physically demanding games.
* Give him responsibility, which is essential for growth. The task should be within by distracting him or discussing the conflict calmly. Removal from the battle zone to the sanctuary of his room for a few minutes is useful. The task should be within his capacity, although the assignment may need much supervision. Acceptance and recognition of his efforts (even when imperfect) should not be forgotten.
* Accept your child limitations. If you can make the best of what he has and then gradually help him improve on it, then you will be doing a good job.
Openly discuss with your physician any fears you have about the use of medications. Know the name and dose of his medication. Give it regularly. Watch and remember the effects to report back to your physician. Always supervise the taking of medication, even if it is routine over a long period of years. One day’s supply at a time can be put in a regular place and checked routinely as he becomes older and more self-reliant.