Attention Deficit Hyperactivity Disorder (ADHD)

Peter never stops. He fiddles, he tampers, he teases, he demands, he interrupts, he’s impulsive, he’s impatient, he risks, he ransacks, and his school reports are a disaster. Yet despite all this, he loves everybody and never carries a grudge no matter how hard he has been punished.

Peter is probably the stereotype of a child with ADHD, but there are three different subtypes of the disorder, as well as differing levels of severity. Some children may exhibit no hyperactivity but just be inattentive, can’t concentrate, don’t listen, easily distracted, never finish their game or work job.

Another subgroup is the impulsive type. Parents usually know if they have this problem as these kids tend to act (and talk) before they think. They tend to be reckless, do dangerous things, do ‘silly’ things, take incredible risks - the sort of kids that have a good heart but leave your heart constantly in your mouth with worry that they’ll do themselves damage.

Then of course there’s the hyperactive group. But parents of young children take note – many young children present as very active – they have bigger neurological engines than brakes – they can go but can’t stop, so don’t label them as hyperactive before checking with your child’s carer or teacher.

Researchers are not yet sure of the precise nature of ADHD; all we can be certain of is that it’s a neuro-chemical disorder affecting various functions in the brain and probably related to a deficiency of dopamine which is needed to relay information. As the message dwindles, so does the concentration.

The mind of a child with ADHD is then likely to drift or get distracted or act without thinking. It would also appear from recent research that the difficulty relates to the limbic or arousal system of the brain stem and to the frontal lobe which is the executive part of the brain - organising, sequencing, planning, analysing and reflecting and therefore also acts to inhibit or stop silly, impulsive or dangerous behaviour.

Unfortunately, the term is overused and often confused with a few look-alikes. These include what I term Attention Demanding Disorder, Attention Digested Disorder and Attention Damaged Disorder.

Attention Seeking or Demanding Disorder can be distinguished from ADHD along these lines.

Attention Seeking Disorder   

• behaviour has a goal (adult attention)
• behaviour ceases if unsuccessful
• adult compliance reduces disruptive behaviour
• often enjoy books and listening if with adult attention
• rarely able to occupy themselves for long periods without adults
• often eager to articulate causes and blame for problem
• often carries grudges about being hard done by etc

Attention Deficit Disorder

• the behaviour seems goalless
• little change if behaviour unsuccessful
• adult compliance makes little difference
• even with adult attention generally find it hard to listen for long to stories.
• flits around activities, often doing dangerous things but can occupy themselves for long periods
• rarely has much insight or even interested in causes
• rarely carries grudges or even thinks about problem after the incident

Attention Digested Disorder tends to be distinguishable from ADHD as follows:

• behaviour changes dramatically within a few hours of eating certain foods
• behaviour becomes consistently more restless, hyperactive, aggressive, noisy or irritable within a few hours of eating certain foods
• child has a particular obsession with certain foods (eg sugars, coke, sauce, wraps, sweets, chocolate)
• child complains of feeling edgy or angry after eating
• child starts to misbehave if he has a build up of particular foods
• child has other allergies.

Attention Damaged Disorder can present with the same listening problems as the other three but in this case the problem is that these poor kids just can’t or couldn’t hear well, so they learnt not to listen. Many a young kid gets off to a bad listening/attending start because of hearing loss or glue ear where there’s too much gunk to let sounds come through clearly or easily or satisfyingly.

Check for the following symptoms of Attention Damaged Disorder

• delayed or distorted speech,
• doesn’t startle to noise
• needs the volume up high or sit up close to the TV,
• seems disinterested in looking at the person talking
• seems disinterested in stories and music
• turns their head to one side when listening,
• doesn’t react to a whisper, wrapping paper, their name or the word ‘chocolate’.

The good news is that there is just so much that can now be done to help children with ADHD lead productive lives.

Behaviour management

As these kids have big engines but poor brakes, they’re best steered in the directions you want. in your behavioural teaching much of it is teaching correct behaviour patterns till they become automatic (as you did, say, learning to use a clutch on a car). As they tend to act before they think, the action sequence should be taught, rather than yelling when they get it wrong. So, for instance, if they’re forever running through the house practise with them, over and over again till it’s automatic, to walk through. If they run after that, teach it again and again till the new pattern is stronger than the old.

Praise what you do like, practise what you would like till you get it, and isolate (eg, in their rooms) behaviour you just can’t cope with till they (and you) get time to calm down.

Children with ADHD also need more structure in their routines and rules to give some order to their behaviour. Often the problems are worse in freewheeling situations, like high stimulation, noise, excitement, other kids around. While some of these are hard to prevent or control, simple learned cues, like on a quiet request going to a quiet area of the house when they’re overexcited, can give them time to regain self-control.

Self-help skills

For children over the age of four, I use appealing, fun charts with lucky dips and goals to record their progress and to give them good news about their improvements. With high-school children who want to improve, we often use a self-recording system of times they were distracted or they interrupted so they self-monitor their progress as they try to get their score down. Kids with ADHD tend to be a little immature and just love charts and rewards and it’s one way to teach them acceptable new habits. But be prepared for the novelty to wear off fast too, so don’t throw the idea of charts away, just create something else that’s interesting and novel so the motivation to change stays high.

Diet

Many children with ADHD appear diet-sensitive. While we think of preservatives and colouring/flavouring as being the big culprits (sauces, lollies, soft drinks), some children seem to react to much more subtle things such as some fruits, or yeast. As elimination diets can be very demanding on families, I often encourage parents to first become ‘diet detectives’ - to just note when the behaviour is at its worst and take a punt on what might have triggered it, then omit that from the diet. If it’s more complicated than that, then seek professional guidance from a dietitian.

Medication

There have been some exciting breakthroughs in the treatment of ADHD with medication. For instance, medications such as Ritalin and Dexamphetamine (especially as families can now use the slow release version, which often gets around the problem of medicating at school) have been real sanity savers. However, other techniques should be tried first, and a thorough and full diagnostic assessment by a clinical or child psychologist should be undertaken before any treatment plan is instigated.

The good news for those families who do tackle it lovingly and patiently is that these children can overcome the disorder. The message is to see kids with ADHD as children with problems, not problem children.

by Dr John Irvine
 

Dr John Irvine is an educational psychologist, a consultant psychologist, a counsellor and a widely recognised specialist on children’s behaviour. He is the author of significant books for parents such as A Handbook for Happy Families and Who’d Be a Parent? His relaxed and warm advice deals with the practicalities of managing real families in everyday life.

This article was first published in Australian Family Magazine, November 2003. Updated July 2009.