Recognizing ADHD

Children with Attention Deficit Hyperactivity Disorder (ADHD) show the following symptoms:

	Poor attention span and concentration - unless totally engrossed in something (like a computer game).
	Poor concentration and memory
	Impulsivity - doing things without thinking first
	Easily frustrated - often leading to temper tantrums and outbursts

Of course all children (and adults) show difficulties such as these at various times. For the child with ADHD, however, these difficulties are so great that they have experienced failures in various areas such as

	at school (getting work done, paying attention, daydreaming, losing homework, talking in class, being disruptive, etc.),
	at home (often distracted, therefore not getting chores finished, constantly talking, “hyperactive”, getting into fights with siblings, difficulty getting ready in the mornings and at night, often clumsy), and
	socially (unable to take turns or wait in line, bossy and overbearing, easily frustrated leading to temper outbursts and aggression, impulsive, so often in trouble for doing antisocial actions e.g. unwise “practical jokes”).

ADHD is not a disease or illness in the sense that it is caused by germs, by injury, or by a clearly defined physical malfunction (such as asthma or diabetes). It is simply the result of parts of the brain not working at full efficiency.

What is clear is that ADHD does run in families and is at least partially genetic - often a parent has the same symptoms. What is also clear is that the symptoms, and therefore the problems, are long term. They are not going to go away or be cured in a short period of time, but are almost certainly going to continue through into the teen years, and probably even into adulthood.

How is ADHD managed?

The big concern for children with ADHD is the danger of developing long term complications. For example:

• because they can not concentrate, they may fail in school and so drop out,

• they may be constantly in trouble because of their impulsivity and so be excluded from school and end up with the police,

• they may be so discouraged by their failures that they turn to drink, drugs, crime, or become depressed and anxious.

All of these may then have long term implications even into adulthood.

The goal of management is therefore to prevent complications. This is a long term process, so the most important people to take charge of this are the parents. It is you as parents who have to live with the child, you who are most concerned about his/her long term well-being, and you who know your child best. If you do not take an active role in managing the difficulties then whatever else other people do will be unlikely to make much difference. However, if you do your part then there is much that others can do to help you along the way. Effective management is likely to include the following components:

1. Committed parents who will work for the best for their child. There is much information, including books and videos, on ADHD and how to help your child - borrow them, buy them, read them, and become informed. But remember there is also much mis-information (especially on the internet and in newspapers and magazines), so discuss what you read with your local support group and professionals. Be especially suspicious of groups who claim to have the “magic cure” for your child.

2. Good communication between home, school and other professionals. This especially applies to home and school, so do all that you can to meet regularly with the school to work together on solutions for your child.

3. Adjustments in the environment. Children with ADHD do best in a quiet, calm, structured, low-stimulation environment (e.g. one to one) and poorly in chaotic situations (e.g. busy classrooms, noisy, busy homes). As a family you may want to find ways to reorganise life so that it is less stressful for all of you. At school the teachers will be doing the same, and it is best if the two can be co-ordinated.

4. Clear behavioural management strategy. These children respond best to very clear expectations of behaviour, and very clear rewards and punishments - with rewards being more frequent than punishments. If you are having difficulty in doing this at home you may want to talk about some strategies with your key worker.

5. Support for the parents. These children are hard work - even for the best of parents. This often produces a lot of stress. Often this can lead to marital breakdowns and parents getting depressed themselves. To prevent this you may need to consider getting help for yourselves - parent support groups, parent training groups, respite care, marital counseling, family therapy are all possible resources.

6. Medication. Medication is not a cure, but can be an invaluable help. Getting it right is important and so you will need to work closely with your key worker and doctor. The goal of medication is to reduce the symptoms so as to give the child the opportunity to learn academic, social, and other life skills. By itself, however, it is unlikely to solve all the problems and so cannot be used as an excuse to opt out of the above ingredients. There are several types of medication that are used. The most common are the “stimulants” (discussed on the next page), but increasingly common is the new medication atomoxetine, which seems to work very well with few side effects. Ask your doctor for full information.

As health professionals we cannot raise your child for you, nor can we solve all your problems as you travel with your child along life’s journey. What we can do, however, is to assist you in getting unstuck when you get stuck along the way. To do this we will try to help you to sort out all of the above points as best you can.