Attention Deficit Hyperactivity Disorder, or ADHD is a medical condition that affects parts of the brain that control attention, brain impulses and concentration. it is not an excuse for "bad parenting"or badly behaved children.
Attention deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), is a neurobiological disorder caused by an imbalance of some of the neurotransmitters (chemicals) found in the brain, called norepinephrine and dopamine (these are little brain chemicals that jump from one nerve cell to the next in the brain to carry a message through the brain).
In other words,
· Norepinephrine affects the part of the brain that controls attention and also the part that controls the fight-or-flight response. An imbalance of this neurotransmitter can affect a child’s ability to focus on anything that they do not find interesting and can also make them very impulsive, as their ‘fight-or-flight’ response is more sensitive.
Dopamine on the other hand has many functions in the brain, including important roles in how we process information, voluntary movement, motivation and reward, sleep, mood, attention, and learning. Again, an imbalance in the production of dopamine can affect a child’s short-term memory, the amount of sleep he/she needs, facial ticks and involuntary movements, whether he/she feels sad or happy and his/her ability to ‘wait’ for a reward rather than needing ‘instant gratification’.
In individuals with ADHD, research shows that there is underactivity’ of the dopamine and norepinephrine in the frontal lobes of the brain.
SYMPTOMS
ADHD is one of the most common conditions of childhood and adolescence and is characterised by symptoms of impulsivity and hyperactivity and inattention.
The symptoms are not seen to the same degree in all people who are diagnosed with ADHD and healthcare professionals recognise that there are 3 main combinations of symptoms:
1. Some people have predominantly hyperactive-impulsive type (Hyperactivity Disorder)
2. Some have predominantly inattentive type (Attention Deficit Disorder (ADD))
3. And some have a combined type (ADHD)(this makes up the majority of cases)
Source NICHCY (National Dissemination Centre for Children with Disabilities)
Hyperactive symptoms may include:
· fidgeting,
· having trouble playing quietly,
· talks constantly - interrupting others
· always ‘on the go’ and ‘in your face’
· unable to sit still,
· no sense of danger – will climb anything!
· may not sleep for more than a couple of hours
· Tourette’s?
Tourettes may not present in the stereotypical way that we have all heard about, but might consist of facial ticks, constant humming or other noise, or repetitive phrase.
· Impairment in ability to recognise consequences of actions – ‘think’ then ‘do’ - no ‘hang on a minute’ button
· Blurting out answers in class
· Picking things up that have been ‘abandoned’ by their owners (magpie)
· Easily distracted – sometimes to the point of vulnerability
·
· Appears ‘not to be listening’
· Short term memory difficulties
· Lack of organisational skills
· Forgets or loses everything they own!
· Gets lost in unfamiliar places
These youngsters find it difficult to prioritise where their attention should be (this causes problems when they should be listening to the teacher but are distracted by something they find more interesting)!
Whilst ADHD symptoms occur to some extent in all of us, the difference between ADHD behaviours and average, expected behaviours, is the degree of to which the child’s symptoms have a negative impact on their life and the lives of those around them. Children with ADHD show these symptoms to a significantly greater extent and severity that the rest of us.
Children with ADHD may exhibit behaviours that cannot be explained by any other psychiatric condition and are not in keeping with the child’s age and intellectual ability. Mood swings and ‘social clumsiness’ is common and parents and teachers may report that children often misread the accepted social cues, saying or doing inappropriate things. Social problems are often highlighted in school situations. Not only do children affected by ADHD have difficulty socially interacting with their peers, they often have difficult relationships with teaching staff as they are unable to understand that speaking to an adult the same as you would another child is socially unacceptable. Often in adolescence, insecurities make the normal social uncertainties of this age even greater.
How Many Youngsters are affected by ADHD?
According to medical guidelines, ADHD affects 5% of school-aged children and the boy to girl ratio in diagnosed ADHD is at least 4 to 1.5. The observed prevalence of ADHD in boys and girls is skewed by the fact that symptoms of hyperactivity and impulsivity are more common in boys, whereas girls with the condition are more commonly diagnosed with ADD and have inattentive symptoms. Indeed many girls remain undiagnosed, as they tend to be less disruptive. But while they may not be referred to a clinic, they may still be failing at school and be experiencing other difficulties due to their ADD.
ADHD in girls (who have ADHD with hyperactivity, (either combined type or hyperactive type) is associated with more severe cognitive and language problems and greater social problems.
Some youngsters who are affected by ADHD might have additional difficulties (co-morbidities), some of the more common co-morbidities include:
Even though it can be challenging to live with a child with ADHD these youngsters have many skills and there are many things that you can do to try and make life a little less stressful for your child and yourself.
Medication: Yes or No? You Decide. ADHD medication generally increases the activity of the brain neurotransmitters (chemicals) dopamine and noradrenaline. These are little brain chemicals that jump from one nerve cell to the next to carry a message through the brain. Research shows that in people who have ADHD, there is ‘underactivity’ of the dopamine and noradrenaline in the frontal lobes of the brain and suggests that the ADHD brain causes breaks in the neurotransmitters and that this slows down the brain’s ability to process information. The idea is that if medication can increase the levels of dopamine in the brain, it will provide a smoother flow along the neurotransmitters and can help a child or young person to process information. This can lead to less impulsive behaviour and it can also encourage a more steady activity level and increase the child’s ability to concentrate. So, what we are saying is that the frontal lobe of the brain is the ‘command centre’ and is also the area of the brain that is most affected by ADHD. This command centre allows people to use their ‘thinking skills’ or their ‘executive functions’ to concentrate, control their impulses, delay gratification (rewards) etc. Because people who have ADHD do not have enough of these chemicals, different types of medication are used to try to increase the levels of the chemicals that are needed to carry out these ‘executive functions’. Methylphenidate. For example, Ritalin, Equasym and Concerta. Methyphenidate is a stimulant medication and all stimulants work by increasing the dopamine levels in the brain. The therapeutic effect of stimulants is achieved by slow and steady increases of dopamine by ingestion (swallowing), which is similar to the natural production by the brain. Taken in this way, methylphenidate is not addictive and will only stay in the body for between 4 hours and 8 hours depending upon whether the child is taking the slow release tablet or not. However, when taken in doses and routes other than those prescribed, for example by crushing and snorting, stimulants can increase brain dopamine in a rapid and highly amplified manner as do most other drugs of abuse, disrupting normal communication between brain cells, producing euphoria, and increasing the risk of addiction. For children taking methylphenidate for ADHD, the most common side effects are loss of appetite, weight loss, and sleep problems. At the beginning of the treatment they may experience abdominal pain and nausea. Other side effects might include long-term nausea, vomiting, dizziness, palpitations, headache, involuntary movements, chest pain, increased heart rate and increased blood pressure. There have been some rare reports of an increase in Tourette's syndrome, a syndrome in which there are uncontrollable tics such as grimacing. Children taking this medicine for long periods of time should have their height, weight and appetite regularly checked every six months. If your child is not growing or gaining weight satisfactorily, your doctor may suggest breaks from the medicine to allow growth to catch up. Your child's blood pressure and heart rate (pulse) should also be monitored at least every six months and after any dose changes, particularly if your child has existing high blood pressure. Children should also have periodic blood tests to make sure there are no problems with their blood cells. Atemoxetine hydrochloride. For example Straterra. Straterra is a non-stimulant medicine approved to treat ADHD. It contains atemoxetine hydrochloride, which is a ‘selective noradrenaline re-uptake inhibitor’. In other words, it works in the brain where it increases levels of natural noradrenaline. The noradrenaline is one of the chemicals involved in passing messages between brain cells and is known to help regulate attention, impulsiveness and activity levels. Strattera treats symptoms all day and evening and has not shown potential for abuse. Like methylphenidate, Straterra may decrease appetite so height and weight should be measured regularly. This medication has been associated with liver problems, so parents have to look out for jaundice type symptoms or back and side pain. In some children and teens, Strattera increases the risk of suicidal thoughts. A combined analysis of 12 studies of Strattera showed that in children and teens, 4 out of every 1000 patients developed suicidal thoughts, although no suicides occurred. A similar analysis in adults treated with Strattera did not reveal an increased risk of suicidal thoughts. Call your doctor right away if your child has thoughts of suicide or sudden changes in mood or behaviour, especially at the beginning of treatment or after a change in dose. Straterra has been associated with causing or worsening some psychiatric disorders, such as depression, suicidal thoughts, hostility, anxiety, agitation, psychosis, hallucinations and mania. About 4 in every thousand Children and adolescents taking this medicine report thoughts about suicide or self-harm, depression, anxiety, agitation, irritability, mood changes. Source: strattera.com Both medications have been used effectively to limit the effects of the core symptoms of ADHD. Both have been seen to help with attention, concentration and activity levels. Medication might also in helping the child to process information and might help in the followings ways. Get Informed:
Find out as much as you can about ADHD. You can do this by talking to people who are involved with your child such as Doctors, Local link Nurses or Psychologists. We have found that Sefton parents have benefited significantly from attending the courses that are run here at Parent Partnership. We offer training for parents, grandparents, siblings, other family members and friends, the youngsters themselves and we even offer a course for Dads on their own. You can find out the dates of any of these courses by contacting us directly by phone on 0151 291 0551 or looking at the ‘Dates for your diary’ page.
The Internet is also a good source of information, but make sure you visit websites of organizations that you know are trustworthy. Possibly the best source of information are other parents and we have a thriving support group that meets between 7pm-9pm on the first Wednesday of every month. They will be able to share their experiences and tell you about the strategies that they use to help their children. We also have a support group for secondary age siblings that meet on the same night.
Think Positive:
Start talking in a positive manner. "Can you please pick up your toys" works better then "stop messing with those toys". In this manner you give a positive direction that is easy to follow.
Set Clear rules:
Rules should be set in stone (or on paper). This will avoid argument about what the exact rules are. Try to keep to the parts of the Childs behaviour that you find are really important, the words "Choose your battles wisely" will soon become clear.
Speak face to face:
When you are giving instructions to a child with ADHD make sure you have their full attention. You can do this by taking away any background distractions (turn down the TV or radio), speaking in a clear, low manner, use the Childs name and ask him/her to repeat what you have said to make sure they have heard. This is better than insisting on eye contact as sometimes they are concentrating so hard on looking at you that they can’t listen to what you are saying.
And Praise:
Praise your child constantly. Catch them being good, even if it for a small amount of time. Be specific about what they were doing that you are pleased with for example, let them know how happy you are they are playing nicely. Thank them for putting a toy away even if its what you expect anyway. If they ‘don’t’ kick the leg of the table and rock back and forth whilst eating their tea, tell them how clever they are for managing to sit still. Even older children need a bit of positive feedback. For example, if your teenager doesn’t swear at you during an argument, tell him/her how pleased you are that he managed to ‘discuss’ things without swearing!
All children thrive on praise, non-more so then children with ADHD. Children with ADHD get bombarded with negativity throughout the day, "don't do that", "stop that", "sit still" it never ends. You will be amazed how well praise works.
Try not to get caught in a Positive- Negative situation. "Wow you put those dishes in the dishwasher, but you could have rinsed them a bit better". The child will remember the negative 10 times faster then the positive.
Even though any parent of a child with ADHD will tell you that living with ADHD can be hard, there are many rewards as well. Many children affected by the condition are highly creative, innovative, enthusiastic, inquisitive and energetic. These skills, if not used positively can sometimes end up being used negatively and it may be that the only outlet for their creativity is when they are trying and get themselves out of difficult situations that they have got themselves into.
Having ADHD in no way means that your child cannot become a high flyer. Look at this list of people affected by ADHD who have made a difference to our world:
Beethoven— (1770-1827) — Composer
Thomas Eddison- Inventor
Jim Carrey— (1962-present) — Comedian
Winston Churchill— (1874-1965) — Prime Minister
Leonardo Da Vinci— (1452-1519) — Inventor, Artist
Walt Disney — (1901-1971)
Albert Einstein — (1879-1955) — Physicist
(Einstein was four years old before he could speak,
and seven before he could read)
Robin Williams — (1952-present) — Comedian
Steven Spielberg — (1946-present) — Filmmaker
Will Smith— Actor, Rapper, Entertainer
Ozzy Osbourne— (1948-present) — Musician who disclosed he had ADHD on Television
Sir Isaac Newton —(1642-1727) — Scientist, Mathematician
(Did poorly in grade school)
Steve McQueen — (1930-1980) — Actor
And with them many, many more.
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