Wednesday, November 25, 2009

Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-Deficit/Hyperactivity Disorder (ADHD)

Some children seem unmanageable to both their parents and teachers. They have trouble paying attention to things that other children can easily focus in on. They frequently do not follow instructions, do not finish tasks, are careless and messy in their school work, and become frustrated and give up on challenging work. These children are also likely to be disorganized and easily distracted by irrelevant stimuli (trivial noises, or other features of people or the environment), and they have trouble following rules.

Children with attention problems may, or may not, show the additional problem of hyperactivity. What we call hyperactivity consists of frequently and rapidly doing a large number of annoying things such as squirming and fidgeting, running, jumping, shouting, climbing and walking on furniture or tables, all of which can lead to danger and make them accident prone. They may also annoy others by tapping, poking, pulling, and pushing on them, or the various things around them. Such children often talk loudly, rapidly and excessively which makes them difficult and irritating to be with.

Hyperactivity naturally includes actions that we call impulsive . These children may frequently knock things over, bump into people, or break and spill things. They interrupt, “goof around”, “blurt-out” interrupting comments, touch things and people that they should not, and do things that are dangerous without thinking about the consequences of their actions.

Children who behave in these ways tend to do so in a wide variety of settings (school, church, vacations, home), but some settings and activities worsen these problems. Generally conditions that require sitting still, concentrating, and doing monotonous tasks, requiring close attention and concentration, will produce more such troubles.

It is common for children to show some of these behavior patterns when they are younger than four of five years old. If these actions persist and intensify ADHD may be diagnosed in their early school years, when they first begin to encounter public social and educational problems. ADHD is diagnosed much more often in boys than it is in girls.

Untreated ADHD symptoms can lead to other very significant problems and impairments. About half of these children develop various learning and communication problems and about 80% of them misbehave, often quite seriously.

One preschool child showed almost all of these features. He ran away and climbed under the dresses of manikins in stores. In play, he ran jumped and yelled so loud that he could be heard though-out the neighborhood. School problems started in kindergarten when he constantly played and splashed the water in a shallow ceramic gold-fish pond built into the floor in his classroom. He wandered away from story time, and made noises and talked to others at rest time (they used to have children rest upon little mats on the floor). Due to the mischief he caused, teachers naturally suspected him whenever there was a problem of unknown origin. Negative expectations by teachers and others who care for such children is common. He was once accused of stealing things from his kindergarten teachers desk (he was innocent). Later he had great difficulty learning to read and to do mathematics. His parents tutored him and they became exceedingly frustrated while trying. But his parents never gave up and they hired tutors. In grade school, while the teacher was trying to hold class attention, he noticed the first snow of winter and loudly directed class attention out the windows to see that “great event”. He similarly interrupted class to announce that men were working on the traffic light at the corner, just outside of the school, and all of the students ran to the window to see. This boy was quite a challenge.

I am both happy and mildly embarrassed to report that this boy was me. I extend my deepest heartfelt appreciation to all of my heroic helpers of the distant past and, especially, to my beloved Mother and Father who did a wonderful job in a time when there was “no such thing as ADHD”. The experts said I was “just all boy”. That was indeed the truth, but it was not the whole truth!

Suspected Causes

ADHD behaviors appear to be caused by many things; and these things appear to summate and interact with each other. Attention-deficit/hyperactive disorder tends to run in families and may have an inherited biological basis (this was, and is, very true in my family). Also, the disorder was once called "Minimal Brain Dysfunction", attesting to the possibility of actual neurological damage attributable to fetal development or birth related problems. There is also the suspicion that ADHD may be caused by slowly maturing parts of the brain that filter extraneous stimuli and which are needed to help concentration.

Also, there is evidence that this pattern of behavior is more prevalent among homes that suffer high levels of stress, chaos and family dysfunction: This suggests that these behavior patterns can occur in children who simply failed to learn to follow rules, organize and attend in orderly ways to their environmental surroundings. As you can see, as with many psychological disorders, there is no one cause for ADHD.

Learning Disorders

ADHD puts children at increased risk of developing significant academic learning problems. A learning disorder is diagnosed when a child’s achievement test scores fall significantly behind those of his normal peers. The child’s existing learning problems then interfere with the learning of new information and the child falls further and further behind the academic achievements of his peers.

When an ADHD child has trouble being patient and focusing upon uninteresting details and activities they will have difficulty learning to read, learning mathematics, and learning to write. Putting information into memory, to a large extent, requires that we focus upon information and work to make sense of that information, or repeat it over and over again (i.e., do rote learning). Doing this effortful work is the main way in which we place our academic information in our long-term memory.

There are ways, other than having ADHD, that children can develop learning disorders. Research has implicated other possible causes of learning disorders such as: Inferior teaching, poor diet, lead poisoning, genetic defects, birth injuries, and sensory and perceptual problems. The true causes of a child’s learning disorder, in many cases, remain uncertain.

Effective treatment for ADHD involves early detection and treatment. The behavior problems involved in ADHD should be treated first with behavior modification methods. After consulting a pediatrician, further professional assistance from psychologists who can teach parents behavior modification skills can be very helpful.

If these methods do not reduce behavior problems significantly, psychological testing for primary school children to screen for ADHD is appropriate. If a formal diagnosis of ADHD is made, and behavior modification methods are not sufficient, treatment with both medication and behavior modification methods may be a necessary consideration.

ADHD is a condition that is preventable when it is a learned behavior pattern. Whether ADHD is a learned condition or not, like all psychological disorders, it is a problem that greatly benefits from early intervention.

An ounce of prevention, or early intervention, is worth a pound of late attempted cure.

God Bless

Dr. Tom

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