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A Real Disorder, Not a Myth!

Abstract

Attention Deficit Hyperactivity Disorder [ADHD] is one of the most common disorders amongst children. It has been the most studied of all psychological disorders in children. Over the last three decades the numbers have been increasing for children diagnosed with ADHD. There are a variety of reasons for this. First, there is a growing awareness by the general public about ADHD. Second, over the last decade, pre-school and adolescent children are increasingly being identified as so, where as in the past, pre-schoolers were rarely identified and professionals believed that most children outgrew ADHD by the time they reached adolescence. Third, most children are diagnosed by pediatricians and family doctors who may have inadequate expertise in ADHD, as a consequence a child may be misdiagnosed.

There is an urgent need to identify children with ADHD early in order to increase school success and decrease the escalation of more severe social and academic problems. An important beginning step for teachers is the acceptance of ADHD as a real disorder and not a myth, because pre-school and school age educational support is very important in minimizing problematic ADHD behaviours and learning challenges. Positive and supportive relationships are essential not only for cognitive development but also for a healthy social emotional development.

Your Attention, Please

ADHD is one of the most common disorders among children. It is currently recognized  as a disorder with behavioural, emotional, educational and cognitive aspects that impact on the life of a child with ADHD every day of the year. Children who have this disorder face two  different  problems  at school. First, as they have difficulty in focusing and maintaining attention for the right amount of time on a given task, they have poor academic performance. Even bright and gifted children with ADHD may get poor grades. ADHD is also known to affect memory. Second, as they are unable to control their emotions, actions, gestures and behave the way they want to, they end up having poor relations with classmates. ADHD is a term used by clinical psychologists but for us it simply means that our children are hyperactive and impulsive. Those who have never had to cope with the problems presented by hyperactive and impulsive children on a day-to-day basis have little knowledge of the colossal commitment, time and energy involved. These are children who won’t listen to anyone. Disciplining them is an uphill task and because of their constant motion and explosive energy, they get into trouble with teachers, parents and peers. On many occasions there is no understanding of the child’s basic temperament, with the result, parents  especially,  the  mother is frequently blamed for being unable to control the child. This results in the mother being overwhelmed with the task of taking care of the child.

ADHD arises as a developmental failure in the brain circuit that underlines inhibition and self- control. This loss of self-control in turn impairs other important brain functions that are crucial for maintaining attention, including the ability  of  behavioural  organization.  No one knows for sure what causes ADHD. There is no simple primary cause. However, heredity or a positive family history appears to be the most common identifiable cause. There are two clear sub-types of ADHD and for each of these the children who have them will show different kinds of behaviour. In one case children will be very inattentive and in the other hyper-active with or without impulsivity. The pre-dominant behaviour will help in diagnosing the type.

The focus of this article is not on the diagnosis of ADHD but to provide teachers and parents with a better understanding of it.

Attention is the ability to select and focus on what is important for the right amount of time and discard what is irrelevant. It allows us to plan, monitor and regulate our thoughts and actions. It also supports the more complex neurodevelopmental functions such as language and higher order cognition. When attention is focused as it is supposed to, it helps a child learn, become productive and behave appropriately. On the other hand, when we are unable to be attentive it leads to chaos in the learning process and in the daily life of a family. Children with hyperactivity and impulsivity are driven by the moment. Because of delay in inhibitions, they often say or do what first comes to their mind, without stopping to think about the consequences. They lack control needed to slow down. ADHD children with impulsivity have an insatiable appetite for stimulation, entertainment, and new play things. In their frenzied pursuit for stimulation, they look for opportunities that provide excitement. They behave recklessly and this makes them prone to accidents. Permissive parents allow children who are already uninhabited and extrovert by nature to do “their own thing”. It may be easier for the  moment, but the long term consequences can be disastrous. It can impair the development of important brain processes relating to self and impulse control, empathy and behavioural organization.

For lay people, ADHD is typically synonymous with hyperactive and impulsive behaviour but there is another sub-type of ADHD which often gets overlooked. It is known as Inattention. Children who are inattentive tend to be overlooked far more than those displaying outwardly noticeable symptoms. They may sit quietly and look as if they are paying attention but the fact is they are probably attending to the most irrelevant things such as the colour of the teacher’s saree or the cover of the book she is holding. As a consequence, they miss out on important information given by her. Children with inattention are internally rather than externally distracted. They often are seen as underactive, day-dreamers and cognitively sluggish. They tend to have problems with academics as they move to higher studies.

Children with attention problems hate routine  activities  as  sustaining  attention for longer period of time is an issue. They find completing worksheets, assignments, class work and home work boring and uninteresting. They may give up or  move on to something else. But what is surprising  is that when these children are introduced to novel and stimulating situations,  they  are as attentive as  those  without  ADHD.  In fact, these children baffle their parents and teachers by being able to attend to high interest activities such as video games and TV shows for long hours. They get so obsessed with what they are doing that they are totally oblivious to what is happening around them. This inconsistency in task performance confuses parents and teachers alike. “He remembered to complete the math assignment yesterday; why can’t he remember today?” Unfortunately this erratic performance is confusing to the affected child. The ability to perform on some days and not on others brings a heavy toll of unfair accusations of laziness and willfulness.

Luckily, children who struggle to focus their attention often possess remarkable positive traits we cannot afford to overlook. They are often amazing people in their own right, displaying refreshingly unorthodox pathways of thought. There is more that is right than wrong with these children. Many of them turn out to be extraordinary adults. Parents and teachers have to be on a constant diligent quest to discover the buried treasures within these children.

Treatment involves a mix of medication, behavioural therapy, occupational therapy and educational support. Treatment is individually designed, as each case is different in symptoms, intensity, response and family background. Children with constitutional hyperactivity usually outgrow the disorder even without treatment. They just need proper handling – discipline and direction. In cases where neurological causes are behind the problem, neuronal maturation and impulse control can come with age and development.

When reviewing findings related to attention, it is important to consider that observed or reported symptoms could stem from several different constructs. For example, language problems can create the appearance of weak attention. When you are not fluent in the language of medium of instructions in school, then your understanding of what you hear and read is limited and your capacity to communicate your ideas and needs is laborious. As you struggle to comprehend you might drift off and appear inattentive. You would be likely to miss details. Picking up details, trouble with expressive language or difficulty putting thoughts into oral or written words can lead to frustration and inappropriate decision making in an effort to get needs met, which can look like impulsivity. In short you might seem like a person with attention weakness!

Problems of attention cause children to develop gaps in learning as they are not able to remain attentive when the teacher introduces information. Their decisions are based on partial information and this leads to incomplete assignments. But as they are not aware of their mistakes, they are confused. Teachers and parents need to  take note of the above mentioned and modify their teaching instructions otherwise there is a  risk that they may develop problematic behavior and secondary disorders.

Adults have a tendency to assume that a struggling child is lazy, willful, unmotivated or worse, he is not bright. We tend to perceive children with ADHD as having an attitudinal problem or simply bad behaviour. Yet, these are struggling and confused children, who very much want to succeed and win the respect of adults.

They need our support and want us  to  help them to cope with attention issues. When they sense we are on their side and not accusing them of being bad or lazy, they often rise to the occasion and show steady improvement. Teachers need to form strong alliances with their children rather than adversarial relationships. Forming relationships built on trust, respect and empathy is one of the most important strategies for success. Children with ADHD benefit the most when families, teachers and when necessary, doctors work together.

Characteristics of a child with ADHD In terms of Inattention.

  • Often fails to give close attention to details or make careless mistakes in schoolwork or other on tasks or play activities.
  • Often has difficulty in sustaining attention on tasks or play activities
  • Often does not seem to listen when spoken to
  • Often does not follow through on instructions and fails to finish school work
  • Often has difficulty organizing tasks and activities
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
  • Is often easily distracted by extraneous stimuli.
  • Is often forgetful in daily

The child’s distractibility is many times internalized and is not always recognized by teachers.

Remember: Seizure, middle ear infections, lack of sleep, emotional problems and learning disabilities can cause symptoms similar to ADHD.

Characteristics of a child with ADHD

In terms of Hyperactivity

  • Often fidgets with hands or feet or squirms in seat
  • Often leaves seat in classroom or in other situations in which remaining seated is expected.
  • Often runs about or climbs excessively in inappropriate
  • Often has difficulty playing or engaging in leisure activities quietly.
  • Is often ‘on the go’ or acts as if ‘driven by a motor’
  • Often talks

Characteristics of a child with ADHD

In terms of Impulsivity 

  • Often blurts out answers before questions have been
  • Often has difficulty awaiting turn
  • Often interrupts or intrudes on others (for example, butts into conversations)

The child may be diagnosed as ADHD combined type if he exhibits symptoms of the above mentioned subtypes for at least six months.

About the Author /

There are hundreds of scientific articles, numerous books, newsletters and web sites available on Attention Deficit Hyperactivity Disorder (ADHD). One might question why I chose to write on this topic. Over the years, I have come to believe it is a disorder that is often misunderstood both by parents and teachers that the term is loosely used. Dr. Farida Raj Director, Centre for Special Education, Hyderabad, Remedial Educator, the RCI gives a better understanding on it in this sharing with MENTOR.

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