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Looking at ADD and ADHD
Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) have been recognised for many years as specific brain disorders, although no-one knows for certain what causes them. Typically, children with ADD often seem unable to listen to what they are told and they may be incapable of concentrating on a conversation or an activity.
They are often extremely disorganised and chaotic; they may fail to complete tasks or to follow even simple instructions. Children with ADD may appear as dreamy, quiet and withdrawn, and their attention is diverted by anything and everything. They may flit from one thing to another and it is common to find that only activities which are highly stimulating will engage their attention.
Computer games
Computer games may grip them because their rapid pace and constant movement leave little time for the mind to wander.
Worried parents may find it frustrating and incomprehensible that some children with these conditions can play computer games endlessly but they can’t concentrate on any other activity. The child is not being difficult. Researchers think that the way in which computer games are constructed, requiring short bursts of attention and fast responses, enables children to focus without having time to be distracted.
Motivation
It’s very common for children with these conditions to have severe problems with anything that doesn’t have an immediate ‘payback’. They may be very reluctant to stop what they are doing right now when it’s time to go out, even if they are going to do something which they’ll enjoy. This is extremely frustrating for us but it helps us to plan strategies to make things easier if we understand something of the way their minds work.
The need for immediate gratification can cause difficulties in future with making any effort towards a goal which isn’t immediately accessible, so they find it very hard to motivate themselves to work towards objectives which are not within reach. In the years to come, working towards exams, learning a foreign language, thinking ahead and realising that the present affects the future may be a real struggle for them.
Gradual and ongoing efforts to help them to look ahead are needed, with interim rewards and encouragement to help to keep them on track with motivation.
The hyperactive child
Children with ADHD have the added problem of hyperactivity, and they may be impulsive and prone to accidents; as well as being mentally restless, they appear to have boundless physical energy. They may react rapidly with explosive anger if someone annoys them, often lashing out before those around them have realised that anything is wrong.
They have difficulty in playing quietly and their impulsiveness may cause them to be extremely disruptive and intrusive. They may talk excessively without regard to the reactions of others, and they may find it impossible to remain seated even for a short while.
Their inability to control their impulsiveness gets them into trouble especially in unstructured social situations, for example at break time and lunchtime at school. Some have no sense of risk. One child climbed a tree in his primary school playground when he was upset, sitting dangerously high in the tree for several hours. It was raining and he was soaked to the skin, but he didn’t come down until his mother arrived and was able to coax him to leave the tree. Five minutes later he was on the school roof.
A medical condition
The behaviour of children with these disorders is consistently difficult and it goes far beyond the bounds of normality. Children with ADD or ADHD are not simply naughty or lazy and they are not the products of poor parenting or inadequate discipline. These disorders are clearly defined and they are assessed and identified according to internationally agreed diagnostic criteria.
Your GP will arrange a paediatric assessment if the child’s problems make it necessary to seek help. The problems usually show themselves during nursery and by the time they reach the end of the reception year it’s clear that they will struggle to adapt to the more ordered learning of the year 1 curriculum.
ADHD and autism
ADHD in particular often co-exists with autistic tendencies, so if you have concerns about your child it’s wise to seek a diagnosis. Your GP will refer you to specialists who will make detailed and thorough assessments to see if the child has these traits. Autism is considered to be part of a spectrum of conditions which range from mild tendencies to a severe form in which children find it virtually impossible to communicate with the world outside themselves. The term ‘Asperger syndrome’ is now rarely used as it is included as part of the autism spectrum of communication disorders.
Medication
The question of medication for young children is always a vexed one, and there’s no easy answer. Some people – usually those who don’t live with a child who is suffering – are very dismissive of it and condemn it as unnecessary and irresponsible, but parents must make up their own minds as to what is right for their child. It is not normally prescribed before a child is six years old, but there are exceptions to this when the child’s difficulties are acute.
Depending on the circumstances medication may be an option as a last resort, for a while at least. In addition to Ritalin there are a number of newer medications available and it may be a question of trial and improvement before the best dosage and medication is found. Even then, constant monitoring is necessary as the child grows and changes. There may be side-effects, including lethargy and loss of interest in food. These may improve if a different medication is tried. Sometimes it may be possible to reduce it gradually especially if practical changes (home education, for example) lead to an improvement.
The condition is a lifelong one, but try to be positive about your child as many children with ADD and ADHD improve as they grow up and learn about the expectations of the world around them.
Mary, London