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Family
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Preview of Understanding ADHD, Autism, Dyslexia & Dyspraxia
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Attention deficit hyperactivity disorder |
What is attention deficit hyperactivity
disorder?
Medical research now suggests that attention deficit
hyperactivity disorder (ADHD) affects different people in different
ways and to different degrees of severity. There are a number of definitions
but the following characteristics, generally accepted as the most common,
are acknowledged in most definitions.
Children with ADHD are always ‘on the go’;
they often talk incessantly, frequently blurt out inappropriate comments,
often act impulsively, rarely pause to think before they act and sometimes
endanger themselves by taking unnecessary risks. These children are a
major cause of concern to parents and teachers
It is usually parents who
first suspect that there is something different about their child’s
behaviour. Many parents are embarrassed and feel that they are in some
way to blame. Research in recent years, however, has suggested that
the bad or challenging behaviour displayed by some children is not
the fault of their parents or the children themselves. It may be caused
by inactivity in the areas of the brain that control concentration
and impulsive behaviour.
The behaviours associated with ADHD become
apparent during early childhood, before the age of five years. ADHD
is considered a lifelong condition but autobiographies of adults who
had ADHD in childhood tend to agree that, although the ‘symptoms’ never
go away, increasing maturity enables the individual to develop effective
strategies which keep the behaviours in check.
Is there something wrong with my child?
Although parents sometimes sense there is something ‘not
right’ or uncontrollable about their child’s behaviour, it
is often an outsider, someone not in the immediate family, who is the
first to suggest that a child might need specialist help. John’s
mother tells a typical story.
Case study: John
John’s my second eldest
so I only had his older sister to compare him with. I thought he was
just like a boy should be – always rushing about like he was driven
by a motor, couldn’t stick at one thing for more than a few minutes
and, even more worryingly, no sense of danger. When we were out shopping,
if I let go of his hand, he’d race out of the shop and be across
the road in a flash.
‘John
was always rushing about with no sense of danger.’ |
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He was four when he started at
nursery and I still remember his teacher bringing him to me at the
end of the first day, saying, ‘He’s a little terror isn’t
he?’. She wasn’t joking, she meant it. After the first
week she spoke to me again and said she didn’t think he was ready
for nursery. Apparently he’d bitten the cheek of one of the little
girls because she wouldn’t get out of a toy car he wanted, and
then he’d kicked the nursery nurse who told him off. We tried
two other nurseries but the longest he lasted was two weeks.
‘We
tried two nurseries but the longest he lasted was two weeks.’ |
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When he started school, one or
other of his teachers asked to speak to me about his behaviour almost
every week. They said John seemed incapable of sitting still for more
than a couple of minutes, was always shouting out answers in class,
throwing tantrums and constantly quarrelling with other children. We
had trouble too whenever he was invited to parties. He’d just
get so excited he was uncontrollable and it wasn’t unusual for
the parents running the party to ring up and ask me to collect him
before the party was finished.
The problem
with John and his behaviour came to a head when he was in his third
year at junior school. We arrived at school a bit early one morning
in the summer and, as usual, as soon as I let go of John’s hand at the gate, he shot
off straight away. I started talking to some of the other mothers and
about five minutes later there was this huge commotion in the playground.
A small girl was on the ground, screaming, with blood pouring from
a cut on her head. My heart sank because, in among the screaming, I
could also hear John shouting and yelling. Apparently, he’d been
playing cricket with some of the children and, just like always, when
he was bowled out, John wouldn’t let go of the bat and started
shouting he wasn’t out. When one of the boys tried to take it
off him, John had grabbed it back and, shouting the others were cheating,
had thrown it across the playground as hard as he could and hit the
girl on the head.
‘There
was huge commotion in the playground; John had thrown a cricket
bat across the playground, hitting a girl on the head.’ |
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When I got to John he was completely
out of control, still yelling that it was the other boy’s fault
and kicking and swearing at the teacher who was trying to hold him.
I managed to calm him down to the point where he stopped struggling
and shouting and he started to cry, great big sobs, saying over and
over again: ‘I’m really sorry Mum, I didn’t mean
to hurt her. It wasn’t my fault. I don’t know why I do
things like that. They all hate me. I wish I was dead.’ I took
him home and he cried all day. What really upset me was that he kept
on about how all the teachers and the other children hated him, how
he’d never had any friends and how he wished he could kill himself.
I’d never felt so down because I knew a lot of what he said was
true.
‘What
really upset me was that he kept on about how all the teachers
and other children hated him.’ |
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The following morning I had an
appointment to see the head teacher. He started by saying that, although
he knew that John hadn’t meant to hurt the little girl, there
was a major problem with John’s behaviour. It wasn’t just
what John did but how often he behaved badly. Just before I left, he
gave me a magazine from his coffee table, saying: ‘I’m
not an expert but I’ve seen kids like John before, he may have
a problem he can’t help. Take a look at this page and see if
you recognise John.’
‘The
head teacher gave me an article that described a boy with ADHD.’ |
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I went straight home and read
the article. It described a boy who’d been diagnosed with a clinical
behaviour problem called attention deficit hyperactivity disorder (ADHD).
The article described our John and even said what could be done. I
can’t tell you the relief that flooded over me.
The
next day I took John to our family doctor and showed her the article
and she arranged for John to be seen by a specialist. It took about
six weeks for the appointment to come through but then, once John was
diagnosed as having ADHD, things really started look to up. The specialist
gave us advice on how we could help him and he arranged for someone
to go in to the school to give advice to the teachers. From that point
what they did in school to handle John when he got excited, we also
did at home. Believe me it wasn’t easy, but that was seven years ago and John has just
passed his GCSEs. He wants to be a PE teacher; the Careers Officer
said he couldn’t think of a better job for him!
‘Once
John was diagnosed as having ADHD, things really started to look
up.’ |
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What causes ADHD?
Precisely what causes ADHD is not yet known. However,
it is generally accepted by medical experts that children are born with
ADHD rather than developing it. Evidence to support this comes from studies
of children who have identical genetic make-up: identical twins. It has
been found that, even if identical twins have been separated at birth
and brought up apart, if one twin has ADHD the other twin will almost
invariably have it too. It is genetic make-up, not the way that the child
is brought up, that seems to be the major factor in determining whether
a child will suffer from ADHD. Further research evidence suggests that
ADHD affects more boys than girls in a ratio of approximately four to
one.
| Characteristics
of a child with ADHD |
- Often moves more quickly into a state
of high agitation or excitement than other children
- Often talks incessantly and loudly, is
constantly moving, and frequently switches from one activity
to another without pause
- Cannot filter out unimportant stimuli – everything
grabs his or her attention
- Annoys everybody and cannot help it
- Is disliked by others and realises this
- Has low self-esteem and often dislikes
himself
- Is often remorseful after behaving ‘badly’,
saying ‘I can’t help it’
- Demonstrates this behaviour in a persistent
and enduring way
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What is it like to have ADHD?
Activities that, for other children, have relatively
low levels of excitement are likely to overexcite a child with ADHD.
For example, waiting his turn to throw the dice in a board game will
be difficult for him and he is likely to grab the dice, possibly unaware
that this will annoy everyone else. In the lunchtime queue at school,
he may push past others to get his food as quickly as possible, again
heedless of the fact that he’ll lose friends and annoy lunchtime
supervisors.
The child with ADHD sometimes talks incessantly, constantly
interrupting others; his impulsive behaviour does not happen occasionally,
it is a persistent and enduring characteristic, day after day. The ADHD
child will, almost inevitably, be ‘a pain’ to everyone – members
of his family, his teachers and last, but certainly not least, those
who could be his friends. The ADHD child is most often shunned by others
of his own age because his unpredictable, impatient behaviour spoils
games. When he is shunned, he is invariably sorry for what he has done.
The
child or young adult with ADHD may, at times, look carefree and sometimes
even ‘devil may care’. However, the
biographies of adults who have experienced this disorder in childhood
often catalogue a series of unhappy memories. They describe emotional
distress, low self-esteem and loneliness, not being liked, being shunned
by others, being persistently excluded from groups and banned from situations
or activities in which they greatly wanted to participate.
To illustrate
the problems of the ADHD child, let’s
take what you are doing right now as an example. Assume that you are
reading this book in a relatively quiet room but are within earshot of
a road where your car is parked alongside those of your neighbours. A
few seconds ago, you may have heard a car door slam but a part of your
brain will have immediately filtered that noise out as normal and unimportant.
You would, therefore, have been able to continue reading with your focus
of attention uninterrupted.
Now assume that you hear a different sound,
of crunching metal and tinkling glass. This time your filtering system
identifies the sound as potentially significant and your reading will
now be rapidly interrupted as you run to the window hoping your car is
still in one piece!
In essence, one sound did not interrupt your train
of thought because your brain ‘unconsciously’ filtered it
out as ‘unimportant’ and you continued reading, yet another
noise of roughly the same acoustic volume was not filtered out and caused
you to interrupt your reading.
Now, as you are reading this book, sit
quietly, try not to move and just listen to the noises around you. There
may be a clock ticking, the low hum of a central heating or air-conditioning
unit switching on, faint footsteps on the floor above, a muted burst
of laughter from a television in a distant room. For a minute or two
close your eyes and just listen to the noises around you. Imagine that
every time you hear any sound, it will completely interrupt your train
of thought and divert your attention away from the book, towards the
source of the sound. Add to that all the other stimuli your brain automatically
filters out: inconsequential changes in light, temperature, touch, smell
and sounds all have the potential to divert your attention. In most cases,
however, because you have an effective filtering system, the distractions
that are relatively unimportant do not divert your attention. The child
with ADHD does not have an effective filtering system, so each ‘distraction’ that
his brain encounters has the same effect as that sound of crunching metal
and tinkling glass may have had on you: it completely diverts his attention
from a task.
Imagine then how such a child copes in a busy modern
school with up to 30 other children in the same classroom and possibly
hundreds of others in the school, all moving around the corridors and
playgrounds. In such an environment, this child is likely to exhibit
inappropriate behaviour by flitting his attention from one thing to another,
distracting and annoying not only himself but also his fellow classmates
and his teachers.
How is ADHD diagnosed?
In the UK, formal diagnosis of ADHD always requires
specialist assessment by a paediatrician or a child/adolescent psychiatrist.
However, the first point of contact should be with the child’s
family doctor who will need specific details of the behaviours that are
of most concern. If you think a child may have ADHD, the screening questionnaire
in the box on page 12 will help decide whether a referral to a medical
specialist is warranted. Ideally, two adults who know the child well,
usually a parent and a teacher, should complete the questionnaire independently.
| Screening
questionnaire for ADHD |
Before starting, read the instructions below
and follow them carefully.
Tick a box ONLY if both of the following
are true:
1. The child shows a particular behaviour to
an excessive degree. (If you have to spend time thinking about
your response then that aspect of the child’s behaviour
will probably not be excessive).
AND
2. The behaviour has been present since before
the age of seven years, has been present for at least the previous
six months, and is present in different settings – for example,
in school and at home.
Tick the box if the child:
 often
fidgets with his hands and/or feet or squirms in his seat
often
leaves his seat when being seated is expected (for example, at
mealtimes)
often
runs or climbs excessively in situations in which it is not appropriate
often
has difficulties playing or engaging in leisure activities quietly
often
appears ‘on the go’ and/or acts as if driven by a
motor
often
talks excessively
often
blurts or shouts answers before questions have been completed
often
has difficulty waiting turns in games, etc.
often
interrupts or intrudes on others – for example, butts into
conversations or games.
If more than six behaviours are ticked
then it is worth visiting your family doctor to discuss your
child’s
behaviour. |
How frequently is ADHD diagnosed?
The National Institute for Health and Clinical Excellence
(NICE) is a group of experts who provide the government with advice on
matters related to health. The NICE guidelines estimated that:
- About 1 in 100 of school-aged children manifest
the most severe symptoms and acute difficulties associated with ADHD
- About 5 in 100 manifest less severe symptoms but
nevertheless experience significant difficulties.
This means, of course, that there are likely to be
at least one or two children with ADHD in almost every school in the
country.
What are the effects on families?
In the same report, NICE noted that the knock-on effects
for families who have an ADHD child can be very serious. In our culture,
the parents of a child with ADHD will feel guilty about what they believe
to be their own failure. These feeings of guilt will often be reinforced
by barely disguised negative comments and asides from relatives, friends,
parents of other children, teachers, health professionals and even strangers
in shops. If a child with ADHD has a hard time, so do his parents. The
pressure imposed on the parents and siblings of a child with ADHD can
be so extreme that it can contribute significantly to family breakdown.
What can your doctor do?
From the completed questionnaire, your family doctor
will have a good indication of the behaviours that are of particular
cause for concern.
Once your family doctor has this information she or
he will usually begin the full assessment procedure by asking the advice
of a range of specialists who might include a paediatrician, a child
psychiatrist, an educational psychologist and your child’s teachers.
These specialists will obviously seek information from you, as parents,
because you are the adults who know your child best. There is no one,
single test for identifying ADHD so be prepared for the assessment process
to take some time. Full reports on your child’s medical history,
family background and educational experience will probably be needed
and it is likely he or she will undergo a formal assessment, taking at
least 2 hours, in a clinic as part of the referral to the paediatrician
and/or the child psychiatrist.
How can my child be helped?
You will no doubt be relieved to learn that, if provided
with appropriate treatment and sensitive skilled support, a child with
ADHD can develop into a happy and successful adult.
However, living with
a child with ADHD is not easy and you need to be reassured that many other
parents also experience the frustration, tension and anxiety that you feel.
How to treat a child with ADHD is one of the most hotly contested debates
in the media today and there are two major, and often opposing, schools
of thought:
- Those who believe ADHD can be ‘controlled’ without
medication – many of whom also believe that medication is simply ‘wrong’.
- Those who believe the behaviours associated with
ADHD can be effectively addressed with medication.
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KEY POINTS
- Overactive or impulsive behaviour is shown at
some time by most young children
- Overactive behaviour is not necessarily the fault
of the child or parent
- A child’s behaviour may not be within his
control
- A child who is notable for excessive levels of
activity may be suffering from a condition known as attention deficit
hyperactivity disorder (ADHD)
- The exact causes of ADHD are unknown
- ADHD is thought to be genetic and unlikely to
be caused by faulty upbringing
- ADHD affects more boys than girls in a ratio of
approximately four to one
- If you are worried about your child’s behaviour
you should take him to your family doctor
- Your family doctor will need detailed information
about the behaviours that worry you
- You may be referred to a team of specialists to
assess your child fully
- Inform the school so that you can work cooperatively
in arranging a full assessment
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