ADHD (Hyperactive Child)

 

ADHD stands for Attention Deficit Hyperactivity Disorder. This describes the brain defect that results in inabilty to "pay attention" for more than a few seconds, which then results in the child acting "hyper" because his mind keeps wandering around to other things. Sometimes a child just phases out without acting hyper, so these children are just ADD. About 9% of all school children have at least some form of ADHD or ADD, more commonly in boys, but it is also found in about 3% of girls.

What are the signs of ADHD?

    Short Attention Span: daydreams, doesn't seem to listen, easily distracted from both work and play, disorganized, forgets things, loses important things, makes careless mistakes, does not finish what he starts, doesn't seem to care about details.

    Impulsive: acts and speaks without thinking, has trouble taking turns, cannot wait for things, interrupts others, inappropriate touching of others.

    Hyper: constant motion, cannot play quietly, squirms and fidgets, talks too much, cannot stay long in a chair, will not stay with a group.

Is there a test for ADHD?

   Unfortunately, no, but the signs listed above, and many other signs, can be quantified by psychological tests. The scores on these tests will tell how severely your child is affected, and which type of ADHD it is. Your psychologist or psychiatrist can then recommend the appropriate treatment. It is also important to test for other conditions commonly found with ADHD, such as conduct disorder, oppositional behavior, depression, anxiety disorder, and learning disabilities.

What causes ADHD?

    The exact cause is not known, but we do see a tendancy for it to run in families. It can also result from exposure to toxins or from brain injury. We do know that these children (and adults) with ADHD have lower brain activity in areas of the brain that control the focus of attention. As these children get older the ADHD seems to improve in many cases, probably because they have learned to adapt and compensate for the defect.

What treatments are available?

    Since ADHD is a life-long condition, long-term planning is essential. Each year, the school will hold a conference with the parents, the child, the teacher(s), the principal, and the psychologist to develop an IEP (Individualized Education Plan) for the whole school year.

    Behavior therapy is the main part of treatment, used at home and at school. This mainly consists of setting goals, proving rewards and consequences for certain behaviors, and continuing a consistent re-inforcement of these goals. This can get pretty complicated, so usually requires ongoing help from the psychologist or psychiatrist. Teachers at school will have to be constantly aware of these goals as well.

    In some cases, medications can be helpful to help a child with ADHD to concentrate better in school. Many types of medications have been tried, but the most commonly used are stimulants, such as amphetamine or ritalin. There are several different forms of these, with slightly different effects. In 2003, a new class of medication was approved by the FDA, atomoxatine, which is a non-stimulant effective in treating ADHD.

    Medications are given in the lowest possible dose, then increased (ONLY if necessary) to achieve a positive effect. We want to limit side effects if at all possible. Some of the side effects include decreased appetite, weight loss, sleep problems, headaches, jitteriness, social withdrawal, and stomach ache. Less commonly, we see dry mouth, dizziness, tics (involuntary movements), and rebound effect after the medication wears off. Rarely seen side effects are growth delay (shorter height), increased blood pressure, and stuttering.

    If your child is taking medication for ADHD, inform your doctor if any of the above side effects occur. These can be lessened or eliminated by changing the dose, or changing to a different medication.

Beware of phony treatments!

    There are tons of phony treatments for ADHD that you will see advertised and on the internet. Several books claim other phony treatments can help. If it sounds too good to be true, it probably isn't true. If it sounds quite different from the techniques discussed in health-bytes, it is probably not approved by the American Academy of Pediatrics (my major source of information), and is probably not backed by any scientific testing.

   Diet therapies, such as avoiding sugar, or certain foods, have been tested quite thoroughly, and the great majority of studies have shown that dietary changes have no effect on ADHD.

What can I do at home to help my child with ADHD?

1. Keep your child on a daily schedule, doing things about the same time every day.

2. Limit the distractions. Loud music, computer games and television should not be on during meal times and homework times.

3. Organize your house, so that your child can find things easily, and he can learn the proper place for things, such as backpack, schoolwork, clothes, toys, etc.

4. Reward positive behavior. Your child has to deal with a lot of negative feedback, so try to balance it with as much positive as possible. A kind word, a hug, a treat will help to give him incentive to keep trying.

5. Set small reachable goals. Be thankful for small improvements, and know that these will add up to bigger improvement in the long run.

6. Help your child stay on task. Use charts and checklists to track progress with homework and chores. Keep each task as simple and brief as possible. Make your reminders friendly and positive, but you will have to give reminders frequently.

7. Limit choices. Offer choices whenever possible, to help him learn to make good decisions, but limit the choices to two, maybe three. Having too many choices is pushing the limits of his attention span.

8. Find activities where your child can succeed. Self-esteem is often hard to come by for children with ADHD, because there are so many failed attempts during each day. Sports or energetic physical activities can be very rewarding. Every child is different, and your child might find a certain  activity that he can really relate to well.

9. Use calm discipline. Time out or just removing the child from the situation is usually enough. Some behaviors are better ignored, as they are affecting the parent more than the child. For example, loud play which is not hurting any other children might be very annoying to the parent, but could be just ignored with a little physical separation (moving to another room). When discipline is given, use a calm tone, apply known consequences in a consistent manner, and avoid physical punishments like slapping or spanking.

Source: Clinical Practice Guideline: Attention-Deficit Hyperactivity Disorder, Pediatrics, May 2000.
[Thanks for help from UK medical student Chris Johnner]

© Rick Voakes 1999, Health-bytes LOGO  by Rie Cramer