1. ADHD IN CHILDREN
- DEFINITION, MYTHS AND FACTS
- IS IT ADD? OR ADHD? WHAT’S THE DIFFERENCE?
- ADHD TYPES
- THE CAUSES OF ADHD
- TREATMENT OF ADHD:
- HOW CAN I HELP YOU AND YOUR CHILD?
- WITH THE CHILD
- PARENT’S ROLE
2. ADHD IN ADULTS:
1. ADHD IN CHILDREN
DEFINITION, MYTHS AND FACTS:
ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviours (may act without thinking about what the result will be), or be overly active.
MYTHS AND FACTS ABOUT ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
|There is no such medical condition as ADHD.||ADHD is a medical disorder, not a condition of the child’s will. A child with ADHD does not choose to misbehave.|
|ADHD is caused by bad parenting. All the child needs is good discipline.||ADHD is not caused by bad parenting. But parenting techniques can often improve some symptoms and make others worse.|
|ADHD is a life sentence.||Although ADHD symptoms usually continue into adulthood, the person learns ways to cope with the symptoms. People with ADHD have plenty of energy, are creative, and can often accomplish more than people who do not have the condition.|
|Having ADHD means the person is lazy or dumb.||ADHD has nothing to do with a person’s intellectual ability. Some highly intelligent people have ADHD.|
|Medicine for ADHD will make a person seem drugged.||Properly adjusted medicine for ADHD sharpens a person’s focus and increases his or her ability to control behaviour.The risks of using appropriate medications to treat ADHD are minimal, whereas the risks of not using medication to treat ADHD are significant. The medications used for ADHD are among the best researched for any disorder.|
|Medicine prescriptions for ADHD have greatly increased in the past few years, because the condition is being overdiagnosed.||ADHD is estimated to affect about 3% to 10% of children. There is little evidence to support claims that ADHD is overdiagnosed and that ADHD medicines are over-prescribed.|
|Medication is no longer useful after puberty.||Teens and adults with ADHD continue to benefit from medicine treatment.|
|Children with ADHD are learning to use the condition as an excuse for their behaviour.||ADHD is a disability. Children with ADHD have to learn ways to deal with their symptoms (inattention, impulsivity, and hyperactivity) that cause them to have difficulties in life.|
|Children outgrow ADHD.||About 70 out of 100 children with ADHD continue to have symptoms during their teen years and about 50 out of 100 have symptoms into adulthood. If left untreated, adult ADHD can generate low self-esteem, anxiety, employment problems, forgetfulness, substance abuse, chronic boredom, depression, and relationship problems.|
|Children get ADHD because of poor parenting.||ADHD is not caused by anything parents do, although symptoms can be exacerbated by a negative, chaotic, inconsistent home atmosphere. And through programs like Parent-Child Interaction Therapy, parents can learn effective techniques for helping children rein in disruptive behaviours and increase positive ones.|
IS IT ADD? OR ADHD? WHAT’S THE DIFFERENCE?
The difference is mainly one of terminology, which can be confusing at times. The “official” clinical diagnosis is Attention Deficit Hyperactivity Disorder, or AD/HD. Known as both ADD and ADHD, both terms refer to the same condition.
There are three different types of ADHD, depending on which types of symptoms are strongest in the individual:
Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
Combined Presentation: Symptoms of the above two types are equally present in the person.
THE CAUSES OF ADHD
ADHD is not caused by
- poor parenting,
- family problems,
- poor teachers or schools,
- too much TV,
- food allergies,
- or excess sugar.
One early theory was that attention disorders were caused by minor head injuries or damage to the brain, and thus for many years ADHD was called “minimal brain damage” or “minimal brain dysfunction.” The vast majority of people with ADHD have no history of head injury or evidence of brain damage, however. Another theory, which is still heard in the media, is that refined sugar and food additives make children hyperactive and inattentive. Scientists at the National Institutes of Health (NIH) concluded that this may apply to only about 5 percent of children with ADHD, mostly either very young children or children with food allergies.
ADHD is very likely caused by
- biological factors which influence neurotransmitter activity in certain parts of the brain, and which have a strong genetic basis.
Studies at NIMH using a PET (positron emission tomography) scanner to observe the brain at work have shown a link between a person’s ability to pay continued attention and the level of activity in the brain. Researchers measured the level of glucose used by the areas of the brain that inhibit impulses and control attention. In people with ADHD, the brain areas that control attention used less glucose, indicating that they were less active. It appears from this research that a lower level of activity in some parts of the brain may cause inattention and other ADHD symptoms.
- There is a great deal of evidence that ADHD runs in families, which is suggestive of genetic factors. If one person in a family is diagnosed with ADHD, there is a 25% to 35% probability that any other family member also has ADHD, compared to a 4% to 6% probability for someone in the general population.
Deciding if a child has ADHD is a several step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Another part of the process may include a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.
TREATMENT OF ADHD:
Most effective treatment for ADHD is a combination of medication (when necessary), therapy or counselling to learn coping skills and adaptive behaviours, and ADHD coaching for adults.
Medication is often used to help normalize brain activity, as prescribed by a physician.
Cognitive Behaviour Therapy often helpful to modify certain behaviours and to deal with the emotional effects of ADHD. Many adults and children learn to manage problem behaviours and develop coping skills, such as improving organizational skills and improving productivity.
HOW CAN I HELP YOU AND YOUR CHILD?
In order to make sure your child reaches his or her full potential, it is very important to get help for ADHD as early as possible.
I will first meet with the parent(s) by taking a complete history of their child’s problems at home and school and during social activities. Then, I will meet with your child to get a sense of what he or she is like.
After my evaluation,I will create a list of target behaviours for treatment. Target behaviours are ones that need to be changed so the child gets better. They can be either behaviours that need to stop or new skills that need to be learned.
The areas targeted for treatment may not be the symptoms of ADHD (such as being much too active, not paying attention, and doing rash or sudden things without thinking). Instead, they may address the problems that those symptoms cause in daily life, such as playing well with brothers and sisters, or obeying parent’s requests.
The treatment changes as the child changes.
Why use behavioural treatments?
Behaviour treatment involves both social and psychological therapies and is a very important part of treatment for attention-deficit/hyperactivity disorder (ADHD) in children and teens.
Behavioural treatment for ADHD is important because it helps with issues such as:
- problems doing well in school
- behaviour problems at school
- problems with friendships
- problems getting along with parents and siblings
Behavioural treatments work by teaching new skills to parents and the children for handling problems. It works by changing the behaviour of a child or adolescent. Research shows that behavioural treatments work well for the symptoms of ADHD, especially when they are used with stimulant medication.
COUNSELLING WITH THE CHILD
During the sessions, I may work on the followings:
- Teach social skills (how to get along with other people)
- Help to solve social problems
- Decrease unwanted behaviours such as bossiness or not sharing
- Help to form a close friendship between the child with ADHD and another child
Parents play an important role in behaviour therapy and are always included in the therapy process. I expect parents to do the following:
- Start with goals that the child can succeed at, in small steps.
- Be consistent — even at different times of the day, in different places and with different people around.
- Use the new skills over the long haul — not just for a few months.
Remember that teaching and learning new skills take time, and the child’s improvement will be little by little.
Parents need careful teaching and support to learn the new parenting skills and how to use them all the time. The topics that I cover in parent-training sessions may include the following:
- Setting house rules and a routine
- Learning to praise wanted behaviours and to ignore mild unwanted behaviours (choosing your battles)
- Using appropriate ways to let your child know what you want from him or her
- Using “when-then” directions (when there is unwanted behaviour, then adults take away rewards or privileges)
- Planning ahead and working with your child in public places
- Using “time outs” during or after unwanted behaviour
- Using daily charts and point systems for both rewards and consequences
- Using a school-home note system to reward school behaviour and to track homework
Parent training can be done with or without the child. Parent training can also happen during individual family sessions that include the child. When the child is a teenager, parent training is a bit different. Parents learn skills that are right for teens. The parents and teenager may meet with the therapist to come up with solutions they can agree on for behavioural problems. Parents try to gain improvements in the teenager’s target behaviours (such as better grades in school) in exchange for rewards that they can control (such as allowing the teenager to go out with friends).
2. ADHD IN ADULTS:
MYTHS AND FACTS:
|Unless you have been diagnosed with ADHD as a child, you can’t have it as an adult.||Many adults have struggled all their lives with unrecognized ADD impairments. They haven’t received help because they assumed that their chronic difficulties, like depression or anxiety, were caused by other impairments that did not respond to the usual treatments.|
|ADHD isn’t a real disorder||In fact, brain-imaging research has revealed physical differences in the brains of people with ADHD, and a recent genetic study published in The Lancet found that children with ADHD are more likely to have small segments of duplicated or missing DNA than other children. “ADHD is a chronic disorder that has a negative impact on virtually every aspect of daily social, emotional, academic and work functioning,” says Russell A. Barkley, Ph.D., author of Taking Charge of Adult ADHD(Guilford Press, 2010).|
|ADHD Medications are dangerous and addictive||Every medication has the potential for side effects, including those for ADHD. Stimulant medications, including methylphenidate (Concerta, Focalin XR) and amphetamines (Vyvanse, Adderall XR) are the most frequently prescribed drugs for adult ADHD. These medications, believed to affect the activity of the brain chemicals dopamine and norepinephrine, have, at the right doses, a paradoxically calming and focusing effect on people with ADHD.The newer time-released formulations (such as Vyvanse, Concerta), are less likely to be abused because of the way your body processes them (Dr. Goodman (assistant professor of psychiatry at the Johns Hopkins University School of Medicine in Baltimore).
Overall, research has found stimulant medications to be effective and safe. “Over 80 percent of people with ADHD will respond to the first or second stimulant they try,” says Goodman. “In psychiatry, that’s an extraordinarily high response rate.”
HOW CAN I HELP?
Adults who suffer from attention-deficit/hyperactivity disorder (ADHD) know that it can have harmful effects in their work, in their self-esteem, and in the way they interact with theirfamily and friends.
I provide my clients with practical and effective skills that have been scientifically tested and shown to help adults cope with their ADHD symptoms. These symptoms include difficulty focusing attention and being easily distracted, difficulties with organization and planning, and impulsivity.
I use evidence-based Cognitive-Behavioural Therapy (CBT) to train you to:
- Think adaptively, which will enable you to increase your awareness of negative, interfering thoughts
- Develop strategies for keeping your thoughts incheck
- Minimize symptoms
- Use adaptive thinking skills for managing procrastination
While the coping solutions may seem simple — use a daily planner, start working on tasks well in advance of their deadline, break large tasks into smaller tasks — they can be difficult to implement. Facing these longstanding challenges may also trigger negative thoughts, pessimism, self-criticism, and feelings of frustration that create additional barriers to follow through.