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Attention-deficit/hyperactivity disorder

The ability to ignore distractions and to focus on one activity at a time is a skill that children usually develop gradually as they grow. It is quite normal for toddlers and pre-school-aged children to be easily distractible, but the ability to channel attention selectively usually increases progressively once children start school.

Some children experience significant difficulties in learning to attend. As a result, they are easily distractible and do not persist for long with tasks. If this is a significant problem, it is referred to by the umbrella term ‘attention- deficit/hyperactivity disorder’ (ADHD). This means attention-deficit with or without hyperactivity.

Such children may be overactive and impulsive, although this is not always the case. It is this overactivity that has given rise to the term hyperactivity (‘hyper’ is Greek for ‘over’).

All children with attention-deficit/hyperactivity disorder experience difficulty with concentration. There are two forms of the condition: one where overactivity and impulsivity are present and the other where these coexisting problems are absent.

The two forms of attention-deficit/hyperactivity disorder may be clarified by describing two children, each with one of the forms of the disorder.

A child with attention-deficit/hyperactivity disorder with overactivity and impulsivity

George is his mother’s third child. She describes him as completely different from the other two. As a baby he slept very little and cried constantly. As a toddler he was always on the go, ‘as if driven by a motor’. Now, aged nine years, his teacher describes him as ‘disorganized, disruptive, and fidgety’. His mother reports that he hardly ever sits still at home. He will not sit through a favourite TV programme or a meal. He is still so disorganized that if she did not help him to dress in the morning, he would not be in time for school.

He is also very impulsive. He does not seem to think before he acts. He takes terrible risks and often says the first thing that comes in to his head. The worst thing is that he does not seem to learn from his mistakes.

The school psychologist has tested George. The test was carried out with great difficulty because of George’s distractability and tendency to answer questions without thinking. The psychologist found his intelligence to be in the normal range, but his reading, spelling, and arithmetic were all significantly below the average range.

George was then examined by a developmental paediatrician who made a diagnosis of attention-deficit/hyperactivity disorder. Treatment with appropriate medication and remedial assistance resulted in a dramatic improvement in George’s behaviour and learning.

A child with attention-deficit/hyperactivity disorder without overactivity

Caroline was a bright child who experienced great difficulty learning to read. She was tested by the psychologist attached to her school and a diagnosis of ‘dyslexia’ was made. Remedial help was commenced early in her school career but Caroline made slow progress. At the age of 11 it was clear she had worked hard but was becoming increasingly discouraged by her difficulties. She was often in tears and started refusing to attend remedial classes. Her parents were very concerned about her as time was running out before she entered high school.

They took her to a developmental paediatrician. He arranged for the educational psychologist in his practice to do further detailed testing of Caroline’s difficulties. This, in conjuction with the paediatrician’s own findings, led to a diagnosis of dyslexia complicated by attention-deficit/hyperactivity disorder. Caroline’s parents were surprised about the diagnosis of attention-deficit/ hyperactivity disorder as they believed that children with this disorder were overactive while Caroline was a quiet, responsible girl. The developmental paediatrician explained that there are two types of attention-deficit/hyperac- tivity disorder: one associated with overactivity and one where this is not present. Caroline had the latter form and this was interfering with her need to concentrate in order to overcome her dyslexia.

Treatment was commenced with medication given on school days only. Remedial help continued as before. Within a matter of days there was a remarkable change in Caroline’s attitude to her work. Her mood improved and she became enthusiastic about her ability to concentrate and learn. Six months later her reading had caught up to her age level.

Both George and Caroline have attention-deficit/hyperactivity disorder and yet their behaviour is very different. Children such as George are often diagnosed at a young age, children like Caroline often do not receive appropriate treatment until high school.

A diagnosis of attention-deficit/hyperactivity disorder should only be made after information about the child has been carefully collected, and the child has been observed by an experienced development paediatrician working in collaboration with an educational psychologist. It is essential that the opinion of the child’s teacher is obtained to determine the nature of the child’s behaviour at school. All other possible causes, such as emotional and environmental stresses, should be searched for and excluded before a diagnosis of attention- deficit/hyperactivity disorder is made.

When diagnosed in this way, attention-deficit/hyperactivity disorder is approximately five times more common in males. Often there is a history of similar difficulties in other family relatives. It may occur on its own, but often accompanies other forms of specific learning difficulty.

The major feature of such children is their poor persistence with tasks. They often fail to finish things they start. They are easily distracted, do not seem to listen, and have difficulty concentrating on school work and other tasks requiring sustained attention.

What parents can do

Children with attention-deficit/hyperactivity disorder who are impulsive can be very trying to live with. It is important to realize that your child’s behaviour is not your fault or the fault of your child, who may have great difficulty fulfilling expectations.

It is important to set appropriate goals for your child. For example, you may initially expect him to remain at the table for only five minutes, and then gradually increase your expectations. Be generous with your praise when goals are achieved.

If he is overactive give him an opportunity to burn off extra energy with active play. A trampoline is good in this respect. Swimming is also a good way to get rid of pent-up energy. Allow him to go out even if it’s raining. Rain will not harm him, but staying indoors for protracted periods can be very trying for all concerned.

If possible, avoid restrictive, confusing, and overstimulating places if your child seems to be adversely affected by these.

When you give your child an instruction, make sure that you have his attention. It may be necessary to touch him gently and make certain that he is looking at you. When speaking to him talk slowly, and pause after each phrase.

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