Attention Deficit Hyperactivity Disorder (ADHD) in Children

Image courtesy of cooldesign at FreeDigitalPhotos.net

Image courtesy of cooldesign at FreeDigitalPhotos.net

What is ADHD?

  • ADHD is a psychiatric condition marked by the following symptoms:
  • Poor sustained attention: your child may likely have difficulty concentrating on things they are not very interested in.
  • Limited ability to delay gratification (impulsivity).
  • Diminished rule-governed behavior: rule-governed behavior is the capacity to hold a mental map within one’s thinking and to operate easily from that map. This could also be called “internalizing a rule.”
  • Poor compliance: compliance is simply the process of following a rule or doing what you are told.
  • Your child may have difficulty learning a rule by simply being told about the rule.
  • Difficulty learning from experience: your child may likely have difficulty learning from experiences and may repeat undesirable behavior without effectively learning from consequences.
  • Variability of performance: your child’s performance at school may vary significantly from day to day, either academically or behaviorally.

Prevalence

ADHD is not uncommon. Between 3% and 5% of the population has ADHD, with ratio of 3:1 male to female.

Situational Factors Affecting Symptoms

1

Image courtesy of photostock at FreeDigitalPhotos.net

Image courtesy of photostock at FreeDigitalPhotos.net

Long Term Outlook

  • ADHD Symptoms generally decline over time, but 50% have significant problems as adults. The symptom of hyperactivity tends to improve over time, but problems with concentration and organization tend to persist.
  • Children with ADHD tend to have difficulties adjusting in school and may be at higher risk for other problems such as drug abuse during their adolescent years.

Important Concepts

  • Time Horizon: the ability to project self into the future or into the past. Children with ADHD have severe limits on time horizon. Therefore, they are generally not motivated by long term goals or rewards. ADHD kids need frequent, immediate reinforcement for desired behavior. Rewards tend to be less motivating the further away in time the reward happens after the desired behavior.
  • Developmental Issues: children with ADHD are generally behind in organizational skills and social skills. This is not their fault; it is part of their condition. Schools sometimes have a hard time accepting this. Despite the diagnosis, schools can sometimes interpret behavior problems simply as willful misbehavior. Parents can expect that their child with ADHD may need more assistance with organizing schoolwork and monitoring their compliance with schoolwork than same age children who do not have ADHD.
  • Reinforcement Patterns Necessary for Change: children with ADHD need very frequent positive reinforcement, which is contrary to the intuition of most parents. Parents normally tend to provide less praise and less frequent positive reinforcement to children as they get older. Children with ADHD need more frequent positive reinforcement than same age children who do not have ADHD to help change their behavior.

How to Help   

  • Parent Education: it is essential that parents understand the nature of ADHD and what the most sensible approaches are.
  • Image courtesy of ponsulak at FreeDigitalPhotos.net

    Image courtesy of ponsulak at FreeDigitalPhotos.net

    Medication is the primary intervention: children with moderate to severe ADHD require medication as the primary means to assist them.

  • Counseling is generally not very effective, although parents can benefit from education about ADHD. Children can sometimes benefit from therapy related to other issues such as depression or low self-esteem related to ADHD.
  • Behavior training at the time either a problem behavior or a desired behavior is occurring is generally very helpful. This may involve immediately linking behavior (either positive or negative behavior) to an immediate consequence. Additionally, it may help when misbehavior occurs, to have the child display or rehearse the appropriate behavior as a way of helping to train new behavior. This can take the form of: “You made a mistake, now let’s go back and practice how you could have done this better.”
Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

In Home Behavioral Approaches

  • Structure: Have specific times for waking, bedtime, chores, homework, playtime, TV time. Explain any changes in pattern in advance to your child.
  • Clear and concise rules and consequences. Children with ADHD need clear, simple rules to understand what is expected. They also find inconsistency with rules very confusing.
  • Clear and simple instructions: when giving a directive, make the request very simple, use a minimum of words. Also include how much time the child has to comply.
  • Have a quiet spot for study. Minimize clutter and distractions.
  • Parents should have a regular pattern of communication with the school to monitor assignments and tests.
  • Use a timer to help give the child a sense of time limitations when asked to do tasks..
  • Avoid lengthy lectures about problems: this is counter-productive. Keep your messages short and simple.
  • Stay calm: Angry or aggressive responding by parents tends to confuse and agitate children with ADHD.
Image courtesy of photostock at FreeDigitalPhotos.net

Image courtesy of photostock at FreeDigitalPhotos.net

In-School Behavioral Approaches

  • Place the child next to students who will not distract them. Place close to the teacher.
  • Teacher should provide frequent, specific, positive feedback and encouragement.
  • Provide small group learning experiences.
  • Provide shortened assignments or assignments broken down to smaller pieces.
  • Set firm limits with concrete suggestions for behavior improvement.
  • Prepare for changes in routine. This takes the form of letting the child know in advance that the routine will be different.
  • Use a timer to assist the child in managing tasks.
  • Teachers can manage the child better when they remain calm.

 

About the Author: Steve Tyler is the Director of Outpatient Services at Aspire Indiana’s Lebanon office. While the beliefs and opinions expressed in this blog are solely those of Mr. Tyler, you can learn more about Aspire Indiana at https://www.facebook.com/AspireIndiana.

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