ADHD
Attention Deficit Hyperactivity Disorder
By Jimmy Henderson

Def: This is a disorder characterised by a persistent pattern of inattention and/or hyperactivity/impulsivity that occurs in academic, occupational or social settings

• In other words the child is simply unable to pay attention, focus or concentrate during school, when doing tasks at home or even when playing with friends it is classified as ADHD -Predominantly inattentive. (Old classification= ADD)
• And this can also be coupled with impulsive, disruptive and hyperactive behaviour
= full-blown ADHD
• Can lead to other disorders such as conduct and anxiety disorders later on

Most small children are active, but ADHD is classified as very severe, pervasive (at least 6 of more symptoms) not age–appropriate and must continue for at least 6 months in at least 2 of the settings (school, work, home and social interactions
Statistics
ADHD can occur in adults but usually detected early in with children.
It is pervasive and latest statistics suggest that 3-5 % of all children are ADHD
ADHD makes up 50 % of all childhood disorders
Boys are 4 times more likely to be ADHD

Symptoms in school or at home
• Home : Children are emotional, disruptive, disobedient and willful (temper)
• School : Cannot sit still, do not listen to instructions, , do not finish tasks, inattentive –
severely affects school performance (low frustration tolerance)
• Social (peer relationships) : usually unpopular and rejected due to bullying, bossy and
selfish and impulsive behaviour (also low self-esteem)
Interesting facts
The IQ of ADHD children can be normal
They can often play TV games and watch TV without a problem
The problems appear to occur mostly in controlled settings, such as school or when they are given demanding or boring tasks
Symptoms can fluctuate (erratic behavior)

ADHD in older children and adults
• Although there is generally improvement with age, if left unattended, it can result in later teenage problems
 Lack of social skills
 Low self-esteem
 Relationship problems (anti-social, selfish and impulsive)
• ADHD in adults
• Their social and emotional problems can continue, resulting in …
 Can be disorganized, lack concentration, procrastinate and have anti-social tendencies and emotional outbursts
 Can also transform into adult disorders such as anxiety and mood disorders
 May even lead to alcohol abuse
Causes
ADHD results from a number of factors influencing each other.
Inherited vulnerabilities (predisposing)
• Parents may have been ADHD (underlying genetic problems)
• Chemical imbalances can be inherited
• Pre-Natal problems can lead to ADHD (low birth weight, Fetal alcohol syndrome)
Childhood illnesses
• Neural damage( viral infection)
• Physical illnesses (Biochemical imbalances)
Family factors (not really causal-more aggravating factor)
• Parents with personality disorders (model parents behavior)
• Disrupted home or family situation –eg alcoholism, abuse (emotional tensions & marital conflict)
• Separated families - Divorce-Children 3 times more likely-to get ADHD
• Early learning –lack of parental discipline /weak child rearing practices
• Parents lack coping skills –(especially single parents) others with low self-esteem / less responsive /socially isolated (lack of support)
Environmental factors (not conclusively proven)
• Bad diet
• Food additives and toxins
• Too much sugar (sweets)
• Usually only plays a role if the child is deficient or intolerant (Prof Rabiner, 1999)
• Type of setting (crowded classes, noise, hunger, inadequate teaching methods)
Effect on child
• Child may be ignored and isolated (not taken out )
• Child may be abused
• Lowers school performance and chances of success
Effects on family
• Tiresome and exhausting for parents (increased demands , therapy etc)
• Stresses entire family (costs of treatment and medication)
• Can cause anger and frustration on part of parents –lead to arguments and marital conflict (domestic violence)
• Can cause imbalance in family (all focusing on ADHD child)
• Co-dependency- mother adjusts to ADHD - affects her life (low self-esteem and loss of identity)
Effects on society
• Excessive demands on school ( not equipped to cope) –stresses teachers
• Less productive adults
• Can lead to crime -high correlation with conduct disorder /delinquency
ADHD is a factor in alcohol /drug abuse/ domestic violence)
• Demands on social support structures (cost to medical aids, clinic, hospitals etc)
Proper assessment is required (multiple assessments)
Comprehensive assessment is required for diagnosis of ADHD
(May not be ADHD but rather a medical or learning problem)
Methods of checking
• Teachers reports
• Parent interviews
• Academic progress reports
• Social workers reports (problems at home)
• Educational psychologists –child interview and tests (VADS)/ learning disabilities
• Doctors reports –neurological rating scales, sensory defects (hearing, speech etc)
Treatment for ADHD
Home interventions (dr Phil)

• Stick to a schedule -this doesn't confuse the child.
• Keep the house and the child's activities organised
• Apply consistent disicipline
• Use positive re-inforcement -praise and rewards for good behaviour

Medications
• Ritalin produces improvement in70-80% of cases (corrects biochemical condition)
(some side effects – loss of appetite, dizziness, headaches, too much produces lethargy
and apathy) (majority do not experience side effects & safe for long term use )
• No evidence to suggest Ritalin is addictive (less likely to use alcohol or drugs )
• Tranquilisers –Can relive some symptoms in 70% of cases
(also side effects – lethargy and affects ability to learn)
• Anti-depressants can sometimes help (esp in cases where there is anxiety or depression)
• Medication is not popular due to ethics (sometimes physicians quick to medicate)
• Should be a last resort and combined with long-term psychotherapy.

Psychological treatments
• Cognitive –behavioural therapy and program
(controlling bad behaviour by means of positive and negative reinforcement techniques
(reward and punishment )
• Token reinforcement programmes (merit/demerit system)
• Individual counseling –for emotional issues and anger management
• Remedial schooling to deal with underlying learning problems
• Relaxation therapy
• Visual attention training ( special attention and focus-building computer games)

Social interventions
• Parent education and parenting skills training (empower parents to cope better)
• Social skills training for kids
• School intervention programmes
(better placement, more focus on ADHD children, merit programmes)
Diet (No long term proper studies done –anecdotal successes only)
• Can be improvement in certain cases
• Usually related to food intolerances or deficiencies
• Herbal remedies (St Johns Wort and Pycnogenol) (may be placebo effect)

References
Coleman, J., Butcher, J., Carson, R.(Ed.)( 1984). Abnormal Psychology and Modern Life. N.J.: Scott, Foresman and company.
Edwards, M., Schultz, G. & Long, N. (1995). The role of the family in the assessment of Attention Deficit Hyperactivity Disorder, in Clinical Psychological Review. Vol. 15 no.5. pp 375-394.
Prof Rabiner (2004) in http://www.helpforadd.com/over.htm and http://www.helpforadd.com/medtreat.htm
UNISA Tutoral 101 and 103 (PSY 481-U) (2005)
Dr. Phi McGraw SABC 1 : 18 Nov 2009