Single-Parents.net

WHAT IS ADD?

There are many different ways of describing attention deficit disorder, and often the names ADD and ADHD are used to mean the same thing. Most experts now view ADD and ADHD as part of a group of behaviour problems where children have difficulty with concentrating on what they are doing (problems with attention).

SIGNS AND SYMPTOMS

Your school age child may have ADD if he or she is having difficulties both at school and at home and has had at least six of the listed behaviours in either of the following groups.

Inattention
Your child often:

• misses details or makes careless mistakes in school-work or other activities
• has trouble organising tasks and activities
• loses things needed for tasks or activities eg toys, school assignments, pencils, books
• has trouble sticking to tasks or play activities
• does not seem to listen when spoken to directly
• doesn't follow through instructions that he is able to understand, and does not finish tasks (eg at school or chores at home)
• tries to get out of doing things that require a lot of thinking and concentrating
• is easily distracted
• is forgetful in daily activities.

Hyperactivity/Impulsivity
Your child often:

• fidgets with hands or feet, or squirms in his seat
• leaves his seat in the classroom when he should be seated
• runs about or climbs excessively (more than most other children)
• has trouble playing quietly
• is continually "on the go"
• talks "all the time"
• blurts out answers before the questions have been completed
• has difficulty awaiting his turn
• butts into conversations or games

and

1. his behaviour pattern is different from most other children of about the same age
2. the behaviours happen in more than one place, for example at home and school
3. the behaviour has lasted for more than 6 months
4. the behaviour pattern started before age 7 years
5. your child does not have other major health or development problems, and
6. the behaviour is causing your child problems with school work, friends and daily living.

The last thing listed here is most important - the behaviour pattern must be interfering with your child's ability to get on with his life, to learn or fit in with his world. It is not ADD if it is only a problem for the adults.
(Adapted from the Diagnostic and Statical Manual, DSM-IV).

WHAT CAUSES ADD?

Despite at least 30 years of research worldwide there is no clear explanation for why ADD happens in some children. More recent theories suggest that there is a problem with how the front part of the brain works. This causes the child's brain to deal with information and feelings in a different way from other children.

Research has found that family inheritance is part of the explanation of ADD. However, because medical experts don't have a clear explanation for ADD doesn't mean that it does not exist - we simply have to wait for some of the answers.

For some children who have ADHD, some foods seem to trigger more 'out of control' behaviour but food is not a trigger for all children with ADHD. Being at a party often triggers 'out of control' behaviour which might be due to foods but also might be due to too much excitement.

THE IMPORTANCE OF ASSESSMENT

"Quick-fix" management of behaviour difficulties in children, runs the risk of over-looking very important aspects of the child's needs, and of using the wrong treatment for the problem. Insist on thorough assessment for your child if you are worried about ADD before you try any remedies.

The assessment should include:

• assessment of the child including his development, behaviour, how he does at school
• psychology assessments to work out how he manages different tasks including learning
• assessment should also include thinking about what is happening for the child at home and how your discipline works for him
• assessment of the child's school and friendships
• a family assessment - recent research suggests that ADD runs in families, so thinking about other people in the family is important
• checking that he can see clearly and he has normal hearing.

Assessment should involve parents, teachers, psychologists, doctors, and possibly others depending on your child's needs. Brain scans and EEGs (Electro-encephalograms or brain wave tracings) are not helpful in working out whether a child has ADD, but they are useful for some other problems, which might have to be checked. It is also important that other problems which often come with ADD, such as specific learning problems, and difficulties with movements (coordination) are fully checked and a plan is made to help your child manage them.

Note: Preschool age children do many of the things that would be called ADD if they were older - yet ADD does happen in this age group - extra care is needed in assessing young children's behaviour.

WHAT YOU CAN DO

• If children do not have treatment, they will get better at controlling their own behaviour as they get older, but they may have had many difficult years at school.
• The best help for a child with ADD starts with a careful and thorough assessment. Often a wide range of ideas to help your child manage are needed. This can include classroom management, behaviour management plans, specific educational ideas, family counselling and medical management.
• Often medical treatment, such as the use of medicines for ADD, is useful but should not be the only thing that is tried. Other ways of helping your child control her behaviour and help for learning, need to happen at the same time.
• For your child to get the best help it is important that everyone who is working with her talks with each other, works together and explains clearly what is happening so that she understands.
• Whatever actions are decided on, It is also important that everyone knows what to expect from them. For example if your child is having school work problems one action may be to have her sit in a part of the room where there are less distractions - and the aim of this would be to help her with her school work.

USING MEDICATION (drugs)

• There is increasing evidence that using medication can lead to improvement in a child's ability to think, concentrate and learn.
• Treatment does not make the problem go away (when the medication is stopped the difficulties may come back) but the learning that the child has done might make the problems less severe.
• The medications used for ADD/ADHS have been used for a long time and are known to be safe when used for a long period of time.
• The use of medicine for ADD needs ongoing close supervision by a doctor, to make sure your child is getting the right dose, and to check for any possible side-effects of the drugs. Children on these medications can:
  • lose weight
  • have some problems with sleep.
    Problems can usually be managed by changing the time of taking the medication.
• Drug treatment may be needed for long periods - it is therefore important to make sure the medicine works as well as possible with few or any side effects.

THINGS TO TRY

The following are some practical suggestions, some or all of which may help your child.

• Have clear and consistent routines at home and school.
• Look for things at home and school that may be stressing your child. Children with ADD are often more upset when things go wrong than other children. For example if they are being bullied at school or there are family problems at home, they will find it really hard to behave well.
• If you know there are things which will be very difficult for your child, try to avoid them until your child is more able to manage (eg staying calm at big birthday parties will be very hard to do, and staying calm in supermarkets is almost impossible).
• Make sure that your child is not tired or hungry when he needs to behave well (eg have food in the car if you need to drive far after school).
• Allow wind down time between activities (eg allow her to play on the equipment after school before she has to sit still in the car).
• Try to ignore irritating behaviour that is really not important so that she is not being told off all the time.
• Don't give too many choices. Say "would you like to do this or that?" rather than "What would you like to do?"
• Have fun and relaxing things that your child likes to do for when things get stressful.

AT SCHOOL

• Have your child sit at the front of the class at school, so that if his attention wanders the teacher can remind him of the task.
• Use work areas that do not have distractions for school work and home work. For example find him a quiet spot to work, and remove any clutter from the desk.
• A note book to go from school to home and back can help to make sure that everyone is clear about what is expected and what he is doing.
• When you want him to change an activity, let him know that you are going to ask him to do something different and that he needs to listen carefully.
• Make sure you have eye contact with him before you tell her what you want.
• Keep instructions short and clear. Give the instructions in 2 or 3 ways. Many children cannot remember what they are told. Have the instructions written on the board too, or on paper, which he can stick on his desk.
• Break up tasks into small bits that the child can manage and go onto the next bit when he has finished the first. For example, get him to put away one activity before telling him to get out the things needed for the next activity, and when he has done that, tell him where he needs to move to. Get him to say what he is doing to himself as he does it. You can gradually give more directions and longer tasks as he learns to manage better.
• Give children rewards and/or praise when they are able to concentrate on what they are doing and finish a task.

SELF ESTEEM

Children and young people with attention deficit disorder can find it difficult to feel good about themselves. Many things that others take for granted are hard for them. Often, too, everyone concentrates on all the things they need help with, rather than what they can do.

Some things you can do to help your child appreciate all the good things about herself.

• Encourage your child to do the things she enjoys and does well, take an interest and show you are proud of her.
• Set goals and tasks in small steps that she can succeed at. Gradually make them more difficult so she has lots of chances to succeed.
• Try to ignore irritating behaviour so that she is not being told off all the time.
• Let her know your are proud of what she can do - tell her and leave her little notes when you see she does something well.
• Let her know that what she does to help in the home is really important.
• Give lots of support and reassurance.
• Spend time having fun with her.

MAKING FRIENDS

Children with attention deficit disorder sometimes find it difficult to play well with others and make friends. They may need your help to learn how to do this.

• Start your child in a small group with no more than one or two other children.
• Teach your child about how to join a group and start a conversation. He needs to understand that to join a group you have to move close to the people and listen to what they are talking about first, before you say anything. You may have to practice with the child exactly what to say.
• Arrange some structured activity for when friends come over at first.
• Teach your child about what friends do eg how to share, wait for a turn, not push in, and then give lots of encouragement when he gets it right. You might even have little practices at home if there are some things he is struggling with. For example, if he has trouble with interrupting, you could be having a conversation and let him practise waiting for a break before he interrupts. Make sure he gets lots of successes by making breaks after only a short time at first.
• Teach your child some ways to cope with teasing eg pretend not to hear, walk away, tell a teacher etc.
• Help your child find groups where there is some adult guidance eg Boy Scouts, a sport that he can manage.

LOOKING AFTER YOURSELF.

• Don't get discouraged. Every parent finds living with a child with ADD very tiring. You will need to say things 'a hundred times' and still he will have trouble remembering.
• Some parents find that sharing their problems with other parents who are also having difficulties with behaviour can be helpful. Check with your local community health centre for parent groups for ADD.

Note: This topic gives some practical suggestions and information about health. It is important to see your doctor if you are worried about your child's health as information about a particular illness may not exactly fit for your child.