adhd/add israel  attention deficit hyperactivity disorder

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What is ADHDWhat is ADHD


 What is ADHD


Attention Deficit Hyperactivity Disorder

 

 

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder where a child, adolescent, or adult may have difficulty concentrating, completing assigned tasks, keeping track of things, and waiting ones turn. Persons may even have difficulty sitting in their seats and may excessively fidget, squirm or talk. These behaviors should persist for at least 6 months and be exhibited in both the home and school setting before the individual is classified as having ADHD (DSM-IV American Psychiatric Association [APA], 1994 ). It is estimated that between 3 and 5% of schoolage children have this disorder, but boys seem to be affected by this disorder more than girls (APA, 1994 ).

What are the symptoms of ADHD?

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV American Psychiatric Association [APA],1994) list eighteen symptoms. These eighteen symptoms are as follows:

Either inattention or hyperactivity-impulsivity symptoms

Inattention

Six (or more) of the following symptoms of inattention must persist for at least 6 months.

  • often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

  • often has difficulty sustaining attention in tasks or play activities

  • often does not seem to listen when spoken to directly

  • often does not follow through on instructions and fails to finish schoolwork, chores, duties in the workplace (not due to oppositional behavior or failure to understand instructions)

  • often has difficulty organizing tasks and activities

  • often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

  • often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)

  • is often easily distracted by extraneous stimuli

  • is often forgetful in daily activities

Hyperactivity-Impulsivity

Six (or more) of the following symptoms of inattention must persist for at least 6 months.

  • often fidgets with hands or feet or squirms in seat

  • often leaves seat in classroom or in other situations in which remaining seated is expected

  • often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

  • often has difficulty playing or engaging in leisure activities quietly

  • is often on the go or often acts as if driven by a motor

  • often talks excessively

  • often blurts out answers before questions have been completed

  • often has difficulty awaiting turn

  • often interrupts or intrudes on others (e.g., butts into conversations or games p. 83-84).

In order to be officially diagnosed with ADHD, the symptoms must have appeared before the age of seven and have resulted in the impairment of the childs social or academic functioning, and the symptoms must be exhibited in the home and at school (APA, 1994).

Because children vary in the way they display ADHD symptoms, three categories of ADHD symptoms have been recognized. For example, children who often fidget, squirm, run and excessively climb, and cannot wait their turn to play a game would be diagnosed as ADHD predominantly hyperactive-impulsive type. Those children who fail to complete a task, are easily distracted, and are often forgetful would be diagnosed as ADHD predominantly inattentive-type. Meanwhile, those children who are easily distracted, often forgetful, fidget, and cannot wait their turn to play a game would be diagnosed as ADHD combined type.

How is ADHD Diagnosed?

Currently, the only way to determine if your child has ADHD is by going to a psychiatrist, psychologist, pediatrician, or social worker who will evaluate your child. These persons will ask you to describe your childs behavior, and then will determine if your child meets the criteria discussed above. Once this is determined, your child will be classified as having ADHD.

In addition to interviewing you and/or your partner, the social worker will also interview your child and the your childs teacher. Beside basing the diagnosis on the interviews with you, your child, and the childs teacher, the social worker may ask you, your child, and the teacher to fill out some questionnaires. The most likely questionnaires that you, your child, and the teacher may be requested to fill out are the Child Behavior Checklist (CBCL Achenbach, 1991) Connors Parent Rating Scale--Revised (CPRS-R Connors, Sitarenios, Parker, & Epstein, 1998a) and Connors Teacher Rating Scale--Revised (CTRS-R Connors, Sitarenios, Parker, & Epstein, 1998b ). These questionnaires are widely used, and are considered to be useful in determining if both children and adolescents have ADHD symptoms.

Social and Emotional Problems Associated with ADHD

Some children with ADHD have difficulty socializing with peers and cooperating with authority figures (Child Development Institute, 1999). While others may experience low frustration tolerance, temper outbursts, depressed mood, and stubbornness. Academic underachievement is common. As a result of the childs behavior, family relations may also be strained, and family members may believe that the child may be engaging in the problematic behavior on purpose (What is ADHD? A General Overview, 1999).

All children may not have the above-identified problems associated with ADHD. It is hard to determine if these identified problems are the result of ADHD or some other factors (What is ADHD? A General Overview, 1999). Therefore, it is important that persons do not assume that if a child is experiencing academic difficulties that the child has ADHD.

Treatments

Medication

The most commonly prescribed medication to treat ADHD is Ritalin, which is a stimulant. Other stimulants that may be used are Adderall, Dexedrine, and Cylert. These medications are effective in treating the symptoms of inattention, hyperactivity, and impulsivity (Mental Health Report of the Surgeon General, 1999). Moreover, these medications have been effective in treating the symptoms of ADHD in 75 to 90% of children (Mental Health Report of the Surgeon General, 1999).

Children as well as adolescents are initially started on a low dosage. Normally, the stimulant is tried for one week to determine if the medication is having an affect on the ADHD symptoms. Depending on the effects of the medication, the physician or the psychiatrist may recommend that the dosage stay the same or be increased.

Side effects of stimulants are insomnia, decreased appetite, stomach aches, headaches, and jitteriness. These side effects are considered to be mild and responsive to dose changes (Mental Health Report of the Surgeon General, 1999).

Counseling

Research has demonstrated that both behavior modification and cognitive behavioral therapy are effective in treating children with ADHD. The underlying premise behind behavior modification is that behaviors will increase or decrease depending on the consequences that follow the behaviors. Thus, parents can increase the childs desirable behaviors by providing rewards, and decrease the childs undesirable behaviors by providing consequences (i.e., taking away of a privilege, grounding). For more information about the use of behavior modification with children with ADHD, see Taking Charge of ADHD by Dr. Russell Barkley.

Cognitive behavioral therapy (CBT) focuses on teaching the child new ways to solve problems and skills to enhance peer relationships. Cognitive behavioral parenting programs help parents manage their childs behavior more effectively, as well as enhance their understanding about ADHD (Barkley, 1997). More importantly, these programs serve as a source of social support for the participants.

Other Types of Treatment

In addition to treatments to address the ADHD symptoms, interventions may be needed to treat the problems associated with ADHD. For example, children who are having academic difficulties may need tutoring. Children who have difficulty making friends may benefit from being involved in a social skills training program. Family therapy may be needed, as . Family therapy increases the parents and siblings overall knowledge about ADHD, reduces parental guilt, and reduces the stress of living with children who have ADHD (Meyer, & Deitsch, 1996). More importantly, is that effective treatment and management of ADHD requires that both the ADHD symptoms and the associated problems be addressed (What is ADHD? A General Overview).

Helpful Techniques for Families that have a Child with ADHD

Many helpful techniques for managing a child with ADHD can be found at www.add.org. A few of these techniques are listed below:

  • Create positive alternative choices based on the childs purposes and encourage him or her to make successful choices.

  • Use positive statements to motivate him or her towards positive outcomes.

  • Use reminders to overcome short-term memory difficulties.

  • Provide structure for your child.

  • Develop songs or written charts to remind the child what chores need to be done.

  • Know what behaviors your child engages in that causes you stress.

  • Have a support system to help you alleviate stress.

How Schools Can Help Children with ADHD

Hogan (1997) lists the following techniques that teachers may use in the classroom when working with children with ADHD:

  • Applaud the childs strengths to encourage self-esteem and increase trust.

  • Provide a calm, positive, structured environment.

  • Be firm, patient, and consistent.

  • Provide immediate feedback.

  • Model positive behavior rather than focusing on negative or inappropriate behavior.

  • Assign work that is within the childs capabilities. This prevents frustration.

  • Mix high-and low-interest tasks.

  • Offer time out periods, when needed.

  • Develop a method of reporting between home and school.

  • Offer tangible rewards for children for success.

  • Discourage competition.

  • Make eye contact with the child, speak clearly and slowly, and provide brief directions.

Websites about ADHD

www.mentalhealth.com/dis/p20-chol.html . This site has two psychologists, Dr. Hallowlel and Dr. Ratly, who answer parental questions about ADHD. Also, the site contains links to current ADHD research. One drawback of this site is that the credentials of the above-mentioned psychologists are not indicated.

www.additudemag.com. This site contains information about a magazine endorsed by the Children and Adults with Attention Deficit Disorder (CHADD), which is the largest support group for person with ADHD and their families. This site tackles controversial issues related to ADHD, and highlights the accomplishments of persons with ADHD. An $18 subscription fee is required.

www.add.org. This site contains links to a variety of journals, books, and lecturers that specialize on ADHD. The National Organization for ADHD is associated with this website.

www.familyvillage.com. This site contains information and links about specific neurological conditions, including ADHD. This site is user-friendly but may be difficult to navigate due to the amount of information.

www.cdipage.com/adhd.htm . This site contains information about ADHD including diagnosis, treatment, classroom management, and parent education. The information is updated as needed to reflect the current state of knowledge about ADHD.

www.surgeongeneral.gov/Library/MentalHealth/chapter3/sec4.html. This site contains information about the diagnostic criteria for ADHD its causes and treatment. The effectiveness of each treatment is described, along with related concerns, about the treatment.

References

Achenbach, T. (1991). Manual for the child behavior checklist/4-18 profile. Burlington, VT: University of Vermont Department of Psychiatry.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Barkley, R. (1997). Defiant children: A clinicians guide to parent training (2nd ed.). New York: Guilford Press.

Child Development Institute (1999). About Attention Deficit Hyperactivity Disorder ADD/ADHD. Available [On-line]. www.cdipage.com/adhd.htm.

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998a). The revised Connors parent rating scale (CPRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 257-268.

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998b). Revision and restandardization of the Connors teacher rating scale (CTRS--R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Hogan, D. (1997). ADHD: A travel guide to success. Childhood Education, 73, 158-160.

Mental health: A report of the surgeon general (1999). Available [On-line]. www.nimh.nih.gov/mhsgrpt/chapter3/sec4.html.

Meyer, R. G., & Deitsch, S. E. (1996). The clinicians handbook: Integrated diagnostics, assessment, and intervention in adult and adolescent psychopathology (4th ed.). Needham Heights, MA: Simon & Schuster.

What is ADHD? A general overview (1999). Available [On-line]. www.helpforadhd.com/over.htm.

Annotated Bibliography

Achenbach, T. (1991). Manual for the child behavior checklist/4-18 profile. Burlington, VT: University of Vermont Department of Psychiatry.

This manual describes how the Child Behavior Checklist (CBCL) was developed. Information related to how the scale is scored and how the score is interpreted is presented. Scores for children who have ADHD compared to children who do not have ADHD are provided. Items from the entire scale are presented for review.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

This manual gives an overview of more than 200 mental disorders. Each disorders diagnostic criteria is described along with its prevalence rates. Socioemotional and behavioral problems associated with each disorder are described,as well.

Barkley, R. (1997). Defiant children: A clinicians guide to parent training (2nd ed.). New York: Guilford Press.

This manual describes the authors 10--session parent management training program. Parent handouts are provided that reinforce the concepts and skills outlined in each of the sessions.

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998a). The revised Connors parent rating scale (CPRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 257-268.

This article describes the development of the revised Connors parent rating scale (CPRS-R). Information related to how the scale is scored and how the score is intrepreted also is presented.

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998b). Revision and restandardization of the Connors teacher rating scale (CTRS--R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

This article describes the development of the revised Connors teacher rating scale (CPRS-R). Information related to how the scale is scored and how the score is interpreted also is presented.

Hogan, D. (1997). ADHD: A travel guide to success. Childhood Education, 73, 158-160.

This article outlines 14 techniques that teachers can use when working with children with ADHD in the classroom. The author stresses the importance of working with the childs parents, previous teachers, and appropriate education specialists in order to work effectively with children with ADHD.

Meyer, R. G., & Deitsch, S. E. (1996). The clinicians handbook: Integrated diagnostics, assessment, and intervention in adult and adolescent psychopathology (4th ed.). Needham Heights, MA: Simon & Schuster.

This book serves as a reference for those individuals who diagnose and tradolescents and adults who have mental health problems. This book gives an overview of the different disorders, along with information related to assessing and treating the disorders.

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Published at U.S. adoption human services.


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