An OAASIS Publication for Parents and Professionals A First Guide to … A D / H D (Attention Deficit/Hyperactivity Disorder) Published by OAASIS Support and Information on Special Needs OAASIS is a part of Cambian Education Services A First Guide to … ADHD A First Guide to A D H D: Price: by Di Wilkinson, Caroline Lacey 1998
• Asperger Syndrome (2nd edition) • Attachment Disorder • Autism (2nd edition) • Dyslexia • Dyspraxia (Developmental Coordination Disorder) • Complex and Severe Learning Difficulties (2nd edition) • Tourette’s Syndrome OAASIS – Office for Advice, Assistance, Support and Information on Special needs Website: www.oaasis.co.uk Vicar’s Hill Boldre Lymington Hanpshire SO41 5QBCambian Education Services Website: www.cambianeducation.com Waterfront Chancellors Road Hammersmith Embankment London W6 9RU A First Guide to … ADHD About First Guides
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A First Guide to … ADHD Contents Contents Introduction and Historical Overview Description and Diagnosis Complications Getting Help Treating and Managing Recommended Reading And check out other OAASIS publications A First Guide to … ADHD Introduction and Historical Overview This First Guide sets out to provide basic information describing Attention Deficit / Hyperactivity Disorder: its causes, symptoms and effects. In addition, it is intended to support parents who may be experiencing anxiety with regard to their child’s behaviour.
Advice is offered on a variety of interventions that are proving helpful to sufferers and lists sources of further information.
Throughout the 1900s, the disorder was described in various ways, but Rutter’s use of the description ‘hyperkinesis’ in 1960 is still used as a benchmark today. Hyperkinetic Syndrome is the term used by the World Health Organisation (the European Guidelines) when comparing extreme levels of motor activity in children with ‘normal’ peers. It is now recognised as a sub-category of AD/HD which applies to highly hyperactive children. Attention Deficit Disorder is a medical diagnosis used by the American Psychiatric Association since the 1980s to describe a syndrome of emotional and behavioural difficulties exhibiting core features of extreme levels of impulsivity, inattentiveness and motor activity. Three sub-types have been recognised: ADD with hyperactivity (the ‘impulsive-hyperactive’ type) ADD without hyperactivity (the ‘inattentive-impulsive’ type) ADD – residual type (found in adults whose childhood symptoms persist after adolescence). It is estimated that in the USA between 2 and 5% of children may suffer from AD/HD. Because in the UK standards are organised in a different way, experts believe the rate to be between 1 and 2%. The condition is more common in boys who are more likely to be hyperactive. A First Guide to … ADHD Description and Diagnosis Attention Deficit Disorder with or without hyperactivity has been described as a condition when, compared with most children of the same age and sex, a child is considerably less able to –
¾ to think before saying or doing something thus controlling impulsivity
and, when hyperactivity is also present -
¾ to control the amount of physical activity which is appropriate to a situation.
The onset of ADHD has normally been signalled by the presence of a number of core symptoms before the age of seven. Set out below is the Diagnostic Criteria taken from the “Diagnostic and Statistical Manual of Mental Disorders” (DSM IV 1993) Washington DC American Psychiatric Disorders. CRITERIA FOR ATTENTION DEFICIT / HYPERACTIVITY DISORDER A.1. Inattention: At least six of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level.
a) Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or
b) Often has difficulty sustaining attention in tasks or play activities.
c) Often does not seem to listen to what is being said to him or her.
d) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties
in the workplace (not due to oppositional behaviour or failure to understand instructions).
e) Often has difficulty organising tasks and activities.
f) Often avoids or expresses reluctance about, or has difficulties in engaging in tasks that require
sustained effort (such as schoolwork or homework).
Guide to … ADHD Diagnosis
g) Often loses things necessary for tasks or activities (eg. school assignments, pencils, books,
h) Is often easily distracted by extraneous stimuli.
A.2. Hyperactivity-Impulsivity: At least five of the following symptoms of hyperactivity- Impulsivity have persisted for at least five months to a degree that is maladaptive and inconsistent with developmental level:
a) Often fidgets with hands or feet or squirms in seat.
b) Leaves seat in classroom or in other situations in which remaining seated is expected.
c) Often runs about or climbs excessively in situations where it is inappropriate (in adolescents or
adults, may be limited to subjective feelings of restlessness).
d) Often has difficulty playing or engaging in leisure activities quietly.
e) Is always ‘on the go’ and acts as if driven by a motor.
g) Often blurts out answers to questions before they have been completed.
h) Often has difficulty waiting in lines or waiting in games or group situations.
B. Some symptoms that cause impairment were present before age 7. C. Some symptoms that cause impairment must be present in two or more settings (eg. at school, D. There must be clear evidence of clinically significant impairment in social, academic or E. Does not occur exclusively during the course of a Pervasive Developmental Disorder,
Schizophrenia or other Psychotic Disorder, or a Personality Disorder.
A First Guide to … ADHD Much research has been carried out but there is no claim that the disorder is, as yet, completely understood. Most experts now believe that the basis of ADHD is brain dysfunction. Some children appear to suffer from a neuro-developmental disorder where there is a problem with chemistry in those parts of the brain which are involved in concentration, an awareness of time and in impulse control.
It is agreed that ADHD has an early onset in childhood making it a chronic condition. It has not been found to be due to other more serious physical and / or psychological problems present in some infants and young children. However, the biological basis to ADHD is influenced by the child’s environment giving significance to social and biological factors. Parents do have an impact on the condition but they do NOT cause ADHD.
There are strong indications that there are genetic determinants. Parents and other siblings are frequently found also to have ADHD or to have had it as a child.
A First Guide to … ADHD Complications It has been demonstrated that there are different types of ADHD. Some children are just inattentive and have difficulty in concentrating and focusing whilst others also have problems with over-activity or physical, verbal and emotional impulsiveness.
A number of complications are likely to be associated with ADHD. Children are more likely to suffer from anxiety and depression. They could be obsessive or have speech and language difficulties, or coordination problems: they may be dyslexic or dyspraxic.
Other complications include oppositional behaviour where young people are argumentative and defiant. This condition can escalate into a more serious Conduct Disorder whereby major anti- social behaviours are exhibited. Motor and verbal tics are common although if these symptoms persist for more than one year, Tourette’s Syndrome could be diagnosed.
Hyperactive children can display disruptive and destructive behaviours causing adults dealing with them great difficulties. Attention Deficit Disorder children are less likely to prove to be a management problem, causing little trouble but they will fail to learn effectively or achieve their potential at school.
In any event, children suffer low self-esteem and their social skills become damaged. Most research literature stresses the need to ‘tease’ out complications of ADHD in order to treat them separately from the condition itself. Associated Difficulties
Poor self-esteem, as cited above, is an associated difficulty faced by children with ADHD.
They may be insatiable and need to go ‘on and on and on …’.
They may find it hard to make and maintain appropriate social relationships and may experience difficulty in demonstrating other social skills. A tendency to perceive situations as ‘black and white’ leads to further confusion and there may be considerable variability in their performance or behaviour to the extent that, if a child is seen on a ‘good’ day, they will be adjudged as being within the normal criteria of child development.
Another resulting difficulty associated with ADHD is the possibility of delayed academic development. Young people with ADHD are likely to have learning difficulties which must be addressed.
A First Guide to … ADHD Getting Help Parents concerned that their child may be displaying core symptoms of ADHD should, in the first instance, approach their GP. Parents have reported difficulties at this stage when a GP has been reluctant to refer a child on to a consultant, feeling that the behaviours being described fit into normal patterns of child development.
This indeed may be the case, but worried parents may wish to consider trying to see another doctor in the practice or even changing their family GP practice if they are unable to persuade their doctors that further advice is needed.
The other route is via the school’s educational psychologist: unlike some disorders, such as Asperger Syndrome (sometimes called ‘The Hidden Disorder’) a child with ADHD will not be able to control him or herself during a long school day, and then only ‘let it all out’ at home. The school will know there is a problem, and should be more than cooperative in helping parents obtain a proper diagnosis.
The child with ADD might not be so easy for the school teacher to detect, as generally it is the hyperactivity which is so noticeable in those with ADHD. Talking through your own concerns with the teacher should help conclude that a problem does exist, however, even if actually pinpointing what it is proves more difficult. But then that is why you want to consult the expert!
There are a number of specialists who could be involved in diagnosing ADHD, but generally a referral will be made to either a consultant paediatrician or child psychiatrist. These consultants may be based at a local Child and Family Guidance Centre, a Hospital Assessment Unit, or have set up in practice themselves.
From detailed tests (which include standardised tests measuring ability and attentiveness) observations and reports from parents, teachers and psychologists, it is hoped that problems can be identified.
As other associated disorders can make the diagnosis of ADHD difficult, it is essential to gain as clear a picture as possible.
A First Guide to … ADHD Treating and Managing Most experts favour a multi-modal approach toward treating and managing the disorder, recognising the co-existing conditions and the importance of treating all symptoms. Usually, the most effective form of therapy is in conjunction with other treatments.
The aim of giving medical, educational and / or psychological help is to create opportunities and the right environment whereby the affected young person can develop and make up to lost learning.
MEDICATION A doctor or consultant are the ONLY people who should prescribe drugs given to help young people with ADD or HD. They should be given and taken only as and when directed. Each individual reacts uniquely to medication: if one causes unwanted side effects (such as weight loss, headaches or insomnia) then consult your GP again: the amount given, the time it is given, or the drug itself may need changing.
There are several well-known and tried drug treatments for addressing the problems posed to young people with ADHD. There are stimulants (Ritalin, Dexedrine), anti-depressants (Tofranil, Norpram) and anti-hypertensives (Clonidine). All of these drugs can increase attention, reduce hyperactivity and impulsivity. See the attached chart for information on these five most commonly used drug treatments in the UK EDUCATION
Help create a structured environment so that these children have less problems with starting and completing tasks, making transitions, working with others following directions, organising multi-faceted projects and maintaining attention:
They need predictability, structure, short work periods, more individual instruction, positive reinforcement and an interesting curriculum. Teachers should have positive expectations, monitor progress regularly throughout the lesson, give directions clearly and frequently, be consistent, firm, fair and patient and give constant feedback.
¾ Appreciate and accept that the child cannot help him or herself: it is not naughtiness.
¾ Seat the child close to you so he is less easily distracted.
¾ Display a large, clear, timetable, easily visible which the child can understand.
¾ Display ‘classroom rules’ which are unambiguous and written in a positive way.
¾ Make clear lists - these children need reminders they can access themselves.
Guide to … ADHD Treating and Managing
¾ Repeat directions: write them down, say them out loud more than once. Check that the child
¾ Make sure the ADD child knows the boundaries: avoid long discussions about what is right
and wrong in their behaviour: tell them what you want - give them the positives.
¾ Avoid timed tests; they will not tell you what the child with ADD knows.
¾ Do not set lengthy homework tasks: go for quality.
¾ Break down each task into its smaller component parts.
¾ Allow ‘time out’ if required (ie if the student feels he or she is about to blow - or indeed if you
are about to!). Make sure the ‘time out’ place is within your view (ie the reading corner of the classroom) or is somewhere close by and safe.
¾ Don’t expect the child to return of his own accord: you may have to go and enquire if all is
¾ Make learning FUN - they hate being bored.
¾ Announce things before you say them: in other words: say things twice. “In a minute I am
going to tell you all about the trip this afternoon to the dairy farm” then a few minutes later “Now, let’s talk about our trip this afternoon. Put your pencils down. Where are we going this afternoon?” etc.
¾ Introduce a behavioural points system, or star chart for staying on task, staying at the desk,
¾ Help with social and conversational clues; make eye contact during a conversation, guide their
eyes to yours when they are speaking to you.
¾ Encourage use of computers, word processors etc if handwriting is a problem.
¾ Include parents in all that you do. Start a Homebook which travels to and from home with the
student, and through which you and the parents can exchange information.
¾ Give extra support when change occurs, eg changing lessons, going to lunch, etc.
¾ These pupils need a highly structured environment where the teacher is there each day.
¾ Be firm but encouraging and know when to ‘back off’.
AND AT HOME …
To help your child improve their own behaviour and expectations, he/she will need
Guide to … ADHD Treating and Managing
Your child was born like this; appreciate this. Do not try to use confrontation to change him or her: make your expectations realistic and give them your patience and your time, but most of all make them feel valued and loved.
¾ Remember that an ADHD child does not think of consequences before he or she acts: a
standard behaviour management programme for the child is not likely to be successful.
¾ Learn to accept all but the most important / serious misdemeanours. You need to act on these.
¾ Good behaviours should be rewarded. These rewards should be as frequent as possible.
¾ Avoid ‘head-on’ confrontation. This will escalate into negative behaviours in your child and
¾ Remain calm and in control; try not to get emotional. Give yourself ‘time out’ if this helps.
¾ Catch him or her being good and give lots of praise when you do.
¾ Encourage your child to try a variety of activities that he or she may enjoy. This may lead to
¾ Try not to use negative words. Listen and appreciate what your child says.
¾ Encourage friendships when possible and include those friends in some of your family
¾ Spend 1:1 time with your child as often as you can. This will make them feel more valued
¾ Encourage brothers and sisters to be calm and tolerant whenever possible, but this will not be
easy when they are much younger than the ADHD sibling.
¾ Do not despair when - or if - your child behaves in a negative way. Remember you are not a poor parent whatever anyone else might think. To sum up you will be most successful if you can:
¾ Anticipate a problem which may be about to manifest itself and act accordingly.
¾ Recognise the unimportant and ignore it.
¾ Make good eye contact and give direct, unambiguous communication.
¾ Try to divert and diffuse whenever you recognise a problematic situation arising.
¾ Try to avoid over-use of the word ‘no’.
¾ Give yourself space and ‘time out’.
¾ Remember your child is different and make allowances for this. When you find something
¾ Never be afraid to admit you may need some help – there are numerous organisations to give
A First Guide to … ADHD The Five Most Commonly used ADHD Medications in the UK DEXEDRINE TOFRANIL (Imipramine) CLONIDINE
(Dextroamphetamine) NORPRAM (Desipramine) Brand and Chemical name
Very individual. The average dose is 5-20 mg
Start with a low dosage and monitor closely.
every 4 hours. Start with a morning dose of
5mg/day and increase by 5mg every 4-5 days. Close observation must be made until correct dose is reached. DURATION
Ritalin will begin to work in 15-20 minutes and
OF ACTION will last about 4-5 hours. The effective dosage
will need to be repeated every 3-4 hours to keep the positive effect constant.
Helpful for ADHD individuals with comorbid
Ritalin is one of the most effective drugs used
throughout the day. Higher doses may help
It improves concentration, memory and will
help the person concerned control frustration
Oppositional Defiance Disorder. Helps with anger control and management.
DEXEDRINE TOFRANIL, CLONIDINE POSSIBLE Insomnia.
May affect the conduction time of the heart. This
It has been know to affect blood count, but this is
dizziness and/or dry mouth. Some will notice that they are becoming irritable and there may be some form of conduct disorder. In this case the medication should be discontinued.
Good safety record. Good safety
Often works when stimulants such as Ritalin
Very easy to use, monitor and evaluate. record.
and Dexedrine are not effective. (Oppositional Defiance Disorder)
As there is a 24 hour effect, it is often
(necessity for a school dose eliminated). Does not affect sleep patterns or
Must be administered frequently during the
Can affect heart conduction rate. An ECG
needs to be carried out prior to medication
Clonidine MUST NEVER BE
This should be repeated once a treatment
STOPPED ABRUPTLY: it must
Levels of positive behaviour may fluctuate,
level is established. be reduced gradually.
As it can affect the blood count, this should
anxiety, motor tics or a family history of
This medication should not start or stop abruptly. A First Guide to … ADHD Recommended Reading 1-2-3 MAGIC: Effective Discipline for Children 2-12 Author Thomas W Phelan, PhD. 1995, Child Management Inc. ISBN 0 9633861 9 0. Attention Deficit / Hyperactivity Disorder: A Practical Guide for Teachers Authors Paul Cooper and Katherine Ideus. 1996, Reprinted 1997. David Fulton Publishers. ISBN 1 85346 431 7 ADHD: How to deal with Very Difficult Children Author Alan Train. 1996, Souvenir Press Ltd. ISBN 0- 285-63311-2 How to Teach and Manager Children with ADHD Author Fintan O’Regan. 2002. LDA. Tel: 01945 463441. ISBN 18 5503 348 8. My Brother’s a World-Class Pain : A sibling’s guide to ADHD. Author: Michael Gordon, PhD. GSI Publications Inc. ISBN 0 9627701 2 4. The Ritalin Fact Book. Author Peter R Breggin, MD. Perseus Publishing, 2003. Available from www.amazon.co.uk for £8.07 = p&p. Taking Charge of ADHD: The Complete Authoritative Guide for Parents Author: Russell Barkley, PhD. 1995 The Guildford Press. ISBN 0-89862-099-6 Understanding ADHD: A parent’s guide to ADHD in Children Authors Dr Christopher Green and Dr Kit Chee. Vermillion, London. ISBN 0 09 181700 5. Contact also: ADDISS: 0208 906 9068 for their own publications list (many of their titles come from America) Website www.addiss.co.uk Email [email protected] The ADHD UK Alliance is a group aiming to coordinate, promote and develop new work and work already being done across the country by various local ADHD support groups. It is supported by the Contact a Family charity. Membership is open to parents, professionals and support groups. Tel: 020 7608 8760 Dore Achievement Centres help children, teenagers and adults affected by learning difficulties, including ADHD, to achieve their full potential through exercises to improve the performance of the cerebellum, enabling the brain to use its full power. Tel:0870 880 6060 Web: www.dorecentres.co.uk Email: [email protected] Hyperactive Children’s Support Group helps children, their families, teachers etc and runs workshops. Lots of information on foods and substances that affect children and teenagers with ADHD/hyperactivity. 71 Whyke Lane, Chichester, W Sussex PO19 7PD. Web: www.hacsg.org.uk Tel: 01243 539966 David Fulton Publishers: Freephone Order No: 0500 618052Website www.fultonpublishers.co.uk Email [email protected] Jessica Kingsley Publisher: 0207 833 2307Website: www.jkp.com Email [email protected] Sage Publications – Web: www.sagepub.co.uk (includes Paul Chapman Publishing and Luck Duck books) for all professionals working in schools and educational settings. SEN Marketing - Website: www.sen.uk.com Email: [email protected] Tel/Fax: 01924 871697 The internet book shop www.amazon.co.uk. These publishing houses produce a wide range of literature on different special educational needs and autism spectrum difficulties. A First Guide to … ADHD And check out … … the OAASIS Information Sheets –
• ADHD • Exams and Access Arrangements for Students with Special Needs • Finding a Special Needs School • |Independent Special Schools – what to look for • Books – where to find them • Forthcoming Conferences and Seminars from other organisations • Useful Contacts and Websites
Visit the OAASIS website for the full list of free downloadable information sheets and other publications: www.oaasis.co.uk.
Stocktake on cropping and crop science for a diverse planet. M.S.Swaminathan MSSwaminathan Research Foundation, 3rd Cross St., Taramani Institutional Area, Chennai 600 113, INDIA [email protected] Abstract The paper begins by examining recent progress in yield and area of the major world crops, and the general underlying technologies which have driven this progress. But despite these
Chemical Head Lice Products Pillow cases of persons known to be infested should be washed daily on hot cycle or put in the clothes dryer for 15 minutes Pyrethrins Eg Amcal Head Lice Foam, Lyban Foam Treat all household members whose head lice have been detected. Synthetic Pyrethroids (bioalletrhin, permethrin) eg Paralice, Keep hair short, particularly during an outbre