Attention Deficit and Hyperactivity Disorder (ADHD)

What is ADHD:
The main feature of Attention-Deficit/Hyperactivity Disorder is a persistent puttern of
inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically
observed in individuals at a comparable level of development. (DSM-IV, 1994). These behaviors
contribute to significant problems in relationships, learning and behavior. For this reason,
children who have ADHD are sometimes seen as being "difficult" or as having behavior
problems. In the majority of cases, symptoms of the disorder last throughout childhood and is
relatively stable throughout adolescence (DSM-IV, 1994), 3-4 times more prevalent in males
then females.
Diagnostic Criteria:
Diagnosis usually as multi-disciplinary team. Following are the diagnostic criteria Attention-
Deficit/Hyperactivity Disorder according to the American Psychiatric Association (DSM-IV,
1994):
Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a
degree that is maladaptive and inconsistent with the developmental level:

Inattention:
 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, or
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.
 Six (or more) of the following symptoms of hyperactivity -- impulsivity have persisted for at
least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity:
 Often fidgets with hands or feet or squirms in seat.
 Often leaves seat in classroom or in other situations in which remaining in seat 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.

Impulsivity:
 Often blurts out answers before questions have been completed.
 Often has difficulty waiting turn.
 Often interrupts or intrudes on others (e.g., interrupts conversations or games).
 Some hyperactive-impulsive or inattentive symptoms that caused impairment were
present before age 7 years.

Some impairment from the symptoms is present in two or more settings (e.g., at school for
work] and at home).
There must be clear evidence of clinically significant impairment in social, academic, or
occupational functioning.
The symptoms do not occur exclusively during the course of a Pervasive Developmental
Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by
another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a
Personality Disorder).
Implications of ADHD:
If ADHD is left unidentified or untreated, a child may be at risk for;
 impaired learning ability
 decreased self-esteem
 social problems
 family difficulties
 potential long-term effects
Associated Behaviors:
There are many common behaviors you may see with children with ADHD. Some of these may
be; non-compliance; attention-getting behavior; immaturity; school problems; emotional
difficulties poor peer relationships; family interaction problems; low frustration tolerance;
temper outbursts; bossiness; stubbornness excessive and frequent insistence that requests be
met; mood lability: demoralization; dysphoria (a state of dissatisfaction and restlessness):
rejection by peers; poor self-esteem; family relationships characterized by resentment and
antagonism.

Causes of ADHD:
Children who have ADHD do not make enough chemicals in key areas in the brain that are
responsible for organizing thought. Without enough of these chemicals, the organizing centers
of the brain don't work well. This causes the symptoms in children who have ADHD. Research
shows that ADHD is more common in children who have close relatives with the disorder.
Recent research also links smoking and other substance abuse during pregnancy to ADHD.
There are many myths surrounding causes of ADHD. ADHD is not caused by, Bad parenting
(though a disorganized home life and school environment can make symptoms worse); Too
much sugar, Too little sugar, Aspartame (brand name: NutraSweet); Food additives or colorings;
Food allergies or other allergies: Lock of vitamins; Fluorescent lights, Too much TV, Video
games.

ADHD & Learning difficulties:

Only 20% to 40% of ADHD diagnosed children also have leaning difficulties. Frequently, they are
one or more of the following (validity of ADHD Syndrome, AADD23); Auditory perception and
processing problems; Visual perception and visual processing problems; Auditory and visual
memory problems (both short and long-term); Sequencing problems; Fine-motor problems;
Visual-motor integration delays, Poor eye-hand coordination; Dyslexia and reading disorders.
OT have a great role in providing strategies to address these difficulties and assist child
accessing their academic learning opportunities.
Possible Treatment:
Medication. Stimulants. For more details see lecture on 'Medications used in children with
disabilities.
Behavior Management. This method uses operant conditioning techniques, which means that it
focuses on straightforward use of attention and tangible reinforcers of behavior which are
systematically applied.
Goal based: Developing activity goals with the child can help increase their motivation and
attention to task. Eg. Learning to ride a hike.

Tips for Home:

 Make a schedule. Set specific times for waking up, eating, playing, doing homework,
doing chores, watching TV or playing video games, and going to bed. Post the schedule
where your child will always see it. Explain any changes to the routine in advance.
 Make simple house rules. It's important to explain what will happen when the rules are
obeyed and when they are broken. Write down the rules and the results of not
following then.
 Make sure your directions are understood. Get your child's attention and look directly
into his or her eyes. Then tell your child in a clear, calm voice specifically what you want.
Keep directions simple and short. Ask your child to repeat the directions back to you.
 Reward good behavior. Congratulate your child when he or she completes each step of
a task.
 Make sure your child is supervised all the time. Because they are impulsive, children
who have ADHD may need more adult supervision than other children their age.
 Watch your child around his or her friends. It's sometimes hard for children who have
ADHD to learn social skills. Reward good play behaviors. Explain to them social
expectations if struggling eg concept of sharing.
  Set a homework routine. Pick a regular place for doing homework, away from
distractions such as other people. TV and video games. Break homework time into small
parts and have breaks.
 Focus on effort, not grades. Reward your child when he or she tries to finish school
work, not just for good grades. You can give extra rewards for earning better grades.
 Talk with your child's teachers. Find out how your child is doing at school--in class, at
playtime, at lunchtime. Ask for daily or weekly progress notes from the teacher.

Tips for School: ("attention deficit disorder: and educator's guide," 1993)
 Predictability: can help child understand expectations
 Structure: To help break day into achievable steps.
 Repetition.: used throughout class to reinforce concepts and ideas
 Shorter work periods: guarantees attention for whole period, frequent breaks help.
 Small student-teacher ratio
 Individualized instruction: combination best. Written instruction, verbal instruction.
 Making sure child is paying attention.
 Motivating and interesting curriculum.
 Use of positive reinforcement
 Good mix of physical/movement opportunities with desk based working

References:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC: Author.
Attention Deficit Disorder: an educator's guide. (1993) CH.A.D.D. Facts, 5, 1-4.
Parenting a child with attention deficit disorder. (1993). CH.A.D.D. Facts, 2, 1-2.
Dixon G. & Addy LM (2004) Making Inclusion Work for Children with Dyspraxia; practical
strategies for teachers. Routledge Falmer, UK.
Parker, Harvey C., Ph.D. (1992). ADD fact sheet. Children with attention deficit disorders, 1-2
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