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Getting Clear About ADD and ADHD in Children
Marie-Josée Trudel has a Master’s Degree in Psychology. She
developed an expertise on ADD and ADHD. She is working as a Coordinator for the
PANDA Association. PANDA Québec helps parents, people and organizations to meet
the needs of people with ADD/ADHD and requirements of their loved ones.
There is much confusion recently about ADD/ADHD in the media, at schools, within family life and the community. Trudel help us get clear on the facts about ADD/ ADHD in children.
Attention-Deficit/Hyperactivity Disorder (ADD) is a neurological condition that leads to difficulty modulating attention, movement and behaviour. The three core symptoms of ADHD are inattention, hyperactivity and impulsivity. These symptoms can manifest differently from one person to another. Some people may present more inattentive symptoms (ADD: Attention Deficit Disorder) while others, more hyperactivity and impulsivity (ADHD). Others may have all 3 core symptoms (ADHD - combined type). Treatment strategies vary depending on symptom presentation.
Inattention: a child up to 16 years of age has six or more symptoms of inattention, five or more for adolescents 17 and older and adults. These symptoms must have been present for at least 6 months.
Signs of inattention include when the child/person: ·
- Fails to pay close attention to details, makes careless mistakes at school, at work, or other activities. ·
- Has trouble with their attention span regarding tasks/play activities. ·
- Does not seem to listen when spoken to directly. ·
- Does not follow through on instructions, fails to complete schoolwork, chores, or duties in the workplace ·
- Has trouble with organizational skills ·
- Avoids, dislikes, or is reluctant to finish tasks that require mental effort over a long period of time (such as schoolwork/homework). ·
- Loses things necessary for tasks or activities (school books, pencils, tools, wallet, keys, paperwork, eyeglasses, cell phone). ·
- Is often easily distracted/forgetful in daily activities.
Signs of hyperactivity and impulsivity include when the child/person: ·
- Fidgets or taps hands or feet, or squirms in their seat. ·
- Leaves their seat unexpectedly when remaining seated is appropriate. ·
- Runs about/climbs in situations when it is inappropriate
(adolescents/adults may be limited to feeling restless).
- Unable to participate in leisure activities quietly. ·
- Often "on the go" acting as if "driven by a motor". ·
- Talks excessively and blurts out an answer before a question has been completed. ·
- Has trouble waiting for his/her turn. ·
- Interrupts/intrudes on others (butts into conversations/games)
- Several inattentive or hyperactive-impulsive symptoms being present before the age of 12 years old.
- Several symptoms present in two or more settings, (home, school, work, with friends or relatives; in other activities)
- There is clear evidence symptoms interfere with/reduce the quality of socializing, school life, or work functioning.
- Symptoms are not better explained by another mental disorder (Mood, Anxiety, Dissociative, or Personality Disorders).
Demands from the school environment require better attention skills and functioning than at home. Social skills become demanding in school and these challenges can quickly become insurmountable. Without help, children move from one failure to another. Consequently, many children/adults with ADD/ADHD suffer from poor self-esteem and a sense of underachievement.
With better access to information on these challenges, adults discover that they too have this condition. While a diagnosis is never easy to receive, one often feels relieved because it finally explains why they struggled throughout their life. Simultaneously, they wish they had known and been treated earlier.
There is much controversy over medication that young people take as they don’t like the way they feel. They may feel tired and not hungry. Most parents are uncomfortable or resistant to give medication to their child. Much false/incomplete information has been written about medications. In order to make sense of all the info, PANDA Basses-Laurentides-Sud-Ouest organizes conferences on this subject each year. Medication is only one of the strategies to help treat ADHD. It is not magic, or the solution.
According to specialists, a good way to understand ADHD treatment is to compare it to diabetes treatment. Amongst diabetics, there is a large spectrum of disease severity. Some people can control their sugar level by changing their lifestyle, while others need medication in combination with lifestyle change to compensate for their insulin deficiency. In all cases, lifestyle changes are mandatory.
It is the same for the treatment of ADHD. Some people have mild symptoms of attention deficit and/or impulsivity and hyperactivity. It is possible to control these symptoms with different strategies such as routine, organization, school accommodations, etc. Once these strategies have been tried, if the symptoms still interfere with the child’s full potential, then medication is considered.
It is interesting to note that in the case of diabetes, most parents would agree to give medication to their child. This is not true for ADHD medications. However, the goal of medication is to improve functioning and quality of life, which it does in the majority of patients. When there are side effects, one must keep in mind that health professionals monitor effectiveness and side effects throughout the process to find the optimal treatment. There are guiding principles to minimize side effects. Healthcare professionals will make decisions in the best interest of patients they treat.
“I believe there are lots of adults walking around who have not yet been diagnosed, says Trudel.”ADD OR ADHD is a chronic condition. A head injury could lead to symptoms at a later age, but the condition is usually present at birth. There are more and more adults finding out that they have this challenge who discover it through the evaluation of their own child… the condition is often hereditary.
While inattention remains constant from childhood to adulthood, hyperactivity manifests itself differently. Adults with ADHD often speak about inner restlessness. Impulsivity is also an issue in adulthood. Adults with ADHD have a higher risk of car accidents, have more frequent job changes and less stable inter-personal relationships. Medications and strategies are the same.
A physician or psychiatrist makes the diagnosis based on the evaluation. Psychiatrists can evaluate, but some physicians don’t feel comfortable with the evaluation and refer parents to psychologists or neuro-psychologists. An evaluation should include questionnaires to parents and teachers because the symptoms must cause significant impairment in at least two life settings (home and school) to meet diagnostic criteria. The evaluation results are then returned to the physician who will make the diagnosis.
Medication is a strategy for treatment, but does not cure ADD OR ADHD. The goal is to lessen symptoms so that patients can function more effectively. Medication has positive outcomes in 70-80% of patients. Reports on medication use vary. Attention span, impulsivity and on-task behavior often improve, especially in structured environments. Some children demonstrate improvement in frustration, tolerance and compliance. Relationships with parents, peers and teachers may also improve.
The most common side effects are reduced appetite loss and difficulty sleeping. These side effects are managed by changing a dose. It may take many attempts to reach an effective dosage with the least side effects. A decision is always made in the best interest of the person treated. Pros and cons specific to each medication must be discussed with the doctor.
Children who talk excessively, blurt out answers before everyone else and who are inattentive to the social cues, are eventually rejected by others. A treatment plan must include social skill strategies.
Over the past decade prescriptions have increased, leading to the belief that there is an increase in the number of ADD OR ADHD diagnoses; however, the rate of diagnoses has stabilized in children - from 5 to 8%. According to some specialists, increase in prescriptions may be explained by the introduction of long-action medications 10 years ago. Another explanation for the prescription increase may be growing awareness of the condition in adults.
We cannot measure neurotransmitters and consequently, diagnosis is based on the observation and assessment of behaviors. Anxiety can affect executive functions the same way ADD or ADHD does. Emotions become so overwhelming that the child cannot have access to their cognitive potential. Anxiety is usually not chronic and can resolve with appropriate strategies. ADD OR ADHD on the other hand, affects all spheres of life and is a chronic condition. Parents should look for mental health professionals with expertise in ADD OR ADHD due to the complexity of the diagnosis.
If parents suspect their child has ADD or ADHD, they should seek information, then talk to their physician/pediatrician and school staff to raise awareness around their child’s difficulties and build a team approach to finding solutions. Parents can also seek help and information from PANDA associations, non-profit organizations recognized for their expertise with this condition. PANDA Basses-Laurentides-Sud-Ouest offers services in English (www.pandablso.ca) in the Deux-Montagnes area.
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