Attention Deficit Hyperactivity Disorder and Your Child
The Disorder
Recent research has determined that the brains of those children showing marked symptoms of ADHD have in common a certain pattern of uncommon activity in the areas of the brain reserved for attention (the anterior and posterior attentional systems). That, however, is only part of the process that causes the easily-recognizable constellation of symptoms. The region of the brain reserved for coordinating movement also shows unusual activity.
The result of the interaction of these two activity centers is, in a normally-functioning child, planned activity with sustained periods of attention. The brain of a child with ADHD, however, has lost the ability to plan movement and monitor its outcome. They simply can’t hold onto a plan for a long enough period of time to enable them to see it through to completion. The result appears to the observer to be chaotic movement and a lack of self-control coupled with gaps in comprehension.
In addition to the brain function abnormalities, there have been suggestions that the processing and transmittal of dopamine and norepinephrine, both naturally-occurring chemicals that are involved in brain functioning and feelings of well-being, are somehow altered. If this is the case, the sufferer’s sense that nothing he does is ever quite right would be a direct result. It is not unusual for individuals with ADHD to also feel depressed and anxious, and no wonder! This world and its social requirements are difficult enough to navigate without a malfunctioning signaling device onboard.
Oddly (and fortunately), in some children some of the neurological abnormalities fade as they grow and their ADHD along with them. In others, the problem remains and is compounded by the effects on learning and social development.
The Symptoms
ADHD is usually apparent by the time a child is in second grade. The child may suffer all or some of the following:
âÂ?¢ Unusual levels of activity in circumstances that don’t require it.
� Confusion over rules and social rituals
� An inability to sit still for long periods of time
� Difficulty with spelling, reading, and math
� Difficulty following directions requiring more than two or three steps
� Distractibility
� Difficulty explaining actions and decisions
� An inability to connect his behavior with the results
� Disorganization with regard to personal possessions
� Poor sense of the passage of time
� Poor control over emotions
A child (or adult) suffering from ADHD will be confused and confusing. Conversations are frustrating on all sides, as he cannot always focus long enough to be a real participant. Often the sufferer will have little patience for lengthy talks or instructions. He may be very bright, but have a hard time collecting his thoughts and applying what he knows. Lacking many of the “executive” (regulatory) functions of the brain, he may fly off the handle when confronted. He will settle for the easiest way out, the most obvious reward for his efforts, and the shortest path to satisfying his needs and yours.
The Social Side
Since an individual with ADHD is constantly bombarded by conflicting thoughts and misdirected energy, his effect on the people around him can be negative indeed. Sadly, while he can sense the disturbance around him and the anger he seems to evoke in others, he has no idea why this is happening or how to change the situation. As a result, he may try many different things in rapid-fire order, confounding the situation even more.
The result for the sufferer is a feeling of depression, anxiety, and anger. The comment “I never do anything right!” is not uncommon, and asked to describe himself, he may use words like bad, stupid, annoying and irritating. Indeed, that is how many of his peers and social contacts might also describe him! Jokes about ADHD abound (“Fifty-seven times four is . . . hey look! A chicken! Do you have any cookies?”), but they are only veiled, socially-acceptable comments on the difficulty the general, unafflicted population has in dealing with the disorder.
It is unusual for a child with ADHD to choose as a friend another child with the same problem. Though they might gravitate to each other for brief periods, people with the disorder are constantly in search of a sane direction and lots of structure. Put two children with ADHD in a room together for too long, and there will probably be fireworks. Children with ADHD may find it difficult to form lasting relationships. They are good at many things, though, and sometimes they will be accepted into a group because of their strengths, and their difficulties will be overlooked and accepted as well. Still, eventually there will be conflict. Depending on the level of maturity of all involved and the degree to which the child is symptomatic, conflicts may be resolved or may result in friends losing interest.
In one case, a young man I will call “Steven”, who had been a long-time, untreated ADHD sufferer, managed to maintain a close friendship with another young man with slightly less-pronounced and well-managed ADHD. This appeared to be a perfect match until adulthood, when the second young man, successfully operating his own contracting business, hired his friend. The conflict began almost immediately as the first young man could not get to work on time, tended to be sloppy in completing his tasks, and often became distracted and left the job before the day was over. Within days his friend was forced to fire him, destroying the friendship as well.
In another case, “Ryan” who was diagnosed with ADHD as an adult after a misdiagnosis of dyslexia as a child, was able to find a woman who, though not similarly afflicted, had other problems. Since the pair were in their twenties and capable of making educated choices, the woman researched the disorder, helped her new partner get the help he needed, and together they were able to work through the conflicts that still arose.
At the elementary school level, conflicts can be very pronounced. Children of that age are already conflicted over behavioral issues. They want very much to earn the praise and love of the adults in their lives, and friendships with their peers tend to be secondary. Thus a child whose control over his own behavior is sketchy at best adds to the confusion. He may be ostracized, or he may be seen as somewhat apart from the group; someone the others like to watch from a distance without endangering their own acceptance by parents, teachers and other adults. Students viewed this way as small children often take on the role of class clown or underminer of authority later on in order to hold onto the attention they so desperately seek.
“Rob” was such a child. As he traveled through elementary school, his errant behavior made him the bane of his teachers’ lives while fascinating his peers. He developed no real friendships, but was the focal point of a large group of followers. Among his teachers, the word “cult” was often used in describing this situation. His hyperactivity and lack of focus gave him plenty of energy and the errant thought processes required to put that energy to work in negative ways. His classmates did not mimic his behavior, but they did openly admire his ability to run roughshod over the rules set by the adults in control. “Rob”, in turn, loved the attention. In order to maintain its level, he escalated in his negative behaviors until he finally reached the point of being diagnosed Emotionally Disturbed and placed in a special class with intensive instruction and counseling.
This brings us to the next area deeply affected by ADHD.
Academic Impact
ADHD was once described as “static” in the brain. The person suffering from the disorder really isn’t actually “not paying attention”. That is a common mistake derived from the “attention deficit” part of the name of the disorder. In fact, he may well be paying attention, but without the ability to determine which are important things requiring attention and which are incidental. The executive functions that help make that determination are missing, so the passing fire truck and the teacher’s instructions receive equal weight. Mother’s warning not to cross the street may have to vie with the bird taking flight from a nearby bush and a squashed caterpillar on the sidewalk. None is seen as more important than any other. Add the fact that the sufferer has an unusually short attention span, and it’s easy to imagine the kind of uproar that can result.
Apply this idea to the classroom. Miss Jones is repeating for the fourth time that the students need to write their names, class and date in the upper right corner of the paper. Billy got as far as “write your name” before he was distracted by a breeze ruffling papers on the windowsill. That focus, in turn, was broken by thoughts of a video game he plays after school every day. By the time the teacher’s voice comes back into the forefront of his attention, he has missed part of the instructions. He writes his name at the top of his paper.
Having done that, he has no idea what to do next. He may raise his hand to ask, or he may be too embarrassed by other such incidents and just do what seems to come next. He writes the first answer on the test paper. He missed the part when the teacher told them how to write the answers and how much of their work needed to be shown. Likewise, the day the class was learning long-division, he blinked out for a bit and missed the part about what to do with the remainder.
This sort of thing is cumulative. Billy will probably fail the test at hand. If he’s really frustrated, he may just write anything on the paper to get it over with. If he’s reached the point of acting out to vent his frustration, he may even tear up the paper or write his name all over it in different styles and sizes.
Failing the test isn’t the real issue. Billy will fail not because he missed the instructions on this test or on remainders, but because he has had so many lapses like those that now, at the age of ten, he has gaps in his education. He didn’t get long-division because he didn’t get single-digit division or subtraction, or decimals, or some other pertinent piece of the puzzle.
By the time he reaches high school, he will be functioning significantly below grade level. If the discrepancy between functioning and IQ is significant enough, someone may determine that he has a learning disability and needs to receive special education. This is when an even bigger question rears its head.
Handling ADHD
Parents can begin at home:
1. Maintain a structured environment without last-minute changes to routine.
2. Give instructions in writing as well as verbally.
3. If necessary, use post-it notes in conspicuous places to remind the ADHD child of what he needs to do.
4. Make sure there are clocks in every room. If the child has an appointment, set a timer or give him a watch with an alarm on it that you will set for him until he learns the routine of doing so.
5. Do not lose patience. Teach him each routine you want him to learn. Reteach it as many times as necessary until he has it memorized and performs it without fail.
6. Don’t argue. He can out-argue you because he does not need to rely on logic to support his side. He is completely emotional and out-of-control.
7. Don’t belittle the child, particularly in public. You will be setting the stage for negative attention-getting behavior.
8. Don’t give him more responsibility than he can handle.
9. Keep him on task by tapping him on the shoulder or hand or tapping near him where he is sitting. You need to be the distraction that he pays attention to.
10. If you suspect ADHD, have your child seen by a pediatrician as soon as possible.
Is ADHD a learning disability? No. In itself, it is a neurological impairment, unrelated to learning ability. However, it impacts so severely on a child’s ability to learn that special education often winds up the answer of choice in school. More often, a child with ADHD will be given, and rightly so according to the regulations, access to Section 504 accommodations under the 1973 Americans with Disabilities Act (ADA), a civil rights law. In either case, unless additional measures are taken, the child will be no more successful in special classes than he was in his regular classroom.
There is a huge wave of negative attention being focused at ADHD diagnosis right now. It has been suggested that “boys will be boys” is a more accurate assessment of many of the behaviors listed under the symptoms of ADHD. This is particularly easy to do since more boys by far are afflicted with the disorder (or show symptoms openly) than girls. In addition, there is a sense among parents that schools are trying to medicate the children into behaving well.
Neither school of thought is supported by the evidence of scientific study. What is supported is the fact that with medication (and new ones are being developed all the time) a child with ADHD can focus and slow down his irrational activity. Add counseling, and the child has a chance to learn appropriate behavior patterns by rote while he’s waiting for them to become habit by virtue of his new-found focusing ability.
With both of these in place, the educational process has a shot at filling the gaps in his learning. Special Ed? Not necessarily. Tutoring might suffice. The child with ADHD is fully capable of learning, but he needs the chance to do so and to be taught how.
