Attention Deficit Disorder
ATTENTION DEFICIT DISORDER and HYPERACTIVITY
Attention Deficit Disorder (A.D.D.) occurs in 3% to 5% of children, mostly boys. A child with A.D.D. hasn’t learned to listen when someone talks, wait his turn, complete a task, or return to a task if interrupted. They are easily distractible and have a low frustration for tolerance. Many children with A.D.D. also are hyperactive (also called hyperkinetic), with symptoms of being restless, impulsive, and in perpetual motion. Their activity is poorly organized and not directed towards a purposeful goal.
Hyperactivity usually starts before age 4, often starts in infancy, and some mothers claim that their baby was hyperactive in the uterus! The most important thing to remember is that the truly hyperactive child has little control over his actions and is not deliberately doing things to drive his parents and teachers crazy.
Most of these children have normal intelligence. However some do have an associated learning disability the most common being an auditory processing deficit (i.e., they have difficulty understanding complex instructions).
Diagnosis: Physicians make the diagnosis of A.D.D. or hyperactivity mainly from the parent’s and teacher’s description of the child’s behavior. Some doctors use standardized questionnaires that are answered by the parent and/or the teacher. It’s important to find out if any of the child’s relatives had a similar type of problem. The physician will need to have a clear picture of the home and social situations. A thorough physical exam is performed, which is usually normal. Lab tests are seldom useful. Your child should have psychological and learning tests done by the school to test his intelligence level and to check for the presence of any specific learning disabilities.
Causes: Attention Deficit Disorder is the most common developmental disability. This means that the disability is caused by delayed brain development (immaturity). Some children’s hyperactive behavior is a subconscious attentiongetting device to compensate for failing in school because of learning problems. A small percentage of children with A.D.D. are reacting to chaotic home environments, but in most cases the parents’ style of child-rearing has not caused the disability. No one knows the actual cause of most cases of A.D.D. Often, it is hereditary. Obviously, there is something different about these children’s nervous symptoms, but brain damage has not been proven to be a cause of A.D.D.
Guidelines for Living with a Child with A.D.D.
Most children with A.D.D. can improve significantly if parents and teachers provide understanding and direction and preserve the child’s self-esteem. When these children become adults, many of them have good attention spans but remain restless, need to keep busy, and, in a sense, have not entirely outgrown the problem. However, not only does society learn to tolerate such traits in adults, but in some settings the person with endless energy has a real advantage.
- Accept your child’s limitations:
Accept the fact that your child is intrinsically active and energetic and possibly always will be. The hyperactivity is not intentional. Don’t expect to eliminate the hyperactivity but merely to bring it under reasonable control. Any criticism or other attempt to change an energetic child into a quiet or model child will cause more harm than good. Nothing helps a hyperactive child more than having a tolerant, patient, lowkeyed parent.
Set realistic goals for him. Recognize his areas of strength and encourage achievement there. Perhaps he can channel his excess energy into sports, drama, or gymnastics. He can take on certain household responsibilities like washing the car, making beds, dusting, etc. Positive experiences and parental approval go a long way toward elevating his self-esteem.
2. Provide an outlet for the release of excess energy:
This energy can’t be bottled up and stored. Daily outdoor activities such as running, swimming, sports, and long walks are good outlets. A fenced yard helps. In bad weather, he needs a room where he can play as he pleases with minimal restrictions and supervision. He should not have too many toys, for this can cause more distraction. Encourage him to play with only one toy at a time. The toys should be safe and relatively unbreakable.
Although hyperactivity is “allowed”, it should not be needlessly encouraged. Don’t initiate roughhousing with your child. Forbid siblings to instigate noisy play. Encouraging hyperactive behavior can lead to its becoming your child’s main style of interacting with people.
3. Keep your home well-organized:
Household routines help the hyperactive child to accept order. Keep the times for wake-up, meals, snacks, chores, naps, and bed as regular as possible. Try to keep his environment relatively quiet to encourage thinking and listening. Leave the radio and TV off as much as possible.
4. Make sure that he gets enough sleep:
When a hyperactive child becomes exhausted, his selfcontrol often breaks down and the hyperactivity becomes worse. Try to have him sleep or rest when he is fatigued. If he can’t seem to “turn off his motor”, hold and rock him in a rocking chair.
5. Avoid taking him to formal gatherings:
Except for special occasions, avoid places where hyperactivity would be inappropriate or embarrassing (such as restaurants). You may also wish to reduce the number of times that you take him to stores and supermarkets. After he develops adequate self-control at home, he can gradually be introduced to these situations. Be sure to praise him when he plays independently rather than interrupting you when you are talking to guests or are on the telephone.
6. Have a few simple and consistent rules of discipline:
Rules should be formulated mainly to prevent harm to your child or to others. Aggressive behavior, such as hitting, biting, and pushing, must not be allowed. However, don’t make unattainable rules; for instance, don’t expect him to keep his hands and feet still. Hyperactive children tolerate fewer rules than other children. Enforce a few clear, consistent, important rules and add other rules at your child’s pace. Avoid constant negative comments like “Don’t do this” and Stop that.”
7. Enforce rules with non-physical punishment:
Physical punishment may teach him that physically aggressive behavior is OK. He needs adult models of control and calmness. Try to use a friendly, matter-of-fact tone of voice when you discipline him. If you yell and scream, your child will be quick to imitate you.
Punish him for misbehavior immediately. When he breaks a rule, isolate him in a chair or time-out room if a show o disapproval doesn’t work. The time-out should last about 1 minute per year of age.
8. Stretch your child’s attention span:
Encouraging attentive (non-hyperactive) behavior is the key to preparing him for school. Increased attention span and persistence with tasks can be taught at home. By age 5 he needs at least a 25-minute attention span to perform adequately in school.
Set aside several brief periods each day to teach him listening skills by reading to him. Coloring pictures should be encouraged. Play card or board games with him. His toys should include building blocks and puzzles and he should be praised whenever he is able to spend some quiet time playing.
9. From time to time, get away from it all:
Periodic breaks help parents to tolerate hyperactive behavior. If the father is the only parent that works outside the home, he should try to look after the child in the evenings, not only to give his wife a deserved break, but also to better understand what she must contend with during the day. A babysitter one afternoon and one evening each week can be essential to the parents of a hyperactive child. Preschool is another helpful option for the younger child.
10. Utilize special programs at school:
Once he enters grade school, the school is required by law to provide appropriate programs for your child’s attention deficit disorder. If he is not doing well in academic subjects, insist that the school psychologist test him for learning disabilities. Some aproaches that teachers use to help children with A.D.D. are smaller class size, isolated study space, spaced learning techniques, and inclusion of the child in tasks like erasing the blackboard or passing out books. If appropriate, he may spend part of his day with a teacher that specializes in learning disabilities. Your main job is to continue to help him improve his attention span, self-discipline, self-esteem, and friendships at home.
Diet:
Restriction of sugar, artificial substances, and food additives seems to be an appealingly simple way to treat A.D.D. or hyperactivity. However, the diets have been tested by medical researchers many times and have not been found to be helpful. In other words, parents and teachers who did not know if a hyperactive child was on a normal diet or a restricted diet could not tell any difference in the child’s behavior when on or off the diet. Therefore, we don’t recommend that you spend the time and energy pursuing changes in his diet, especially if this makes your child feel like he is being punished. It can also cause you to neglect other aspects of therapy that have been proven to work.
Some parents though remain convinced that certain foods do worsen their child’s behavior. If this is the case and you would like to pursue it further, you should obtain a copy of the book “Why Your Child Is Hyperactive” by Dr. Benjamin Feingold. It contains specific diets that the author believes helps some children with A.D.D.
Medications:
Stimulant drugs can often improve a child’s ability to concentrate. Medications are not usually prescribed before school age. They should also not be prescribed until after he has been evaluated by his pediatrician and a school psychologist or special education teacher, an individualized educational plan (I.E.P.) is in effect at school, and you have followed the suggestions listed above.
Ritalin (methylphenidate) is the most commonly used drug, though sometimes Dexedrine (dextroamphetamine) or Cylert (pemoline) are tried. Most children tolerate these drugs well, with few , if any, side effects. Insomnia and a decrease in appetite are common, but disappear in a few days or weeks. Rarely, the medication may slow a child’s growth, but this does not happen if the drug is stopped on weekends and holidays. These drugs are not addicting when used in the proper dosage.
If your child is prescribed one of these medicines, it is important to keep follow up appointments as directed by his physician. Dosages often need adjustment to obtain maximum benefit with minimal side effects. It’s important that you speak to you child’s teacher about your child’s behavior and scholastic achievement prior to an appointment, so that decisions about the drug’s effectiveness can be made.
In general, drugs may be very helpful but are not the answer to a hyperactive child’s problem. On the other hand, one might consider it unfair to withhold a potentially helpful avenue that might allow more academic and social success and higher self-esteem.
Thus, it’s important that you consider the pros and cons of drug therapy carefully.