Attention Deficit Hyperactivity Disorder (ADHD) is a pervasive illness of neurodevelopmental origin that is diagnosed more frequently every year. Children often have an extensive difficulty in school, in social relationships, and in task oriented behavior. Unfortunately, this illness carries an unfair stigma due to historic battles in the media and the reluctance of families to accept the side effects and perceived problems from traditional medical treatments. However, the face of ADHD is changing, as we now know this illness can carry into adulthood, and many patients treated as a child can go on to have productive and successful lives.
Symptoms of ADHD
Children with ADHD can present at a very young age, as most symptoms are noted by parents in the home. What may first seem to be inattentiveness, increased activity, and poor impulse control may be the early symptoms of ADHD. Typically, it is not until the child is school age when input from teachers helps to shape the diagnosis. Teachers will often confirm that the student is disruptive in class, has a difficult time focusing on material, and milestones the child should be reaching may be delayed. It is in conjunction with the educators that a parent can come to a fuller understanding of a possible diagnosis of ADHD. When a child begins to have trouble in school, the parents can request an Individual Education Plan (IEP) under due process in the school system. This IEP brings all pertinent educators, the child’s counselor and social worker, administration and parents together to discuss the child’s issues and create a plan for the process of improvement. It is often at these sessions that the possibility of ADHD is discussed, and recommendation to consult with a physician is also advised. Ultimately, the concerns most parents have are confirmed during these sessions, as the same behaviors often occur in the home.
Attention Deficit issues can appear different in every child, and in fact, there are three forms of this disorder. One form presents with primarily attentiveness problems (ADD). These children distract easily, lose their train of thought, forget what task they are working on, and have trouble with routine activity. Another form presents with primarily hyperactivity and impulsiveness issues (AHD). These children cannot sit still, they are fidgety, and constantly in motion. They may be unable to control impulsive activity such as running, climbing, interrupting, and can appear restless all the time. The third presentation is a combination of the two above, presenting with both hyperactivity and attentiveness issues.
How is ADHD Diagnosed?
The diagnosis of this illness can take many routes, but it always requires a series of evaluations. Parents often think about the possibility, the school system confirms that concern (if over 3 years) and then a primary physician is consulted, often culminating in a referral to a child psychologist or psychiatrist. There are multiple tools that can be employed during this process, which usually require culling the same information from all adults involved, and tabulating the data. It is imperative, however, that the possibility of a learning disability is considered, and a full medical exam with hearing and vision testing must be done to rule out other comorbidities. If the child is under 3 years, requesting assistance from an early intervention program is often the first step. Most importantly, the parents must advocate and support their child’s needs at all times, to make certain that the best and most accurate evaluation is made.
Why Did My Child Develop This?
The most important issue here is to recognize that there is nothing a family has done to cause the illness, and in fact, most current studies show that attention disorders are caused by a genetic issue, and not a product of parenting or socialization. The medical community is still investigating this, and other issues such as in utero exposure to toxins and drugs, and other birth related problems are being investigated. The critical point is that parents must be reassured that the old wives’ tales about exposure to television, high carbohydrate and high sugar diets, poverty, and family strife as causative factors have been proven not to cause ADHD. These factors, however, could always effect the behaviors and attitude of any child, potentially making the symptoms of ADHD worse.
How Can My Child Be Treated?
Once the child has a confirmed diagnosis, there are great possibilities to treat their issues. What once was thought of as only a medicinal treatment, has now become a multifaceted approach. Treatment is no longer just a pill before school, since proper treatment now includes behavioral interventions, psychologic treatment, play-therapy, and group sessions. All members of the family can be involved in the care of the child, and each member can interact with the child in various predetermined activities in order to reap the greatest rewards from social interaction and the strengths of each family member.
Medicinal Treatment
Of course the general community at large first thinks of the medications that have been on the market for many years as the primary treatment for this constellation of disorders. Most children are treated with a stimulant type of medication, and approximately 75% of children will respond well with a decrease in unwanted behaviors. However, these drugs have been fraught with diversion, abuse by family members and some side effects including weight loss, insomnia and a shortened growth spurt. Children with ADHD do not have a stimulant effect from these drugs, but rather are able to concentrate, pay attention, and reduce hyperactivity. Every drug has a different effect on each patient and the doctor may need to try different agents to find the best outcome. There are also medications that are non-stimulants, and these are typically used by psychiatrists most frequently as a primary or adjunctive therapy. However, medicinal treatment by itself is not as effective, and hence parents should be urged to schedule their child for behavioral therapy.
Behavioral Therapy
Recent research has shown that behavioral therapy is not only important, but critical for younger children of preschool age (4-5 years), and in fact, has been proven to be the most effective primary treatment. There are multiple programs that have been developed over the years, and a few in specific are being employed in many countries. One program is called the “Triple-P” Program, and its purpose is to use many different tools to empower parents to shape their child’s behavior and abilities. It has proven benefits for children of any age. Another program is the “Incredible Years Parenting Program” which is designed to train the parent and teacher to work with the child toward both short term and long term goals. These programs are all a product of over 30 years of research.
Another program which relies on behavioral therapy is called the “Parent-Child Interactive Therapy” program. This program is geared to utilize constant training and updated education to keep the parent-child relationship and interaction healthy. This program requires continual training of counselors and therapists so that they may utilize the latest research and proven activities with parents and children. Finally, a newer program entitled the “New Forest Parenting Program” is an 8 week long intervention of a psychologic nature. It is designed to be an intensive course of training preschoolers to be more self-controlling of their behaviors, and simultaneously bolster the mother-child relationship in positive fashion.
Effective and Interactive Activity
Children of any age with a diagnosis of ADHD in any form are a challenge to interact with. Their world has barriers that must be broken down systematically, in order for the participating adults to be able to reach them. These barriers are often referred to as “skill deficits.” To overcome the absence of these skills, the child must be approached carefully and thoughtfully. The average ADHD child is resistant to learning, as he can have difficulty relaxing and calming down enough so that he is able to participate. Once a child in engaged, his concentration may wane, his thoughts wander, and he may not be able to express his feelings and frustrations, which often leads to an unproductive session. To improve the child’s responsiveness, He will need to feel safe, to be able to relax, and to let his true feelings come forth. It is play therapy that makes these goals achievable.
Open-Ended Play
Any activity with a child with ADHD can become a successful learning experience. In order to enable the child to express themselves freely, he must not fear scrutiny or answering a response incorrectly. Every response is correct and built upon to help the child come to a realization that he has been responsive, and that in itself is a reward. Positive statements affirm the child’s ability to process in the moment and continue to participate. This type of play allows a child to get a better understanding of social cues and nonverbal communication. The key is to simply keep the child engaged, and continue to play. Even in the most difficult ADHD child, open-ended play allows exploration of his imagination, and without rules or expectations, the child learns how to share without withdrawing.
The Tools of Play Therapy
Play therapy, in its most basic form, is a child and an adult using some type of simple objects, and allowing the child to play, unrestricted. This enables the child to create, and imagine, learning that his own thoughts are correct and hence the child can build a wealth of confidence. A skilled or trained parent simply echoes the child’s instincts, encouraging the imaginary concepts which overall helps the child develop abstract and lateral thinking skills. The basic tenet of play therapy, is to use objects or toys that are naturally enjoyable to the one specific child. Every child will not pick up the same objects, but once their safety is established, they will pick up a toy, and so the play begins. Many different tools have been made for this purpose, and although a child may make due with blocks and paper shapes, other tools have a plethora of options open to a child, and unlock the doors to his imagination. Such a toy is made by Spielgaben and it is designed to have limitless play possibilities. In each drawer are various shapes, pieces, and objects that can be used in thousands of ways. Each unit comes with instructional learning resources for all of the play possibilities and skill teaching, but once the imagination begins to lay seed, anything is possible. This toy is often utilized by play therapists, but for the home of a child with ADHD, this type of equipment becomes an investment in that child’s future progress.
The main goal of play therapy is to grab the child’s attention and interact, and a toy as simple as LEGO building blocks can work wonders. They are inexpensive, and readily available. There are also tools that are a bit more technologic, and therefore the child immediately shows interest. One example is the Musical Touch Wall available at Fun and Function. This toy, although a distinct investment, can be used by any adult wishing to engage and interact with a child. This toy plays music and displays a colorful light show completely dependent on the child’s imagination.
Notes to Live By
As noted, ADHD disorders are exceptionally manageable with proper education of the adults in that child’s life, training of the teachers in the local school system, and appropriate therapy and medical treatment as needed. The use of play therapy has become more prevalent, and now parents are commonly able to utilize this skill with their child, and have the child look forward to that activity as fun time with the parent. The family that optimizes these activities will adjust in a much more healthy fashion, and be able to utilize these therapeutic skills and build upon them over the years. Investing in proper equipment can heighten your child’s interest, and ease the ability for all members of the family and school community to effectively communicate with him for years to come.
