Attention Deficit Hyperactivity Disorder Best Resouces
Attention Deficit/Hyperactivity Disorder, or ADHD, is a disorder of self-control. It includes difficulties in impulse control, attention, concentration, and activity level. These problems derive from the child’s inability to control his behavior according to the passage of time, the objectives to be achieved and the demands of the environment. It is imperative to point out that ADHD is not a normal phase of growth that every child must overcome, nor is it the result of an unproductive educational style, nor is it a problem due to the child’s “malevolence”.
ADHD poses problems not only for the individual but also for the family and school and often causes hindrance in achieving personal goals. It is a problem that generates distress and stress in parents and teachers who are not prepared for managing the child’s behavior.
Parents are used to seeing how other people react to the behavior of their hyperactive child. In the beginning, strangers tend to ignore restless behavior, frequent interruptions during adult speeches and violation of common social rules. Faced with repeated manifestations of the absence of behavioral control of the child, these people try to put themselves to restrain the excessive enthusiasm, failing that, they conclude that the child is intentionally rude and destructive. Perhaps parents are also accustomed to the conclusions to which outsiders come, such as The child’s problems are due to the way he was educated. If more discipline, limitations and even some fine punishment are added, their behaviors can be modified. His parents are careless, incapable, excessively tolerant and permissive, and that child is the result of their inefficiency.
Symptoms related to inattentiveness are found in children who, compared to their peers, have evident difficulty in being careful or working on the same task for a sufficiently prolonged period of time. Several consultants argue that the main deficit of the syndrome is represented by the difficulties of attention, which occur both in school/work situations and in social situations. Since the attention construct is multidimensional (selective, maintained, focused, divided), the latest research seems to agree that the most evident problem in ADHD is the maintenance of attention, especially during repetitive or boring activities. These difficulties are also manifested in playful situations in which the child manifests frequent shifts from one game to another, without completing any. At school, there are obvious difficulties in paying attention to details, and the works are incomplete and disordered. Teachers and parents report that children with ADHD seem to not listen or have their minds elsewhere when they are being spoken to directly. Passing close to the desk of a hyperactive child you can be struck by the disorder with which it handles the school material and the ease with which it is distracted by sounds or other irrelevant stimuli.
The second feature of ADHD is hyperactivity, which is an excessive level of motor or vocal activity. The hyperactive child shows continuous agitation, difficulty in remaining seated and stationary in its place. According to the reports of parents and teachers, children with ADHD seem to be always on the move both at school and at home, during homework and play. Very often the movements of all the parts of the body (legs, arms, and trunk) are not harmoniously directed towards achieving a goal.
According to some practitioners, impulsivity is the hallmark of ADHD. Impulsivity manifests itself in the difficulty of delaying a response, inhibiting inappropriate behavior, waiting for gratification. Impulsive children respond too quickly (to the detriment of the accuracy of their answers), frequently interrupt others when they are talking, they cannot stand in line and wait for their turn. In addition to persistent impatience, impulsivity also manifests itself in engaging in dangerous actions without considering the possible negative consequences. Impulsivity is a feature that remains fairly stable during development and is also present in adults with ADHD.
The people with ADHD also exhibit other disturbing behaviors due to the interaction between the pathognomonic characteristics of the disorder and their environment.
Aggressive Behaviors: The development of oppositional and provocative traits is a very problematic aspect of the ADHD. In most cases, aggressive behaviors do not reach such severity that they require a diagnosis of Conduct Disorder or Oppositional Defiant Disorder.
Cognitive Deficits: Children with ADHD have lower education benefits than their peers, despite having the same intellectual abilities because of impulsiveness, hyperactive behavior, difficulties of attention and cognitive self-regulation within the classroom. The proportion of children with ADHD who have repeated at least one class is three times that of the rest of the school population.
Emotional Disorders: The 25% of cases with ADHD also have comorbidity with anxiety disorders. Another 25% of children with ADHD receive a second diagnosis of Mood Disorder.
Development of ADHD
The mean age of onset of Attention-Deficit/Hyperactivity Disorder ranges from 3 to 4 years. However, there are numerous cases presenting the symptoms of ADHD towards 6-7 years. The manifestation of the disorder can vary according to the quality of relationships with and between family members, the acceptance of the child in the school context, the general cognitive profile (and intellectual in particular), and the presence of other disorders which, can complicate the pathological picture.
ADHD and Infants: Parents often report that children with ADHD are difficult from birth: very irritable, prone to inconsolable crying, easily frustrated, with difficulty sleeping and feeding. Furthermore, these children are less sensitive to rewards and are also more difficult to educate, as they give unpredictable responses to the educational techniques usually used for behavioral control. As a consequence, the impulsivity and the low tolerance to the frustration of the child can generate negative effects on the interaction with the mother, triggering a vicious circle that leads to an accentuation of the symptoms.
ADHD and Children: During the elementary school years, the child with ADHD is very active and, although he has intelligence equal to that of his peers, shows a behavior not very mature with respect to the chronological age. In situations of play, in which there is ample opportunity for movement, he does not show particular difficulties, while in contexts in which the respect of certain rules is required, the child is labeled as “problematic and difficult to manage”. With an entry into the elementary school, the difficulties increase precisely because of the presence of a set of rules that must be respected and of tasks that must be performed. Both parents and teachers remain a little disconcerted by the enormous variability of their attentive performances. In the classroom, they can follow the lesson for usually only five minutes, while they successfully complete a video game that lasts even half an hour. Also, interpersonal problems, often already present during pre-school age, persist and tend to increase in severity; this is probably because the positive interactions with the companions require, with the progress of age, ever greater social skills, communication, and self-control.
ADHD and Preadolescents: With age, hyperactivity tends to decrease in terms of frequency and intensity and can be partially replaced by “internalized agitation” which manifests itself mainly with impatience, and continuous changes in activity or body movements. Moreover, with the development, they can generate behavioral traits that further hinder the placement of the child in his social environment.
ADHD and Adolescents/Adults: During adolescence, a slight reduction of the symptoms is observed on average, but this does not mean that the problem is solved, since often other mental disorders are also found, such as depression, antisocial behavior or anxiety. In this age, the problems of identity, of acceptance in the group and of physical development, are problems that do not always manage to be effectively dealt with by a young person with ADHD. The inevitable failures can lead to self-esteem problems, poor self-confidence, or even clinically significant anxiety or depression.
Risk Factors of ADHD
As with other psychological problems, the reason of ADHD is not known. The main factors which are attributed to the cause of ADHD are:
- Genetics: ADHD usually runs in family. A family history of Intellectual Disability also increases the chances of ADHD.
- Neurotransmitters: People with ADHD may have an imbalance in certain neurotransmitters (chemicals) of the brain.
- Brain Changes: Some researches have shown that children with ADHD have a lower level of brain activity. Some other brain imaging studies have shown that some areas of the brain are in the smaller size as compared to brain areas of children without ADHD.
- Complications during Pregnancy: Poor nutrition, infections, smoking, drinking, and substance abuse during pregnancy, premature birth, and small head size can affect a fetus brain development.
- Environmental Factors: Toxins, such as lead may affect a child’s brain development.
- Television: Researchers have found that watching excessive television and screen time can lower the attention span, thus increasing the risk of ADHD.
- Psychosocial Factors: Conflicting home environment, parental abuse, poor living conditions are also the major risk factor of ADHD.
- Significant Head Injury: A brain injury or a brain disorder, damage to the front of the brain, called the frontal lobe, can cause problems with controlling impulses and emotions.
Intervention of ADHD
According to the scientific literature, the ideal treatment for ADHD is multimodal, that is, a treatment that involves school involvement, family and child himself, as well to a pharmacological intervention.
Behavioral Techniques: The behavioral approach is characterized by a detailed assessment of the problematic responses and the environmental conditions that elicit and maintain them, strategies to produce a change in the surrounding environment and therefore in the behavior of the parents. These techniques work best when clinicians, parents, and school simultaneously use them, focusing on a range of behaviors.
Parent Training: Parent training has been suggested as a way to improve the functioning of children with ADHD by teaching parents to recognize the importance of relationships with their peers, to teach, in a natural way and when needed, to take an active role in the organization of the child’s social life, and to facilitate the agreement between adults in the environment in which the child is living (teachers and other educators). Parents are taught to give clear instructions, to positively reinforce acceptable behaviors, to ignore some problematic behaviors, and to use punishments effectively.
Social Skills: This type of intervention is included in multimodal treatment. Clinical experience suggests that individual treatment is not always advantageous, this is due to the lack of self-observation present in patients with ADHD. When treatment is conducted in groups, the set of problematic behaviors emerges naturally and can be modified through modeling, practice, feedback, and reinforcements. The use of environments such as schools, rather than clinics or private practice, can increase generalizability.
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