Attention Deficit Disorder (ADD also ADHD)

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The text for this topic is copyright Parenting SA, Government of South Australia.

Most parents are concerned about their child’s behaviour at some time during childhood. However, for some parents their child seems to be out of control, unpredictable and very difficult to manage. The behaviour may be causing problems with school work and with making friends.

There are many reasons why children’s behaviour might change, get worse or stay very difficult. All parents would like to understand their child’s difficult behaviour so that help can be found for both their child and the family as a whole. Our community is now more aware that some children, who in the past may have been called ‘naughty’, may have Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD).

ADD, or ADHD, is not the reason for every type of difficult behaviour in children. It is important to have a proper assessment, so that the right kind of help can be given to your child.

What is ADD?

Does my child have it?

There are many different ways of describing ADD, and often the names ADD and ADHD are used to mean the same thing. Most experts now view ADD and ADHD as part of a group of behaviour problems where children have difficulty with concentrating on what they are doing (problems with attention).

Your school age child may have ADD if he or she is having difficulties both at school and at home and has had at least six of the listed behaviours in either of the following groups.

Remember that for preschool children these behaviours are part of normal everyday life. Some of these behaviours can also apply to children who have social or learning problems, or children who are distressed or unhappy for other reasons. This is why a proper assessment is so important.

Inattention

Your child often:

• misses details or makes careless mistakes in schoolwork or other activities
• has trouble organising tasks and activities
• loses things needed for tasks or activities, for example, toys, school assignments, pencils
• has trouble sticking to tasks or play activities
• does not seem to listen when spoken to directly
• doesn’t follow through instructions that he is able to understand and does not finish tasks, for example, at school or chores at home
• tries to get out of doing things that require a lot of thinking and concentrating
• is easily distracted
• is forgetful in daily activities.

Hyperactivity/impulsivity

Your child often:

• fidgets with hands or feet, or squirms in his seat
• leaves his seat in the classroom when he should be seated
• runs about or climbs excessively (more than most other children)
• has trouble playing quietly
• is continually ‘on the go’, talks ‘all the time’
• blurts out answers before the questions have been completed
• has difficulty awaiting his turn
• butts into conversations or games

And

• his behaviour pattern is different from most other children of about the same age
• the behaviours happen in more than one place, for example at home and school
• the behaviour has lasted for more than six months
• the behaviour pattern started before age seven years
• your child does not have other major health or development problems
• the behaviour is causing your child problems at home, with school work, friends and daily living.

The last thing listed here is most important—the behaviour pattern must be interfering with your child’s ability to get on with his life, to learn or
fit in with his world.

(Adapted from the Diagnostic and Statistical Manual, DSM-IV).

What causes ADD?

Despite at least 30 years of research worldwide there is no clear explanation for why ADD happens in some children. More recent theories suggest that there is a problem with how the front part of the brain works. This causes the child’s brain to deal with information and feelings in a different way from other children.

Research has found that family inheritance and food are only part of the explanation of ADD, and only for some children. However, because medical experts don’t have a clear explanation for ADD this doesn’t mean that it does not exist—we simply have to wait for some of the answers.

Careful assessment

A thorough and proper assessment is critical. As adults, if we are feeling off-colour or have emotional hassles we would want the best possible advice. Even if our car has broken down, we would like to have the situation very carefully looked into. If we don’t take the same time and care when looking into children’s behaviour difficulties then we are selling them short.

‘Quick-fix’ management of behaviour difficulties in children, runs the risk of over-looking very important aspects of the child’s needs, and of using the wrong treatment for the problem. Insist on a thorough assessment for your child if you are worried about ADD before you try any remedies.

The assessment should include:

• assessment of your child including a history of his development, behaviour and school progress, including what is happening now
• psychology assessments to work out how he manages different tasks including learning
• thinking about what is happening for the child at home and how your discipline works for him
• assessment of the child’s school and friendships
• a family assessment—recent research suggests that ADD runs in families, so thinking about other people in the family is important
• checking to see if there are other reasons to explain your child’s behaviour
• checking to see that he can see clearly and has normal hearing.

Assessment should involve parents, teachers, psychologists, doctors and possibly others depending on your child’s needs. Brain scans and EEGs (electro-encephalograms or brain wave tracings) are not helpful in working out whether a child has ADD, but they are useful for some other problems, which might have to be checked. It is also important that other problems which often come with ADD, such as specific learning problems and difficulties with movements (coordination) are fully checked and a plan is made to help your child manage them.

Preschool aged children do many of the things that would be called ADD if they were older—yet ADD does sometimes happen in this age group—extra care is needed in assessing young children’s behaviour.

What parents can do

If children do not have treatment, they may get better at controlling their own behaviour as they get older, but they may have had many difficult years at school.

The best help for a child with ADD starts with a careful and thorough assessment. Often a wide range of ideas are needed to help your child manage. This can include classroom management, behaviour management plans, specific educational ideas, family counselling and medical management. Often medical treatment, such as the use of medicines for ADD, is useful but should not be the only thing that is tried.

For your child to get the best help it is important that everyone who is working with her talks with each other, works together and explains clearly what is happening so that she understands.

Whatever actions are decided on, it is important that everyone knows who is doing what and what to expect from them. For example if your child is having school work problems, one action may be to have her sit in the classroom where there are less distractions—and the aim of this would be to help her with her school work.

The use of medicine for ADD needs ongoing close supervision by a doctor, to make sure your child is getting the right dose, and to check for any possible side-effects. Drug treatment may be needed for long periods—it is therefore important to make sure the medicine works as well as possible and does as little harm as possible.

Things to try

The following are some practical suggestions, some or all of which may help your child.

• Have clear and consistent routines at home and school.
• Look for things at home and school that may be stressing your child. Children with ADD are often more upset when things go wrong than other children. For example if they are being bullied at school or there are family problems at home, they will find it really hard to behave well.
• Try to avoid things which will be very difficult for your child until he is more able to manage them, for example, staying calm at birthday parties will be very hard to do, and staying calm in supermarkets is almost impossible.
• Make sure that your child is not tired or hungry when he needs to behave well, for example, have food in the car if you need to drive far after school.
• Allow time to get rid of some energy before having to settle down, for example, allow him to play on the equipment after school before he has to sit still in the car.
• Try to ignore irritating behaviour that is really not important so that he is not being told off or in trouble all the time.
• Don’t give too many choices. Say ‘Would you like to do this or that?’ rather than ‘What would you like to do?’
• Have fun and relaxing things that your child likes to do for when things get stressful.

At school

• Ask for your child to sit at the front of the class at school so that if her attention wanders the teacher can remind her of the task.
• Use work areas that do not have any distractions for schoolwork and homework. Find your child a quiet spot to work and remove any clutter.
• Make sure you have eye contact with her before you tell her what you want.
• Keep instructions short and clear. One instruction at a time. (Many children cannot remember what they have been told, so as well as using words, write it on a piece of paper so your child can read it when she forgets.)
• A note book to go from school to home and back can help to make sure that everyone is clear about what is expected and what your child is doing. Make sure it doesn’t become a ‘bad news’ book about her behaviour.
• When you want your child to change an activity, let your child know that you are going to ask her to do something different and that she needs to listen carefully.
• Break up tasks into small bits that your child can manage and go on to the next bit only when she has finished the first. For example, get your child to put away one activity before telling her to get out the things needed for the next activity. When she has done that, tell her where she needs to move to. Get her to say what she is doing to herself as she does it. You can gradually give more directions and longer tasks as she learns to manage better.w
• wGive children rewards and/or praise when they are able to concentrate on what they are doing and finish a task.

Self-esteem

Children and young people with ADD can find it difficult to feel good about themselves. Many things that others take for granted are hard for them. Sometimes they feel they are different which can make them unhappy and lonely. Often, too, everyone concentrates on what they do wrong or all the things they need help with, rather than what they can do well. This makes them feel bad and they end up misbehaving more.

• Here are some things you can do to help your child appreciate all the good things about herself.
• Encourage your child to do the things she enjoys and does well, take an interest and show you are proud of her.
• Set goals and tasks in small steps so that she can succeed. Gradually make them more difficult so she has lots of chances to succeed.
• Try to ignore irritating behaviour so that she is not being told off all the time.
• Let her know you are proud of what she can do—tell her or leave her little notes when you see she does something well.
• Let her know that what she does to help in the home really makes a difference.
• Give lots of support and reassurance.
• Spend time having fun with her and just love her.

Making friends

Children with ADD sometimes find it difficult to play well with others and make friends. They find it difficult to take turns and to wait and may need your help to learn how to do this.

• Start your child in a small group with no more than one or two other children.
• Teach your child about how to join a group and start a conversation. He needs to understand that to join a group you have to move close to the people and listen to what they are talking about first, before you say anything. You may have to practice with your child exactly what to say.
• Arrange some structured activity for when friends first come over.
• Teach your child about what friends do, for example, how to share, wait for a turn, not push in and then give lots of encouragement when he gets it right.
• Have little practices at home if there are some things he is struggling with. For example, if he has trouble with interrupting, have a conversation and let him practise waiting for a break before he interrupts.
• Teach your child some ways to cope with teasing, for example, pretend not to hear, walk away, tell a teacher.

Look after yourself

• Don’t get discouraged. Every parent finds living with a child with ADD very tiring and demanding. You will need to say things ‘a hundred times’ and still find your child has trouble remembering.
• Some parents find that sharing their problems with other parents who are also having difficulties with behaviour can be helpful. Check with Canberra Queanbeyan Attention Deficit Disorder Group about support groups or with your local Community Health Centre.
• Find the best way for you to relax and try to make sure you take time for yourself each week.

Reminders

Want more information?

Lifeline  13 11 14 www.lifeline.org.au

ACT Govt Publication No 07/0849 July 2007