In clinical practice, the child that presents with either A.D.D or A.D.H.D is usually a stand out.
The terminology can be confusing. A.D.D is Attention Deficit Disorder.
A.D.H.D is Attentional Deficit Hyperactivity Disorder.
It thought that there are 3 forms that this disorder takes
1. Attention Deficit Hyperactivity Disorder: Primarily Inattentive Type: Children that present with this disorder are generally inattentive and distractible. These children are often diagnosed as having A.D.D.
2. Attention Deficit Hyperactivity Disorder: Primarily Hyperactivity/Impulsive Type.
This child tends to be overactive and impulsive.
3. Attention Deficit Disorder: Combined Type.
This child is inattentive and distractible, as well as being hyperactive and impulsive.
These children are also referred to as A.D.H.D.
The following behaviours and observations are made with these children.
• Does not seem to listen when spoken to directly
• Difficulties sustaining attention
• Is easily distracted by environmental stimuli
• Problems in organising tasks and sequential goal orientated activity
• Generally forgetful in daily activity
• Lack of attention to detail when attempting homework
• Losing things that are necessary for task completion
• Tends to not follow through on specific tasks, schoolwork and chores
• Dislikes and is reluctant to exert sustained mental effort
This disorder generally becomes apparent at the age of 4-5 years of age when the child’s cognitive ability and functional activities demonstrate a lack of independence. For a clinical diagnosis these symptoms must be present for at least 6 months and be evident in more than one setting. The symptoms are generally observed at home or at school but are also evident when attentional skills are required e.g. sporting activities, music lessons or whilst involved in a home project. Any situation that requires sustained attention and organisational skills, will be a challenge for the child with A.D.D
A.D.H.D is the hyperactive/ impulsive type of A.D.H.D.
These children present with an array of the following symptoms:
• Always active, can`t sit still, always squirming in the chair
• Is constantly on the go, as if driven by a motor
• Jumps up, runs or climbs when it is inappropriate to do so.
• Has difficulty waiting for their turn
• Has difficulty playing quietly
• Interrupts or intrudes on others when inappropriate to do so
• Seems to talk excessively
• Yells out answers before the question is complete or out of turn
These behaviours are usually present at the age of 3-4 as a toddler. These children are easily visible to others as behaving differently from other children of the same age.
Parents describe these children as being high maintenance. These children find it difficult to sit down, be quiet and wait their turn. They are the children that are most likely to run around the classroom, run away from parents, jump up and down in restaurants and shops, not listen to their teachers, grab toys and act impulsively without awareness or having little regard of consequence.
Parents report at home, there are constant battles over every minor request. Wherever they are, they talk too much, too often and too loudly. In kindergarten they run around constantly, do not listen to teachers, grab toys impulsively and disturb other students. On the playground they will grab the ball, disrupt games and shove their way to the front with little regard for rules. Of an evening, they have difficulties settling down and playing quietly.
Ironically, if they cope well with computer games they can sit peacefully for long periods of time. These children eventually frustrate their parents, siblings, teachers and coaches. They are frequently rejected by their peers, especially as they get older, causing significant emotional/social and self esteem problems.
Validity of Diagnosis
It is true that most children can exhibit some of these behaviours, at some time throughout their day. Children that are observed with some of these behaviours may be at risk of early labelling.
A diagnosis however, is usually based on a definition of symptoms being excessive and sustained. There is also the question of the symptoms being maladaptive, that is, the symptoms are causing significant impairment in the child’s functioning.
A.D.H.D is predominantly a male disorder with between 4-5 times the numbers diagnosed when compared to girls. A.D.D however have equal representations.
AD/HD can be treated with an array of interventions. The most effective being that of a multimodal treatment plan.
Behaviour Modification is used to control the majority of the symptoms in both the home and school environment. Behaviour modification is the systematic use of rules/limits, rewards, consequences and privileges based upon the child’s compliance. This is the most effective tool in managing the child’s behaviour. The use of a meaningful, consistent and well structured behaviour modification program creates a highly structured environment to operate within where the expectations of behaviour are very clear.
Each reward or consequence is spelled out in advance so that the child is fully aware of what will happen if they engage in certain undesirable behaviours.
Social Skills Training is useful to assist the child gain self awareness and learn new skills to increase their ability to make and keep new friends. The use of The Buddy Program within the school environment can assist greatly. Please refer to the accompanying piece on Social Skills Training on our website.
Teaching Strategies should be employed to assist the distractible child in the classroom. Seating the child up front of class where the visual distraction of the other students is behind them. The teacher may use more visually rich teaching aids to assist. Teacher involvement is essential. They may be able to offer the information in smaller sound bites/information bites and then ask the student to repeat what they have heard, to reinforce the message/information. Special education teaching or tutoring may be required in the more severe of presentations. A managed child should have all the positive experiences as other children.
Medication can be used to decrease inattention, hyperactivity and impulsivity. Like all medications, they should be controlled and balanced carefully by an experienced Paediatrician. Treatment will reduce and manage the symptoms, however behaviour modification should be the first line of treatment.
There is no magic cure for the AD/HD disorder and the treatment tends to be long term.
Parents should gather and then stick with a team of professionals they trust and can develop a relationship with. The Speech Pathologist can assess language delay, learning disorders and attentional deficits associated with the AD/HD child. They can also counsel as to behaviour management and differential diagnosis between this and associated developmental disorders.
Mr Craig Gorman
Melbourne Speech Clinics