A GUIDE TO ATTENTION DEFICIT HYPERACTIVITY DISORDER

Todd Cartmell, Psy.D.

Attention Deficit Hyperactivity Disorder (ADHD) is the name of one of the most common disorders experienced by children today. Approximately half of all the referrals for child mental health services are made for ADHD youngsters. While the exact cause of ADHD is not currently known, leading research indicates that neurological and genetic factors play major role in its development. If you think your child may have ADHD, you need to become very familiar with the "ADHD basics".

What does ADHD look like?

Children with ADHD have significant problems in one or more of three basic areas: inattention, impulsivity, and hyperactivity. These difficulties show up in a variety of settings, most notably at school and home. While playing outdoor or video games, children with ADHD are often difficult to distinguish from non-ADHD children. However, when engaged in a more "boring" activity, such as doing homework, ADHD children are much more easy to recognize. Here are some common ADHD behaviors:

• Makes careless mistakes in schoolwork
• Has difficulty organizing tasks and activities
• Is easily distracted by things going on around him/her
• Often forgets things
• Frequently fidgets and has difficulty remaining seated
• Blurts out answers before questions are completed
• Has difficulty playing quietly
• Often interrupts others

While all children may exhibit these behaviors on occasion, ADHD children display them more frequently and more severely than expected for their developmental age. In addition, ADHD children often have difficulty following rules, even everyday ones. Even though they may know the rules, they find it difficult to consistently follow them. These children may also display inconsistent behavior when it comes to schoolwork and doing chores. Both grades and behavior may fluctuate in an unpredictable manner.

What other problems do ADHD children and families experience?

As you may imagine, ADHD children are often in trouble at home or school. Their disruptive behavior can strain relationships with parents, teachers, and peers. Parents and teachers may view the ADHD child's behavior as intentional and label the child as a "troublemaker" or "disobedient". Teachers often become exasperated as typical classroom management techniques yield little success. Academic work is often rushed and messy, with little attention given to instructions. As such, grades are often "up and down' for the ADHD child. Many times, teachers must repeat directions to ADHD children and often have to redirect them back to their work. Parents of ADHD children may question their own parenting skills or blame themselves for their child's behavior. They will keenly feel the frustration of the constant conflict and struggle that often exists in families with ADHD children.

Socially, ADHD children often act in ways that alienate them from their peers. Their difficulty inhibiting impulses and controlling their behavior can often cause them to be viewed as "annoying" by other children. Some ADHD children also exhibit problems with verbal and physical aggression, which can also lead to problems establishing healthy peer relationships.

As ADHD children can often experience negative interactions with both adults and other children, low self-esteem is another area of concern. Feelings of sadness, being "left-out", and frustration are all too common in ADHD children. As such, they are at a greater-than-normal risk for problems with depression, oppositional behavior, aggression, and academic difficulties.

How is ADHD diagnosed?

ADHD is diagnosed by identifying the presence of specific "ADHD behaviors" at a significant level of severity. Some signs of these behaviors must have been present before the age of seven and must result in notable impairment for the child. Because of the types of problems that ADHD children can experience, early diagnosis and treatment is extremely important.

Evaluating a child for ADHD is a complex process and will involve the child's physician and/or a mental health professional. Information must be gathered from several sources in order to get a complete picture of the child's behavior. A typical evaluation will involve a thorough interview with the parents, a brief interview with the child, and the gathering of observations from parents and school personnel on behavioral rating scales in order to compare the child's behavior with that of same-aged peers. A physical examination should also be completed to rule out possible medical conditions. The child may be observed in the classroom setting and a Continuous Performance Test may also be used to help identify problems with inattention and impulsivity. Other psychological testing may be necessary to evaluate for conditions that may play a role in the observed behaviors, such as learning disabilities, giftedness, or emotional disorders.

What is the treatment for ADHD?

ADHD is not a disorder for which there is a "cure". For some children, ADHD symptoms lessen in severity as they enter adolescence. The majority of ADHD children will carry notable ADHD behaviors with them into adolescence and adulthood. As such, treatment for ADHD focuses on helping the child to learn to function more successfully at home, school, and with their peers. To date, research has found that the most effective treatments in reducing the problems associated with ADHD include environmental/behavioral interventions and the use of stimulant medication. Common treatment approaches may include any or all of the following:

• Education for parents regarding ADHD and training in effective behavior management techniques.
• School-based behavioral interventions focused on improving academic performance and classroom behavior.
• Medication for the child, especially on school days, which improves attention, reduces excessive activity, and helps with task completion.
• Family therapy to help repair relationships and devise strategies for solving problems.
• Short-term therapy for the child to improve social skills, anger-management skills, organizational skills, and self-esteem.

Early identification and treatment for ADHD can be a key factor in facilitating positive relationships and experiences for the ADHD child. If you suspect that your child may have ADHD, consult with your child's physician or a mental health professional.

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"YOU MEAN THEY TALK?"
The Do's and Don'ts of Talking To A Teen

Todd Cartmell, Psy.D.

Talking with a teenager? Sounds almost like a contradiction. Believe it or not, however, most teenagers actually can talk. In fact, they do it quite well with their friends. The challenge is, of course, to get some of this same verbosity to take place after the friends leave and it's just you and your teen. Here's an example of a conversation that you may have heard before: "Hi, honey." "Hmmm." "How was school?" "Hmmm." "Do you have any homework?" "Hmmm." Sound appealing? If not, here are some "Do's and Don'ts" that will help get things going in the right direction with your teen.

DON'TS

1. Don't nag. Nagging has got to be one of the most useless parent tricks in the book. It accomplishes nothing and trains your teen to tune you out.
   
2. Don't "grill" your teen. "20 questions" may help in police work, but it can drain the life out of a conversation with your teen.
3. Don't lecture. Think of how exciting it would be to listen to a lecture on the nature of the biochemical properties of a piece of wood. Multiply this by two and you get a picture of how effective most parent lectures are.

DO'S

1. Pay attention. When your teen says something to you - anything - treat that information as if it was worth a million bucks. Stop whatever you are doing, look at your teen, and respond. This communicates that what your teen has to say is important to you. Remember, even teenagers like to feel important.
2. Talk about enjoyable things. If discussing homework or personal grooming habits is getting you nowhere, then try talking about basketball, clothes, or a recent movie. In fact, you could even do something enjoyable with your teen and limit yourself to only pleasant conversation topics. Remember, you have to be able to talk about the easy stuff before you can talk about the hard stuff.
3. Make an appointment. When you have something important to talk about, don't hit your teen over the head with it out of the blue. Instead, calmly and respectfully (teens like respect), tell your teen that there are a couple things that you would like to talk about together. Set a time and place. If you really want to knock your teen dead, take him or her out for a coke or a hamburger while you talk.
4. Listen. Too often, this is the fatal flaw for most parents. They forget to listen. How can you expect your teen to talk to you if you don't listen? Hold on to your opinions, interruptions, facial grimaces, and groans, and let your teen talk! Try to understand how your teen feels and why he or she feels that way. If you don't, your teen won't listen to you either. If you do, you will better understand where your teen is coming from and your teen will be more likely to actually listen to your point of view. Who knows, you might even find yourselves talking on a regular basis!

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