I was asked to write an article on ADHD to coincide with the National ADHD Awareness Week which falls on the third week of October every year (Proclamation No. 472). I reluctantly agreed as I had a full weekend ahead of me. However, as I sat down to organize my thoughts, I realized there were too many things to discuss and contain in a 1000 word article. This will be the first in a series of discussions on the matter.
ADHD is the most common neurobehavioral condition in childhood. The Diagnostic and Statistical Manual of Mental Disorders — 5th edition (DSM-5) defines ADHD as 1) a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, 2) has symptoms presenting in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities), and 3) negatively impacts directly on social, academic or occupational functioning. Several symptoms must have been present before age 12 years.
ADHD is a behavioral disorder that most often occurs in children.
Individuals with ADHD may present symptoms according to 3 types.
1) Hyperactive/Impulsive
– diagnosed if 6+ symptoms of Hyp/Imp are present for 6+ months
2) Inattentive — diagnosed if 6+ symptoms of Ina are present for 6+ months
3) Combined — diagnosed if 6+ symptoms of Hyp/Imp and 6+ symptoms of Ina are present for 6+ months
3 TYPES of ADHD
-Hyperactive/Impulsive
-Inattentive
-Combined
Children who have symptoms of hyperactivity may:
*Often fidgets with hands or feet and squirms in seat
*Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents and adults may be limited to feelings of restlessness)
*Is often “on the go” or often acts as if “driven by a motor”
*Often has difficulty playing or engaging in leisure activities quietly
*Often talks excessively
*Often leaves seat in classroom or story-time, during dinner or in other situations in which remaining seated is expected
Children who have symptoms of impulsivity may:
*Be very impatient
*Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
*Have difficulty waiting for things they want or waiting their turns in games
*Often interrupt conversations or others’ activities.
Children who have symptoms of inattention may:
*Be easily distracted, miss details, forget things, and frequently switch from one activity to another
*Have difficulty focusing on one thing
*Become bored with a task after only a few minutes, unless they are doing something enjoyable
*Have difficulty focusing attention on organizing and completing a task or learning something new
*Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
*Not seem to listen when spoken to
*Daydream, become easily confused, and move slowly
*Have difficulty processing information as quickly and accurately as others
*Struggle to follow instructions
Some common signs of ADHD are: inability to keep still, inability to focus on one thing or finish a task, inability to wait for a turn or to control emotions, overly bold or fearlessness, aggressive behavior when playing.
No single test can diagnose a child as having ADHD. Evaluation at different levels of assessment should take place prior to formal diagnosis. It is therefore important for parents, teachers, caregivers and other adults who know the child well to gather and provide pertinent information to a referring pediatrician who will be working with a specialist like a neuro-developmental pediatrician/psychologist, or a psychiatrist who have training and expertise in diagnosing ADHD. The assessment of ADHD should include
*Clinical examination
*Clinical interviews with patient, parents, and teachers
*Assessment tools and rating scales
Identification of patient and family needs
There are a range of options in the treatment of ADHD which fall under 2 categories: Pharmacological or Non-Pharmacological. In layman’s terms, we can probably state it as medicated or non-medicated options. It is usually recommended that the first line of treatment is non-pharmacological. This treatment includes Behavioral Therapy or Psychoeducation. Depending on the severity of the symptoms, Pharmacological Treatment is initiated when remedial measures are not sufficient.
There are 2 types of pharmacological treatment or medication: stimulants and non- stimulants. These are best discussed with your doctor as ADHD medications have side-effects. When these occur, dosage reduction or discontinuance may be ordered by the doctor. Common side effects are insomnia, nervousness, headache, decreased appetite, dry mouth, weight loss, abdominal pain, nausea, or vomiting.
ADHD may be treated through behavioral therapy/psycho-education, medication or a combination of both.
ADHD affects people of different ages, gender and IQ. You may not have a child, or a child showing symptoms of ADHD; but ADHD affects adults too. You may think a co-worker or a friend is rude, lazy, self-centered or irresponsible. These and other kinds of behavior can lead to rejection. A person with ADHD who is rejected by co-workers, family members, and friends can suffer emotional stress which can lead to low self-esteem and many other problems.
What can it look like? Here are some situations:
A spouse or a friend is angered by a re-curring inappropriate behavior from the partner or friend and experiences a “burn out”. It eventually leads to that person giving up on the marriage or friendship. An employee or co-worker is constantly reprimanded for poor organizational and planning skills which results in unfinished tasks or failed projects. The situation becomes too frequent, and results in dismissal from work. If you recognize any of these persons in yourself or in someone you care for, you may want to learn more about ADHD and how you can seek help.
There are several items relating to ADHD that still need to be discussed in order to clear the misconceptions, negative perceptions and hopeless mindsets that surround it.
For families that have a diagnosed member in their midst, diagnosis and treatment alone will not suffice. They need each other’s support, as well the support of an informed and responsive society; which includes schools, government agencies and policy makers.
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Melanie is Center director of the Chapelhouse Learning Center in Dumaguete City.
