DEFINATION:
As the name of this category of disorder describe, it is a disorder where child is having deficiency in paying attention towards a task.
EXPLANATION:
Attention Deficit Disorder, otherwise commonly know as ADD, is a psychosomatic condition which is normally characterized by learning and behavioral disorders. They have difficulty remaining on task and focusing attention generally but may be able to attend to tasks they find enjoyable. ADD is commonly seen in preschooler”s, schooling kids and adolescents to prompt diagnosis and early intervention is must. ADHD is the commonest form of ADD seen. This is a condition that becomes apparent in some children in preschool and early school years.
ETIOLOGY:
Disorder is a developmental disability based on neurobiological factors. However, the real cause of ADHD is still not known Cause is unknown and not well defined.
Some researchers believe it is associated with minimal Brain damage which may be in frontal lobes, Inhibitory mechanism of cortex, limbic system, RAS, based on EEG results. Maturational lag is proposed by one group of researchers emphasizing on Developmental delay.
Neurotransmitters like Glutamate theory, Epinephrine and Norephinephrine are studied upon as cause of ADHD.
Genetics though not clearly seen, is also supposed to be the cause.
CLASSIFICATION: Attention Deficit Disorders occurs in 4 forms based on behaviors seen.
1. Attention deficit disorder with hyperactivity
2. Attention deficit disorder without hyperactivity
3. Residual type
4. Hyperkinetic disorder with Conduct disorder
SIGNS AND SYMPTOMS:
Attention deficit disorder with hyperactivity
Characteristic symptoms of ADHD are inattention, hyperactivity and impulsivity. But these symptoms need careful screening before labeling any child with diagnosis as these symptoms may be shown by many normal children but as a low level.
Symptoms of impulsiveness and hyperactivity preceding those of inattention.
These symptoms are situation-specific, is demonstrated when demands of situation cannot be coped well. Demands can be anything; discipline, sitting at one place, etc. Focusing on individual symptoms we can see:
1. POOR ATTENTION with distractibility:
These children struggle to pay attention to one task for a longer time and get bored easily in few minutes.
Focusing deliberate, conscious attention to organizing and completing a task or learning is difficult.
When doing anything which is enjoyable to them, attention is not a problem.
Home works are often accompanied by frustration for both parent and child.
Gets easily distracted with irrelevant sights and sounds.
Makes careless mistakes.
They appear to be day dreaming, easily confused.
Skipping from one activity to other is common.
Fails to finish work which is started at once.
Often forgets or looses things.
2. HYPERACTIVITY
Always seems to be “on the go” or constantly in motion.
Sitting at one place for Meal or lectures is problem.
They dash around touching or playing with whatever is in sight, Speak or talk nonstop to self and others
Hyperactivity Teenagers or adults feel internally restless. They always report need to stay busy and try to do several things at once.
Often fidgeting with hands or feet or squirming while seated.
Running, climbing or leaving seat is common.
Have difficulty waiting in line or Taking Turn.
3. IMPULSIVITY Unable to calculate immediate reaction or think before act, interrupts or intrudes upon other.
2 types of Impulsivities are therapeutically recognized.
Behavioral Impulsivity – the things that you do Cognitive Impulsivity – the way that you think and make choices Behavioral Impulsivity ADHD individuals with behavioral impulsivity don’t stop and think first before they act.
Children with ADHD often aren’t learning from their past mistakes. Their learning threshold is very high, and if they are not excited or motivated to get above that learning threshold, they don’t learn, and they make the same mistake again and again. ADHD children with behavioral impulsivity often:
May act without thinking first,
cut in line,
can’t wait their turn in line or in a game,
blurt out answers in class,
speak when they’re supposed to be quiet,
may show aggressive behaviors,
are often a little too loud,
sometimes fight,
often have poor social skills, which of course is the death socially for teenagers with ADHD, Impulsively say the wrong thing at the wrong time. Also, sometimes these kids fail to learn those subtle social cues that everybody else has learned, and so they’re socially awkward and often don’t understand why.
Cognitive Impulsivity
Cognitive impulsivity means that they guess a lot.
Guessing is their problem solving method of choice.
Cognitively impulsive ADHD kids will make a multiple number of guesses in a short period of time.
On a matching task, or if you give them multiple choices orally, you’ll see them guess for the right answer very quickly, “it’s this one, no, its this one, no, wait, its this one,” until finally you step in and, when he guesses right, you’ll say, “That’s it!” Of course this just reinforces his guessing.
These cognitively impulsive ADHD kids have very limited problem solving strategies.
They don’t stop and look and the problem and then say, “Well, I could do it this way first, and then do that, and then I’ll be done.” They don’t approach problem solving that way. They usually just guess and let trial and error take its course.
Being fast is NOT a Problem
Now remember, being fast is not a problem. Some have pointed out that “being fast and accurate is good.” It’s fast and inaccurate that is a problem.
Children and adolescent continue to be disabled by core symptoms of the syndrome and are at risk for developing personality disorder, criminal behavior and more psychopathologies.
This abnormality brings about family disputes, social maladjustment which can be prevented if intervened early in the critical period.
Attention deficit disorder without hyperactivity
All the clinical symptoms, onset, progression are same, with absence of Hyperactivity.
Residual type
This type of ADD is diagnosed for adults who had past history of ADD of any form and shows Residual features of same carried in Adulthood.
Hyperkinetic disorder with Conduct disorder
This sub type of ADD shows mixed picture of hyperactivity and conduct disorder.
ASSOCIATED PROBLEMS: Attention deficit disorder with autism.
Attention deficit disorder with learning disorder.
Attention deficit disorder with mental retardation.
Attention deficit disorder with seizures.
Attention deficit disorder with developmental delay.
Attention deficit disorder with emotional instability.
MYTHS/QUERIES: ADHD is not curable.: false
DR. SUMIT (OCCUPATIONAL THERAPIST): YES! ADHD if left untreated may lead to a child with academics problem, learning problems, lack of social skills and social interaction, conduct disorder, emotional imbalance, intrapersonal disharmony, lack of adjustment, behavioral problems and finally an adult with disturbed personality. If treated early these future complications can be prevented.
1. ADHD is a behavior :
DR. SUMIT (OCCUPATIONAL THERAPIST): NO, ADHD is not a behavior. Child with ADHD does not roam in class or is inattentive on his own. He is rather unaware of his inner drives and flows with those. 2. ADHD is energy consumption related disorder.
DR. SUMIT (OCCUPATIONAL THERAPIST): ADHD is not at all energy consumption related disorder. Making child tired is not at all a remedy; mostly they are treated by over exerting or by giving sedatives which is not at all a option. Rather by giving appropriate sensory integration the arousal can be brought down to appropriate level where maximum learning can happen and this learning is not just academic but overall i.e. physical motor, cognitive, social skills and interaction, language and communication skills..
EARLY DETECTION, A STEP TOWARDS BETTER CURE:
Attention deficit disorder is mainly diagnosed when the child starts going school i.e. At the age of 3 and later, but the onset in much earlier. When child”s hyperactivity, distractibility, poor concentration or impulsivity begin to affect performance in school, social relationships with other children, or behavior at home, ADHD is suspected.
So a parent should always keep a check whether child is attending environmental stimuli appropriately, whether child is giving appropriate eye contact during communication, is he responding to names appropriately, is appropriate learning happening out of play, is the child able to produce appropriate social skills such as staying in conversation taking turns, expressing himself/herself and most important showing patience.
This can be screened early at home. As this disability is directly associated with basic learning which in turn affects academic performance and social interaction, The child suffers in the school. Early intervention programme is very much necessary in add to prevent early academic learning problem and overall performance.
ADD later left untreated may lead to early school dropouts, severe learning disabilities . A child with ADHD faces a difficult path for learning in order to achieve success all he needs is help, guidance, understanding of his underlying inabilities
PARENTS APPROACH TO DISORDER:
In ADD /ADHD due to abnormal sensory seeking, processing or faulty modulation and inappropriate behavior sets in. which needs to be taken care of with appropriate behavior modification techniques. Parents should consult with the therapist regarding techniques.
There is always a good prognosis with an appropriate environmental stimulus.
Empathetic approach will help the parents to control behavioral traits.