ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
Written by Durre Sahar
Senior Psychologist, Special Education
Attention deficit hyperactivity disorder (ADHD) is a common condition that affects children and adolescents and can continue into adulthood for some. The ADHD is also called hyperkinetic disorder or neuro-behavioural disorder. It is characterized by inattention, restlessness, impulsivity and hyperactivity. These symptoms are disruptive and create social environmental problems for the child. The behaviors that are common with ADHD interfere with a child’s ability to function at school and at home.
The ADHD is defined as,
“the ADHD is a common condition that affects the children which is characterized by inattention, restlessness, impulsivity and hyperactivity”
The National Institute of Mental Health (NIMH) estimates that 3% to 5% of children have ADHD. Some experts, though, say ADHD may occur in 8% to 10% of school-aged children.
It may further be defined as,
“the ADHD is a psychiatric disorder of the neuro developmental type in which there are significant problems of attention, hyperactivity, or acting impulsivity that are not appropriate for a person’s age”
Children with ADHD generally have problems of paying attention or concentrating. They can’t seem to follow directions and are easily bored or frustrated with tasks. They also tend to move constantly and are impulsive, not stopping to think before they act. These behaviors are generally common in children. But they occur more often than usual and are more severe in a child with ADHD.
CLINICAL DESCRIPTION OF ADHD
DSM -5 divides ADHD criteria into two groups. The inattention group consists of symptoms reflecting lack of attention to details, difficulty sustaining attention, failure to listen, organizational problems, distractibility, failure to complete activities and forgetfulness. The hyperactivity-impulsivity groups consist of excessive behaviour, squirming, difficulty remaining seated, inappropriate noise / vocalization and difficulty waiting. Children must meet six of the inattention symptoms or six of the hyperactivity-impulsivity symptoms to qualify for ADHD diagnosis. Furthermore, the symptoms must present in two or more situations.
Biederman (1991) suggests two other subtypes of ADHD based on occurring diagnosis, ADHD with major depression symptoms (as many of ADHD cases, Barkley, 1991). These subtypes represent child have emotional difficulties superimposed on their inattention-hyperactivity problem. The delineation of ADHD subtypes suggests that children with should routinely be evaluated for related conduct, mood or anxiety. The presence of an associated problem may require more intensive inattention and may signal increased risk for negative long-term outcome.
MANIFESTATION OF ATTENTION DEFICIT HYPERACTIVITY DISORDER
The children who meet only inattention criteria in a 6 month period are coded as being predominantly inattentive type with those who meet only hyperactivity-impulsivity criteria in a 6 months period are coded as being predominantly hyperactive-impulsive type. Children who meet both the inattention and the hyperactivity-impulsivity criteria are coded as being combined type. Hence, ADHD is coded in DSM – IV as having few some types, depending on whether the predominant features are inattention, hyperactivity-impulsivity or both.
The child with ADHD frequent shifts from one activity to another. He fails to complete his given chore. He feels difficulty in organizing tasks and activities. Adults with ADHD may have difficulty with time management, organizational skills, goal setting and employment. They may also have problems with relationships, self-esteem and addictions.
APPEARANCE AND FEATURES OF ADHD
Despite the apparent existence of ADHD subtypes, certain features are common across many ADHD children. Perhaps the most common feature is difficulty sustaining attention during relatively long, group oriented or repetitive tasks. In some cases, the child is distracted by extraneous stimuli, but in other the child simply loses interest and fails to persist with the task.
The features listed below are often seen but are not universal. Some features may be diagnostically relevant or required. There are two types of features of attention deficit hyperactivity disorder as defined the following. The common features are typical of the disorder and occasional features appear frequently but are not necessary seen in a majority of cases.
- Common Features
- Occasional Features
- COMMON FEATURES
The common features are related to attention problems as like over activity, restlessness, inability to sit still, fidgeting, constant movement, impulsivity, adoption of acting as opposed to reflective style, interrupting others, difficulty waiting for turn, blurting out answer.
The common features in children are generally grouped into three categories as defined the following.
A child with ADHD:-
- Is easily distracted.
- Does not follow directions or finish tasks.
- Does not appear to be listening when someone is speaking.
- Does not pay attention and makes careless mistakes.
- Is forgetful about daily activities.
- Has problems organizing daily tasks.
- Avoids or dislikes activities that require sitting still or a sustained effort.
- Often loses things, including personal items.
- Has a tendency to daydream.
A child with ADHD:-
- Often squirms, fidgets, or bounces when sitting.
- Does not stay seated as expected.
- Has difficulty playing quietly.
- Is always moving, such as running or climbing on things (Inteens and adults, this is more commonly described as a sense of restlessness).
- Talks excessively.
- Is often on the go.
- Difficulty in gaining different tasks.
A child with ADHD:
- Has difficulty waiting for his or her turn.
- Has impatience.
- Difficulty in delaying.
- Blurts out answers before the question has been completed.
- Often interrupts others.
- It causes sometime accidents.
A child with ADHD has restlessness. He performs all his tasks given to him with bizarre behaviour. Many children with ADHD have difficulties with compliance and any social behaviors being restless.
- OCCASIONAL FEATURES
The occasional features are more common in boys and their onset is prior to age 4, although the diagnosis may not be made until child enters the school. The physical problems including higher injury risk, motor coordination problems aggressive and antisocial behaviour are included in the occasional features.
In addition to showing poor sustained attention, ADHD children frequently manifest difficulty with impulse control. This leads to the behaviours such as interrupting others, difficulty waiting for turn and poor performance on tasks requiring waiting or thoughtful decisions.
A third common feature of ADHD is overactivity, which may be more prevalent in younger children with ADHD. The overactivity is particularly noticeable in situations requiring the child to sit or to remain in same place for an extended period of time. At these times, ADHD children tend to squirm, stretch, change position, make noises, play with anything, reach and stand.
On tasks that are interesting, unstructured and involve shifts of focus to choose activity or immediate reinforcement, behavioural difference between ADHD children and normal children may be unnoticeable. Thus, an ADHD child may appear focused at home or in a video game but is quite inattentive and disruptive at school. These situation differences suggest that behavioural data must be gathered from multiple servers in multiple setting in order to diagnose ADHD.
Recently more attention has been given to the persistence of ADHD through out adolescence and adulthood, as many as 30-50% of children with ADHD show symptoms persisting through adolescence and into adulthood. From 50-80% of children with ADHD continuation meet ADHD criteria in adolescence. Behavioural symptoms such as impulsivity, inattention, immaturity oppositionality / defiance, social-skills deficits and distractibility often end into adolescence. However, symptoms of hyperactivity decline. Elevated rates of academic failure, antisocial personality, substance abuse, criminal behaviour and depression have been reported in adolescents and adults who were diagnosed with ADHD as children, although the risk of these negative long term outcomes is probably limited to the ADHD and CD subtype. These negative outcomes are less prevalent in adults than adolescents.
Hechtman (1991) reviews literature supporting three types of ADHD outcome, normal functioning (probably fewer than half of children), moderate disability (serious concentration, social and emotional. Low self-esteem, anxiety and irritability, perhaps as high) and significant disability (major depression, substance abuse, antisocial behaviour), those with co-occurring CD or Mood Disorder diagnoses are particularly at long term risk. Factors related to more adult outcome are higher IQ, internal locus of control, better social skills, family SES, supportive family and good health (Hechtman, 1991).
ASSOCIATION OF ATTENTION DEFICIT HYPERACTIVITY DISORDER
ADHD is associated with a plethora of medical, behavioural, cognitive and academic disorders, children with ADHD frequently do poorly in school and they are more likely to have physical problems than other children. They have increased difficulties with peer acceptance and they are more likely to be anxious and depressed.
50% children of ADHD are associated with conduct disorder (CD) and oppositional defiant disorder (ODD). The symptoms are seen before the age of 7 in these children. Their learning ability is affected by hyperactivity and impulsivity. These children are group oriented and repetitive tasks are difficult for them. .
The ADHD differentiates from anxiety disorder. It also differentiates from learning disorder and expected with oppositional defiant disorder (ODD).
The large but incomplete overlap between ADHD and CD (Conduct Disorder) suggests that subtypes of ADHD may exist in addition to those recognized by DSM – IV. Several authors have noted the heterogeneity of the ADHD population, which argues for the importance of delineating ADHD subtypes.