Positive Actions to Support Attention Deficit Hyperactivity Disorder (ADHD)

28 June 2020

Attention Deficit Hyperactivity Disorder (ADHD) is a common occurrence in children which causes behavioural or developmental problems. Global statistics show that up to 10% of children in a classroom will have ADHD, but children with higher IQ who are more capable in controlling their behaviour can make it difficult for others to be aware of their symptoms.

Sunway Medical Centre Developmental Paediatrician, Dr Cindy Chan Su Huay said many children with ADHD cannot explain why they can’t control themselves at times and compared to other children, these children cannot focus on many tasks at once and have more difficulty in shifting their attention between tasks.

“ADHD is associated with the genes you inherit from your parents and is more common in boys. Children begin to show symptoms before school-going age, which is around 5 years old. Some even show symptoms in infancy,” she said.

ADHD is essentially characterised by several features as below:

  1. Attention Deficit Disorder (ADD): These children have difficulty in paying attention or concentrating on a task, or are highly distracted. They have a tendency to look around when a parent or teacher is talking, and are easily distracted by surrounding factors.
  2. Hyperactive: These children are super active, restless and are always moving around and climbing high places. They enjoy being stimulated and are not wary of danger.
  3. Impulsive behaviour/verbal impulses: These children tend to be impatient, fickle in their behaviour, have trouble waiting for their turn, be too blunt in their speech and interrupt conversations or actions, which can affect friendships or cause social difficulties.
  4. Lack of organisational skills: Due to a lack of planning and organisational skills, these children may tend to be forgetful in managing or carrying out tasks in everyday life, including at home and at school. This would cause them to frequently lose their personal belongings, forget what they were supposed to do in a sequence and more.

Dr Cindy added that some children may have a combination of symptoms and are often misunderstood or labelled as lazy, mischievous, irresponsible or having discipline or emotional problems. Meanwhile, those who are quiet or well-behaved may have a delay in diagnosis because their symptoms were overlooked.

Some parents may complain that their children are unable to concentrate on reading or complete their homework, instead they are interested in video games and are able to focus when watching television or using a smartphone or tablet.

This is because the visuals and mechanics of video games, television and smart devices make children feel excited, Dr Cindy explained. Moreover, they are rewarded with instant gratification whenever they successfully clear a stage. Whereas, in real life, they are rarely recognised or rewarded.

Behaviour management and parental support are important for children with ADHD, Dr Cindy emphasised. Most parents want their children to grow up healthy and happy, therefore in the early stages of ADHD, treatment is focused on combining behaviour management, psychological counselling, behavioural treatment, and parenting through integrated approaches.

“There is no cure for ADHD. However, it can be improved through behavioural therapy and positive parenting. Medication plays a complementary role along these psychological therapies. This approach will benefit the child throughout his or her lifetime,” Dr Cindy said.

Behavioural therapy can be done one-on-one or with a group of three to four children. Therapy in a group allows children to be influenced by each other which encourages a change in behaviour through interaction, activity and socialisation as the child is rewarded and recognised for doing well. Also, having a parent support group helps promote parent-child relationship as the platform allows them to share their problems with more diverse strategies to overcome them.

Dr Cindy encourages parents to tap into their children’s positive motivations by complimenting them for good and correct behaviour, reinforcing their self-confidence, and giving them rewards such as regular breaks or praise where appropriate.

Reinforcing positive behaviours help build your child’s self-esteem and improve symptoms like lack of focus. Encouraging your child to go outdoors and get regular exercise every day can also benefit children with ADHD. It is important to eat a balanced diet to avoid sugar overload or food with additives such as colouring.

The correct diagnosis of ADHD is especially important for preschool-aged children to ensure they have no other underlying problems that lead to their lack of focus and hyperactivity. This also allows parents or doctors to make appropriate adjustments or treatments according to each child’s condition.

Adults encounter emotional distress when ADHD goes undiagnosed as a child

ADHD is caused by an imbalance of neurotransmitters between the brain cells in the prefrontal cortical area, which affects the brain area that controls the ability to concentrate, manage, plan and organise.

During childhood, some ADHD patients might go undiagnosed due to high IQ and environmental factors. By the time they go to high school or college, or when they start working, they will face bigger challenges in study, socialising, organising, execution, emotion management and time management.

Sunway Medical Centre Consultant Child & Adolescent Psychiatrist, Dr Tee Bee Chin pointed that ADHD symptoms generally appear before the age of 12, although some people are not diagnosed until adulthood because their symptoms are not recognised or identified during an early age. About 50% of children with ADHD bring the disease until their adolescence and adulthood.

“With parents and teachers to supervise and guide them during their childhood, the symptoms of ADHD in children are either not apparent or visible. As they get older, they begin to face challenges in school work when they go to college, and once they enter the workplace, they need to manage multiple tasks. This is compounded by the inability to know where to start and prioritise, as well as the lack of abilities and time management, or inability to multitask,” Dr Tee said.

The average adult would come with problems in their inability to meet deadlines, low productivity, or having emotional distress such as panic, anxiety, depression or impatience.

“The signs associated with ADHD include being overly active, acting impulsively and irritably, and most notably, the inability to concentrate or focus on the work being done. Most patients who seek medical attention are already self-doubting and psychologically feeling guilty, self-blaming or frustrated,” she added.

The symptoms of ADHD can also cause learning disabilities and poor academic performance in patients. Emotionally, most of them are restless, irritable, depressed, have low stress tolerance and have mood swings. Cognitively, they have poor self-control and generally do not understand the consequences of inappropriate behaviour.

In terms of social communication, they are talkative with words often spoken without thought. They are also often interrupting people, aren’t able to follow instructions, impatient and can be aggressive and being unable to control themselves.

Dr Tee stressed that the diagnosis of ADHD is not to label a child, but to help them live a better quality of life in the future. Often times, children with ADHD are creative and imaginative.

“Children with ADHD are rarely affirmed. If there are academic or social obstacles, they can easily give up on themselves if they don’t achieve anything or have behavioural deviation,” she said.

ADHD cannot be diagnosed through blood tests or machines, but rather by tracking the parents’ family history or a teacher’s observations, and sometimes through a clinical assessment from healthcare providers such as paediatricians.

“Besides asking parents to obtain information, we also need to know how the individual is doing in school, in the workplace, and in other areas. ADHD should not just occur in a single circumstance. We must gather all the information to see whether the continued lack of concentration happens on other circumstances as well. Therefore, we have longer consultation sessions than other doctors,” Dr Tee said.

Although medication helps ADHD patients to some extent, doctors won’t prescribe it to children with ADHD under 6 years old.

Parental attitude is key

For children with ADHD, the most commonly used medication is methylphenidate, a central nervous system stimulant drug to modulate chemical imbalances in the brain that is responsible for concentration and self-control.

ADHD can also be treated through behavioural therapy such as schedule planning, setting reminders, breaking down tasks, and improving attention and adjusting behaviour via visual aids. This strengthens an ADHD patient’s organisational skills so that they can learn time management, self-management and problem solving skills.

Although ADHD patients may improve their condition through an acquired environment, there will always be limitations, hence the parents’ attitude and guidance are crucial.

American swimmer, Michael Phelps was diagnosed with ADHD as a child. However, he found joy and direction in swimming, overcoming attention deficit disorder and hyperactivity and using his talents for extraordinary achievements.

ADHD must be diagnosed through comprehensive assessment by a licensed medical practitioner such as a paediatrician, psychologist or psychiatrist. The more you are able to respond to the condition and treat it, the better your child will learn and grow healthily, enjoy a quality life, and continue to pursue life.

Source: Sin Chew Daily

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