Prevalence

Between 3-5% of population is affected.

Ratio of male to female is 3:1 worldwide, and up to 12:1 in Australia (Wallace, 1999).

Aetiology

Neurological studies have found abnormal prefrontal activity in ADHD (Monastra et al, 1999).

Research suggests a genetic link. Up to 90% of ADHD children have a family history of ADHD or related disorder.

Neurochemical and neurobiological abnormalities are the most accepted causes (Barkley, 1997).In some cases prenatal exposure to lead or other toxins is implicated.

Food allergies and sensitivity to additives or colouring is not causally related, however in some cases, a modified diet can alleviate symptoms of hyperactivity.

Early childhood environment, including parent-child relationships are not causally related, but may exasperate symptoms (especially the development of disruptive or oppositional defiance disorder).

Diagnostic Criteria

Poor sustained attention.

Children with ADHD are typically very easily distracted and they have difficulty ‘staying on task’. In school and throughout their adult lives, these individuals fail to finish tasks, fail to follow through with instructions, fail to pay attention when being spoken to, and remain disorganised in daily living. These children ‘forget’ important items necessary for school (E.g. pens, erasers, books, warm jumper, or bus pass).

Lack of impulse control.

Children with ADHD do not necessarily fail to think before they act, but they do lack the ability to inhibit actions. In school, impulsive behaviours may be evident; blurting out answers, repeatedly breaking school rules, continual talking in class and risk-taking behaviours. Young children may impulsively run out in front of traffic to get a ball, whilst older ADHD children are easily persuaded to try dangerous hobbies and habits (E.g. jumping off buildings, or illicit drugs use). However, it is emphasised that these impulsive actions are not malicious or pre-planned (Wallace, 1999).

Hyperactivity.

Children with ADHD often fidget or wriggle in their seat. Difficulty remaining still for any length of time persists into adulthood, but as these children mature, gross motor movements may decline. Not all ADHD children are hyperactive, some may even present hypo-activity (lethargy or under activity).

Social skills deficits.

Although not a diagnostic criteria, almost all of these children will have poor social skills. They may have younger or older friends, but difficulty ‘fitting’ in with their same-age peers. Due to their ‘clowning’ behaviour in class, younger children with ADHD may have a larger group of ‘friends’, but become increasingly isolated as their friends ‘grow up’ and seemingly tire of the ADHD adolescents’ antics.

Comorbidity (other disorders that may co-occur with ADHD)

Learning Disabilities.

About 20 % to 30 % of children with ADHD will also suffer from a specific learning disability (LD). They may have a phonological processing deficit, central auditory processing deficit, reading disabilities, dyslexia, problems with writing, and arithmetic disorders

Oppositional Defiant Disorder.

Between 30% to 50% of children with ADHD have an oppositional defiant disorder (ODD). These children are defiant, stubborn, non-compliant, have outbursts of temper, argue with adults and refuse to obey rules.

Conduct Disorder.

About 20 to 40 percent of ADHD children may develop conduct disorder (CD), which ia a pattern of antisocial behaviour. These children bully others, lie and steal, are aggressive toward people and animals, destroy property, engage in vandalism. As teenagers, they are at greater risk of substance abuse and juvenile delinquency.

Nearly 90% of ADHD children and adults will underachieve.

Anti-social behaviour (delinquency) in approximately 5-30% cases.

Approximately 2-10% will attempt suicide

It is important for teachers & parents to:

Be aware of the signs of depression and social isolation.

Monitor social interaction and encourage appropriate social behaviour. Help the young adult to make appropriate choices; socially, academically and personally. Assist the ADHD adolescent to set short term goals. Encourage participation in group activities and sports.

Provide constant and immediate POSITIVE feedback.

Provide praise (or rewards) for appropriate behaviour. It is important to remember that individuals with ADHD have experienced more negative consequences than others, and become easily discouraged. Children with the predominantly innattention-impulsive type will have great difficulty delaying gratification. They need immediate tangible rewards (e.g., stickers, trading stamps, praise, pat on the back).

Deal with inappropriate behaviour quickly and consistently.

These children respond well to a structured environment with clear rules and consequences. However, children with ADHD need the consequences to be clearly explained to them, as they tend not to understand natural consequences. Adolescents with ADHD may agree to school policy or class rules with little real understanding or appreciation for the process. Therefore, do not simply think that because you have “told them the rules” that they understand. Talk them through some examples.

Help break up tasks into small steps.

Children with ADHD need help in developing an organisational strategy or a plan for each task. ADHD children and adults have great difficulty getting started on a task. What may appear to be laziness or procrastination may actually be a severe planning (frontal lobe) deficit. Tasks requiring sustained mental effort are most difficult for children with ADHD. They have difficulty concentrating on long complex tasks. Help them to break the task in to smaller units and provide a framework to scaffold their progress.

Build Self-Esteem and Self-Efficacy.

Due to considerable failure and embarrassment, teenagers with ADHD may learn to not hand in work, rather than to be seen to fail because they could not understand the task. Children with ADHD need extra encouragement to try again in the face of failure. Reward the attempt rather than the success. Assisting the young person with ADHD to plan and accept responsibility for outcomes is empowering for them. The more success they have following a framework or outline, the more likely they will develop a sense of achievement and belief in themselves. This will help counteract some of the negative outcomes of their disorder.