Friday, August 19, 2011

ADHD Attention Deficit/Hyperactivity Disorder written by our Guest Clinical Psychologist Dr Nicole Arthur @ New Directions Psychology Jindalee Brisbane

Today, I have invited Dr Nicole Arthur from New Directions
Psychology to write about Attention Deficit/Hyperactivity Disorder.


Children are normally active.  With high energy, they constantly move around responding to their environments.  Their attention tends to be shorter and can wander from one subject to another.   Sometimes, they also get carried away by their imagination.  All in all, these characteristics keep children ready for constant learning.  However, sometimes these behaviours exceed the level commonly expected in the children's age group and can interfere with various areas fo life eg social and school.

ADHD is characterized by a set of behaviours including persistent over-activity, impulsivity, and difficulties maintaining attention.  Children with ADHD may experience challenges only with their:
  1. Overactivity and impulsivity ie ADHD, predominantly hyperactive-impulsive type
  2. Attention ie ADHD, predominantly inattentive type
  3. For others, the challenges may include all of the above ie ADHD, combined type
Normally, children will receive a diagnosis of ADHD only when the challenges outlined affect them in two or more settings eg at home and at school and present before and continue until after they are 7.  The diagnosis cannot be given when the children are under 7.

Symptoms of ADHD
In general, ADHD involves a mixture of physical, emotional, and thought symptoms, including:

Symptoms of inattention
  • Carelessness
  • Failure to give attention to details
  • Short attention span
  • Difficulties maintaining attention
  • Being easily distracted
  • Difficulties following instruction
  • Avoidance of tasks that require mental effort ie homework, school work
  • Losing or misplacing things
  • Forgetfulness
Symptoms of hyperactivity-impulsitivity
  • Being "on the go" or acting as if "driven by a motor"
  • Fidgetiting
  • Difficulties remaining in seat
  • Excessive and inappropriate running or climbing
  • Talking excessively
  • Difficulty playing quietly
  • Interrupting or intruding others
  • Difficulties awaiting turn
Commonly Associated Symptoms
  • Low tolerance of frustration
  • Excitability, poor regulation of emotion, and poor impulse control
  • Compromised intellectual abilities (e.g., poor estimation of time, difficulties foreseeing consequences, poor planning skills and organization)
  • High risk-taking behaviour
  • Social and academic difficulties
  • Poor motor coordination
  • Proneness to accidents
  • Low self-esteem
  • Low motivation
  • Low mood or high anxiety
Increased prevalence of ADHD has been reported, with the current estimation of approximately 3-9% of children diagnosed with ADHD. Higher vulnerability is consistently reported in boys.

Causes of ADHD
As with many mental health conditions, the exact cause of ADHD is not fully understood. Different children develop ADHD for different reasons. It is unlikely that one factor can fully explain the cause of ADHD. Combinations of factors should be considered. These include:
Biological factors:
Findings initially suggest that the brain of children with ADHD might structure or operate in a unique way which leads them to be particularly vulnerable to hyperactivity/impulsivity and/or inattention. Additionally, ADHD seems to run in families, so it may be inherited.

Psychological factors:
Environmental factors might aggravate or maintain the difficulties that children with ADHD experience in inhibiting behaviour. Additionally, lack of intellectual, social, or emotional maturity might not allow them to regulate their motivation, emotion, or behaviour effectively.
It is important to note that, although the exact cause of ADHD is not fully identified, ADHD is not caused by poor parenting. Still, as outlined below, positive family relationship and effective parenting strategies are associated with positive outcomes for the treatment of ADHD.

Although there is no cure for ADHD, there are several types of treatments that help parents and children manage and reduce the symptoms of ADHD. To achieve this, the use of a combination of medication and psychotherapy is most effective.

Medical intervention:
Medical intervention for ADHD is normally in the form of psychostimulants (e.g., Ritalin, Dexedrine) which act on the chemicals in the brain. Findings have shown improvement in children’s attention and concentration as well as reduction in their excessive activity and impulsivity. Although dependency on these medications is reportedly rare, the long-term benefits remain limited. Some children may also experience, to a varying degree, common side effects of appetite loss, dry mouth, and nausea.

Psychological intervention:
Both parents and children with ADHD benefit from psychological intervention which equips them with effective strategies in effectively managing ADHD symptoms and related difficulties.
Child support: Strategies can be provided to children with ADHD to enhance their abilities to regulate behaviour and emotion as well as to equip them with social skills.
Parent support: Strategies can be provided to parents to assist them to modify their environments so as to best manage their children’s ADHD symptoms. Parenting strategies as well as strategies for reward management also help the parents to enhance their children’s desirable behaviour.

Treatment outcome
The course of ADHD varies across children. About 30-50% children will still have ADHD as adults. For other children, symptoms will gradually decrease over the course of childhood.
Still, unmanaged ADHD is associated with increased use of alcohol and drugs, unemployment and legal problems. Such problems, however, are not inevitable and the probability of occurrence can be greatly reduced with proper medical and psychological intervention. Medical intervention of ADHD has been shown beneficial in the management of its symptoms for approximately 70% of children with moderate to severe ADHD. These benefits increase substantially when presented with psychological intervention.

Dr Nicole Arthur
Clinical Psychologist
BHMS(Ed) B Arts(Psych)(Hons)D Psych(Clinical) MAPS
Interest in:
Chronic health, Depression
Grief and loss, Peri and Postnatal Depression
Child and Parenting issues.