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Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioural disorder that has been related to the brain's chemistry and anatomy. ADHD is a persistent pattern of inattention and/or hyperactivity/impulsivity that occurs more frequently and more severely than is typically seen in people at comparable levels of development. Symptoms must occur for at least six months and some symptoms have been present since before the age of 7 years.
ADHD begins in childhood and symptoms can persist into adulthood as well. While some children outgrow ADHD, as many as 60% continue to have features of ADHD persisting into adulthood.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (a physicians manual for diagnosis), the symptoms of ADHD fall into the following categories: inattention, hyperactivity/impulsivity, and a combination of the two.
Although the exact cause of Attention-deficit/hyperactivity disorder (ADHD) remains unknown it has become increasingly clear that ADHD has a biological component and requires early diagnosis and intervention. There is evidence that ADHD appears to have a hereditary component, the result of genetics. A number of unproven causes have been suggested over the years but most of these have been shown to be false.
Research has shown that ADHD runs in families. One study suggests, if a parent has ADHD, there is a 57% chance his/her children will also have ADHD. In addition, about 32% of siblings of children with ADHD will also have the disorder.
In addition to genetic causes, there are other medical factors that can cause ADHD-like symptoms. Careful examination, however, reveals important differences between these disorders and ADHD.
In the past, uncertainty about the causes of ADHD created a fertile climate for speculation of all kinds. Many theories - notably those holding parents to blame in some way for their child's uncontrolled behaviour - have been advanced and were later determined to be unfounded. Among the most well-known myths, are environmental causes such as:
Extensive research demonstrated that food additives had little if any effect on children's behaviour. The theory that refined sugar causes hyperactivity is not supported.
A common view was that poor child rearing and poor child behaviour management led to hyperactivity. While parents may react negatively to their children's behaviour that does not mean they cause it. It is likely parental frustration is an effect, not a cause, of ADHD. In fact when a child's ADHD symptoms are reduced, parental negative behaviour is reduced. More and more evidence shows that ADHD does not stem from home environment, but from biological causes. It has become increasingly clear that ADHD is a neurobehavioural disorder that requires a medical diagnosis and treatment.
Attention Deficit Hyperactive Disorder (ADHD) can have a significant impact on the lives of children. Children with ADHD often perform poorly in school. They may also have a more difficult time in making and maintaining friendships. Home and family life is also difficult as there can be significant conflict between parent and child.
If left untreated children and adolescents with ADHD are at greater risk for: poor self-esteem, increased parent-child conflict and stress, problems with social skill and peer relationships, and becoming a juvenile offender.
Adolescents and adults with ADHD also face significant challenges. At work, these individuals may have lower work performance ratings because of difficulties staying organized and focused. It may also take them longer to complete certain tasks. These individuals also suffer significant social impairment with as many as 50% to 70% of patients with ADHD having few or no friends.
Getting answers isn't always easy. Here, we'll help you distinguish Fiction from Facts regarding Attention Deficit Hyperactive Disorder (ADHD) information. We'll also review some of the most common questions asked about ADHD.
As an individual with ADHD or a parent of a child with ADHD, separating fact from fiction in ADHD can help you remain committed to the course of treatment you have selected.
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| All children with ADHD eventually "outgrow" it | As many as 60% of children with ADHD continue to have features of ADHD persisting into adulthood. |
| ADHD is not a medical condition | ADHD is a medical condition. It is officially recognized by leading medical experts and institutions, including Health Canada, and the Canadian Psychiatric Association. |
| Bad parenting is responsible for ADHD | Scientists are finding more and more evidence that ADHD does not stem from home environment, but from biological causes. |
| ADHD affects only boys | In children, approximately 8-10% of males and 3-4 % of females under the age of 18 have ADHD. |
| ADHD can only be treated with medications | The NIMH Multimodal Treatment Study for Children with ADHD (MTA Study) studied nearly 600 elementary school children and found that the most effective treatment strategies were a combination of behavioural therapy and medication. Talk to your healthcare professional about the most appropriate options for your child. |
| Children with ADHD can only be identified by their hyperactive behaviour | ADHD has 3 main types of symptoms: inattention, hyperactivity, and impulsiveness. |
| If a child with ADHD is doing well at school, his or her treatment is sufficient | ADHD can affect children in many areas of their lives outside of school. ADHD symptoms may impair both academic performance and peer relationships. The symptoms may cause children to have stressful family relationships and problems in social situations. Successful management of this condition needs to address all aspects of a young person's daily life. |
| Children with ADHD should only take their medication while in school | ADHD is a chronic disorder. Giving medication continuously through weekends and holidays may enable the child to better control behaviour and improve socialization and self esteem. |
| ADHD is the result of eating too much sugar or preservatives | ADHD is not caused by sugar or preservatives. |
Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioural disorder that has been related to the brain's chemistry and anatomy. It is a persistent pattern of inattention and/or hyperactivity/impulsivity that occurs more frequently and more severely than is typically seen in people at comparable levels of development. ADHD begins in childhood, and as many as 60% of children with ADHD continue to have features of ADHD persisting into adulthood.
Research repeatedly demonstrates that Attention Deficit Hyperactive Disorder (ADHD) runs in families. One study suggests, if a parent has ADHD, the risk of the children having ADHD is up to 57%.
Attention Deficit Hyperactive Disorder (ADHD) is a chronic disorder that can be managed through treatment. Some patients have a remission of the disease, and most can lead productive adolescent and adult lives. However, and as many as 60% of children with ADHD continue to have features of ADHD persisting into adulthood.
ADHD is treatable. Fortunately, research is continuing on many fronts, making the outlook for people with ADHD much more positive. Progress has been made toward a better understanding of this illness and its treatment, and scientists are using many approaches to learn more about what causes ADHD. There are many therapies that can help to manage ADHD. Many people with ADHD are able to lead more satisfying lives with treatment.
www.caddra.ca/english/parents.html
The Canadian Attention-Deficit/Hyperactivity Disorder Resource Alliance (CADDRA) is a national, independent, not-for- profit association whose members are drawn from Family Practice, Pediatrics, Psychiatry and Child Psychiatry. This group represents the voice of doctors who support patients and their families suffering from ADHD. As opinion leaders in the field, CADDRA members conduct research, treat patients, and design practice guidelines for ADHD.
www.caddac.ca
The Centre for ADHD/ADD Advocacy, Canada (CADDAC) is a national not-for-profit organization providing leadership in education and advocacy for ADHD organizations and individuals with ADHD across Canada.
www.ldac-taac.ca
The Learning Disabilities Association of Canada (LDAC) is a national, non-profit voluntary organization which was founded in 1963 and incorporated in 1971. The organization's mission is to be the national voice for persons with learning disabilities and those who support them. LDAC is dedicated to a level playing field for individuals with learning disabilities to enable them to function as citizens with equitable opportunities and to develop to their chosen potential. LDAC accomplishes these goals through public awareness about the nature and impact of learning disabilities, advocacy, research, health, education and collaborative efforts.
www.chaddcanada.org
Children and Adults with A.D.D. (CH.A.D.D.) Canada is a non-profit, parent-run organization that aims to help support, educate, and ultimately better the lives of individuals with ADHD and those who care for them. CH.A.D.D. has chapters in communities across the nation, where meetings are held. CH.A.D.D. also sponsors various workshops, presentations and conferences, distributing the latest breakthroughs and techniques involved in dealing with ADHD.
www.aqeta.qc.ca
The Learning Disabilities Association of Quebec (LDAQ) is a non-profit organization whose mission is to advocate and defend the rights of children and adults with learning disabilities. LDAQ represents parents and supports them in their efforts to help their children.
www.associationpanda.qc.ca/regroupement
The Regroupement des associations de parents PANDA du Québec provides help and support to the Parents Aptes à Négocier le Déficit de l'Attention (PANDA) parents' associations and to the parents of children with attention deficit/hyperactivity disorder. The Regroupement works in concert with other associations, groups or committees to use all available resources to help social and community workers provide the best specialized care and support to people affected by the disorder.
The good news is that Attention Deficit Hyperactive Disorder (ADHD) can be treated. Current ADHD treatment practices focus on management of symptoms through a combination of ADHD treatment methods:
ADHD Treatment should be individualized for each person. ADHD treatment is best approached as a partnership between the child, family, school personnel, and healthcare professionals. Making sure everyone involved understands his or her contribution to a child's successful treatment plan is fundamental to symptom management. Since every child's treatment should be customized to his or her needs, be sure to help your healthcare professional understand your child's particular challenges.
The basic stages of the treatment process are:
The focus of ADHD treatment is the management of symptoms. Medication is typically the backbone of therapy. The most common types of medication used to treat ADHD are stimulants (e.g., methylphenidate and amphetamines) and non-stimulants (e.g., atomoxetine).
Stimulants have been used since the 1930s, for the treatment of ADHD. The primary effect of stimulants is through regulation of dopamine and norepinephrine.
Stimulants used in the treatment of ADHD include:
Short-acting
Intermediate-acting
Long-acting
There is currently one non-stimulant that has been used since 2005 for the treatment of ADHD. This treatment option works by blocking the uptake of norepinephrine, a chemical neurotransmitter.
Non-stimulants used in ADHD treatment include:
Long-acting
Behaviour modification can play an important role in the treatment of children with Attention Deficit Hyperactive Disorder (ADHD). It involves using strategies such as positive reinforcement for desired behaviour, and consequences for inappropriate behaviour. Behaviour modification should not be confused with traditional individual therapy such as "talk" or "play" therapy, which have not proven to be very effective.
Essentially, behaviour modification is used to help improve not only a child's behavior but also his or her relationships - by improving interactions with other children and adults. Behavioural therapy has shown more benefit when parents and teachers are involved than when children undergo therapy alone. There are different behaviour modification techniques for preschoolers, elementary school-aged children, and adolescents. Ask your doctor to recommend a local mental health center or other agency to help you organize services with your child's school.
Parent training is designed to improve your understanding of the child's behaviour and to teach you skills to deal with the behavioural problems. Parent training can improve the child's functioning and decreases disruptive behaviour. Programs offer specific techniques for giving commands, reinforcing positive social behaviour, and decreasing inappropriate behaviour.
Combination treatment for Attention Deficit Hyperactive Disorder (ADHD) involves using two or more types of treatment at the same time, such as medication and behavioural therapy. The National Institute of Mental Health completed a landmark study of 579 children with ADHD, called the Multimodal Treatment Study of Children with ADHD (MTA study) that found combination therapy can be very effective.
In the study, the children received one of four possible ADHD treatments:
The researchers found that the children who received the combination of medication and behavioural management, had the greatest improvement in their ADHD symptoms. Children who received combination therapy had better results in the areas of oppositional/aggressive symptoms, social skills, parent-child relationships and academic outcomes compared to behavioural treatment and/or community care.
If your child has been diagnosed with Attention Deficit Hyperactive Disorder (ADHD), educating yourself about treatment options like medications and behavioural therapy will help you with the situation. If possible, schedule a meeting with your healthcare professional to discuss ADHD treatments and where you can find information. Also, don't be afraid to talk to your pharmacist, and ask him questions about the medications.
It is important to remember that the first medication used may not be the best one for your child. The healthcare professional might try several medications before the most appropriate one is found - a process that could take some time.
Also important is to follow your healthcare professional's treatment instructions because no matter how good medical or behavioural therapy is supposed to be, limitations can arise if the treatment is not maintained, or has not been well applied.
Atilla Turgay MD, FRCPC
Dr. Atilla Turgay is an internationally renowned child, adolescent and adult psychiatrist specializing in the field of ADHD and disorders commonly associated with ADHD. He is currently the Director of the Toronto ADHD Clinic and a full professor in the Faculty of Medicine at the University of Toronto.
As a parent of a child with Attention Deficit Hyperactive Disorder (ADHD), you probably know that the symptoms associated with ADHD do not just present themselves during school hours. After all, Attention Deficit Hyperactive Disorder is a year-round condition and not just a seasonal challenge that only needs to be addressed during school hours.
As a condition that affects children, ADHD often requires medication. And, for any medication to work effectively, it should be taken as prescribed. But because some parents see administering ADHD treatment during school hours as the priority they might feel compelled to give their children with ADHD "drug breaks" or "drug holidays" when their children are not in school. While it makes sense that during school hours, children with ADHD benefit from medication that helps them manage the challenges of ADHD in a classroom setting, taking "drug breaks" whether during the summer holidays, or even on weekends may not be the best idea.
In fact, the benefits and risks of such "drug holidays" remains unproven and are not generally recommended when the child is involved in social activities such as summer camp. According to Canadian ADHD Practice Guidelines, giving medication continuously through weekends and holidays may enable the child to better control behaviour and improve socialization and self-esteem.
Giving your child the prescribed ADHD treatment will help your child to better manage all those hours outside of the classroom - the hectic morning rush as well as suppertime and early evening. Life has continuous opportunities for learning and developing, outside and away from the classroom environment. The World Federation for Mental Health's international Without Boundaries survey found that parents reported they found it difficult to go places with their child (43%); experienced difficulties finding a baby sitter (46%); felt uncomfortable inviting friends and family to their home because of their child's symptoms (32%) and that their child frequently caused trouble with others in their neighborhood (37%).
Discontinuing medication for any period of time, and then starting again is not recommended. For many parents of children with ADHD, often getting through those unstructured periods outside of school without medication - from weekends to summer holidays - may be even more challenging when trying to meet the challenges of ADHD symptoms.
Talking With Your Doctor Can Help
Parents should talk with their doctor about those symptoms that interfere beyond school hours and how the child's ADHD affects the whole family. In fact, most parents can benefit from more information that can help them to better care for their child with ADHD.
Atilla Turgay MD, FRCPC
Dr. Atilla Turgay is an internationally renowned child, adolescent and adult psychiatrist specializing in the field of ADHD and disorders commonly associated with ADHD. He is currently the Director of the Toronto ADHD Clinic and a full professor in the Faculty of Medicine at the University of Toronto.
Knowing that your child has Attention Deficit Hyperactive Disorder (ADHD) is the first step towards understanding how to meet its challenges. But as a parent of a child with ADHD, how do you tell your child he or she has ADHD? It is understandable that many parents want to avoid "labeling" their child with ADHD and are unsure what exactly they should say.
Talk to your child using easy-to-understand language about what it means to have ADHD. Be honest and supportive. Explain to your child that this is a medical condition similar to people who need to wear a pair of glasses. Tell your child that you will get through this together.
The most important and effective behavioral technique is verbal reinforcement of appropriate behavior, that is praise when a child begins and completes an activity or exhibits a particular desired behavior9.
When your child displays positive behavior you should ensure that you give your child praise for that specific behavior. Praise should be specific for the positive behavior displayed by your child. Your comments should focus on what your child did right and should include exactly what part(s) of their behavior was desirable. Rather than praising your child for not fighting with their sibling during a family meal, for example, you should praise him or her for sitting still while eating their meal.
Good parenting involves praising a child with ADHD frequently and looking for good behavior to praise before, and not after, a child gets distracted off a task.
Emphasize your child's unique gifts. Just because they have ADHD doesn't mean they can't realize their dreams. Give positive examples of successful people (professional athletes, actors, politicians) who have ADHD to reinforce the idea that having ADHD should never stand in their way.
Talk about ADHD as being a challenge, not an excuse. Let your child know it's a challenge the whole family will be supportive about. Life in a household where at least one child has ADHD can be chaotic. For the child with ADHD, trying to behave takes tremendous effort. It can also be frustrating for siblings of a child with ADHD as so much attention is focused around the ADHD, they can often feel forgotten or resentful.
At the end of the day, it's important that your child feels comfortable discussing ADHD so that together, you can find ways to problem solve and find strategies to deal with the challenges ADHD presents.
It is beneficial to develop strategies with your child to help them manage their Attention Deficit Hyperactive Disorder (ADHD) because he or she may encounter behavioral difficulties. Certain skill sets may also take longer to acquire. Many of these strategies involve a change in mindset and/or behaviour of the parent. ADHD is a deficit, not a behaviour that can be altered by simply demanding your child to obey. Children with ADHD are very good at tuning out when lectured to, so lecturing is not an effective means of communicating with them.
The following are some principles you may want to consider to help your child manage their ADHD:
Children with ADHD benefit from frequently hearing positive comments about their actions. They also derive benefit from receiving frequent feedback and correction when their actions are inappropriate. Feedback given too long after the action has taken place is ineffective. Please use short/simple sentences and show affection for positive behaviors.
It can be helpful to encourage children with ADHD for appropriate behaviours or actions by providing incentives and then providing immediate reward when the desired behaviours or actions occur.
It can be difficult to stay on track with a child with ADHD. They can be confrontational and wear you down over time. It is important to stick to any interventions or expectations that have been put in place.
Continually repeating negative consequences and not following through when your child does not comply with requests will quickly teach them that mom or dad is "all-talk-no-action". Consequences need to be conveyed on a consistent basis so that they are taken seriously and then enforced if the desired behaviour does not occur.
There are simple strategies that you can employ to help your child with ADHD. The following are some examples that you may consider:
