Attention Deficit Disorder

The classical model of Attention Deficit Disorder involves three major themes; inattention, impulsivity and hyperactivity. A child can exhibit one or all of these trends to be diagnosed with this specific learning disability. In fact girls tend more often to exhibit inattention only, appearing dreamy and spaced out while boys are more often diagnosed with the Attention Deficit/Hyperactivity Defict.

(Brown ADD scales, The Psychological Corporation)

At home problems are trying to get the child to do routine tasks, homework and the child procrastinates, protests at being overwhelmed by what are really quite manageable tasks and is easily irritated, frustrated and very impatient. And yet cannot finish things they have started. They will daydream, appear not to be listening and will tend to misunderstand directions and instructions. As they grow, getting up in the morning can be a problem and the child often appears sleepy during the day. A tendency to obsessions and perfectionism can develop.

From being a coliky, crying baby the typical AD/HD child usually progresses through a hyperactive toddlerhood and often the nursery will bring up concerns of lack of concentration, and possibly impulsivity. The emotionally secure child learns to soothe themselves after a stressful episode, but a chemically deficient child remains miserable, and will cry or scream to exhaustion. When this is at an extreme level the child grows up unable to read the emotions of others and so stumbles into conflicts that emotionally literate children can avoid. These AD/HD children may not learn to empathise with others problems and fail to develop good relationships.

There is a cascade of neurochemistry shown to be lower than normal in children who have poor attention spans and a consequent hyperactivity. The major chemistry deficit is Dopamine, which structures working memory, attention and also is our feel good factor, that gives us the buzz after completing a goal. That being the case low Dopamine levels tend to go with low self-esteem and lack of motivation. True AD/HD which is genetically determined is thought to be due to a dysfunction in one of the Dopamine receptors and there is a corresponding decrease in the brainwaves of alertness and an increase in the brain-waves that are correlated with drowsiness. Thus the child is trying to learn while their brain is still half-asleep and attention cannot be activated or sustained.

To learn effectively the child must attend to the information. Unless the attention span is long enough to consign what is learnt to long term memory, information is forgotten and new skills come slowly. This further affects concentration and also affects motivation, so that the child is vulnerable to the stresses of life, especially criticism from others which further decreases motivation. That being the case there is little expectation of competence. A perfectionist and rather rigid attitude can develop since fear failing then becomes a dominant motivation. When a task presents challenges it is easier to abandon it rather than persevere. In the classroom it is difficult to concentrate on routine learning with the effect that only activities of strong interest can motivate the child to keep on task. Sometimes particular interests (or avoidances) will be developed to the exclusion of almost all else. The stresses and mood of the day will affect performance so that the quality of schoolwork is inconsistent.

Other family members may have related problems such as alcoholism, addiction, tourettes syndrome, social phobias, allergies and other learning difficulties such as Dyslexia and Autism. In fact Dyslexia co-exists with AD/HD in about 30% of cases.
(Blum K. The Reward Deficiency Theory, Scientific American 1992)

However, prolonged stress, long term abuse and troubled, insecure relationships can alter neurochemical systems even in children who are not genetically vulnerable. When the stress hormones flood the emotions constantly it damages both emotional and immune systems. The child becomes hypervigilant, constantly on the lookout for insults and can misperceive threat and may therefore often gets into fights. They will have a short attention span which looks very much like AD/HD.

The working memory weakness in AD/HD means that it is difficult for the child to remember lists, instructions, polysyllabic words, long sentences and even abstract words and concepts. Added to which much parental communication is necessarily short No/Stop it/Give it back/Don’t do that! etc. rather than complex philosophical discussions, so conversational skills are often less good than in non-AD/HD children.

At school the child will be distractible, tend to give up easily, never trying again. They will have difficulty remaining seated, tending towards impulsive grabbing, interrupting and intruding on others. There will often be an inability to wait for his/her turn and the AD/HD child will start off on work before listening to the instructions. They will be better at concrete subjects than abstract ones and although they may talk incessantly will still be a loner. Social skills are lacking.

As the AD/HD child grows older the impulsivity, difficulty in suppressing responses, the lack of foresight and uneven motivation that is seen as normal for a child can become stubbornness, obstinacy and negativism. Such a decline is often accompanied by mood swings, a low frustration point, temper outburst, maybe bullying and low self-esteem. If this difficult adolescence period coincides with criticism and punishment the adolescent is likely to develop these characteristics as part of their personality and go on to some form of delinquency by 17 years of age. Even if this doesn’t happen they may have a driving, tense mode of life, changing job frequently and the childhood unfinished hobbies become adult unfinished projects. This personality is especially vulnerable to addictive drugs and dangerous activities.

On the other hand with self-awareness/management strategies and a job that offers variety the distractibility can become a high energy level, with the AD/HD adult zipping around, motivating others, thinking laterally and painting creative visions of the future. Included in the right job would be a secretary following along, taking care of the details.

The assessment of Attention Deficit is a combination of the genetic, childhood and medical History with teacher and parental ratings of current behaviour. Age-oppropriate attention Span is measured by one or other of the standard computerized attention tests. An I.Q. test is usually done since there is often a suggestive discrepancy between the reasoning scales And the scales measuring distractibility and speed of processing.

Strategies include reinforcement for lengthening attention span and desirable behavior, self-awareness/monitoring and thinking strategies, activity regulation, social skills groups, neurofeedback, nutritional intervention, identification of food and substances the child may be allergic to, and/or medication.