June 9, 2020 / By thadmin2
What is Attention Deficit/Hyperactivity Disorder (ADHD)?
Attention Deficit/Hyperactivity Disorder, also known as ADHD, is one of the most common neurodevelopmental disorders. It impacts parts of the brain that helps us to plan, focus and execute tasks. As a neurodevelopmental disorder, ADHD usually first develops and is diagnosed during childhood where inattention during lesson times becomes more prominent and impairing, and its symptoms often last through adolescence and adulthood (Centers for Disease Control and Prevention (CDC), 2021). However, some individuals are diagnosed with ADHD only in adulthood, but they would have had certain ADHD symptoms present of varying intensities when they were younger. As this disorder is relatively stable throughout the years, adults who have ADHD might show more symptoms of inattention than hyperactivity.
While it may be normal for children to be active, impulsive and inattentive, children with ADHD tend to display these behaviours persistently, across various situations. ADHD can cause one to feel restless and have trouble concentrating on tasks at hand, as it can be difficult for these individuals to keep a calm physical and mental state. This can result in problems as it makes everyday life difficult. For example, ADHD may cause poor job or academic performance, complications in interpersonal relations with friends or family, and even low self-esteem (Ministry of Health Singapore, 2019).
Diagnosis & Symptoms
ADHD can be diagnosed under one of these 3 major types – hyperactivity type, inattentive and distractible type, as well as, combined type (The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System, 2021). The severity of the symptoms and how much it affects an individual can also vary on a spectrum to be mild, moderate or severe (CHADD, 2021).
Hyperactive type. Individuals with ADHD who fall under this category tend to display impulsive behaviours, but are not inattentive nor easily distracted. This is the least common type of ADHD. Some common symptoms include (National University Hospital, 2021):
- Fidgeting, or feeling restless
- Having difficulty sitting still
- Having trouble engaging in quiet activities, talking constantly
- Touching and playing with objects, even when inappropriate to the task at hand
- Acting impulsively and not thinking about consequences of actions
- Being impatient, blurting out answers and inappropriate comments
Inattentive and easily distractible type. This type of ADHD is characterized predominately by inattention and distractibility, but without the hyperactivity element. For individuals who fall under this category, common presenting symptoms include (National University Hospital, 2021):
- Missing details and being easily distracted, getting bored quickly
- Having trouble focusing on a single task and following directions
- Having difficulty organizing thoughts and learning new information
- Often lose pencils, papers, or other items needed to complete a task
- Moving slowly and appear as if they’re daydreaming
- Processing information slower and less accurately than others
Combined type. Finally, this is the most common form of ADHD where the presenting symptoms do not fall exclusively in either the inattentive or hyperactive ADHD type. It is instead a combination of both hyperactive and impulsive behaviours, in addition to being easily distracted (CHADD, 2021).
ADHD is the most commonly diagnosed behavioral disorder in childhood. A pediatrician, child psychiatrist, or a qualified mental health professional usually diagnoses ADHD in children only after a thorough clinical assessment, e.g. the Behaviour Assessment System of Children – Third Edition (BASC-3). The assessment will include a detailed history of the child’s behavior, which will be gathered from an interview with the parent or significant caregiver of the child. Information that will aid in understanding the child’s condition will also be gathered from other adults in the child’s life, e.g. teachers, close relatives. Certain tests may also be used to rule out other conditions, or to test intelligence and certain skill sets, when required (The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System, 2021).
It is important to note that children with ADHD exhibit these symptoms, not because they wish to defy a parent’s or teacher’s instructions, but because they suffer from cognitive impairments that reduce their ability to restraint and control their behaviours.
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How does one develop ADHD?
Despite being one of the most researched areas in child and adolescent mental health, the precise cause of the disorder is still unknown. As with many other disorders, several risk factors contribute to the development of ADHD.
Twin studies suggest that genetic factors have a role to play in the development of ADHD. In addition, cigarette smoking, alcohol use, or drug use as well as being exposed to environmental toxins during pregnancy are also considered to be at the top of the list when considering what causes ADHD (Healthline, 2018). As such, current research supports the idea that ADHD may be attributed to the interaction between genetic influences and external environmental factors that increases susceptibility of the fetus to developing ADHD (National Institute of Mental Health, 2016).
A common misunderstanding is that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or dysfunctional familial environment. Although these factors might worsen the symptoms already pre-existing in certain individuals, there is no evidence strong enough to suggest that these factors are the main cause of ADHD (CHADD, 2021).
Therapies to treat ADHD in children and youth
Although there is no cure for ADHD, early detection and intervention are crucial in reducing the severity of symptoms, decrease the interference of behavioral symptoms on school functioning, and improve the quality of life experienced by individuals with ADHD. ADHD is commonly treated with medication, behavioural therapy, or a combination of treatments (National University Hospital, 2021). What works best is dependent on the child and family. Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.
Here are some of the therapies that may help a child with ADHD:
- Behavioural Therapy
- Neurocognitive Therapy (can be used to complement Behavioural Therapy)
- Art Therapy
- Music Therapy
- Animal-assisted Therapy
An inability to control their attention and behaviours is characteristic of ADHD. As typical classroom learning requires a child to sit at a desk for continued hours while listening quietly to a teacher, children with ADHD (even those with mild ADHD), might struggle with mainstream education. Besides receiving poor grades, teachers might also view the child as disruptive and disrespectful during lesson timings.
As children with ADHD often display behaviours that are disruptive to others, behavioural therapy can be used to reduce these behaviours. This can be achieved by replacing bad behaviour with good ones and strengthening positive behaviours. Behavioral therapy is recommended as the first line of treatment before medication is tried. This is because the long-term effects of ADHD medication can have are not well studied (Centers for Disease Control and Prevention (CDC), 2021).
Especially for ADHD, neurocognitive therapy has been consistently proven as an effective means to help improve attention span and reduce impulsiveness in children. Neurocognitive therapy is typically implemented alongside behaviour therapy to improve the brain’s ability to sustain concentration for prolonged periods of time. Through playing interactive games and monitoring brain activities through a Neeuro SenzeBand on two digital platforms, children with ADHD can learn better self-regulation skills in a fun and engaging manner while improving their abilities to sustain their attention on tasks. The first digital platform which we use to administer neurocognitive therapy is the Memorie mobile application, which is administered to both children and teenagers. This application targets attention levels in addition to other main executive functioning skills such as working memory and cognitive flexibility, among others. Another digital platform we have recently launched this year is Cogoland, which is an attention training programme targeted specifically for children with ADHD between the ages of 7 to 12. Cogoland utilises a non-invasive Brain-Computer-Interface (BCI) game to measure the neurofeedback levels of children, to track the progress of their attention levels throughout the course of therapy.
The use of neurocognitive therapy, together with behaviour therapy, can increase the self-control and attention span of children with ADHD, therefore, significantly enhancing their ability to cope with school, social interactions and their daily activities.
Education in Singapore for children with ADHD
In Singapore, there are several Special Education (SPED) schools that have been established to support children and youths with special needs. Learn how to identify a school that would best support your child with Special Educational Needs (SEN). Prepare criteria for entry to SPED schools which typically include:
- A diagnosis
- Intelligence Quotient (IQ) assessment
- Adaptive behaviour assessment [may also include school (on-site) observations]
- Psychologist’s report
Tips for parents of a child/teen with ADHD
- Use goals and praise or other rewards. Letting your child know they have done well by rewarding their efforts is a good way to maintain and encourage positive behaviours. Be sure to set realistic and achievable goals, so as not to discourage yourself or your child — small steps are important!
- Creating a routine and being organised. Routine and structure is very important for children with ADHD. Try to follow the same schedule every day, from wake-up time to bedtime. It is also recommended to help your child break down complicated tasks into simpler, shorter steps. For longer tasks, taking breaks may help to reduce stress and manage their attention levels on the task/activity at hand.
- Managing distractions. Be sure to remove all distractions, e.g. turning off the TV, limiting noise, and providing a clean and quiet workspace free of visual or auditory distractions, when your child is doing work. However, some children with ADHD learn well if they are moving or listening to background music. As such, parents can try different strategies with your child to see what works best for them.
- Limiting choices. To prevent your child from feeling overwhelmed or being overstimulated, offer them choices with only a few options. For example, have them choose between only 2 choices, either this meal or that, or this or that toy.
- Use clear, simple and specific instructions. Children with ADHD may have a hard time processing long and unclear instructions. This may cause unnecessary stress and confusion that will result in overstimulation. As such, parents should use clear, brief directions when you need your child to do something. It is also helpful to let your child know that you are listening by describing or repeating what they have said.
While guidance and understanding from loved ones and teachers are crucial for children and adults with ADHD to reach their full potential, this may also be physically and mentally draining for parents, partners and caretakers. As such, it is essential to ensure that you also have the proper support and guidance in managing and supporting your child, for instance by joining parent support groups to connect with others who have similar problems and concerns. This will greatly help in times when you might feel discouraged. Furthermore, support groups are a great place to source advice from the horse’s mouth, when at a loss of how to handle situations related to ADHD (National Institute of Mental Health, 2016).
At Thrive Psychology Clinic, we are committed to providing effective and efficient support for every child, adolescent or adult in their mental health. If you believe that your child may be struggling with behavioural/mental health issues, feel free to contact us via email: email@example.com or call: 6962 9753 and we will be happy to assist you.
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- Centers for Disease Control and Prevention (CDC). (2021). Attention-Deficit / Hyperactivity Disorder (ADHD).Retrieved from Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/ncbddd/adhd/facts.html
- CHADD. (2021). Understanding ADHD. Retrieved from CHADD : https://chadd.org/about-adhd/overview/
- Healthline. (2018). Causes of and Risk Factors for ADHD. Retrieved from Healthline: https://www.healthline.com/health/adhd/causes#smoking-and-alcohol
- Ministry of Health Singapore. (2019). Attention deficit hyperactivity disorder (ADHD), a condition that is typically associated with children, can also affect adults. Retrieved from Health Hub: https://www.healthhub.sg/a-z/diseases-and-conditions/665/adhd-in-adults
- National Institute of Mental Health. (2016). Retrieved from National Institute of Mental Health : https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics
- National University Hospital. (2021). Attention Deficit Hyperactivity Disorder (ADHD). Retrieved from National University Hospital: https://www.nuh.com.sg/Health-Information/Diseases-Conditions/Pages/Attention-Deficit-Hyperactivity-Disorder-(ADHD).aspx
- The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. (2021). Attention-Deficit / Hyperactivity Disorder (ADHD) in Children. Retrieved from The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System: https://www.hopkinsmedicine.org/health/conditions-and-diseases/adhdadd