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However their long-term memory can be better than a lot of adults'.

Poor peer group relations: not in all cases but quite often these children can be avoided by others due to their behaviour and possible aggressive tendencies.

ADHD can be diagnosed in under-fives contrary to many popular beliefs. A number of children have a history of symptoms going back to the first few weeks of life.

The child's GP should be able to refer a suspected case of ADD/ADHD to either a consultant paediatrician or a child psychiatrist with experience in this field.

Without a diagnosis and/or treatment, these children can quickly lose all self- confidence, self-esteem and become increasingly more difficult to control.

This can lead to truancy and aggressive behaviour when they move into mainstream education, often resulting in exclusion.

It is not uncommon for them to turn to drug, alcohol abuse (a subconscious attempt to self-medicate) and finally a life of crime.

For the rest of the family, this can lead to break-up, depression and, in extreme cases, child abuse.

It is, therefore, vital that those who work with under-fives he aware of ADD/ADHD. Early detection could really make a huge difference to their future lives.

These are only used in extreme cases of ADD/ADHD in under- fives. The most common medications are Ritalin, Dexedrine and Clonidine.

Ritalin and Dexedrine work to help correct the underlying brain dysfunction. Clonidine is used to help curb aggressive tendencies and to help correct poor sleep patterns.

Medications can only be used on the advice of a child psychiatrist or paediatrician who is very experienced in treatment of ADD/ADHD. Careful monitoring and fine tuning of dosages is essential.

How practitioners can help
The first and most important way of helping children with attention problems is to provide a safe and kinaesthetic learning environment. These children learn best from hands-on experience and positive role-play.

ADHD must also be explained to even the youngest diagnosed children so that they can understand their condition.

There are many ways of doing this. One way is to talk about the different way their brains are wired, e.g. a bike with no brakes.

My favourite way is the hunter/farmer theory of Thom Hartman. It tells of how humans had to hunt to live and then how we learnt to farm. The hunter genes are more prevalent in those with ADHD, i.e. quick to change direction, impulsive and restless.

Change must be paced very slowly. Sudden changes to routine and structure should be avoided as they find these difficult to cope with and will more than likely revert to old behaviours.

Give one instruction at a time: it is crucial not to overload the child with short-term memory problems with a list of instructions. Maintain eye contact with the child to make sure he is listening to you and speak clearly.

Try to see the positive behaviour and react to that, with immediate praise. Avoid problem areas and conflict if you know the child will throw a tantrum when for example, you put the sand away. Try to find something else for the child to do before it happens.

Young children with ADHD should be given the opportunity to let themselves go in a safe environment

A child diagnosed with ADHD should at the very least be assessed for a statement of educational need and the authorities informed of the difficulties. Help from the behaviour support team could be useful.

Children with ADHD can appear to have motor skill problems so assessment from an occupational therapist is helpful. About 30o of children with ADHD have speech and language problems. Therefore the involvement of a speech therapist is essential.

Behaviour support is helpful too. Art, music and play therapy can also have good effects in helping the child to focus and pay attention.

Final thought
ADD/ADHD is generally regarded as a disability but we believe that the right help and support at an early enough stage can turn either of these conditions into an ability.

These children have an extra energy that others do not possess and when ii is channelled positively, it can help them achieve great things.

Key points

Basic symptoms Include Inattention, Impulsivity, hyper/over activity and poor short-term memory
ADHD Is a physical condition, a chemical imbalance of the brain, and Is not caused by bad parenting
Medication should only be used in under fives in extreme cases and only if prescribed by a consultant fully trained In ADHD
Early detection and appropriate support can save years of misery for the child, his parents and the staff

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The above article appeared in The Early Years Educator, Volume 1 No.9, January 2000

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