“If we train a bird to run, will it run as fast as a cat? It won`t. if we treat the bird as we would a cat, we will see that the bird is slower and sluggish, clumsier than the cat. Our conclusion is then that the bird has a deficit. But if we adapt and let the bird show us what it truly is, we will notice her wings, which we hadn’t known even existed. Than we will realise the deficit wasn’t in the bird, but in our view of the bird. The bird is no more or less than the cat, but is instead simply different than it.
And don’t forget that which is most important – the wealth of the world is in its diversity.”
Marko Ferek, (2012), Hyperactive Dreamers
In October we dedicate a week to ADHD. Articles, lectures, round tables, radio shows… all dedicated to bring attention to the most common disorder in school-age children, present also in the adult population – ADHD or Attention Deficit Hyperactivity Disorder. At this year’s conferences, a learning program Play Attention (games to help with holding attention) will be presented. Play Attention learning system is a successful method of increasing concentration for all individuals, but particularly children and adults with ADHD. It is advisable that parents and educators familiarise themselves with it.
What is ADHD?
ADHD is considered the most common mental disorder affecting children today, present also in adults. It’s diagnosed according to DSM IV (Diagnostic and Statistical Manual of Mental Disorders). It occurs in 3-8%, by some newer data even up to 10% of school-age children. It is more common for boys, affecting then 4-5 times more. The main symptoms, indicators of ADHD are inattention, hyperactivity and impulsiveness. Not every child exhibits the same behaviour, as the symptoms can vary in intensity, and occur in different ways in different situations.
To this day, the exact causes of ADHD have not been determined. Many parents often ask themselves where they went wrong in raising their child, but they are not the cause of their child’s behaviour. It is most likely that ADHD has a biological basis, meaning that it is a neurobiological dysfunction of brain that can be inherited or acquired, although its physiological mechanisms are not yet completely clear. The newest genetic research suggests that although it can be inherited, ADHD often doesn’t show symptoms in parents, like with many other inherited disorders. The same research tells that 30-40% of relatives of individuals with ADHD have the same problem. It can also be acquired due to various states affecting the brain of a person.
What are the symptoms and types of ADHD?
ADHD doesn’t manifest the same for every child, and so their behaviour can differ. Children with ADHD can have combined difficulties of inattention, hyperactivity and impulsiveness, or the disorder can manifest only in some or even one area. That is why ADHD can be said to have three main types:
– ADHD with combined characteristics of hyperactivity, impulsiveness, and lack of attentiveness
– ADHD with inattention as its primary characteristic
– ADHD with impulsiveness and hyperactivity as its main features.
The first and third type of ADHD are the most commonly recognised ones due to children having very visible and obvious symptoms. They are loud, constantly in motion, often involving themselves in risky activities and acting carelessly and impolitely towards others. The second group, mostly of female children, are the so called “quiet dreamers”. Children that have this type of ADHD lose things often, are less able to work in groups, forget to complete their tasks, and are often lost in their own thoughts. They are not concentrated, often inattentive, withdrawn, in their own world. They can be relatively quiet, uninterested, and unmotivated. As they usually don’t bother anyone, the symptoms can often be overlooked and unrecognised.
The main symptoms of ADHD are as follows:
– Inattention/lack of attention – The most common symptom. Besides the problem of directing their concentration on something, people with this symptom often have a problem with staying focused, memory, and work organisation. Such individuals are usually careless, have a hard time beginning boring or monotone tasks, or too demanding ones.
– Impulsiveness – Individuals often act before thinking, they have a problem with assessing or solving problems. They can also have difficulties in developing and maintaining interpersonal relationships. In adults, this can lead to the inability of keeping a long term job or smart money spending.
– Hyperactivity – A hyperactive child can move around, climb or run when it is not appropriate to do so. It can lead to problems in interaction and play with other children. Oftentimes hyperactive children speak a lot and are incapable of sitting still for longer periods of time. Teenagers and adults with the same symptom usually don’t exhibit the same behaviour as is visible in children. They largely feel restless and nervous, and are not able to enjoy reading or other quiet and calm activities.
A child with milder symptoms is easier to stabilise with the help of parents’ attention and teachers’ engagement, plus under the influence of their own growing maturity, then a child with more pronounced symptoms. ADHD often disappears after puberty, but some people struggle with it their whole life. They are the so called “true” hyperactive people.
How do others see an ADHD child?
Children with ADHD are often labelled as “lazy and uninterested”, “rebellious and disobedient”, “rude” …. But in reality, usually they are curious, imaginative, creative, and full of energy. They ask unusual and interesting questions. Boys are more active and impulsive, and girls are often lost in their thoughts, although that trend is not set in stone and varies based on the individual child. Although ADHD children are considered unruly they usually have average or above average intellectual abilities, which can confuse their parents, teachers, and other adults, as they expect better results.
They consider ADHD children as smart and capable, but see that the results they achieve, especially in school, are far below their capabilities because they find it difficult to function in organized and structured situations. Often, due to a lack of recognition of their difficulties, ranging from absence due to loss of attention to extreme restlessness and impulsiveness, these children encounter criticism and unpleasantries in their everyday environment, which leads to a loss of confidence and they feel bad, incapable, and unloved.
It is not uncommon for parents of children with ADHD also receive a lot of criticism, while what they actually need is help and support.
Children with ADHD may also experience additional difficulties in their school environment, everyday life, and learning disabilities. Behavioural difficulties (destructive tendencies, aggression, running away from home), anxiety, and depression can also be observed, largely as a result of constant misunderstanding and criticism by adults that the child encounters as they grow up. Such misunderstandings can cause a child’s resentment with the system and society’s expectations, ultimately resulting in sadness that transforms from internal suffering to external aggression. Because of this, children may have low self-esteem and no sense of self-worth, increasing the probability of risky behaviour in teen and adult years. Therefore, parents who suspect their child is hyperactive and have difficulty coping with their behaviour should seek professional help and support.
When and where do children with ADHD find it most difficult to function?
Children with ADHD find it most difficult to function in well-organized and structured situations that have clear requirements from the child. This is why they find it most difficult to fit in the education system.
Organized systems don’t always differentiate between hyperactive and other children in needed situations, and children need at least a partly individualized approach. Given that hyperactive children are generally more restless, they tend to have a harder time concentrating on the subject matter, are more prone to going off topic and interrupting mid-sentence, or are mentally absent during class, and are as such often labelled as problematic.
The fact is that a hyperactive child objectively often does hinder group work unless there exists an individualized approach in class suited to the needs and problems of the child. Therefore, in the educational system, it is necessary to facilitate the work of teachers by organising specific educations and workshops that help them in their approach and work with ADHD children.
A hyperactive child is often reprimanded and criticized, their parents are being warned about their child’s behaviour which leads to frustration and anger towards both their child and school, the teachers end up dissatisfied and exhausted because suddenly, they’re facing a much bigger problem than just a hyperactive pupil. Reward, not punishment, should be the motive for learning and work with a hyperactive child in school. They need to be shown support, love, empathy and a sincere wish that they succeed in life. It is pointless to waste time changing a child’s personality and making them adjust to other children when that is simply not possible. Ultimately, children with ADHD can, with adult encouragement and proper support, become very successful, enterprising, and creative people.
Celebrities with ADHD!
Throughout the years, many famous people have had or have ADHD, yet they have found now ways, solutions for inventions, innovations, and success in general. They were often first or best at something because they had what they needed, and that is freedom and opportunity to work in their own way and according to their interests. They were able to preserve their ideas, their confidence and make their dreams come true. A number of well-known scientists, artists and actors have had ADHD. It is almost inconceivable that they, too, were characterized as not well behaved during their developmental years, and not successful in school. Some of them are thought to be Albert Einstein, Thomas Edison, Bill Gates, Wolfgang Amadeus Mozart, Leonardo da Vinci, Vincent Van Gogh, Salvador Dali, Alfred Hitchcock, Steven Spielberg, Brendon Urie, Will Smith, to name a few.
Most people, especially children, who have ADHD are not aware of why they function differently than most. They try to, when possible, conceal that, pull on “masks”, feign interest or calmness, but their true character comes out eventually because they are simply different.
Marko Ferek, author of the book Hyperactive Dreamers, in which he wrote about his own experiences as an ADHD person, writes: “If you think you are not good enough, that’s just because you didn’t look deep enough into yourself. And don’t forget what’s important – the beauty of the world lies in the diversity of its people.”
One actor expressed his thoughts like this: “I wondered if I was normal or an idiot, I tried concentrating but just couldn’t do it. I felt discomfort, frustration and boredom.“
To parents of children with ADHD!
Being a parent to an ADHD child is not an easy task, especially when dealing with combined difficulties in all three areas: attention deficit, hyperactivity, and impulsiveness. Parents often feel angry, blame the child and themselves for parenting lapses, may be disappointed, scared, confused, sad, and worried. Sometimes, even though they understand what’s going on with their child, they have little outside help and support and are criticized. Thus, the negative effects circle from parent to child and back, and oftentimes it is very hard to break that cycle. Of course, it is every parents’ hope that their child is happy and comfortable in society, successful in life, and not marked by negative experiences. Parents seek answers and help for the issue of hyperactivity. But one thing is for sure, there is no simple and straightforward solution! Every child is different, every type of ADHD is different. Children react differently even in similar or seemingly identical situations. There are, though, some general tips and pieces of advice that can help parents. If a parent suspects ADHD, it’s important that they consult with a specialist, the child’s doctor, kindergarten or school psychologist, even a counselling psychologist..
It is of utmost importance that parents approach their children with as little anger and blame as possible, and with all of their energy, love, parenting enthusiasm, time and belief to ensure a successful solution. It’s necessary that every child feels like their parents have endless trust and faith in them to succeed. In that way, parents can help their child grow up happier and better. The support of parents and other adults will help children with ADHD to fully realise their potential, even with their specific behaviour.
Experts have been studying ADHD for over a hundred years and have proposed and tested different approaches. Some have proven to be useful, others not so much.
The first step for parents is a certain amount of knowledge about ADHD in order to understand what is even going on, why their child is having problems, that hyperactivity and inattention is not purposeful behaviour, and how to help them and represent their needs when the child in question is not able to. An ADHD child, under pressure from teachers and parents, tries to change their personality, resulting in a lack of confidence, a feeling of less self-worth, frustration and risky behaviour. The child has the feeling of not being good enough, no matter what they do, simply because they are different. So instead of reducing the problem, in only grows! Teachers complain to the parents, parents to children, children internalise those feelings, and don’t know what to do with themselves, creating a belief that no one understands.
A child needs the help and unconditional love of their parents always, but especially when they go through difficulties in their developmental years.
Lately, cognitive-based and attention-capturing games are the techniques getting the most attention, so it is recommended that parents and educators be educated in this direction and apply this way of working with the child.
How is ADHD determined?
Everyone, even professionals such as educators, can fall into the trap of giving an ADHD “diagnosis” to a somewhat livelier child. ADHD can only be diagnosed by a team of experts. Although ADHD is classified in the DSM IV Diagnostic Manual as a mental disorder, every ADHD individual doesn’t manifest the same symptoms, or the intensity and severity of them that requires diagnosis and serious therapy and treatment. However, if one suspects ADHD, it is important to consult with experts on the proper treatment, channelling energy and impulsiveness, ways of maintaining attention….
It’s important that ADHD diagnosis be agreed on by an expert team, consisting of a paediatrician, education-rehabilitation experts (defectologist, speech therapist), psychologist, teacher, paediatric psychiatrist, neuropaediatrician. Parents should start with their child’s paediatrician, and consult with them about their difficulties first.
Also, it is a good idea for a parent to speak with the school/kindergarten or counselling psychologist.
As a rule, ADHD is generally not diagnosed to people with a milder form of hyperactivity, impulsiveness and/or attention deficit, whose behaviour doesn’t pose a significant problem in daily life, that is, if they can function within the constraints of societal expectations. They go through life with a touch greater personal dynamic, creativity, liveliness and a slight absent-mindedness. Those people find it hard to function in the educational system, but not in the workplace or family life.
ADHD is difficult to detect before the ages of four or five because the characteristic behaviour of young children differs more, and because it’s natural that young children and toddlers have a higher motor activity. Hyperactivity and impulsiveness occur at the age of three to four, while attention related problems appear later, at around five to seven years old, and they are most commonly observed only after the child enters the formal educational system.
Correct approach to an ADHD child?
Studies show that the onset of ADHD causes stress in family, especially if the symptoms are severe or if additional difficulties are present (Barkley, 2000).
The parent-child relationship is often made difficult by the child’s symptoms lead to the parent believe that the child’s hyperactive and/or impulsive actions are intentional. These families have a higher risk of parents’ relationship problems, arguments over parenting styles, even the occurrence of depression because the child’s difficulties require a different approach, significantly more time, energy, attention, and organising than is necessary for children without behavioural difficulties.
In addition, parents deal with the problem in the long run due to its chronic nature, which is why they often need counselling and support. Single parents are in a particularly stressful position because they alone cope with the child’s demanding behaviour. On the other hand, because of their inability to control children’s behaviour and their exposure to pressure and criticism, parents often react negatively to their child’s behaviour with punishment and negative emotions which just amplifies the problem.
Therefore, it is necessary to create a stimulating and encouraging environment which provides peace and security to both the child and the whole family.
- Realistic expectations. As parents, we need to have realistic expectations of the child. Although the child may be above average in intelligence, concentration difficulties and hyperactivity will make adequate academic performance difficult. It’s important to realise that a child is not lazy if they cannot sit over a book for long periods of time, and they are not at fault if the failed to concentrate and scored less on the exam. Too high expectations anger and exhaust parents, and create tension and lack of confidence for the child. For example, we cannot expect a child to sit still and concentrated for an hour doing homework like a child without ADHD could, but should instead praise them after 15 minutes of concentrated work, and after a short break, push them to continue again.
- Organized home. It is important that family and daily life is not chaotic and disorderly. A child needs an organised, orderly schedule, with time for studying, fun, practices, and that schedule needs to followed as much as possible! If something is to be changed the child should know about it in advance. It’s good to allow for smaller deviations from the outlined plan, with which we adapt to the child’s needs, but not large changes. Give your child plenty of time to keep his life from becoming chaotic. It they need more time to get ready for school, get them up a bit earlier. Outside organisation helps a child manage their behaviour better.
- Assist the child with schoolwork. They should have a space to work and study in peace, without disturbances. In addition, they need to have necessary breaks that allow for fun and creativity. Help them organise for studying and writing homework. If not you, someone else can occasionally step in and help your child. Of course, at times back away and let your kid do their work on their own. Praise and support them.
- In the evening, help them prepare for the following day at school. Ensure they get enough sleep and eat breakfast before school. Prepare everything necessary to prevent them from forgetting something and getting into trouble for it.
- Agree on important rules that the whole family adheres to. For example, on weekdays, children should get home by 8 pm, if not, they face some kind of consequences. The consequences to rule breaking must exist, but is such a way as to not harm or humiliate anyone, and they have to be clear and well founded. Rules encourage a child’s self-control and help them understand rules in general.
- Be positive. Clearly tell your child what you expect from them, be sure to notice positive behaviour and reward the same. The reward can be anything from a kiss on the forehead to playing games on the computer. Children with ADHD need a lot of praise, rewards for positive behaviour because they are often exposed to criticism. They also should be rewarded for effort, not just success.
- Be sure that your child has heard and understood you. You need to know they understand when you ask something of them. Speak clearly and briefly, look them in the eyes, and ask them to repeat what you said if needed, commend them on a task well done.
- Be consistent. Don’t repeat your request too many times. If the child hasn’t listened, repeat what you said once in a normal tone. If that doesn’t work, follow up with the pre-agreed consequences. Always promise only what you will do. The consequences mustn’t be corporal punishment, anything humiliating or offensive, but instead something like forbidding an activity (playing computer games, going out…) That should not last for long either, because it leads to a decrease of motivation. It’s necessary to give the child a chance to choose the correct behaviour, and then reward that behaviour. It’s not okay to ask them something they are unable to do and them punish them for failing.
- Try to react calmly. Do not react overemotionally, shout or criticise. Wait and think it through before you say something you’ll regret later.
- Support your children forming friendships. An ADHD child has a harder time learning social skills. Try inviting a few of your child’s friends home. Monitor their communication, don’t allow fights, arguments, swearing, and encourage good activities. Reward them with juice, sweets etc. Encourage and reward your child’s good behaviour towards others..
- Encourage them to describe their actions and intentions to prompt inner speech development. In children with ADHD, inner speech is not well developed. People use inner speech to guide their behaviour and actions. It’s good to lead by example – show your child that you talk to yourself when making decisions. Tell them to practice saying “It’s okay. Calm down. It’s not that important. I will talk to a friend.” when mad at someone, or something similar.
- Relax. Make time for something you love while someone else takes care of your kid for a while. Your child requires a lot of attention and you too sometimes need a break and relaxation. Your child needs care, support, patience, love, and encouragement. If you’re exhausted, feeling a lack of energy and strength, seek help from experts, consult a psychologist.
- Believe in your child. Honestly, deeply, and truly believe that your child can and will be successful and that your effort and belief will help them on their journey! Children look for their reflection in their parents’ eyes. If they see you have full faith in them they begin to believe in themselves too!
Recommended reading for parents and youth with ADHD:
M. Ferek (2012). Hyperactive Dreamers – better, worse, different. Giant Beaver Publications.
Nataša Basanić Čuš
psychologist of Healthy City