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The ADHD Workbook for Parents
A Guide for Parents of Children Ages 2-12 With Attention-Deficit/Hyperactivity Disorder
By Harvey C. Parker
Specialty Press, Inc.Copyright © 2005 Harvey C. Parker
All rights reserved.
What is ADHD?
A June 2005 report released by the Center for Disease Control indicated that about five percent of children in the United States suffer from difficulties with emotions, concentration, behavior, and getting along with others. These children and their parents and caregivers are often upset and distressed by these difficulties and require support and services. Children with Attention-Deficit/Hyperactivity Disorder (ADHD) make up a significant proportion of this group.
Hardly a day goes by that there isn't an article published in a local newspaper, national magazine, or on the Internet about ADHD. Television talk show hosts have addressed the topic and professional journals and texts in psychology and medicine contain numerous research papers on this disorder. Parent support groups have been forming since the mid-1980's throughout the world to assist families of inattentive and hyperactive children and provide a forum by which parents could exchange information and experiences about raising a child affected by ADHD. In the past ten years, interest in ADHD in adulthood has skyrocketed as we have become aware that this is not just a childhood disorder, but one that can significantly impact the lives of adults as well.
Some of the fervor about ADHD has to do with the medication controversy surrounding the treatment of ADHD. Perhaps interest in the disorder is being generated by parents advocating on behalf of their children to ensure their rights to quality education. Perhaps more attention is being paid to ADHD because we've come to realize that it has very important long-range consequences as we learn that it can have a serious impact on the educational achievement, career attainment, mental health, and overall quality of life of sufferers. No matter the reason for all this interest, it can only do some good. It's hard enough to raise children these days, let alone children with ADHD. Both the parents of children with ADHD, and the children themselves, need help.
Most parents of children with ADHD feel alone. As awareness of ADHD grew, parents found information and support in books, articles, and on the Internet. They realized that the problems they and their child experienced were not unique. Mothers, in particular, and especially mothers of young children with ADHD who are hyperactive and impulsive, frequently feel estranged from other parents. Feelings of parental self-doubt, despondency, and loneliness can easily develop. When these parents meet other parents of children with ADHD, an immediate bond is formed by virtue of a common understanding. The loneliness begins to lessen. Many of these parents describe very similar experiences.
"Whenever we go out to a restaurant, my husband and I spend most of our time reminding Jessica to sit still. She's just impossible to take anywhere. She's always going ninety miles an hour."
"Robert just got his license to drive eight months ago and already he's gotten two tickets and was involved in one accident. He's always in a rush and doesn't seem to think things out before acting."
"I never know what to expect when I pick Steven up at school. I can't believe he's only four and already, everyday he gets a bad report from the teacher. I feel like it's my fault. Just once I'd like to pick him up and see his teacher smiling at me."
"My husband and I can't understand it. We fought with Allison all night to do her homework. First, she didn't remember what to do for homework. Then, when we figured out what the assignment was, she didn't know how to do it. After a two-hour struggle, we finally got it finished. Then, to top it off, this afternoon we got a call from her teacher who told us that she didn't hand it in."
Most parents take their children's behavior for granted. When they go to a movie, parents generally anticipate that their children will watch intently, perhaps asking once in a while for a refreshment. On shopping trips most children tag along with their parents, perhaps occasionally getting impatient and out of hand. When most parents go to open school night they are generally looking forward to seeing their child's classroom and are optimistic that they'll be warmly greeted with a good report from teachers. While such positive experiences are commonplace for most parents, they are often quite uncommon for parents of children with ADHD. Such children, due to their inherent restlessness, excitability, over-exuberance, impatience, and inattentiveness, can turn the most routine family or school day into a problematic situation. Parents frequently blame themselves for their child's problems and often try countless different ways to help their child make a better adjustment.
ADHD is a neurobiological disorder that affects between five and seven percent of the population of children and adolescents and between one and three percent of adults. It is characterized by attention skills that are developmentally inappropriate, and, in some cases, impulsivity and hyperactivity.
Symptoms typically appear in early childhood, although some children develop ADHD later as a result of brain injury from illness or injury. Symptoms may persist into adulthood and can pose life-long challenges. The official diagnostic criteria state that symptoms must occur before age seven, however, there is disagreement among researchers, some arguing that the onset criteria should be broadened to include anytime during childhood.
Early ADHD researchers were primarily concerned with the symptoms of hyperactivity and impulsivity and gave little notice to inattention as a problem. Researchers in the 1980's realized that many children had serious problems paying attention, but had no problems with hyperactivity or impulsivity. We have come to accept that although inattention may not be as noticeable as hyperactivity or impulsivity, it often causes serious problems for the child.
The name of the disorder has changed several times over the past thirty years, each change reflecting advances in our understanding of this complicated condition. The Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition-TR (DSM-IV-TR) lists Attention-Deficit/ Hyperactivity Disorder as the official name and specifies three types:
Predominantly Inattentive Type for someone with serious inattention problems, but not much problem with hyperactivity/impulsive symptoms;
Combined Type for someone with serious inattention problems and serious problems with hyperactivity and impulsivity; and,
Predominantly Hyperactive/Impulsive Type for someone with serious problems with hyperactivity/impulsivity, but not much problem with inattention.
While the term ADHD is the technically correct term for either of the three types indicated above, in the past the term attention deficit disorder (ADD) was used, and still is by many. For nearly 20 years ADD and ADHD have been used synonymously in publications and in public policy. In this book we will use the term ADHD.
According to the DSM-IV, for a person to have a diagnosis he must often or very often exhibit at least six of the symptoms listed below reflecting either inattention or hyperactivity and impulsivity for at least six months to a degree that is maladaptive and inconsistent with developmental level. These symptoms must have begun prior to age seven, must be evident in two or more settings (home, school, work, community), must impair functioning, and must not be due to any other mental disorder such as a mood disorder, anxiety, learning disability, pervasive developmental disorder, etc.
a. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
b. often has difficulty sustaining attention in tasks or play activities
c. often does not seem to listen when spoken to directly
d. often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
e. often has difficulty organizing tasks and activities
f. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
g. often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
h. is often easily distracted by extraneous stimuli
i. is often forgetful in daily activities
j. often fidgets with hands or feet or squirms in seat
k. often leaves seat in classroom or in other situations in which remaining seated is expected
l. often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
m. often has difficulty playing or engaging in leisure activities quietly
n. is often "on the go" or often acts as if "driven by a motor"
o. often talks excessively
p. often blurts out answers before questions have been completed
q. often has difficulty awaiting his or her turn
r. often interrupts or intrudes on others (e.g., butts into conversations or games)
Complete This ADHD Symptom Checklist
Below is a checklist containing the eighteen symptoms of ADHD. Items 1-9 describe characteristics of inattention. Items 10-15 describe characteristics of hyperactivity. Items 16-18 describe characteristics of impulsivity. In the space before each statement, put the number that best describes your child's behavior (0=never or rarely; 1 = sometimes; 2 = often; 3 = very often).
___1. Fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities. ___2. Has difficulty sustaining attention in tasks or play activities. ___3. Does not seem to listen when spoken to directly. ___4. Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). ___5. Has difficulty organizing tasks and activities. ___6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework). ___7. Loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools). ___8. Is easily distracted by extraneous stimuli. ___9. Is often forgetful in daily activities.
___10. Fidgets with hands or feet or squirms in seat. ___11. Leaves seat in classroom or in other situations in which remaining seated is expected. ___12. Runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness). ___13. Has difficulty playing or engaging in leisure activities quietly. ___14. Is "on the go" or often acts as if "driven by a motor." ___15. Talks excessively. ___16. Blurts out answers before questions have been completed. ___17. Has difficulty awaiting his or her turn. ___18.Interrupts or intrudes on others (e.g., butts into conversations or games).
Count the number of items in each group (inattention items 1-9 and hyperactivity-impulsivity items 10-18) you marked "2" or "3." If six or more items are marked "2" or "3" in each group this could indicate serious problems in the groups marked.
How the Types of ADHD Compare
Within the general population, children with the inattentive type outnumber those with the combined type or the hyperactive-impulsive type. However, children with the combined type are more commonly referred to clinics for treatment of ADHD over the other two types. Children with the combined type of ADHD are more likely to have problems with behavior than children with the inattentive type. Those in the combined type are at greater risk for associated problems like oppositional defiant disorder, conduct disorder, tics, and bipolar disorder. These are called co-occurring or co-morbid conditions. They will be discussed in more detail in the next chapter.
Children with the inattentive type are often described as daydreamy or "in a fog." They frequently need reminders to stay focused on a task to completion. They may be under-active rather than over-active and they are often sluggish and complete tasks after others. Even motor activities that don't require a great deal of concentration, like getting ready in the morning, picking up their room, or taking the garbage out, may take longer to complete than average. Because they are sluggish and excessively daydreamy, these children may miss out on learning activities and opportunities to interact. They may be more reluctant to initiate social contact, and they may be more passive than others. They tend to make a greater number of errors on academic tasks or tasks that require sustained concentration because they have difficulty staying focused and outputting a consistent amount of energy to complete the task.
Children in either of the ADHD types show more impairment than children without ADHD on measures of intellectual functioning and academic achievement and are at greater risk for problems in school. Those with the combined type are also more likely to be put into special education classes.
As compared to children who are inattentive alone, those in the combined group tend to be identified earlier because of their behavioral and social problems resulting from impulsivity and poor self-control. Problems with self-control are more easily noticed at younger ages than problems with inattention. Even at age two children who are very hyperactive, impulsive, demanding, and fussy stand out. Children who are quiet and passive don't. Young children are not required to pay attention for long when they are in preschool or in the primary grades. Often it isn't until fourth or fifth grade that more seatwork is given requiring the child to complete work that takes considerable attention and time. While teachers of primary age children may be concerned about the inattentive child who is having trouble completing work or learning, they may not consider the problem to be serious until the child goes on to fourth or fifth grade.
The ADHD research is almost exclusively on children with the combined type. We don't know very much about treatment of children with the inattentive type. We know that all three types respond to ADHD medications. This improves attention and has additional benefits with regard to behavior, eye-hand coordination, and short-term memory. Approximately ninety percent of ADHD children with either combined or hyperactive-impulsive type will have a positive response to stimulants. Fewer of the inattentive children have such a robust positive response. When they do, they may be able to benefit from lower doses of medication than those who are hyperactive and impulsive. The most important issue affecting treatment of children who have different types of ADHD is the presence of associated disorders. For example, disruptive behavior in the form of opposition, defiance, and rule breaking occurs more frequently in children who exhibit signs of hyperactivity and impulsivity as opposed to inattention alone. Problems related to associated disorders will be more fully discussed in the following chapter.
What About Girls with ADHD?
The vast majority of research done in the area of ADHD has been done on boys with very few girls included. In 1999, psychiatrist Joseph Biederman and his colleagues from Massachusetts General Hospital studied a large group girls between ages six and eighteen with and without ADHD and compared the two groups. Of the girls who had a diagnosis of ADHD, fifty-nine percent had the combined type, twenty-seven percent had the inattentive type, and seven percent had the hyperactive-impulsive type. Girls in the ADHD group were more likely to have problems with conduct, mood, anxiety, and substance use than those in the non-ADHD group. Although the girls with ADHD did exhibit disruptive behavior disorders, the frequency was about half as compared to boys with ADHD. However, the rate of mood and anxiety disorders in the ADHD girls group was about equal to that found in boys with ADHD. There was an indication that problems with substance use were more common among girls with ADHD than had been previously found to be true for boys. For example, girls with ADHD were about four times as likely to be smokers. In comparing cognitive skills and academic performance of girls with ADHD and those without ADHD, the ADHD girls were about 2.5 times more likely to be diagnosed with a learning disability, more than sixteen times more likely to have repeated a grade in school, and almost ten times as likely to have been placed in a special class at school.
Psychologist Stephen Hinshaw and his colleagues studied girls with ADHD who were attending a summer treatment program at the University of California, Berkeley and found that compared to a matched control group of non-ADHD girls, they were very impaired academically and socially. Another psychologist, Kathleen Nadeau, has written extensively about ADHD in girls as has Ellen Littman and developmental pediatrican, Patricia Quinn. Their book, Understanding Girls with ADHD, is an excellent resource.
Excerpted from The ADHD Workbook for Parents by Harvey C. Parker. Copyright © 2005 Harvey C. Parker. Excerpted by permission of Specialty Press, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Contents1 What is ADHD?,
2 Associated Problems or Co-morbid Disorders,
3 Across the Lifespan,
4 Causes of ADHD,
5 Getting a Good Assessment,
6 Parenting Strategies to Manage Behavior,
7 Strategies to Improve Learning in School,
8 Handling Homework,
9 Teaching Your Child Study Strategies,
10 Understanding Your Child's Educational Rights,
11 Medication Management of ADHD,
References and Resources,