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Alison McClymont Pscyhotherapy - Hong Kong
Navigating the minefield of ADHD

Navigating the minefield of ADHD

So your child has been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) or you suspect that they might have the condition. As we so often do in our age of omnipresent technology when looking for information, you type the letters “ADHD” in to Google and you are confronted with an overwhelming amount of conflicting information.

Is ADHD real?

There are various “reports” and “law suits” saying that the condition is a “hoax” and has been fabricated by multi-billion dollar conglomerates to sell their drugs, along with some very convincing financial data alongside yet more “reports” from serious looking medical sources shouting from the rooftops about their “conclusive findings” for the causes for ADHD. So what do you do?

Firstly, lets look at some figures:

  • ADHD was formally recognized by the APA (American Psychological Association) in 1968 ,when the DSM II listed it as “hyperkinetic impulsive disorder”, later changed to Attention Deficit Disorder in 1988.
  • There is no “agreed” cause for ADHD, some suggest that it is caused due to low levels of dopamine and noriepinephrine in the brain. Some believe, such as American psychiatrist Dr Bruce Perry, that the condition is not a “condition” at all and is simply a list of behavioural concerns.
  • APA currently estimates that 5 % of children suffer from ADHD, however actual diagnoses rates are higher, with figures reaching 11% in 2011
  • The average age of diagnosis is 7
  • ADHD medication and its uptake varies greatly according to geographical location with 6.5% of children in the US being treated using pharmaceutical methods and 1 % of children in the UK. However that 1% is a 50 per cent increase from five years ago.
  • Males are 3 times more likely to be diagnoses than females.
  • Symptoms of ADHD typically begin between the ages of 3-7

Next lets take a look at the symptoms as described in the current DSM V:

People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:

  1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
  • Often has trouble holding attention on tasks or play activities.
  • Often does not seem to listen when spoken to directly.
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
  • Often has trouble organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
  • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
  • Is often easily distracted
  • Is often forgetful in daily activities.
  1. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
  • Often fidgets with or taps hands or feet, or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected.
  • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
  • Often unable to play or take part in leisure activities quietly.
  • Is often “on the go” acting as if “driven by a motor”.
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed.
  • Often has trouble waiting his/her turn.
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

  • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
  • Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.

The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Ok so now we have some idea of facts and diagnosis markers, where do we go…

Well a good first point of call for any individual or parent suspecting that they or their child might have ADHD is to seek the advice of a qualified professional. You will then usually be confronted with the option to adopt a pharmacotherapy approach (ie to take medication, usually Ritalin or Adderall), to receive some form of behavior managing or reducing therapy, or a combination of both.

But what do YOU do…

Lets consider first the pharmacotherapy approach:

ADHD symptoms can be reduced through the assistance of medication and the internet will be full of testimonies and various reports citing this. However medication is generally seen by ADHD experts as a tool not a cure. The reason for this being, the side effects of the medication such as feeling jittery, dry mouth, stomach complaints, headaches etc, are sometimes unmanageable and to remain on medication for a prolonged period is not an option for some people. Another reason being, that some people simply do not like the prospect of medicating a behavior problem irrespective if the cause of the condition is generally shown to have a neurological basis. Also some people may not believe that the symptoms are not a result of organic disturbance in the brain chemistry and therefore do not need to be treated with medication.

If you do choose to go down the medication route, and there are many people that do and happily so. Things to consider, with your doctor, might be:

-what are the possible symptoms and what is their likelihood of appearing? (For example some of the symptoms may be less common than others and may in fact be extremely rare)

– is there a history of psychiatric problems such as bipolar disorder or schizophrenia in the family as these medications may exacerbate certain factors of these illnesses

-is there a history of cardiac problems in the family, again these medications may interfere with the heart functionality

– what does the person taking the medication feel? Do they think it is working?

-Is the medication having a generally positive impact?

All of these ideas should be considered and monitored throughout the life course of the medication with a Doctor. Only a medically trained Doctor such as a psychiatrist can prescribe, or advise on the appropriateness and dosage of any given medication. A psychologist or therapist should not be consulted in this regard as they do not have sufficient training or jurisdiction.

If you do not want to adopt this approach or would like to combine pharmacotherapy with a therapy approach, what should you consider:

Therapy can provide a child or a family with a set of strategies or coping mechanisms to deal with symptoms of ADHD, particularly a therapy approach that involves managing anger or controlling impulsive behaviours. Mindfullness techniques for example, have been shown to be particularly effective in this regard, as they offer a set of skills to reduce stress levels, to attempt to monitor and control ones behaviour, as well as generally promote a feeling of wellbeing.

Arts therapies or indeed any creative activity increases dopamine- a chemical thought to be low in the brain of an ADHD sufferer. Through creative activity the brains natural stress reducers are engaged and the focus is encouraged. Creativity is also a great way to increase a persons range of expression and their own self confidence, particularly useful for an ADHD child who might find themselves constantly being told off by a teacher for not “concentrating” or not “sitting nicely like the other children”. I talk more about the connection of ADHD and creativity in my blog post “Creative therapies for ADHD”.

Cognitive behavioural therapy can help people in managing their responses to thoughts, which may be hugely beneficial for someone with the impulsive desires of an ADHD sufferer. Behavioural approaches also help to reduce certain behaviours by praising the “good” and trying to diminish the “bad”. Consistency is the key with any approach but particularly with a behavioural one. Studies have shown that such approaches greatly reduce the presence of ADHD symptoms, as long as it is maintained and consistent.

Lifestyle choices also to consider for treating ADHD

  • Get your sleep!
  • Eat a balanced and highly diet, low in stimulants such as caffeine and sugar and high in brain chemicals such as zinc and magnesium
  • Get outside! Studies have shown that 30 minutes in the open air can greatly assist in reducing the symptoms of ADHD
  • Get exercise! This reduces stress, burns off energy and promotes a healthier, happier individual.

So with all this in mind- where do you go? As mentioned previously if you are concerned that your child has ADHD seek the advice of a qualified therapist or doctor and discuss your concerns with them. If you choose to adopt a medication approach, a medical doctor must be consulted and continue to monitor the effectiveness of the medication and any symptoms. If you chose to adopt a therapy approach, remember that everything is trial and error and it may take a few different approaches or styles to find the one that suits you and your family. Don’t be afraid to ask someone if you can a have a few “trial” sessions or to enquire more about their background or the approach they will be using. As with any form of therapy it is imperative that the goal between client and therapist should be one of shared trust and mutuality- don’t be afraid to ask questions and don’t be afraid to challenge!

 

 

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