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Attention Deficit Disorder – ADD

Medical References

1. Burns, J. Roos, L. 2016. Textbook of Psychiatry for South Africa. 2nd edn. South Africa: Oxford University Press.
2. Renynolds, C. R. Kamphaus, R. W. Attention-Deficit/Hyperactivity Disorder (ADHD). America: Pearson; 2013.
3. Mayo Clinic Staff [Internet]. Attentiondeficit/hyperactivity disorder (ADHD) in children. America: Mayo Clinic; [updated 2019 Jun 25; cited
2019 Aug 19]. Available from: https://www.mayoclinic.org/diseasesconditions/adhd/symptoms-causes/syc-20350889.
4. Preidt, R. [Internet]. Lifestyle may be key to improving ADHD in kids. America: WebMD;[updated 2016 May 30; cited 2019 Aug 19]. Available
from: https://www.webmd.com/addadhd/childhood-adhd/news/20160530/lifestylemay-be-key-to-improving-adhd-in-kids.

ADD – Attention Deficit Disorder –  Inattentive Type of disorder

Generally, there are two types of attention deficit disorders:
1. ADD – Attention Deficit Disorder – seen as the Inattentive Type
2. ADHD – Attention Deficit Hyperactivity Disorder – seen as the Impulsive Type
 

ADD is a term used to describe a child who has difficulty focusing and maintaining attention. A child must exhibit six or more of the following diagnostic
criteria to be considered as suffering from ADD:

  • Often has difficulty sustaining attention
  • Often fails to pay attention to detail and makes careless mistakes
  • Often does not seem to listen
  • Often fails to complete work
  • Often has problems with organization
  • Often avoids/dislikes tasks that involve mental effort
  • Often loses things
  • Is easily distracted
  • Is often forgetful
  • Daydreaming or spaciness

Symptoms of ADD may start as early as primary school, where the child has trouble playing quietly, sharing toys, taking his nap and listening.

As the ADD child moves into the second, third and fourth grade, the symptoms become more apparent, with their greatest impact seen in the classroom and during homework. Incomplete work, lying about having homework, tantrums, procrastinating, sloppy
work, and losing the necessary homework items are almost daily occurances.

WHAT IS ADHD?

Attention Deficit Hyperactivity Disorder (Hyperactive-Impulsive Type) is typically referred to as ADHD.
To be diagnosed as ADHD, the symptoms must have been present for more than six months, be inappropriate for the child’s age and intelligence, have developed before the age of seven, and have a negative impact in at least two social settings – home and school for instance

ADHD is a disruptive behaviour disorder characterized by:

  • Excessive physical activity
  • Impulsivity
  • Restlessness, fidgeting
  • Intrusiveness
  • Excessive talking
  • Inability to pay attention
  • These children are excessive in their behaviors. They move too much, interrupt others, intrude on others’ games, cannot settle down and seem to be driven by an endless motor. Typically, they have these symptoms in addition to those of ADD.

These symptoms result in a child who is frequently breaking the rules at home, at school, on the playground and consequently is not favored by adults or peers.

Symptoms of ADHD often appear in the toddler years, with the first sign most often being the child’s constant and seemingly endless physical motion. His inability to
take turns in play and conversation looks very much like the lack of empathy seen in AD. Many children with ADHD are diagnosed with AD
 

Any child with ADHD who has problems with social skills should also be evaluated for AD.These children suffer with low self-esteem even though outwardly the child seems fairly robust. The frustration that can lead to violent outburst is a clear sign of the hopelessness many of these children feel but cannot express.
We can all agree that these children are not living their lives as happily as they could. Daily life is tough for them. They live in a world that they cannot understand.
The ADHD and ADD child is also carbohydrate addicts, sugar junkies, surviving on a diet high in carbohydrates and little else. Parents will say that the child is a fussy
eater. The parents have allowed the child to dictate the diet, working on the premise that it is better that they eat something than nothing

The problem is that the brain’s pleasure center loves the sudden influx of sugars but as the levels begin to fall, craves the next fix. This group of children are often ‘sugar junkies’ and disturbingly, there is strong evidence that this addiction can be carried over into adult life, leading to an addiction to alcohol or drugs. ADHD is a neurodevelopmental disorder. It can start early in life and have a persistent course. It is associated with lasting changes in neural development and frequently accompanied with subtle delays and language problems and social and motor developments which overlap with other
disorders such as Autism spectrum disorder (ASD) and specific learning disorder. [1]

ADHD has two dimensions which contain different behavioural and cognitive impairments [1]:
1. Inattentive (Ina): academic difficulties and peer neglect.
2. Hyperactive-impulsive(H-i): aggressive behaviour and peer rejection.

RISK FACTORS [3]

  • Family history: having a first degree relative with the same disorder or another mental disorder related to ADHD.
  • Exposure to certain neurotoxins such as lead.
  • Drug use, smoking and alcohol use while pregnant: this disrupts the development of the brain of the child.
  • Premature birth.
  • Head injuries at a young age: especially the frontal lobe area that controls impulses and emotions

SIGNS AND SYMPTOMS [2]

One can present with a combined (both inattentive and hyperactive-impulsive), predominantly hyperactiveimpulsive or predominantly inattentive picture

Persistent form of inattention or hyperactivityimpulsivity that interferes with daily functioning or developments. This includes interference or reduction in the quality of social, academic or occupational functioning.
Children need six symptoms for six months; adolescents and adults need at least five symptoms.

1. Inattention (Ina):

  • Careless mistakes.
  • Cannot sustain attention.
  • Does not seem to listen.
  • Avoids tasks that require continuous attention.
  • Difficult in organising tasks.
  • Fails to finish school work.
  • Loses things for tasks or activities.
  • Destructed by irrelevant stimuli.
  • Forgetful in daily activities such as chores or paying bills.

2. Hyperactivity-impulsivity (H-i): Children need six symptoms for six months; adolescents and adults need at least five symptoms.

  • Fidgets a lot: taps hands and/or feet or squirming when seated.
  • Leaves seat when should be seated.
  • Runs and climbs at inappropriate times.
  • Excessive talking.
  • Always “on the go” or acting as “driven by a motor”.
  • Not able to play quietly.
  • Before a question is completed, blurts out the answer.
  • Difficulty waiting for their turn.
  • Interrupts or intrudes on others.
  • Numerous inattentive and/or inattentive-impulsive symptoms present before 12 years of age.
  • Numerous inattentive and/or hyperactive-impulsive symptoms present in two or more setting, that is, at home, school or work.

COMPLICATIONS [3]

  • Struggling to concentrate in school which may lead to academic failure and judgment by peers or others.
  • Have a tendency to have more injuries and accidents.
  • May have low self-esteem.
  • Tend to have trouble interacting with others.
  • Have a high risk of alcohol and drug abuse or other offending behaviours.

LIFESTYLE MODIFICATIONS [3;4]

  • Limiting screen time: this includes computer screen, television screens, iPads, phones, etc.
  • Talk to the doctor about behaviour therapy programs.
  • Limit sugar, whether it be in beverages or food.
  • Drink plenty of water: water can be taken instead of sugary beverages such as juices, soft drinks, energy drinks, alcohol, etc.
  • Sensation of smoking.
  • Get plenty of sleep: set up a sleep routine for themselves.
  • Take medication as directed by the doctor. Set up
    reminders if need be.

IMPACT OF ADHD ON THE FAMILY [1]

  • They may be marital conflict due to physical, emotional and financial strain.
  • Financial burdens: from doctor visits, education or unable to sustain employment, medication and other therapies.
  • Strained parent and other children relationships: as they may feel one child is getting more attention and not being disciplined to their extent.
  • Working parents may not have time to monitor their children all the tine which can increase the probability of the child being involved in offensive
    behaviours such as smoking or drug and alcohol abuse.
  • Aggressive behaviour causing strained relationships in the immediate or with distant family members.
  • Sibling rivalry due to physical and/or emotional aggression.
  • Family members may develop mental or emotional disorder due to all the strain

SUPPORT TECHNIQUES [1]

  • Parent management training which can reduce parent-child conflict and disruptive behaviour, promote social and self-regulating behaviours.
  • Family counselling: where they will educate the family on coping with individual and family stress related with ADHD including mood disturbances and marital strain
  • Support groups which can help connect parents with other parents of children with ADHD or connect people with ADHD, sharing information and experiences.
  • Individual counselling which can help address individual concerns and feelings