3.4 Attention-Deficit/Hyperactivity
Please note that Attention Deficit Hyperactivity Disorder falls under the classification of Neurodevelopmental disorders because there is research that indicates ADHD begins in childhood affecting the frontal, anterior cingulate areas that are responsible for impulse control, decision making and executive functioning, and self regulations skills. These skills are the mental processes that enable us to plan, focus attention, remember instructions, while managing multiple tasks.
Attention Deficit Hyperactivity was first observed and documented in 1902 by British pediatrician Sir George Still, calling it hyperkinetic impulse disorder. Sir George Still stated that the children he observed with hyperkinetic impulse “experienced abnormal defect in moral control.” He found that some affected children could not control their behavior the way another developing child would, but they were still intelligent. In 1969, the American Psychiatric Association (APA) added Hyperkinetic Impulse disorder to the Diagnostic Statistical Manual (DSM) 2nd edition. (Health Line Media) Finally, in the publication of the DSM III in 1980, the APA changed Hyperkinetic Impulse Disorder to Attention Deficit Disorder. With this new definition the APA created two subtypes, with hyperactive and without hyperactive. After many research initiatives and reports from clinicians, the APA published a revised edition of the DSM III in 1987, changing the name to Attention Hyper Activity Disorder (ADHD) in that edition; this disorder include several symptoms: “impulsivity, inattentiveness, and hyperactivity.”
Please read pages 59-66 in your DSM-5.
GREAT!! You finished reading the required pages from the DSM-5; you now have some understanding of the diagnostic criteria, diagnostic features, and time to gather data. Initially, a strong and comprehensive assessment is required to make the clinical diagnosis of ADHD. Please obtain consent forms in order to review medical history, to consult with teachers who may have this young person in their class, inquire about classroom behavior, relationships with other students, any school related experience (gym class, exchanging classes etc), review academic progress, and any psychological testing that may have been requested. In addition, there are a variety of Child Behavior Rating Scales that can be administered as well. PLEASE always talk with and engage the parent(s) in your treatment. They truly are the experts; in addition, they are our eyes and ears when the client is not with us.
A child diagnosed with ADHD will experience difficulties in every aspect of their life (Home, School, Social), especially when any situation requires one to focus for a period of time. Kids with this diagnosis are at risk for displaying delinquent behaviors; unfortunately, kids don’t receive positive affirmations because of their inconsistency with appropriate behavior.
Treatment Intervention
There are a variety of therapeutic goals you will have to focus on. One of the first areas is to assess the need for a referral to a psychiatrist for pharmacology therapies. NOTE: Many children are treated with pharmacological interventions that includes medications that are considered stimulants ((Dexedrin, Adderall, Ritalin, Focalin to name a few). Be mindful that the scientific community are still studying the long term effects of psycho stimulants on children under the age of 5. In addition, please be aware some medications that are used may come with a Black Box Warning or a Box Warning. What does that mean? These warnings are required by the U.S. Food and Drug Administration for certain medications that carry serious safety risks. Often these warnings communicate potential rare but dangerous side effects, or they may be used to communicate important instructions for safe use of the drug. It’s been my experience and many other professionals’ recommendations including the American Psychiatric Association (APA) to use Evidenced Based Practice (EBP) and behavior therapy for children under 5 years of age.
In addition to pharmacological interventions, one focus needs to address Parent Management Training that will help parents reduce the parent/child conflict that will occur with children diagnosed with ADHD. There are numerous PMT programs that can be utilized, along with targeted behavioral interventions for the classroom management.
All individuals working with the child should be able to use or be aware of: enhanced communication, improvement of self-esteem, impulse control, anger management, increased coping skills, and problem solving skills.
Additional Resources