What is attention deficit disorder?

What is attention deficit disorder?

Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are usually considered together and fall into a category of learning disorders whereby people who experience them have particular, rather than global, problems with their learning in education and other areas, hence the term Specific Learning Difficulties (SpLd). However, there is some ambiguity about how the term Attention Deficit Disorder is applied in the health and education sectors.

According to Wikipedia and other sources, ADHD was known simply as ADD until the late 1980s (1) and this followed controversy about its symptoms, diagnosis and treatment, which dated back to the 70s (2).

These days, although various sources on the web still use ADD to describe the whole spectrum, ADD has generally been subsumed under ADHD, with ADD representing hypodeficit disorder versus the hyperactivity that also comes under the ADHD umbrella  - a distinction suggested some years ago by the US National Association of School Psychologists.

Depending on what source you look at, you’ll find ADHD can be written AD/HD, ADD/ ADHD or AD(H)D or even still just referred to as ADD. For our purposes, we’ll use the umbrella term ADHD to discuss attention deficit disorder with and without hyperactivity.

ADHD as a Specific Learning Difficulty

Children and adults who have ADHD have things in common with those who have other specific learning difficulties such as dyslexia, dyscalculia and dyspraxia, particularly when it comes to looking at how they learn best.

Effects of SpLds can be mild to severe, but they are not related to an individual’s health, intelligence, educational, intellectual or social potential, nor are they related to cultural or class background. The key word here is potential.

Each of these difficulties can throw up its own set of sometimes overlapping significant challenges to be overcome if an individual is to learn, thrive and achieve success in various aspects of life.

But for children with ADHD, as well as for their teachers and parents, living and achieving with an SpLd can be hard work. Strategies and skills for success need to be understood, learned and applied.

Thankfully, knowledge, understanding and support from parents and teachers can make a world of difference.

To succeed students, teachers and parents need to be aware of how aspects and symptoms of the learning differences affect each individual differently. They need to look at how treatment may impact on health and how specifically selected responses and strategies can facilitate behaviour management and support optimal performance and achievement at school.

ADD ADHD as a brain-based specific learning difficulty

Diagnosis and symptoms

There is no definitive test to assess if someone has ADHD. It is believed that neurobiological, genetic and environmental causal factors can all be involved, and there are still differences of opinion on how to approach diagnosis and treatment (3, 4, 5).

Issues around ADHD treatment, particularly medication are controversial in the health and education sectors and differ from country to country. But there is not much doubt that ADHD is now accepted as a neuro-developmental psychiatric disorder and that for some, medication has a place in its remediation.

A number of concerning behaviours attributed to ADHD can also fall within what is considered to be the normal range and it’s not always easy to tell if a child has ADHD without a proper professional diagnosis. In very young school age children, some behaviours are entirely consistent with early developmental delays. Also, auditory perception symptoms can look a lot like ADHD, so it’s important to ascertain that the difficulty is attention rather than perception.

Learn more about recognizing an auditory processing disorder in children with ADHD.

A diagnosis involves many factors including that the concerning behaviours have lasted for a significant period of time, which may begin before the child started primary school, but certainly by the time the child is twelve.

Symptoms may be mild or severe but for illustrative purposes, the descriptions given here are extreme. It has been speculated that children with ADHD – particularly girls - are underdiagnosed and therefore at risk of academic failure.

They sit there quietly, distracted and unfocused, and fail. Their self-esteem is compromised, so they fail again, and it can become a downward spiral. They have poor social adjustment and behavioural problems, not in the ADHD hyperactive way, but by disengaging and not paying attention.

They are easily frustrated because they are not really sure what’s going on around them. It’s hard on them if, for example, suddenly everyone is laughing and they don’t know why; it can be alienating, stressful as well as tiring, and it’s not surprising they might start to act out or that their mental health may suffer. Without appropriate interventions, a long-term consequence of extreme ADHD can be children dropping out of school, delinquency and substance abuse.

If you are a teacher who suspects that a child in your class has undiagnosed ADD or ADHD, you could consider undertaking focussed observations in a couple of different situations  - perhaps English and Physical Education for contrast.

Take notes on the symptoms you observe. Sometimes this is something observers fail to do, but you know the symptoms you are looking for. Perhaps a Teaching Assistant could be delegated to lead the activities while teachers take thorough notes including observations on how the other children react to the child with ADHD in question. These will be invaluable when it comes time to discuss the child with the parent, ask for a classroom observation by a specialist or refer the child for assessment and or help them find treatment.

 

Breakdown of ADHD types in adults

 

Incidences of ADHD

In 2013 The World Health Organisation recognised ADHD as the most common psychiatric disorder in children and young adults, affecting more than 38 million people (6). It is not known why someone develops ADHD, but it is been more commonly observed in boys than girls (7, 8). That’s why for the purposes of this blog, we’ll refer to the single individual with attention deficit disorder as “he.”

Recognising ADHD in children

According to the definition we are using, children with ADHD have attention deficits without the hyperactivity. They are passive and don’t bother anyone.

They can be likeable, but are often rejected by their peers as there’s not much happening around them. If a child has difficulty making and keeping friends, and struggles to engage in social behaviour, it might help to get them to show another child how to do something, or pair them up with a peer to undertake an activity.

You might also allow them to demonstrate something they’ve accomplished to the whole class, even perhaps letting them show off a little as this is a positive behaviour and these might be children who receive a disproportionate amount of negative recognition in academic environments. This can be quite helpful in the treatment of related mental health issues.

Children with ADHD may come across as timid and ineffectual, or phased out as if in a daze. They are quiet and laid back, so particularly in a disruptive class they may disappear into the background and be overlooked for attention. They won’t necessarily ask for help, and you may have to go to them to initiate it and start to build up a calm and supportive relationship.

The child with ADHD doesn’t concentrate, and because of this lack of focus, their comprehension is poor. They don’t complete or turn in their work. They have impulsivity in a different way to the child with ADHD with hyperactivity and their impulsivity is more subtle. They similarly don’t want to delay gratification, but they lack focus.

These are children who have trouble getting started on assignments even if they understand what they have to do, so you might have to help them to get going.

Tips for teachers

They may put their hand up for attention without first thinking the assignment through and deciding how to proceed. This can apply to a lot of children, not only those with ADHD.

An effective teaching strategy for this might be to introduce the notion that they should always use The Rule of Three – i.e. before you put your hand up for help, 1. Think about it. 2. Read it over. 3. Ask your neighbour. Only when they’ve applied the Rule of Three, and still haven’t found the answer should hands go up for the teacher’s attention. Sometimes they may start an assignment without understanding what they should be doing – here’s that impulsivity kicking in again.

These are children who tend to focus on trivia and might perseverate on a small and insignificant item without getting the big picture. Or alternatively, some will get the big picture but can’t focus on the details. Integration of new learning with what children with ADHD already know can be a problem, and this becomes more apparent as they get older.

So what you might see is that they have discrete bits of information, but they don’t get the whole concept because they haven’t paid enough attention to be able to hang them together. 

Learn more in this post on strategies for children with attention difficutlties with and without hyperactivity.

Symptoms of ADD and ADHD

Keeping their attention

Children with ADHD can quickly become bored. They don’t listen, may be forgetful, lose things, not be prepared, not be able to find their homework, and be disorganised and easily distracted by movement, noise, and what is happening around them.

When it comes to the student or child with ADHD, you can remind him over and over and over again to bring his pencil next time, and he always forgets which can be extremely annoying and lead him to get into trouble for something that for another child might be considered quite minor.

He’s forgotten his pencil yet again, and he knows he’s going to get into trouble and other children are likely to laugh. This can be a trigger for a bit of acting out.

You can try reminder cards, a workbook which goes back and forth to the home, or, in partnership with mum, you might arrange to have a second pencil case which always stays with you or in his locker as an alternative to the time wasting frustration of hunting around for something that isn’t there. In theory, the goal is for the child to take responsibility for himself, but he doesn’t.

For children with SpLds the teacher has to think in terms of adaptations.

Children with ADHD need strong and clear directions and reminders that ideally start with looking them in the eye and possibly saying their name. For a child with ADHD, reminders can be made verbally, or once you both know what it is you want him to do, and you and the child have got to know each other really well, it might even be accomplished with a special look or a raised finger.

Do use lots of praise when they get something right. You might want to especially praise good behaviours that are part of the disorder.

Treatment in the classroom

To manage the child with ADHD you want the least possible stimuli around him so it’s advised that you don’t sit him near a window, a heater or a high traffic area. He will benefit from a stimulus reduced study area both at home and at school.

Children with ADHD might not be bothered by these things, but for children with ADHD, even small distractions can lead to a loss of attention and focus. He simply can’t handle surprises such as a visitor to the class or the fire alarm going off.  It helps to get him settled in the seat he’s going to have for the year, under the teacher’s control.

Teachers may also designate the same seat each time he uses the computer. This is because he has difficulty with transitions and relocations. 

The child with ADHD may be able to watch television or computer games for hours on end – the key being that these are activities he enjoys - but he can’t focus at school, has a short attention span and is easily bored.  

One person described the child being observed as “extremely laid back and passive, but still with a large appetite for chocolate and telly”. He has difficulty processing new information at speed. He works slowly, and may move slowly. He may need extra time.

The child may have poor fine motor skills, and produce messy work, symptoms similar to children who struggle with handwriting difficulties and dyspraxia.

Helping kids with attention difficulties in the classroom

More treatment options

Many teachers, SENCos and parents have let us know that the Touch-type Read and Spell Course has proved both popular and effective with children who have ADHD. While teaching them computer keyboard skills in a unique approach, it improves reading, writing and spelling skills at the same time.

It is also designed to make students feel and be successful, which inevitably helps improve mental health self-esteem and motivates them to go on. It is highly structured, delivers information in a multi-sensory way in small incremental steps, and learners work at their own chosen pace and with as much repetition as they need.

Learn more

The use of head-sets for the vocal track helps screen out distractions. Children may not understand percentages of success, but can see how well they are doing on a big red bar graph. It is appropriate for children aged seven and up once the hands are mature enough to sit comfortably on a keyboard, right through to people who struggle with ADHD in adulthood.

Join the discussion and leave us a comment!

References:

1 Weiss, Lawrence G. (2005). WISC-IV clinical use and interpretation scientist-practitioner perspectives (1st ed.). Amsterdam: Elsevier Academic Press. p. 237. ISBN 9780125649315.
2 Parrillo VN (2008). Encyclopedia of Social Problems. SAGE. p. 63. ISBN 9781412941655. Retrieved 2 May 2009.
3  Sim MG, Hulse G, Khong E (August 2004). "When the child with ADHD grows up" (PDF). Aust Fam Physician 33 (8): 615–618. PMID 15373378. Retrieved 8 November 2014.
4  Silver LB (2004). Attention-deficit/hyperactivity disorder (3rd ed.). American Psychiatric Publishing. pp. 4–7. ISBN 9781585621316.
5  Schonwald A, Lechner E (April 2006). "Attention deficit/hyperactivity disorder: complexities and controversies". Curr. Opin. Pediatr. 18 (2): 189–195. doi:10.1097/01.mop.0000193302.70882.70. PMID 16601502.
6  Cowen, P; Harrison, P; Burns, T (2012). Shorter Oxford Textbook of Psychiatry (6th ed.). Oxford University Press. p. 546. ISBN 9780199605613.
7  Kooij, SJ; Bejerot, S; Blackwell, A; Caci, H; et al. (2010). "European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD". BMC Psychiatry 10: 67. doi:10.1186/1471-244X-10-67. PMC 2942810. PMID 20815868.
8  Bálint, S; Czobor, P; Mészáros, A; Simon, V; et al. (2008). "Neuropszichológiai károsodásokat felnőtt figyelemhiányos hiperaktivitás zavar(ADHD): A szakirodalmi áttekintés" [Neuropsychological impairments in adult attention deficit hyperactivity disorder: A literature review]. Psychiatria Hungarica (in Hungarian) 23 (5): 324–335. PMID 19129549.

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