http://archives.manilatimes.net/national/2009/may/20/yehey/life/20090520lif1.html
Paying attention to ADHD
By Sarah R. Aurelio, Special to The Manila Times
What do German composer Ludwig van Beethoven and American Olympian swimmer Michael Phelps have in common?
These driven and highly focused individuals suffer from Attention-Deficit Hyperactivity Disorder (ADHD). But what exactly is ADHD?
“ADHD is a neurobiological disorder. This means that it originates in the brain,” explains developmental and behavioral pediatrician Mark Reysio-Cruz.
The doctor explained that ADHD has four subtypes, being: (1) Combined hyperactive-impulsive and inattentive; (2) predominantly hyperactive-impulse; (3) predominantly inattentive, also known as Attention-deficit Disorder or ADD; and (4) ADHD, not otherwise specified.
“From the categories, you will see that ADD is a subtype of ADHD,” Dr. Reysio-Cruz said. “ADD also presents with symptoms of hyperactivity and impulsivity but the predominant symptom is that of inattention affecting a child’s academic, social and/or occupational functioning in two or more settings.”
The most common symptoms of ADHD are inattention, hyperactivity and impulsiveness. Easily distracted, never finishing anything, disorganized and restless, children whose disorder go undiagnosed are often misunderstood by their parents, sometimes being punished for being difficult and undisciplined for mannerisms rooted in ADHD.
ADHD doesn’t have any degrees. According to Reysio-Cruz, it’s either you have it or you don’t.
The causes
While Dr. Reysio-Cruz is quick to point out that ADHD is not caused by what a child’s parent did or did not do. He says that the interplay of genetics, injury to the brain via infections, toxic elements (i.e. lead poisoning and alcohol), and trauma predispose a child to having this disorder. The environment is contributory to it due to the fact that it may aggravate the condition.
“It’s genetic,” states Ditas Martelino, president of the ADHD Society of the Philippines, a mother of three, two of which have ADHD. “That’s the trend of the studies . . . they [researchers] have identified the DNA markers,” she notes.
Unequipped
While science takes on ADHD, using technology to develop and further studies on it, medically the country isn’t quite equipped to handle such cases.
Dr. Reysio-Cruz says that anatomic MRI results support prominent role of frontal lobe dysfunction in ADHD and cortical-subcortical circuits while functional MRI’s show blood flow in different parts of the brain with certain parts of the brain having a decrease or increase in the flow in the brain of a child diagnosed with ADHD. However, neuro-imaging techniques have not been validated as tools for ADHD diagnosis or to inform treatment and are very expensive.
“In the medical field, children with ADHD are referred to and handled by developmental and behavioral/neuro-developmental pediatricians, child psychiatrists, pediatric neurologists, child and adolescent pediatricians, and neuropsychologists,” Dr. Reysio-Cruz explains.
It is the most common behavioral disorder in children, affecting three to five percent of school-aged children. Although the prevalence rate has neither gone up or down, Dr. Reysio-Cruz thinks that, “There are more cases diagnosed because of the increased awareness. Based on the prevalence rate of three to five percent, we are even probably under-diagnosing given the number of reported cases.”
The good news
Martelino informs The Manila Times that the ADHD Society of the Philippines, along with the medical associations that deal with the disorder, are now in the process of finalizing the clinical procedures guidelines in diagnosing it.
“When this is ready for implementation, even the pediatricians and general practitioners could diagnose ADHD already,” Martelino added.
Awareness and parents
“There is more awareness in the country about this disorder,” Dr.Reysio-Cruz said. “The ADHD Society of the Philippines is instrumental in bringing about this increased awareness.” He added that he believes that doctors, schools and parents are open to the disorder thanks to the increase in awareness.
The ADHD Society of the Philippines is a non-stock, non-profit organization dedicated to spreading awareness about the disorder and equipping parents and teachers on how to deal with children diagnosed with the disorder.
“It’s a big thing if the parents are trained to deal with their children,” Martelino explains. “It’s education and empowerment for the parent that’s important, because who else will ‘do battle’ with your child but you? I tell parents during our training seminars that their children cannot take medication for life. Behavioral therapy ends after adolescence. You’re the parents, you’ll be with them for life.”
Guillano Mendiola, a Culinary Arts student, attests to Martelino’s statement. He was diagnosed with ADD during his the latter half of his freshman year.
“Everything changed when I was diagnosed. My parents became patient. Even my sister was supportive. My parents even got me a tutor during my sophomore year . . . to keep me steady on my studies,” Mendiola said.
Dr. Reysio-Cruz says that the parents of children diagnosed with ADHD need to have a lot of love, patience and understanding for their children. “They have to advocate for their children and work with their children’s teachers, tutors, caregivers in providing a nurturing environment for their children. The goal should be to protect their child’s self-esteem,” he said.
Parents and ADHD
Dr. Reysio-Cruz advises parents not to see it (ADHD) as the apocalypse. “I mention famous people, both dead and alive, that has or had ADHD. After that I give them the both the best and the worst case scenarios and educate them on the management options.”
There are several ways with which to take ADHD head on, one of which is the multimodal treatment that is medication, behavioral therapy or both.
“ADHD is a manageable condition, Dr. Reysio-Cruz added. “The best scientific evidence supports a combination of medication, behavior therapy, and educational accommodations.”
Another way to deal with it is via logbook therapy. Martelino says she used it with her daughter when things were getting out of hand in school.
“When her school bell rang at the end of each subject, she would go to her teacher and the teacher would check if she wrote the correct assignment and/or project down. After which the teacher would sign it,” Martelino told The Times. “When the homework or project was submitted, the teacher would sign the logbook again.”
There is no particular diet that a child diagnosed with ADHD should follow. Dr. Reysio-Cruz simply recommends a well-balanced meal to contribute to growth and development.
“There is no scientific evidence that sugar, food dye, additives, et cetera cause ADHD,” Dr. Reysio-Cruz explained. But should parents notice that certain food make their children lean towards hyperactivity, he advises that they avoid these food items.
Dr. Reysio-Cruz recommends that watching television be minimized as it contributes to the child’s lessening focus, making a child get used to the fast pace of seeing and hearing things.
How diagnosed children deal with it
Mendiola said that he copes with his ADD through self-control. He never studies at home since a lot of things tempt him. “Problem is, I’m easily tempted with things I like, the TV, the computer, even sleeping, so I have to leave the house so that I can study. I go to my school library, sit there alone, studying.”
Dr.Reysio-Cruz says that there are several conditions closely related to ADHD. “Children with ADHD are at increased risk for having or developing depression, anxiety disorder, oppositional defiant disorder, conduct disorder, tic disorder and learning disability,” he added.
Fortunately for Mendiola, he did not fall prey to these conditions. “I don’t feel misunderstood. Neither do I feel different from other people,” he said. In jest, he added, “Actually there are times when I feel that some of my friends have ADHD or ADD because some of them are simply makulit.”
One of Martelino’s children with ADHD had a narrow escape with depression after suffering from an embarrassing situation in school. Martelino was well aware of the symptoms of depression and quietly observed her child’s behavior after a friend informed her of the problem.
“I remember telling his teachers and the administrators that it was a good thing I knew my child had ADHD and that I was aware he was prone to depression so I keep a close eye on him. But what about the other children who also suffered the same embarrassment along with my son?” Martelino said.
How having ADHD is not so bad
Having ADHD though is not all bad. Dr.Reysio-Cruz explains that emerging literature provides support for the hypothesis that abnormalities in frontal networks or frontal-striatal dysfunction and catecholamine dysregulation are involved but while this is so adds that children with ADHD are often smart and creative.
Martelino expresses no doubts when she says that yes, children with ADHD seem to possess an x-factor, but adds that while this is so, some schools are in denial.
“Take my daughter, for example,” Martelino elucidated. “When she was first diagnosed with ADHD, I would always have a case conference with her teachers every year. I would also bring a doctor or therapist to talk to the teachers as well, to explain to them what ADHD is.”
She got mixed reactions in return. “Some of the teachers accepted it, while others were in denial,” she says.
“Her teachers back in grade school were surprised that she could beat the honor students in science quiz bees when she wasn’t even an honor student herself,” Martelino said. “In her classroom, her teachers would berate her for daydreaming, forgetting something. But she’s smart.” Martelino’s daughter, who is now studying in an exclusive girls college in the country, has an above-average IQ.
If you would like more information regarding ADHD, you may contact the ADHD Society of the Philippines at the following numbers: (02) 426-8568 or telefax (02) 927-3468.The ADHD Society also offers support groups for parents, parent and teacher training, and referrals to doctors.
Does your child have ADHD?
Dr. Mark Reysio-Cruz has provided The Manila Times with a list* that presents parents with symptoms of ADHD.
Symptoms
1. Does not pay attention to details or makes careless mistakes with, for example, homework
2. Has difficulty keeping attention to what needs to be done
3. Does not seem to listen when spoken to directly
4. Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand)
5. Has difficulty organizing tasks and activities
6. Avoids, dislikes, or does not want to start tasks that require ongoing mental effort
7. Loses things necessary for tasks or activities (toys, assignments, pencils, or books)
8. Is easily distracted by noises or other stimuli
9. Is forgetful in daily activities
10. Fidgets with hands or feet or squirms in seat
11. Leaves seat when remaining seated is expected
12. Runs about or climbs too much when remaining seated is expected
13. Has difficulty playing or beginning quiet play activities
14. Is “on the go” or often acts as if “driven by a motor”
15. Talks too much
16. Blurts out answers before questions have been completed
17. Has difficulty waiting his or her turn
18. Interrupts or intrudes in on others’ conversations and/or activities
*Source: Copyright 2002 American Academy of Pediatrics and National Initiative for Children’s Healthcare Quality. Revised 1102
http://www.mb.com.ph/articles/209480/why-school-difficult-students-with-adhd
Underachievement and failure in school is a common thing for children with ADHD. Their grades may not be totally reflective of what they have in their brains and this is what is most frustrating to parents and teachers alike. Others say these children could have achieved more if they worked harder or behaved better in class. But is this the real score?
BASIC PROBLEMS
Children with ADHD have three main characteristics that could interfere with their academic performance. Their inattention, hyperactivity and impulsivity can lead to two basic problems that could spell disaster in school: 1) their difficulty with persistence of attention and resistance to distraction; and 2) disinhibition.
Their inattention makes it difficult for them to continuously focus on something and at the same time resist distractions around them. They may have trouble focusing on important information like a lesson in class and would rather pay attention to what is more exciting or stimulating like the sound of ringing bell or the colorful and sporty bag that a classmate has.
They may be unable to sustain attention, especially when lessons in class seem to be repetitious or when they are given prolonged tasks like copying long notes or answering exams.
What would this lead to? Needless to say, they will not understand the teacher’s lesson if they do not listen attentively and neither will they have notes if they do not finish what they are copying on the board. Some will just pass their papers without reading the directions carefully and checking their answers afterwards just so they could “wrap up” the “long and grueling exam”.
Their hyperactivity and impulsivity may cause the problem of disinhibition. These children may either be physically or verbally hyperactive and some teachers may see this as a “misbehavior” specially when they are expected to sit quietly in class. Some would just stand up and go out of the room unnoticed while others who are more verbally hyperactive will tend to disrupt their seatmates by talking or even disturbing them constantly during class hours. This may seem “odd” or even irritiating for some classmates and worse, an “easy target” for the teacher. And as we all know, behavior is a part of the grading system in the traditional school set-up and an ADHD child who behaves like these will definitely “lose” in the conduct department.
The impulsivity of children with ADHD can also cause them to have great difficulty to do a any task requiring delay or reserve like waiting for their turn in lines, raising hands to answer questions, reading or listening to directions, and asking questions if they don’t understand their teacher, among others. This may result in giving wrong answers during recitation or most specially during
exams.
This not to mention that most children with ADHD have coexisting learning disabilities, especially in spelling, reading, writing, and math.
‘EXECUTIVE FUNCTIONS’ AND ADHD
Right from pre-school up to the higher levels, these children’s biologically-based inability to inhibit behavior and control responses may prevent them from meeting school demands for self-control and self-direction such as: to stay in their seats quietly and ask permission first if they need to go out; to raise their hands before talking; to listen attentively when the teacher speaks; to follow directions in their seatworks, exams and projects, to complete school work on time, and to develop independence and organizational skills.
Most of these difficulties in school may be attributed on these children’s ability to utilize the “executive functions” of the brain.
Executive functions are the so-called “overseers” of the brain. According to Russel Barkley, a renowned ADHD expert, “the deficit in inhibition (the core of ADHD) impairs the development of these executive functions. Apparently, in children with ADHD, the executive functions are developmentally delayed compared with other children of the same age.”
ISandra F. Rief (an award-winning educator, author and speaker who specializes in ADHD) lists down some of the components of executive functions such as: “working memory (holding information in your head long enough to act upon it); organization of thoughts, time and space; planning; sustaining alertness and effort; self-regulation; emotional self-control; sequential thinking; and developing and following through on a plan of action”, among others.
When these executive functions do not work well, children with ADHDADHDADHDADHD may encounter difficulties such as:
Planning how to tackle assignments – they may not know how and where to start specially if they are given multiple tasks (Ex. Too many assignments to do);
Staying on tasks – once they get started on which work to do first, the “persistence of their attention” may get in the way and they may find it hard to stay “on task” and “”block out” distractions
Completing tasks – since they have difficulty staying on task, they may also find it hard to finish what they are supposed to complete most specially long-term projects.
Making transitions – if they are able to finish their work, the next ordeal is making the transition on which task to do next;
Following through on directions – their inattention to details makes it tough for them to follow directions thoroughly;
Producing work at consistently normal levels – they may produce work that are outstanding in one moment or just “so-so” in the next;
Organizing multi-step tasks – they may find it complicated to do things on a “step-to-step” basis, again, their impulsivity gets in the way that they want things done “pronto”!
ACCOMMODATIONS
Ms. Reif adds that “executive function weaknesses causes academic challenges (mild to severe) for most students with ADHD, irrespective of how intelligent, gifted and capable they may be. They will need some supportive strategies and/or accommodations to compensate for their deficit in executive functioning.”
Some of the more common accommodations that a school could easily provide for children with ADHD may include the following:
1. Teacher – place children with ADHD with teachers who are:
• upbeat, positive, highly organized
• use praise and reward liberally
• willing to go on an extra mile to help students succeed
2. Environment
• predictable
• display rules• post daily schedules and assignments
• call attention to schedule changes
• set specific times for specific tasks
• design a quiet work space for use upon request (Ex. Library)
• seat the child with positive peer models
• plan academic subjects for morning hours
• provide regularly scheduled and frequent breaks
• use attention getting devices
3. Curriculum
• modify instruction
• mix high and low interest levels in subject matters
• provide computerized learning materials
• simplify and increase visual presentations
• teach organization and study skills
• use learning strategies such as mnemonic devices and links
UNDERSTANDING ADHD
Aside from the accommodations that the parents and the school will agree upon, it is also highly important for classroom teachers to be constantly aware of how the symptoms of children with ADHD could affect and even impair the child’s academic performance.
Teachers should bear in mind some of the basic principles in teaching children
with ADHD:
1. Even when functioning successfully, an ADHD child may exhibit more restlessness and overactive behavior than other children.
2. Do not assume that a student is lazy because of problems concentrating or staying on task.
3. ADAD/HDHD children are inconsistent; sometimes they are able to work and concentrate and other times are not.
4. Do not give up on a behavior modification and discipline techniques that you try to implement in the classroom.
5. Include other school and mental health professionals in your dealings with an ADHD child.
6. Keep your mind open to new techniques and approaches to the child.
7. Modify assignments and make exceptions when needed to benefit an ADHD child.
8. Be involved in your classroom.
9. Do not give up on an ADAD/HDHD child.
WHO KNOWS?
I would like to end this piece by citing an anecdote: “Thomas (Al) Edison’s schoolmaster,
angered by the lad’s inattentive ‘dreamy,’ distracted behavior, frustrated by his tendency to drift off during recitations, to draw and doodle in his notebook instead of repeating rote lessons – cuffed and ridiculed Al in front of his motley classmates.
Teachers saddled with disaffected students like Edison were judged by how many pupils were promoted from one grade to the next, and they needed to rationalize the actions of children who were ‘not apt.’
Sure enough, ‘One day,’ Edison recalled with bitterness many years later, ‘I heard the teacher tell the visiting school inspector that I was addled and it would not be worthwhile keeping me in school any longer. I was so hurt by this last straw that I burst out crying and went home and told my mother.’ His indignant mother ‘brought [him] back to the school and angrily told the teacher that he didn’t know what he was talking about, that I had more brains than he himself.’”
Mrs. Edison pulled Thomas out of school and began home-schooling, determined that “no formalism would cramp his style, no fetters hobble the free rein, the full sweep of his imagination.”
As we all know, Edison became the American genius of technology inventing the incandescent lamp, the phonograph and the motion picture projector, among others.
Again, who knows if the ADHDADHDADHDADHD child in your class becomes a future Edison? Just give them a chance.
*****
References: Sandra F. Reif (2003). The ADHD Book of Lists, Rosario Margarita A. Aligada, PhD; Marie Michelle Q. Astillero, OTRP and Carlota C. Pineda, PTRP, Eds. (2002). Managing ADHD in the Grade School Classroom, and Neil Baldwin (1995). Edison – Inventing the Century
Editha R. Martelino is the current president of the ADHD Society of the Philippines. A parent of two children with Attention Deficit/Hyperactivity Disorder (ADHD), she initiated and played an active role in the ADHD School Caravan, a public awareness campaign on the disorder. She is an AB Literature graduate of the University of Santo Tomas and is a writer by profession.
http://www.addresources.org/
http://health.groups.yahoo.com/group/adhdpinoy/
http://www.interventioncentral.org/
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