ADHD: Anak saya dah kenapa ni ?

Akhir-akhir ini, istilah ADHD semakin mendapat perhatian dalam kalangan masyarakat. Masyarakat mula mencari maklumat berkaitan dengan ADHD dalam pelbagai medium termasuklah media sosial, guru di sekolah, rakan atau saudara terdekat dan juga daripada pengamal perubatan. Ini menunjukkan masyarakat semakin cakna terhadap yang berkaitan dengan ADHD. 

Menurut Bekley, pada awalnya para sarjana memberikan pelbagai penjelasaan berkaitan dengan ADHD. Bagaiamanapun, disimpulkan bahawa ADHD adalah kondisi medikal yang melibatkan biologikal, psikologikal dan persekitaran. Individu ADHD mengalami perkembangan otak dan aktiviti otak yang berbeza yang memberi kesan sepanjang hayat dalam kehidupan seharian. 

Keadaan ADHD ini memberi kesan terhadap individu ADHD ketika di sekolah, rumah mahupun dalam perhubungan sesama orang lain. dan akan berterusan sampai usia dewasa. Memahami ADHD itu sendiri merupakan salah-satu tindakan bagaimana hendak mengurus kesan ADHD dan invdidu yang mengalami ADHD.

Simptom ADHD semakin jelas kelihatan dalam kalangan kanak-kanak pada ketika kanak-kanak mula bersekolah. Ini kerana kanak-kanak dalam proses transisi antara rutin dirumah dengan situasi baru di di sekolah yang ada peraturan untuk dipatuhi. 

Adalah perkara biasa apabila seseorang kanak-kanak itu sukar memberi perhatian, sukar mengikut araha, sukar duduk diam atau sukar menunggu giliran. Namun bagi kanak-kanak ADHD, kesukaran adalah berlipat ganda dan kerap menghadapi kesukaran tersebut. 

Kanak-kanak ADHD memiliki ciri tersendiri. Kanak-kanak dengan ADHD boleh menunjukan tanda daripada satu, dua atau kesemua daripada tiga kategori ADHD. 

• Inattentive. Kanak-kanak ini memiliki daya tumpuan mudah terganggu dan sukar memberi tumpuan, fokus dan kekal dalam tugasnya. Kelihatan tidak memberi perhatian pada arahan, sering kehilangan/ tidak ingat barang peribadi dan suka berkhayal.
• Hiperaktif. Terlalu aktif, kelihatan gelisah dan cepat bosan. Bertindak kasar, suka memanjat, melompat serta menganggu rakan tanpa makna. 
• Impulsif. Kanak-kanak ini, bertindak laju sebelum berfikir. Sering menyampuk, merebut atau menolak dan sukar menunggu. Melakukan sesuatu tanpa izin, mengambil barang rakan dan melakukan sesuatu berisiko.

           Sungguhpun kanak-kanak yang kelihatan aktif, gelisah, berkhayal atau suka menyampuk, tidak bermakna kanak-kanak tersebut mengalami ADHD terutamanya ada usia sebelum persekolahan. Namun, bila keadaan ADHD berterusan pada usia prasekolah dan berlaku di lebih dari satu situasi seperti di rumah, sekolah, ketika bersama rakan sebaya, ia mungkin ADHD. Maka, tindakan seterusnya perlu diambil oleh ibubapa. Apakah tindakan tersebut ? Bersambung...............

    

ISU # 2 BERMAIN: INTERVENSI MURID BERKEPERLUAN KHAS (MBK)

BERMAIN: INTERVENSI MURID BERKEPERLUAN KHAS (MBK)

Kebelakangan ini bermain sudah menjadi isu yang sering diperbincangan oleh pengamal perkembangan kanak- kanak. Seruan terhadap kepentingan aktiviti bermain di awal perkembangan kanak- kanak sangat mempengaruhi kemahiran masa depan kanak- kanak itu. Bermain bukan sekadar main- main tanpa makna, melalui bermain kanak- kanak memperoleh banyak kemahiran asas kehidupan dan seterusnya membantu dalam kesediaan belajar mereka di sekolah. Bermain adalah satu pekerjaan bagi seorang kanak- kanak, kepuasan kehidupan bergantung kepada kepuasan bermain mereka. 

Bermain adalah fitrah manusia dan dikatakan adalah tidak mungkin boleh memaksa seseorang itu bermain, dan tidak seorang pun boleh tumbuh membesar tanpa bermain (Besio & Carnesecchi 2014). Impak bermain ini telah dihujahkan oleh beberapa tokoh perkembangan kanak- kanak seperti Jean Piaget dan Vygotskij. Piaget fokus kepada kepentingan bermain dalam perkembangan kognitif di mana manusia belajar melalui pengalaman yang di alami sendiri (Besio & Carnesecchi 2014). Manakala Vygotskij menegaskan bahawa sifat bermain kanak- kanak memberi kesan terhadap perkembangan sosial mereka. Aktiviti aktif bermain adalah nadi perkembangan bagi seorang kanak- kanak dimana ianya membantu dalam perkembangan pelbagai kemahiran asas kehidupan seperti kemahiran interaksi dan komunikasi, kemahiran psikomotor, kemahiran pengurusan emosi (self-regulate) dan kematangan mental kanak-kanak (Ruhaena, 2015). Kajian Sandra, W. Russ dalam kajiannya menggunakan Affect in Play Scale, menunjukkan kesan Bermain Olok- olok sebagai asas kreativiti seseorang ketika dewasa kelak (Russ 2014).

Pendekatan bermain dalam intervensi Murid Berkeperluan Khas (MBK) terutamanya telah menunjukkan impak yang positif. Adalah menjadi peranan ibu bapa mendapatkan intervensi seawal usia anak. Intervensi dapat mengurangkan karekteristik yang akan mengganggu proses belajar anak di sekolah kelak. Kajian menunjukkan MBK yang ada intervensi mudah menerima pembelajaran dan pada tahap kebersediaan belajar di sekolah dan juga mampu berada sama dengan rakan perdana. Kepentingan bermain bebas ini telah membuktikan memberi impak positif terhadap perkembangan kemahiran bagi seorang kanak- kanak tipikal termasuklah kanak- kanak MBK. 

Berbanding murid prasekolah perdana, MBK prasekolah integrasi memerlukan bimbingan guru bagi mencetuskan keinginan bermain dalam diri mereka ekoran limitasi belum tahu bermain, belum tahu itu adalah mainan mahupun limitasi kemahiran koordinasi, persepsi, fizikal dan sebagainya yang wujud dalam diri mereka. Sehubungan dengan itu, memahami bermain dalam kontek perkembangan kanak- kanak dan kanak- kanak berkeperluan khas khususnya adalah sangat penting bagi seorang guru prasekolah integrasi. Selain memahami tahap kemahiran bermain individu MBK prasekolah, guru perlu tahu apa peranannya dalam amalan play-based dan bila perlu dia berperanan semasa aktiviti pengajaran dan pembelajaran (Rakap et al. 2018).

‘ZERO REJECT POLISI’ DAN AMALAN KOLABORASI DI PROGRAM PENDIDIKAN KHAS INTEGRASI (PPKI).

ISU #1

Hari OKU Sedunia pada tahun 2018 membawa tema “Memperkasakan golongan OKU dan menjamin inklusitif dan kesamaan- rataan.”  Menurut United Nation (UN), tema pada tahun 2018 ini memberi fokus kepada memperkasakan golongan OKU dalam perkembangan program inklusif, kesama- rataan dan kemampanan dalam mencapai Agenda 2030 untuk Perkembangan Kemapanan. Malaysia dalam usaha merialisasikan Agenda 2030 telah merangka dan melaksanakan program kelestarian perkhidmatan untuk golongan kurang upaya (OKU) ini. Malaysia melalui  Kementerian Pembangunan Wanita, Keluarga dan Masyarakat telah membuat laporan kepada United Nation progress pelaksanaan Agenda 2030,(SINGH n.d.). Majlis OKU Kebangsaan yang ditubuhkan pada 2008 dan dipengerusikan oleh Kementerian Pembangunan Wanita, Keluarga dan Komuniti akan menyelia pelaksanaan polisi nasional dan merancang aktiviti berkaitan OKU. Majlis ini juga bertanggunjawab mencadangkan perkara berkaitan OKU seperti kesihatan OKU, kebajikan OKU, pemulihan OKU daan seumpamanya.

            Majlis OKU Kebangsaan terdiri daripada enam jawatan kuasa yang memainkan peranaan penting dalam memastika kelestarian kebajikan OKU dan juga pelaksanaan kebajikan OKU sebagaimana persetujuan diklerasi yang pernah ditandatangani Malaysia. Enam jawatan kuasa yang dipengerusikan oleh kementerian, JK Pengangkutan (Kementerian Pengangkutan), Kualiti Hidup ( Kementerian Kesihatan ),  Pendaftaran OKU ( Kementerian Pembangunan Wanita Keluarga dan Komuniti ), Rekabentuk Universal dan  Pembinaan Persekitaran ( Kementerian Pembangunan Wanita, Keluarga dan Komuniti ), Pekerjaan ( Kementerian Sumber Manusia ), Pendidikan ( Kementerian Pendidikan ). Bagi memastikan inisiatif kerajaan ini berjaya, jawatan kuasa tersebut perlu memainkan peranan masing- masing dan perlu menghadiri mesyuarat bersama minima tiga kali setahun.

            ‘Zero Reject Policy’ yang menjadi trending dalam media sosial akhir- akhir tahun ini membuka mata pihak pentadbir sekolah, guru perdana, guru pendidikan khas itu sendiri dan ibu bapa serta masyarakat tentang penempatan anak di sekolah. Walaupun polisi ini dikatakan mula diperkenalkan dan dilaksanakan pada tahun 2019, jika diteliti dokumen lama, perkara ini sudah ada dalam sistem pendidikan khas namun pelaksanaannya kurang dikuatkuasakan disesetengah tempat (KPM 2015). Bagaimanapun untuk tahun 2019 polisi dengan penjenamaan semula ini memurnikan lagi penguatkuasaan pelaksanaan. Setiap individu dan organisasi dinyatakan

peranannya secara jelas dan mudah difahami. Kolaborasi pihak sekolah termasuk pentabir, guru pendidikan khas dan guru perdana, ibu bapa dan keluarga serta masyarakat membantu dalam kemenjadian murid pendidikan berkeperluan khas ini.

Banyak kajian menunjukkan hubungan yang kuat antara tingkat penglibatan ibu bapa dengan sikap yang positif dalam diri anak-anak dari segi sosial, emosi, dan perkembangan akademik (Collier, Keefe dan Hirrel 2015). Hubungan penglibatan ibu bapa terhadap perkembangan pembelajaran anak dalam program inklusif juga disokong oleh kajian Hussin dan Hamdan, 2016. Menurut beliau, penglibatan pentadbir, guru dan ibubapa memberikan impak positif dalam pelaksanaan inklusif di sekolah di nama dengan pendekatan pengajaran bersama, peranan ibu bapa dilihat sebagai satu pusat kejayaan murid (Hussin dan Hamdan 2016). Selain daripada komitmen peranan ibu bapa dan sekolah, kolaborasi juga menuntut peranan pihak lain seperti pihak pengamal perubatan, pihak terapis, pihak kaunselor sekolah mahupun pihak komuniti serta agensi koporat. Pihak yang terlibat dalam dalam kolabrasi ini akan terlibat secara lansung mengikut peranan masing- masing. Banyak kajian lalu telah membuktikan bahawa kemahiran kolaboratif dalam diri seorang guru Pendidikan Khas berkolarasi dengan tahap kecekapan guru dalam pengajaran termasuklah dalam mengajar murid berkeperluan khas (Khairuddin, Dally & Foggett 2016).

Dalam kenyataan Pemangku Pengarah Bahagian Pendidikan Khas, Kementerian Pendidikan Malaysia (KPM) pada siaran akhbar 20 Disember 2018, pelaksanaan Zero Reject Policy adalah tanggungjawab semua lapisan masyarakat. Ibu bapa berperanan aktif dalam intervensi awal anak sebagai persediaan anak beradaptasi di alam persekolahan. Ibu bapa memberi pengaruh besar dalam perkembangan pendidikan anak pada masa hadapan (Amin, Jamiah & Md Akhir 2016). Penglibatan ibu bapa juga masih perlu sehingga anak ke sekolah menengah (Lindstrom & Garbacz 2016). Guru antara pihak yang memainkan peranan penting dalam keberjayaan program inklusif di sekolah. Kolaborasi yang baik antara guru pendidikan khas dan guru perdana melancarkan pelaksanaan Rancangan Pendidikan Individu (RPI) murid berkeperluan khas yang diinklusifkan (Simmons, Wk & Liston 2006). Pihak Jabatan Pendidikan Negeri, JPN dan juga Pejabat Pendidikan Daerah (PPD) antara organisasi yang memainkan peranan dalam kolaborasi dan memantau pelaksanaan RPI dan Kurikulum di sekolah. Semua perlu bekerjasama dalam penyediaan perkhidmatan yang terbaik buat murid berkeperluan khas ini. Selain memastikan RPI dilaksanakan ianya juga melahirkan pasukan RPI MBK yang bersikap terbuka dan saling

memahami keperluan masing- masing. Kesefahaman yang wujud antara semua pihak memudahkan koordinasi perkhidmatan yang sesuai untuk murid berkeperluan khas (Lohmann, Hathcote & Hogan 2018). Sehubungan dengan itu, kemahiran kolaborasi dalam sistem pendidikan adalah penting. Pihak institusi yang melahirkan bakal guru dicadangkan memasukkan kemahiran kolaboratif dalam kursus dan dilaksanakan diawal pengajian (Coughlin 2017). 

RUJUKAN

Amin, S.A., Jamiah, M. & Md Akhir, N. 2016. Peranan Keluarga dalam Kehidupan Kanak-Kanak Kurang Upaya Malaysia The Role of Family in the Lives of Disabled Malaysian Children 86(1): 21–30.

Besio, S. & Carnesecchi, M. 2014. The Challenge of a Research Network on Play for Children with Disabilities. Procedia - Social and Behavioral Sciences 146: 9–14.

Collier, M., Keefe, E.B. & Hirrel, L.A. 2015. Preparing special education teachers to collaborate with families. The School Community Journal 25(1): 117–135.

Coughlin, S.L. 2017. Collaborative Practices Among Professionals in Special Education Workplaces Collaborative Practices Among Professionals in Special Education.

Hussin, M.K.A. Bin & Hamdan, A.R. Bin. 2016. Challenges of Co-teaching in Malaysian Inclusive Classroom: Administrators’, Teachers’ and Parents’ Overview. Procedia - Social and Behavioral Sciences 217(2006): 477–486.

Khairuddin, K.F., Dally, K. & Foggett, J. 2016. Collaboration between General and Special Education Teachers in Malaysia. Journal of Research in Special Educational Needs 16: 1.

KPM. 2015. Panduan Pengoperasian Pendidikan Khas 2015.

Lindstrom, L. & Garbacz, S.A. 2016. Parent Involvement in Special Education. Remedial and Special Education, hlm.

Lohmann, M.J., Hathcote, A.R. & Hogan, K.A. 2018. Adressing the Barriers to Family-School Collaboration: A Brief Review of the Literature and Recommendations. International Journal of Early Childhood Special Education 10(1): 26–32.

Rakap, S., Balikci, S., Kalkan, S. & Aydin, B. 2018. Preschool Teachers’ Use of Strategies to Support Social-Emotional Competence in Young Children. International Journal of Early Childhood Special Education 10(1): 11–25.

Razali, N.M., Kamaralzaman, S., Salleh, N.M., Hanafi, M. & Yasin, M. 2013. Teachers ’ Perceptions of Including Children with Autism in a Preschool Teachers ’ Perceptions of Including Children with Autism in a Preschool(April 2015).

Ruhaena, L. 2015. Model multisensori: Solusi stimulasi literasi anak prasekolah. Jurnal Psikologi 42(1): 47–60.

Russ, S.W. 2014. Pretend play in childhood: Foundation of adult creativity.: 410–411.

Simmons, B., Wk, I. & Liston, A. 2006. Collaboration and Support Needed From Special Education Teachers to General Education Teachers Brenda Simmons.

SINGH, Y.D.H. (n.d.). Reporting To Un on Current Status of Pwd Towards an Inclusive Malaysian.

Tariq, R. & Latif, S. 2016. A mobile application to improve learning performance of dyslexic children with writing difficulties. Educational Technology and Society 19(4): 151–166.

SAYA INSPEKTOR AZMAN

Sedang kami bersarapan di kantin, kami didatangi oleh Max. Kelihatan mukanya agak serius. Persis polis yang sedang bertugas.  Ditenungnya kami yang duduk di meja itu satu-persatu seolah-olah kami telah melakukan kesalahan. Saya yang masih guru baru ketika itu ada sedikit rasa janggal berbeza dengan rakan sekerja yang lain. Mereka meneruskan sarapan dan perbualan tanpa peduli. 

        “Hei, saya polis!” sedikit keras suaranya. Saya memandang rakan l lain, riak wajah bertukar. Riak menanyakan 'apa yang sedang berlaku'.

          “Max, ini cikgu. Cikgu Hai. Tidak boleh cakap begitu, cakap bagus-bagus,” Cikgu Ramlah merungkai soal saat itu. 

            “Ini Max, dia memang begitu Hai. Adalah yang dia tidak puas hati tu. Ada kawan dia buli dia kali. Tapi, dia ni yang banyak membuli kawan.. atau ada sahaja halnya...kadang kami layan, kadang kami penat dah layan...” terang Cikgu Ramlah.

            Max masih tercegat di situ.

        “Max, polis?” soal saya. Mudahan cara respon yang kena dihatinya.

            “Ya, saya polis. Inspektor Azman, gerak-gerak khas,”

            “Oh, saya Cikgu Hai,” jawab saya. Saya menyabut salam Max. 

Rawatan segera atasi hiperaktif

Rawatan segera atasi hiperaktif

Oleh ZUHAYATI YAZID

Gambar RAHMAN SALEH

Sumber: Utusan Online

Kanak-kanak yang terlampau aktif berkecenderungan menunjukkan simptom ADHD.

DUDUK diam! Jangan nakal-nakal!'' Mungkin itu adalah ayat biasa yang diungkapkan oleh seorang ibu kepada anak-anak yang sedang 'mengganas'.

Bayangkan mainan yang bersepah di serata ceruk rumah serta tabiat suka melompat dari meja atau sofa selalunya membuatkan si ibu mudah 'naik hantu'.

Jika itu yang sering dilakukan oleh anak-anak, tidak perlu khuatir kerana ia adalah sebahagian daripada proses normal bagi seorang kanak-kanak aktif dan cergas yang sedang membesar.

Jika si kecil gagal memberi tumpuan serta tidak fokus apatah lagi jika mereka juga hiperaktif, cuai, gagal menguruskan apa sahaja, mudah terganggu serta tidak boleh bermain atau melakukan sesuatu dengan senyap, ibu bapa perlu beri perhatian.

Malah bukan sekadar itu, dia juga sering bercakap sendirian, kurang fokus serta kurang sabar dalam menyelesaikan masalah.

Jika anak-anak mengalami simptom- simptom tersebut segeralah berjumpa doktor, kata Perunding Psikiatrik Pusat Perubatan Gleaneagles Intan, Dr. Nor Hamidah Mohd. Salleh

Menurut beliau, simptom itu sebenarnya dipanggil ADHD atau Gangguan Hiperaktiviti dan Kurang Daya Tumpuan yang merupakan satu masalah tidak normal pada bahagian otak yang membuatkan kanak-kanak bersikap terlampau aktif sejak lahir lagi.

Kanak-kanak yang mempunyai gejala ADHD, lebih mudah terganggu dengan bunyi-bunyian dan benda-benda di sekeliling mereka.

Lazimnya, mereka tidak boleh memberi tumpuan untuk tempoh jangka panjang. Ini kerana mereka mudah berasa bosan dan gelisah sekiranya berada dalam keadaan senyap atau tidak melakukan sebarang aktiviti

''Keadaan ini sebenarnya boleh dikesan pada peringkat awal lagi kerana mereka akan berkelakuan mengikut gerak hati sendiri,'' ujarnya ketika ditemui di pejabatnya di Kuala Lumpur, baru-baru ini.

Bagaimanapun tegas Dr. Nor Hamidah, simptom tersebut tidak mudah didiagnosis disebabkan tidak boleh dibezakan seperti penyakit-penyakit lain.

''Jika anda meletakkan 10 budak nakal dan 10 kanak-kanak ADHD dalam satu kumpulan, anda masih tidak nampak perbezaannya. Bagi kanak-kanak nakal biasa, mereka masih boleh dikawal manakala ADHD amat susah dikendalikan sehinggakan kita menyangka mereka menghadapi masalah tingkah laku," ujarnya lagi.

Tegasnya lagi, dalam permasalahan itu, tiada punca utama ditemui berkaitan sindrom tersebut walaupun faktor genetik dan ketidakseimbangan bahan kimia di dalam otak mungkin menyumbang kepada terjadinya masalah itu.

Bagaimanapun, jika tidak diberi rawatan lebih awal, 60 peratus daripada individu ini akan membesar sebagai orang dewasa yang bermasalah sehingga mendorong melakukan perkara yang menyalahi undang-undang.

Terang Dr. Nor Hamidah lagi, disebabkan ADHD mempengaruhi genetik, seseorang bapa boleh mewariskan sindrom ini kepada anak lelaki mereka.

''Keadaan ini juga menjadikan kanak-kanak lelaki lebih cenderung mengalami ADHD sebanyak tiga kali ganda berbanding kanak-kanak perempuan,'' ujarnya lagi.

Satu kajian ke atas kanak-kanak Malaysia berumur di antara 5 - 15 tahun menunjukkan seramai 4.3 peratus mempunyai ciri-ciri ADHD.

Kebanyakannya dihidapi oleh kanak-kanak lelaki berbanding perempuan.

Katanya, masalah itu boleh dipanggil penyakit yang tidak nampak kerana secara realiti, mereka sihat malah kebanyakan mempunyai tahap setara individu biasa dan lebih menakjubkan sebilangan besar mempunyai kebolehan serta bakat seni luar biasa.

''Kanak-kanak ini sebenarnya tidak sakit. Mereka hanya mengalami ketidakseimbangan sistem neuro di dalam otak menjadikan mereka sukar mengawal diri. Penyakit ini juga bukan berpunca daripada pemakanan, pengambilan gula berlebihan, alahan atau terpengaruh dengan televisyen.

Bagaimanapun katanya, ADHD perlu dirawat segera sebaik disedari kerana ia menyebabkan beberapa masalah sampingan seperti perasaan rendah diri, kurang yakin dan lemah pencapaian akademik.

''Dalam situasi ini, ibu bapa seharusnya tidak kecewa jika anak mereka didapati mengalami masalah ini, bawalah mereka bertemu pakar supaya tingkahlaku ini tidak terbawa-bawa ke alam dewasa dan mereka sebenarnya masih berpotensi menjalani hidup normal seperti individu lain," katanya.

Dalam keadaan ini, tegas Dr Nor Hamidah, ada beberapa teknik yang boleh diguna pakai oleh ibu bapa ketika di rumah untuk dipraktikkan.

'' Berikan arahan satu persatu dengan jelas supaya mereka memahami arahan tersebut dan menjelaskan padanya kesan dan akibatnya.

Sekiranya mereka membuatkan sesuatu dengan baik berikan pujian supaya menaikkan rasa harga diri.

Bagaimanapun, biasakan mereka untuk melakukan kerja-kerja asas dirumah bagi membiasakan mereka.

Malah terang Dr. Nor Hamidah lagi, tidak salah jika sebagai ibu bapa wujudkan satu sistem memberi hadiah untuk menggalakkan mereka berkelakuan dengan baik.

Apabila disekolah minta bantuan guru supaya tempatkan mereka dengan kedudukan di hadapan kelas.

Anak Hyperaktif tidak semestinya ADHD

Pernah tak kalian sembang-sembang bukan rasmi dengan kawan2 kalian... Tak pun kawan kalian mengadu pasal anaknya yang nakal ala2 hyper gitu. Tanyakan samada anaknya itu juga anak istimewa....

~~~~ Cuba-cuba kau check budak tu macam boleh masuk kelas khas... hyper! Kata teman 1.

~~~~ Hai, kenapa bah anak aku tu... nakal...hyper...istimewa juga kah tu? Kata teman 2.

Hohohohoho mcmlah aku ni Dr. / pakar psikiatri sahaja yg boleh mendiagnostik. Kami guru2 PK hanya boleh    memberitahu secara umum sahaja berdasarkan ciri umum yang kami tahu.

Oklah jom kita tgk... adakah benar anak itu ADH atau cuma hyperaktif.

Sleep Apnea Pada Anak

Sleep Apnea adalah gangguan tidur di mana simptomnya adalah mendengkur dan rasa mengantuk yang berlebihan. Sleep apnea, yang bermasuk sesak nafas semasa tidur, jika ia berlaku pada orang dewasa ia akan menyebabkan hipertensi berbagai penyakit jantung, diabetes hinggah stroke. Dikalangan kanak-kanak, sleep apnea menjadi lebih serius kerana ianya memberi kesan terhadap pertumbuhannya.

Perhatikan semasa anak anda tidur, ketika dia mendengkur. Pada saat suara dengkurannya mula hilang, anak anda kelihatan sesak seolah tercekik. Perkara  ini berlaku kerana berlaku penyempitan dalam saluran pernafasannya yang mengakibatkan udara tidak dapat masuk atau keluar. Akibat oksigen yang merosot dan kadar karbondioksida yang meningkat mendadak, si anak akan terbangun disertai suara hentakan keras seolah nafas baru terbebas. Episod bangun ini disebut sebagao episo bangun mikro (micro arousal) kerana walaupun gelombang otak terbagun, namun si anak tidak terjaga. Dan episod ini ini terus berulang sepanjang malam hinggah menggangu kualiti tidurnya. Akibat drpd itu, si anak akan terus berada dalam kondisi kurang tidur, walaupun sebenarnya dia sudah cukup tidur. Anak, untuk melawan rasa kantuknya justeru itu dia menjadi aktif secara fizikalnya.

Tidur pada Anak

Proses tidur amatlah penting bagi seorang anak. Kerana proses perkembangan berlaku pada waktu tidur. Pada tahap tidur dalam, dikeluarkan growth hormone yang berperanan dalam proses pertumbuhan. Sedangkan pada tahap tidur mimpi, dipercaya sebagai tahap tidur dimana kemampuan kognitif, mental dan emosional dijaga.

Dengan adanya sleep apnea, proses tidur akan terpotong-potong. Akibatnya proses tumbuh kembang pun terganggu. Kecerdasan dan potensi-potensi mental lain yang seharusnya tumbuh dan berkembang saat tidur, tidak tumbuh. Kondisi emosionalnya pun buruk, anak jadi murung dan mudah marah. Kernana mengantuk, anak juga semakin aktif dan sukar memusatkan perhatian.

Sumber: http://sleepclinicjakarta.tblog.com/post/1970054835

Eating Licorice In Pregnancy May Affect A Child's IQ And Behavior

ScienceDaily (Oct. 7, 2009) — Expectant mothers who eat excessive quantities of licorice during pregnancy could adversely affect their child's intelligence and behavior, a study has shown.

A study of eight year old children whose mothers ate large amounts of licorice when pregnant found they did not perform as well as other youngsters in cognitive tests.
They were also more likely to have poor attention spans and show disruptive behavior such as ADHD (attention deficit hyperactivity disorder).
It is thought that a component in licorice called glycyrrhizin may impair the placenta, allowing stress hormones to cross from the mother to the baby.
High levels of such hormones, known as glucocorticoids, are thought to affect fetal brain development and have been linked to behavioral disorders in children.
The results of the study are published in the American Journal of Epidemiology. Eight-year-olds whose mothers had been monitored for licorice consumption during pregnancy were tested on a range of cognitive functions including vocabulary, memory and spatial awareness.
Behavior was assessed using an in-depth questionnaire completed by the mother, which is also used by clinicians to evaluate children's behavior.
The study, carried out by the University of Helsinki and the University of Edinburgh, looked at children born in Finland, where consumption of licorice among young women is common.
Professor Jonathan Seckl, from the University of Edinburgh's Centre for Cardiovascular Science, said: "This shows that eating licorice during pregnancy may affect a child's behavior or IQ and suggests the importance of the placenta in preventing stress hormones that may affect cognitive development getting through to the baby."
Women who ate more than 500mg of glycyrrhizin per week – found in the equivalent of 100g of pure licorice – were more likely to have children with lower intelligence levels and more behavioral problems.
"Expectant mothers should avoid eating excessive amounts of licorice," said Professor Katri Räikkönen, from the University of Helsinki's Department of Psychology.
Of the children who took part in the study, 64 were exposed to high levels of glycyrrhizin in licorice, 46 to moderate levels and 211 to low levels.
The research followed on from a study which showed that licorice consumption was also linked to shorter pregnancies. Laboratory studies have also shown a link between the placenta not working to prevent stress hormones from passing through to the fetus, as well as a link to cardiac and metabolic disorders and behavioral problems in later life.

Articel Source : http://www.sciencedaily.com

Kenali dan kita pasti cintai..

Pernah tak anda berbual dengan ibubapa murid anda? Dan cuba untuk memahami mengapa sukar baginya untuk menerima bahawa anaknya adalah anak istimewa. Dan begitu mudah bagi kita memberi kesimpulan bahawa si ibubapa ini tidak mahu menerima hakikat bahawa anaknya bermasalah.

Kesukaran ibubapa tidak mahu menerima anak mereka adalah istimewa terutamanya bagi kanak-kanak Autisma, ADHD atau lembam yang secara fizikalnya kelihatan normal bukan kerana mereka TIDAK MAHU MENERIMA sebaliknya MEREKA TIDAK TAHU dan MUNGKIN TIDAK MAHU AMBIL TAHU.

Peranan di pihak kita bukan untuk memberi ajar..namun kita berperanan untuk memberi panduan dan dorongan untuk si ibubapa ini mengenali dan mengendalikan anak mereka.

Berdasarkan pengalaman, sukarnya mereka menerima bahawa anak mereka adalah istimewa memandangkan mereka merujuk kepada pengalaman sendiri dan juga orang terdekat mereka. Contohnya, anak yang pertama katanya juga nakal, hyper dan lambat bertutur. Namun selang beberapa tahun semuanya normal sepertimana kanak-kanak yang lain yang seusianya. Dan dengan itu...si ibubapa ini mempercayai bahawa anak juga pasti begitu akan normal juga.

HAKIKATNYA anak si ibubapa ini adalah istimewa. Bagaimana untuk kita membantunya untuk menerima hakikat ini? Bukan dengan kesimpulan awal. Panduan dan dorongan. Panduan dan dorongan dengan komunikasi yang baik. Dengar apa yang si ibubapa ini luahkan, beri dia semangat bukan janji2 komporfasi, perlihatkan kegembiraan kita apabila ibubapa menyatakan bahawa anaknya sudah ada perubahan, beri pujian dan motivasi kepadanya dan bagitahu dia itu adalah usaha kerasnya dan perlu ada usaha dua pihak-guru dan juga ibubapa. Berikan contoh2 perkembangan murid yang lalu, berikan maklumat tambahan, berikan beberapa cadangan. Biasanya ibubapa yg agak 'degil' ini akan mula percaya kpd guru apabila saranan guru/maklumat guru itu selari dgn apa yg dikatakan oleh doktor anaknya. Dengan itu, guru perlu berpengetahuan dan yakin untuk berkomunikasi dengan ibubapa bukan duduk di meja guru dan malambai dari jauh aja.. he he he...Peace! Bina kedekatan antara kita dan ibubapa agar mesej 'lebih lembut' untuk diterima oleh ibubapa jenis ini.

Kanak-Kanak Istimewa.

Kenapa ada dikalangan kanak-kanak yang perlu lebih usaha untuk mempelajari sesuatu?. Bagaimana pula dengan kanak-kanak boleh belajar namun sukar untuk belajar dan lebih berminat kepada aktiviti diluar kelas? Kanak - kanak ini perlukan pendekatan lain yang lebih kreatif, individual, praktikal dan lebih khusus dengan itu, perkara ini menjelaskan bahawa mereka adalah kanak-kanak istimewa.

Kanak-kanak ini oleh jadi mengalami ketidakupayaan fizikal, mengalami masalah kesukaran dalam pembelajaran atau masalah tingkah - laku atau kedua-duanya sekali. Bagaimanapun kanak-kanak ini memiliki potensinya sendiri. Kategori kanak-kanak ini terdiri daripada:-

1. Terencat akal (mental retardation)

2. Bermasalah Pembelajaran (Learning Disabilities)

3. Kecelaruan Komunikasi ( Communication Disorders)

4. Ketidak upayaan Fizikal (Physcal Disabilities)

5. Bermasalah Tingkah-Laku ( Behavior Disorders - emotional disturbance)

6. Ketidakupayaan Penglihatan (Visual Impairment)

7. Ketidakupayaan Pendengaran (Hearing Impairement)

8. Kepandaian luar biasa (Exceptional Gift)

Apakah punca semua ini?

Terdapat dua faktor high-risk yang dikategorikan sebagai :-

1. Risiko Biologikal

- Risiko Bilogikal merujuk kepada kondisi yang diagnosiskan sebagai gangguan perubatan (medical disorders) seperti Down's Syndrome.

i. Prenatal Period

- Penyakit yang memberi kesan negetif kepada kesihatan si ibu semasa mengandung seperti Rubella, CMV virus (Cytomegalic Inclusion Disease), Herpes Simples, AIDS, Diabetes dan Toxemia.

- Penggunaan ubat kimikal tertentu, penggunaan alkohol, penggunaan dadah dan juga kekurangan zat makanan.

ii. Chromosomal Disorders
iii. Metabolic Disorders
iv. Birth Complication

REFERENCES: Mohd Sharani Ahmad, UPM Serdang; Special Children

******To be cont...

Dysprexia

KESIHATAN
Kelam-kabut sindrom penyakit
Oleh SHANIKA ABADULLATIB

Dysprexia umumnya tidak mampu dilihat dengan mata kasar kerana ia melibatkan ketidakjajaran antara arahan dari otak dan pergerakan tangan atau kaki pada masa yang sama.

SEIMBAS pandang, pelajar lelaki berusia 10 tahun yang dikenali dengan nama ringkasnya, Alim langsung tidak berbeza dengan rakan-rakan sebayanya yang lain sehinggalah guru sekolahnya kerap menegur tingkah lakunya yang suka melanggar meja dan kerusi secara sembrono.

Suatu hari, gurunya melihat koordinasi pergerakan Alim agak berbeza berbanding rakan-rakannya termasuk lambat dalam menyalin sesuatu yang ditulis di papan tulis, lalu akhirnya dia menyarankan agar Alim dibawa berjumpa pakar perubatan.

Diagnosis dan ujian yang dijalankan mendapati, tingkah laku kelam-kabut Alim itu sebenarnya berpunca daripada abnormaliti pada sistem motor dan saraf dalam tubuhnya.
Dikenali sebagai Dysprexia, penyakit ini umumnya tidak mampu dilihat dengan mata kasar kerana ia melibatkan ketidakjajaran antara arahan dari otak dan pergerakan tangan atau kaki pada masa yang sama.

Pakar Runding Psikitri Pusat Perubatan Prince Court, Dr. Nor Hamidah Mohd. Salleh menjelaskan, dysprexia yang banyak dihadapi kanak-kanak lelaki sebenarnya mampu dikesan dari awal lagi.

Gagal ikat tali kasut
“Dysprexia atau istilah mudahnya sindrom kanak-kanak kelam-kabut, merupakan satu keadaan yang tidak ubah seperti autisme, dylexia, dan kanak-kanak hiper aktif (ADHD).”

“Namun yang membezakannya ialah dysprexia melibatkan ketidakjajaran pergerakan motor anggota badan dan otak,” jelasnya.
Tambah Nor Hamidah, simptom awal dysprexia boleh dikesan pada setiap peringkat perkembangan motor bayi iaitu daripada merangkak dan berjalan.

Daripada perkembangan ini, pakar akan melihat sebarang abnormaliti yang wujud terutamanya dari aspek mengimbangkan diri, sensitiviti terhadap sentuhan dan pergerakan fizikal yang berterusan.

“Paling mudah untuk mengesannya ialah kanak-kanak tersebut sukar mengimbangi diri ketika berbasikal, mengikat tali kasut serta sering melanggar objek sewaktu berjalan,” ujarnya.

Pelakon remaja yang terkenal menerusi siri filem Harry Potter, Daniel Radcliffe sebagai contoh, merupakan salah seorang pengidap dysprexia. Meskipun, tidak mempunyai masalah untuk menghafal skrip filem-filem lakonannya, Radcliffe akan menghadapi masalah apabila mahu mengikat tali kasutnya.

“Disebabkan gagal melakukan perkara semudah mengikat tali kasut, saya melalui fasa kehidupan yang sukar ketika zaman persekolahan dulu,” ujarnya kepada akhbar Britain, Daily Mail.

Kesukaran kawal pernafasan
Dalam pada itu, selain melibatkan pergerakan, Dysprexia Oral pula merupakan gangguan melibatkan ketidakjajaran perkembangan linguastik atau fonologi ketika bercakap.
“Masalah ini akan menyebabkan pesakit sukar mengawal organ pertuturan, membuat bunyi-bunyian, serta menyatakan perkataan secara berturut-turut termasuk membina ayat daripada perkataan,” jelas Nor Hamidah.

Bukan itu sahaja, mereka juga mengalami kesukaran mengawal pernafasan dan lambat dari segi perkembangan bahasa.

Bagi pengawalan koordinasi motor halus, ia mengakibatkan pesakit termasuk individu pada peringkat dewasa mengalami masalah untuk menulis dengan tangan.

Lebih malang, ketidakseimbangan koordinasi ini turut membuatkan pesakit sukar menjalani rutin harian seperti membutangkan baju, menggunakan sudu dan garpu serta membuka penutup botol.

“Koordinasi yang tidak simbang melibatkan saraf motor ini akan berterusan dan menyebabkan pesakit sering terlanggar objek, tidak kira kecil atau besar,” ujarnya.
Tambah beliau, kes terjatuh tanpa sebab, tidak dapat mengagak kedudukan objek serta gagal melakukan dua tugasan serentak juga merupakan sebahagian daripada masalah dysprexia.
“Ada kes yang lebih teruk, mereka sukar mengesan arah kanan atau kiri apabila mata ditutup serta terlupa pada pergerakan seterusnya ketika melakukan sesuatu seperti ketika sedang berjalan,” kata Nor Hamidah.

Tiada rawatan khusus
Menyentuh mengenai rawatan, Nor Hamidah menjelaskan bahawa tiada rawatan khusus bagi penyakit namun rawatan terapi dapat memperbaiki koordinasi pergerakan pesakit ini.
Nor Hamidah memberitahu, sekiranya dibiarkan begitu sahaja, kanak-kanak tersebut akan membesar dengan keadaan kurang keyakinan diri, pemalu, kurang matang dan sensitif.

“Disebabkan itu, kanak-kanak yang mengalami masalah tersebut perlu dibiarkan bermain dengan pasir, tanah liat termasuk memanjat serta berlari di taman permainan bagi melatih koordinasi dan sensitiviti pergerakan motor tubuh,” jelasnya.

SUMBER: Kosmo Online!

Tukar Streotaip Anda !

Tukar Streotaip Anda !

KEKUATAN ORANG ADHD:
Ø Kecerdasan lebih tinggi (higher intelligence)
Ø Kreativiti (creativity)
Ø Belas kasihan (compassion)
Ø Sangat berfokus (hyper-focus)
Ø Daya bergerak tak terhingga (unstoppable drive)
Ø Keupayaan menyelesai masalah yang tinggi (increased problem solving ability)
Ø Ketahanan diri (resilience)
Ø Sifat gerak hati (intuitiveness)
Ø Keupayaan melihat isu dan masalah dari perspektif lain
(ability to look at problems and issues from a different perspective)

MIRIP CIRI-CIRI PENGURUS TINGGI (CEO)

KEKUATAN ORANG DISLEKSIA:
Ø Cerdik berbakat dan kreatif (bright, talented & creative)
Ø Aptitud mekanikal (mechanical aptitude)
Ø Keupayaan dalam arkitek, seni kreatif & kejuruteraan
(ability in architecture, creative arts and engineering)
Ø Berbakat dalam muzik (musical gifts)
Ø Kehandalan dalam olahraga (athletic prowess)
Ø Kemahiran sosial yang tinggi (advanced social skill)
Ø Berbakat bidang jualan, komputer, teknologi, sains & matematik
(talents in sales, computer, technology, science & mathematics)

MIRIP CIRI-CIRI PERSONALITI BIDANG KHUSUS

Sumber: Bahan Seminar

Makanan untuk ADHD

Saya pernah bertanya kepada seorang ibu mengapa suatu masa dulu anaknya sudah boleh duduk diam (kosentrasi) untuk belajar dan TIADA KOSENTRASINYA datang balik. Ketidakkosentrasi anak ini bukan sedikit tapi banyak mengganngu P&P dan adakalanya menimbulkan sedikit rasa geram dikalangan guru, ppm dan rakannya yang lain. Apa tidaknya baru seminit nak mula mengajar dia dah lari keluar kelas. Mulalah proses kejar mengejar. Kalau guru perdana yang tak paham, akan senyum2 saja menengok telatah kami...kalau mereka2 yang tak paham lagi..akan mengatakan kami2 ini sebagai tidak bertanggungjawab membiarkan dia terlepas....

Bagi menjawab saolan... si ibu menyatakan dia ada beri anaknya makan minyak ikan.. omega 3...

Minyak ikan? Omega 3... ... saya pun cuba mencari apa ka benda itu.....

Omega 3 bukan ubat untuk ADHD seperti mana ritalin...Omega 3 hanya makanan tambahan untuk beberapa kelebihan antaranya untuk perkembangan otak kanak -kanak, kosentrasi kanak-kanak...dan mungkin kerana itulah omega 3 dikatakan boleh membantu menimbulkan kosentrasi kanak-kanak ADHD..

Rujuk sini >>>>>>> OMEGA 3

Omega 3 is the name of a type of fat that is found in oil-rich fish and some plant oils and is also known as ‘n-3‘. They are from the family of ‘good’ fats - polyunsaturated fatty acids (PUFAs) that are not only beneficial for health but are essential in the diet.

Fatty acids are the building blocks of fats and there are many different types of fatty acids, some of which can be made by the body, and some which cannot. The so-called essential fatty acids are vital substances that the body must have to maintain optimal health, yet they cannot be made by the body, so a dietary supply is essential.

Omega 3 fatty acids are one of two families of essential fatty acids, and they are derived from the parent of this family: ALA (alpha linolenic acid). The most effective omega 3’s are EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Although the body is able to convert ALA to EPA and DHA, the way it does this is inadequate, which is why oil-rich fish are such an important food, as they contain the omega 3’s already in long-chain form omega 3.

DHA and EPA are long-chain polyunsaturated fatty acids and are also referred to as: LC omega 3 PUFAs. Oil-rich fish are the only nutritionally significant source of long-chain omega 3 fatty acids. The other ’family’ of essential fatty acids is the omega 6 group, found in plant oils and some animal fats.

Long-chain omega 3 fatty acids are needed for normal growth and development in the body, and are also required to maintain cardiovascular health and brain function. Therefore, everybody should be aiming to consume enough regularly to prevent deficiencies and to be healthy.

Since omega 3 essential fatty acids are needed for the membranes of all body cells their role in health is wide reaching: encompassing not only healthy heart and brain function but also playing an important role in the normal function of the eyes, the nervous system, the kidney, and the liver, in fact all body systems. Other functions also include the contraction of muscles and the dilation/constriction of blood vessels, blood clotting, and inflammatory processes.

Only consuming plant sources of essential fatty acids (i.e. ALA) means that the conversion process to the longer chain fats, DHA and EPA, will not be efficient therefore possibly requiring an additional source of omega 3 to maintain optimum intakes.

It is oil-rich fish that are a great source of long-chain omega 3 polyunsaturated fatty acids. The main oil-rich fish available in the UK are: salmon, trout, mackerel, sardines, pilchards, herring, kipper, eel and whitebait, fresh, frozen or tinned. Tuna is only counted as an oily fish if it is fresh or frozen, as the tinned variety does have some oils, but not as much as the fresh one.

Areas where omega 3 may promote health and well-being:
•	heart health: lowering blood pressure, reducing the risk of heart attacks and strokes and protection against heartbeat abnormalities
•	brain function: optimal brain and eye development in babies, especially in premature babies, attention deficit disorder, Alzheimer’s disease and depression
•	rheumatoid arthritis
•	inflammatory skin disorders
•	inflammatory bowel disease

Cara Mudah Meredahkan Kemarahan

Saya sering berdepan murid pendidikan khas yang sering marah secara tiba - tiba ataupun marah apabila kehendaknya tidak dituruti. Boleh menjadi tekanan juga kepada saya. Apa tidaknya. Sedang kita mengajar murid yang lain, seorang ini pula marah dan mengamuk. Terpaksalah kena mengambil masa untuk 'melayan' emosi murid yang satu ini. Dan akhirnya p&p murid yang lain terabai.

Situasi ini walaupun bukannlah sesuatu yang baru bagi seseorang guru pendidikan khas (PKBP) mahupun mereka yang terlibat secara lansung dengan murid sebegini. Bagaimanapun ia boleh menimbulkan tekanan dan sedikit kemaraha kepada si guru itu. Apa tidaknya, perancangan sudah dibuat namun apa yang berlaku adalah disebaliknya. Situasi ini bukan sahaja menganggu perancangan guru malah menganggu pembelajaran murid yang lain.

MARAH. Bukan satu jalan yang perlu dipilih oleh guru. Apatah lagi guru yang sudah berpengalaman berhadapan situasi sebegini. BIARKAN. Bukan juga pilihan yang bijak. Membiarkan mereka dengan kemarahan mereka sepertinya membiarkan murid itu tanpa penyelesaian dan akhirnya guru juga tidak tahu cara menanganinya.

Sedikit TIP yang saya petik dari email....

In it you’ll see a quick and easy way to:

**Calm your child. Tenangkan anak / murid itu terlebih dahulu.

**Calm yourself. Tenangkan diri anda.

**Reduce tension and eliminate anger in just about any situation

This is easy to do and it’s quick. And you can do it anywhere.

So, Cikgu2 jangan marah2 lagi......Nanti tua dari umur... hehheheheh peace!

Attention Deficit Hyperactivitity Disoder (ADHD)

ADHD - Attention deficit hyperactivity disorder merupakan kecelaruan mental yang biasa dihadapi dikalangan kanak-kanak. Ianya memberi kesan kepada 3 - 5% keseluruhan kanak-kanak, dan dihadapi hampir dua juta kanak - kanak Amerika.





"ADHD - attention deficit hyperactivity disorder - is one of the most common mental disorders among children. It affects 3-5% of all children, perhaps as many as 2 million American children." From the National Institute of Mental Health,

Attention Deficit Hyperactivity Disorder

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that becomes apparent in some children in the preschool and early school years. It is hard for these children to control their behavior and/or pay attention. It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States. This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD.

ADHD was first described by Dr. Heinrich Hoffman in 1845. A physician who wrote books on medicine and psychiatry, Dr. Hoffman was also a poet who became interested in writing for children when he couldn't find suitable materials to read to his 3-year-old son. The result was a book of poems, complete with illustrations, about children and their characteristics. "The Story of Fidgety Philip" was an accurate description of a little boy who had attention deficit hyperactivity disorder. Yet it was not until 1902 that Sir George F. Still published a series of lectures to the Royal College of Physicians in England in which he described a group of impulsive children with significant behavioral problems, caused by a genetic dysfunction and not by poor child rearing—children who today would be easily recognized as having ADHD.1 Since then, several thousand scientific papers on the disorder have been published, providing information on its nature, course, causes, impairments, and treatments.

A child with ADHD faces a difficult but not insurmountable task ahead. In order to achieve his or her full potential, he or she should receive help, guidance, and understanding from parents, guidance counselors, and the public education system. This document offers information on ADHD and its management, including research on medications and behavioral interventions, as well as helpful resources on educational options.

Because ADHD often continues into adulthood, this document contains a section on the diagnosis and treatment of ADHD in adults.
Symptoms
The principal characteristics of ADHD are inattention, hyperactivity, and impulsivity. These symptoms appear early in a child’s life. Because many normal children may have these symptoms, but at a low level, or the symptoms may be caused by another disorder, it is important that the child receive a thorough examination and appropriate diagnosis by a well-qualified professional.

Symptoms of ADHD will appear over the course of many months, often with the symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more. Different symptoms may appear in different settings, depending on the demands the situation may pose for the child’s self-control. A child who “can’t sit still” or is otherwise disruptive will be noticeable in school, but the inattentive daydreamer may be overlooked. The impulsive child who acts before thinking may be considered just a “discipline problem,” while the child who is passive or sluggish may be viewed as merely unmotivated. Yet both may have different types of ADHD. All children are sometimes restless, sometimes act without thinking, sometimes daydream the time away. When the child’s hyperactivity, distractibility, poor concentration, or impulsivity begin to affect performance in school, social relationships with other children, or behavior at home, ADHD may be suspected. But because the symptoms vary so much across settings, ADHD is not easy to diagnose. This is especially true when inattentiveness is the primary symptom.

According to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders2 (DSM-IV-TR), there are three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive far more than others of their age. Or they may show all three types of behavior. This means that there are three subtypes of ADHD recognized by professionals. These are the predominantly hyperactive-impulsive type (that does not show significant inattention); the predominantly inattentive type (that does not show significant hyperactive-impulsive behavior) sometimes called ADD—an outdated term for this entire disorder; and the combined type (that displays both inattentive and hyperactive-impulsive symptoms).
Hyperactivity-Impulsivity

Hyperactive children always seem to be “on the go” or constantly in motion. They dash around touching or playing with whatever is in sight, or talk incessantly. Sitting still at dinner or during a school lesson or story can be a difficult task. They squirm and fidget in their seats or roam around the room. Or they may wiggle their feet, touch everything, or noisily tap their pencil. Hyperactive teenagers or adults may feel internally restless. They often report needing to stay busy and may try to do several things at once.

Impulsive children seem unable to curb their immediate reactions or think before they act. They will often blurt out inappropriate comments, display their emotions without restraint, and act without regard for the later consequences of their conduct. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they’re upset. Even as teenagers or adults, they may impulsively choose to do things that have an immediate but small payoff rather than engage in activities that may take more effort yet provide much greater but delayed rewards.

Some signs of hyperactivity-impulsivity are:

* Feeling restless, often fidgeting with hands or feet, or squirming while seated
* Running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected
* Blurting out answers before hearing the whole question
* Having difficulty waiting in line or taking turns.

Inattention

Children who are inattentive have a hard time keeping their minds on any one thing and may get bored with a task after only a few minutes. If they are doing something they really enjoy, they have no trouble paying attention. But focusing deliberate, conscious attention to organizing and completing a task or learning something new is difficult.

Homework is particularly hard for these children. They will forget to write down an assignment, or leave it at school. They will forget to bring a book home, or bring the wrong one. The homework, if finally finished, is full of errors and erasures. Homework is often accompanied by frustration for both parent and child.

The DSM-IV-TR gives these signs of inattention:

* Often becoming easily distracted by irrelevant sights and sounds
* Often failing to pay attention to details and making careless mistakes
* Rarely following instructions carefully and completely losing or forgetting things like toys, or pencils, books, and tools needed for a task
* Often skipping from one uncompleted activity to another.

Children diagnosed with the Predominantly Inattentive Type of ADHD are seldom impulsive or hyperactive, yet they have significant problems paying attention. They appear to be daydreaming, “spacey,” easily confused, slow moving, and lethargic. They may have difficulty processing information as quickly and accurately as other children. When the teacher gives oral or even written instructions, this child has a hard time understanding what he or she is supposed to do and makes frequent mistakes. Yet the child may sit quietly, unobtrusively, and even appear to be working but not fully attending to or understanding the task and the instructions.

These children don’t show significant problems with impulsivity and overactivity in the classroom, on the school ground, or at home. They may get along better with other children than the more impulsive and hyperactive types of ADHD, and they may not have the same sorts of social problems so common with the combined type of ADHD. So often their problems with inattention are overlooked. But they need help just as much as children with other types of ADHD, who cause more obvious problems in the classroom.
Is It Really ADHD?

Not everyone who is overly hyperactive, inattentive, or impulsive has ADHD. Since most people sometimes blurt out things they didn’t mean to say, or jump from one task to another, or become disorganized and forgetful, how can specialists tell if the problem is ADHD?

Because everyone shows some of these behaviors at times, the diagnosis requires that such behavior be demonstrated to a degree that is inappropriate for the person’s age. The diagnostic guidelines also contain specific requirements for determining when the symptoms indicate ADHD. The behaviors must appear early in life, before age 7, and continue for at least 6 months. Above all, the behaviors must create a real handicap in at least two areas of a person’s life such as in the schoolroom, on the playground, at home, in the community, or in social settings. So someone who shows some symptoms but whose schoolwork or friendships are not impaired by these behaviors would not be diagnosed with ADHD. Nor would a child who seems overly active on the playground but functions well elsewhere receive an ADHD diagnosis.

To assess whether a child has ADHD, specialists consider several critical questions: Are these behaviors excessive, long-term, and pervasive? That is, do they occur more often than in other children the same age? Are they a continuous problem, not just a response to a temporary situation? Do the behaviors occur in several settings or only in one specific place like the playground or in the schoolroom? The person’s pattern of behavior is compared against a set of criteria and characteristics of the disorder as listed in the DSM-IV-TR.
Diagnosis

Some parents see signs of inattention, hyperactivity, and impulsivity in their toddler long before the child enters school. The child may lose interest in playing a game or watching a TV show, or may run around completely out of control. But because children mature at different rates and are very different in personality, temperament, and energy levels, it’s useful to get an expert’s opinion of whether the behavior is appropriate for the child’s age. Parents can ask their child’s pediatrician, or a child psychologist or psychiatrist, to assess whether their toddler has an attention deficit hyperactivity disorder or is, more likely at this age, just immature or unusually exuberant.

ADHD may be suspected by a parent or caretaker or may go unnoticed until the child runs into problems at school. Given that ADHD tends to affect functioning most strongly in school, sometimes the teacher is the first to recognize that a child is hyperactive or inattentive and may point it out to the parents and/or consult with the school psychologist. Because teachers work with many children, they come to know how “average” children behave in learning situations that require attention and self-control. However, teachers sometimes fail to notice the needs of children who may be more inattentive and passive yet who are quiet and cooperative, such as those with the predominantly inattentive form of ADHD.
Professionals Who Make the Diagnosis

If ADHD is suspected, to whom can the family turn? What kinds of specialists do they need?

Ideally, the diagnosis should be made by a professional in your area with training in ADHD or in the diagnosis of mental disorders. Child psychiatrists and psychologists, developmental/behavioral pediatricians, or behavioral neurologists are those most often trained in differential diagnosis. Clinical social workers may also have such training.

The family can start by talking with the child’s pediatrician or their family doctor. Some pediatricians may do the assessment themselves, but often they refer the family to an appropriate mental health specialist they know and trust. In addition, state and local agencies that serve families and children, as well as some of the volunteer organizations listed at the end of this document, can help identify appropriate specialists.
Specialty Can Diagnose ADHD Can prescribe medication, if needed Provides counseling or training
Psychiatrists yes yes yes
Psychologists yes yes* yes
Pediatricians or Family Physicians yes yes no
Neurologists yes yes no
Clinical Social workers yes no yes

* As of October 2006, Louisiana and New Mexico laws and regulations allow psychologists who have completed specific training and meet other requirements to prescribe psychotropic medications. The other 48 states and the District of Columbia allow only physicians to prescribe medications.

Knowing the differences in qualifications and services can help the family choose someone who can best meet their needs. There are several types of specialists qualified to diagnose and treat ADHD. Child psychiatrists are doctors who specialize in diagnosing and treating childhood mental and behavioral disorders. A psychiatrist can provide therapy and prescribe any needed medications. Child psychologists are also qualified to diagnose and treat ADHD. They can provide therapy for the child and help the family develop ways to deal with the disorder. But psychologists are not medical doctors and must rely on the child’s physician to do medical exams and prescribe medication. Neurologists, doctors who work with disorders of the brain and nervous system, can also diagnose ADHD and prescribe medicines. But unlike psychiatrists and psychologists, neurologists usually do not provide therapy for the emotional aspects of the disorder.

Within each specialty, individual doctors and mental health professionals differ in their experiences with ADHD. So in selecting a specialist, it’s important to find someone with specific training and experience in diagnosing and treating the disorder.

Whatever the specialist’s expertise, his or her first task is to gather information that will rule out other possible reasons for the child’s behavior. Among possible causes of ADHD-like behavior are the following:

* A sudden change in the child’s life—the death of a parent or grandparent; parents’ divorce; a parent’s job loss
* Undetected seizures, such as in petit mal or temporal lobe seizures
* A middle ear infection that causes intermittent hearing problems
* Medical disorders that may affect brain functioning
* Underachievement caused by learning disability
* Anxiety or depression.

Ideally, in ruling out other causes, the specialist checks the child’s school and medical records. There may be a school record of hearing or vision problems, since most schools automatically screen for these. The specialist tries to determine whether the home and classroom environments are unusually stressful or chaotic, and how the child’s parents and teachers deal with the child.

Next the specialist gathers information on the child’s ongoing behavior in order to compare these behaviors to the symptoms and diagnostic criteria listed in the DSM-IV-TR. This also involves talking with the child and, if possible, observing the child in class and other settings.

The child’s teachers, past and present, are asked to rate their observations of the child’s behavior on standardized evaluation forms, known as behavior rating scales, to compare the child’s behavior to that of other children the same age. While rating scales might seem overly subjective, teachers often get to know so many children that their judgment of how a child compares to others is usually a reliable and valid measure.

The specialist interviews the child’s teachers and parents, and may contact other people who know the child well, such as coaches or baby-sitters. Parents are asked to describe their child’s behavior in a variety of situations. They may also fill out a rating scale to indicate how severe and frequent the behaviors seem to be.

In most cases, the child will be evaluated for social adjustment and mental health. Tests of intelligence and learning achievement may be given to see if the child has a learning disability and whether the disability is in one or more subjects.

In looking at the results of these various sources of information, the specialist pays special attention to the child’s behavior during situations that are the most demanding of self-control, as well as noisy or unstructured situations such as parties, or during tasks that require sustained attention, like reading, working math problems, or playing a board game. Behavior during free play or while getting individual attention is given less importance in the evaluation. In such situations, most children with ADHD are able to control their behavior and perform better than in more restrictive situations.

The specialist then pieces together a profile of the child’s behavior. Which ADHD-like behaviors listed in the most recent DSM does the child show? How often? In what situations? How long has the child been doing them? How old was the child when the problem started? Are the behavior problems relatively chronic or enduring or are they periodic in nature? Are the behaviors seriously interfering with the child’s friendships, school activities, home life, or participation in community activities? Does the child have any other related problems? The answers to these questions help identify whether the child’s hyperactivity, impulsivity, and inattention are significant and long-standing. If so, the child may be diagnosed with ADHD.

A correct diagnosis often resolves confusion about the reasons for the child’s problems that lets parents and child move forward in their lives with more accurate information on what is wrong and what can be done to help. Once the disorder is diagnosed, the child and family can begin to receive whatever combination of educational, medical, and emotional help they need. This may include providing recommendations to school staff, seeking out a more appropriate classroom setting, selecting the right medication, and helping parents to manage their child’s behavior.
What Causes ADHD?

One of the first questions a parent will have is “Why? What went wrong?” “Did I do something to cause this?” There is little compelling evidence at this time that ADHD can arise purely from social factors or child-rearing methods. Most substantiated causes appear to fall in the realm of neurobiology and genetics. This is not to say that environmental factors may not influence the severity of the disorder, and especially the degree of impairment and suffering the child may experience, but that such factors do not seem to give rise to the condition by themselves.

The parents’ focus should be on looking forward and finding the best possible way to help their child. Scientists are studying causes in an effort to identify better ways to treat, and perhaps someday, to prevent ADHD. They are finding more and more evidence that ADHD does not stem from the home environment, but from biological causes. Knowing this can remove a huge burden of guilt from parents who might blame themselves for their child’s behavior.

Over the last few decades, scientists have come up with possible theories about what causes ADHD. Some of these theories have led to dead ends, some to exciting new avenues of investigation.
Environmental Agents

Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the offspring of that pregnancy. As a precaution, it is best during pregnancy to refrain from both cigarette and alcohol use.

Another environmental agent that may be associated with a higher risk of ADHD is high levels of lead in the bodies of young preschool children. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels is not as prevalent as it once was. Children who live in old buildings in which lead still exists in the plumbing or in lead paint that has been painted over may be at risk.
Brain Injury

One early theory was that attention disorders were caused by brain injury. Some children who have suffered accidents leading to brain injury may show some signs of behavior similar to that of ADHD, but only a small percentage of children with ADHD have been found to have suffered a traumatic brain injury.
Food Additives and Sugar

It has been suggested that attention disorders are caused by refined sugar or food additives, or that symptoms of ADHD are exacerbated by sugar or food additives. In 1982, the National Institutes of Health held a scientific consensus conference to discuss this issue. It was found that diet restrictions helped about 5 percent of children with ADHD, mostly young children who had food allergies.3 A more recent study on the effect of sugar on children, using sugar one day and a sugar substitute on alternate days, without parents, staff, or children knowing which substance was being used, showed no significant effects of the sugar on behavior or learning.4

In another study, children whose mothers felt they were sugar-sensitive were given aspartame as a substitute for sugar. Half the mothers were told their children were given sugar, half that their children were given aspartame. The mothers who thought their children had received sugar rated them as more hyperactive than the other children and were more critical of their behavior.5
Genetics

Attention disorders often run in families, so there are likely to be genetic influences. Studies indicate that 25 percent of the close relatives in the families of ADHD children also have ADHD, whereas the rate is about 5 percent in the general population.6 Many studies of twins now show that a strong genetic influence exists in the disorder.7

Researchers continue to study the genetic contribution to ADHD and to identify the genes that cause a person to be susceptible to ADHD. Since its inception in 1999, the Attention-Deficit Hyperactivity Disorder Molecular Genetics Network has served as a way for researchers to share findings regarding possible genetic influences on ADHD.8
Recent Studies on Causes of ADHD

Some knowledge of the structure of the brain is helpful in understanding the research scientists are doing in searching for a physical basis for attention deficit hyperactivity disorder. One part of the brain that scientists have focused on in their search is the frontal lobes of the cerebrum. The frontal lobes allow us to solve problems, plan ahead, understand the behavior of others, and restrain our impulses. The two frontal lobes, the right and the left, communicate with each other through the corpus callosum, (nerve fibers that connect the right and left frontal lobes).

The basal ganglia are the interconnected gray masses deep in the cerebral hemisphere that serve as the connection between the cerebrum and the cerebellum and, with the cerebellum, are responsible for motor coordination. The cerebellum is divided into three parts. The middle part is called the vermis.

All of these parts of the brain have been studied through the use of various methods for seeing into or imaging the brain. These methods include functional magnetic resonance imaging (fMRI) positron emission tomography (PET), and single photon emission computed tomography (SPECT). The main or central psychological deficits in those with ADHD have been linked through these studies. By 2002 the researchers in the NIMH Child Psychiatry Branch had studied 152 boys and girls with ADHD, matched with 139 age- and gender-matched controls without ADHD. The children were scanned at least twice, some as many as four times over a decade. As a group, the ADHD children showed 3-4 percent smaller brain volumes in all regions—the frontal lobes, temporal gray matter, caudate nucleus, and cerebellum.

This study also showed that the ADHD children who were on medication had a white matter volume that did not differ from that of controls. Those never-medicated patients had an abnormally small volume of white matter. The white matter consists of fibers that establish long-distance connections between brain regions. It normally thickens as a child grows older and the brain matures.9

Although this long-term study used MRI to scan the children’s brains, the researchers stressed that MRI remains a research tool and cannot be used to diagnose ADHD in any given child. This is true for other neurological methods of evaluating the brain, such as PET and SPECT.
Disorders that Sometimes Accompany ADHD
Learning Disabilities

Many children with ADHD—approximately 20 to 30 percent—also have a specific learning disability (LD).10 In preschool years, these disabilities include difficulty in understanding certain sounds or words and/or difficulty in expressing oneself in words. In school age children, reading or spelling disabilities, writing disorders, and arithmetic disorders may appear. A type of reading disorder, dyslexia, is quite widespread. Reading disabilities affect up to 8 percent of elementary school children.
Tourette Syndrome

A very small proportion of people with ADHD have a neurological disorder called Tourette syndrome. People with Tourette syndrome have various nervous tics and repetitive mannerisms, such as eye blinks, facial twitches, or grimacing. Others may clear their throats frequently, snort, sniff, or bark out words. These behaviors can be controlled with medication. While very few children have this syndrome, many of the cases of Tourette syndrome have associated ADHD. In such cases, both disorders often require treatment that may include medications.
Oppositional Defiant Disorder

As many as one-third to one-half of all children with ADHD—mostly boys—have another condition, known as oppositional defiant disorder (ODD). These children are often defiant, stubborn, non-compliant, have outbursts of temper, or become belligerent. They argue with adults and refuse to obey.
Conduct Disorder

About 20 to 40 percent of ADHD children may eventually develop conduct disorder (CD), a more serious pattern of antisocial behavior. These children frequently lie or steal, fight with or bully others, and are at a real risk of getting into trouble at school or with the police. They violate the basic rights of other people, are aggressive toward people and/or animals, destroy property, break into people’s homes, commit thefts, carry or use weapons, or engage in vandalism. These children or teens are at greater risk for substance use experimentation, and later dependence and abuse. They need immediate help.
Anxiety and Depression

Some children with ADHD often have co-occurring anxiety or depression. If the anxiety or depression is recognized and treated, the child will be better able to handle the problems that accompany ADHD. Conversely, effective treatment of ADHD can have a positive impact on anxiety as the child is better able to master academic tasks.
Bipolar Disorder

There are no accurate statistics on how many children with ADHD also have bipolar disorder. Differentiating between ADHD and bipolar disorder in childhood can be difficult. In its classic form, bipolar disorder is characterized by mood cycling between periods of intense highs and lows. But in children, bipolar disorder often seems to be a rather chronic mood dysregulation with a mixture of elation, depression, and irritability. Furthermore, there are some symptoms that can be present both in ADHD and bipolar disorder, such as a high level of energy and a reduced need for sleep. Of the symptoms differentiating children with ADHD from those with bipolar disorder, elated mood and grandiosity of the bipolar child are distinguishing characteristics.11
The Treatment of ADHD

Every family wants to determine what treatment will be most effective for their child. This question needs to be answered by each family in consultation with their health care professional. To help families make this important decision, the National Institute of Mental Health (NIMH) has funded many studies of treatments for ADHD and has conducted the most intensive study ever undertaken for evaluating the treatment of this disorder. This study is known as the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA).12 The NIMH is now conducting a clinical trial for younger children ages 3 to 5.5 years (Treatment of ADHD in Preschool-Age Children).
The Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder

The MTA study included 579 (95-98 at each of 6 treatment sites) elementary school boys and girls with ADHD, who were randomly assigned to one of four treatment programs: (1) medication management alone; (2) behavioral treatment alone; (3) a combination of both; or (4) routine community care. In each of the study sites, three groups were treated for the first 14 months in a specified protocol and the fourth group was referred for community treatment of the parents’ choosing. All of the children were reassessed regularly throughout the study period. An essential part of the program was the cooperation of the schools, including principals and teachers. Both teachers and parents rated the children on hyperactivity, impulsivity, and inattention, and symptoms of anxiety and depression, as well as social skills.

The children in two groups (medication management alone and the combination treatment) were seen monthly for one-half hour at each medication visit. During the treatment visits, the prescribing physician spoke with the parent, met with the child, and sought to determine any concerns that the family might have regarding the medication or the child’s ADHD-related difficulties. The physicians, in addition, sought input from the teachers on a monthly basis. The physicians in the medication-only group did not provide behavioral therapy but did advise the parents when necessary concerning any problems the child might have.

In the behavior treatment-only group, families met up to 35 times with a behavior therapist, mostly in group sessions. These therapists also made repeated visits to schools to consult with children’s teachers and to supervise a special aide assigned to each child in the group. In addition, children attended a special 8-week summer treatment program where they worked on academic, social, and sports skills, and where intensive behavioral therapy was delivered to assist children in improving their behavior.

Children in the combined therapy group received both treatments, that is, all the same assistance that the medication-only received, as well as all of the behavior therapy treatments.

In routine community care, the children saw the community-treatment doctor of their parents’ choice one to two times per year for short periods of time. Also, the community-treatment doctor did not have any interaction with the teachers.

The results of the study indicated that long-term combination treatments and the medication-management alone were superior to intensive behavioral treatment and routine community treatment. And in some areas—anxiety, academic performance, oppositionality, parent-child relations, and social skills—the combined treatment was usually superior. Another advantage of combined treatment was that children could be successfully treated with lower doses of medicine, compared with the medication-only group.
Treatment of Attention Deficit Hyperactivity Disorder in Preschool-Age Children (PATS)

Because many children in the preschool years are diagnosed with ADHD and are given medication, it is important to know the safety and efficacy of such treatment. The NIMH is sponsoring an ongoing multi-site study, “Preschool ADHD Treatment Study” (PATS). It is the first major effort to examine the safety and efficacy of a stimulant, methylphenidate, for ADHD in this age group. The PATS study uses a randomized, placebo-controlled, double-blind design. Children ages 3 to 5 who have severe and persistent symptoms of ADHD that impair their functioning are eligible for this study. To avoid using medications at such an early age, all children who enter the study are first treated with behavioral therapy. Only children who do not show sufficient improvement with behavior therapy are considered for the medication part of the study. The study is being conducted at New York State Psychiatric Institute, Duke University, Johns Hopkins University, New York University, the University of California at Los Angeles, and the University of California at Irvine. Enrollment in the study will total 165 children.
Which Treatment Should My Child Have?

For children with ADHD, no single treatment is the answer for every child. A child may sometimes have undesirable side effects to a medication that would make that particular treatment unacceptable. And if a child with ADHD also has anxiety or depression, a treatment combining medication and behavioral therapy might be best. Each child’s needs and personal history must be carefully considered.
Medications

For decades, medications have been used to treat the symptoms of ADHD.

The medications that seem to be the most effective are a class of drugs known as stimulants. Following is a list of the stimulants, their trade (or brand) names, and their generic names. “Approved age” means that the drug has been tested and found safe and effective in children of that age.
Trade Name Generic Name Approved Age
Adderall amphetamine 3 and older
Concerta methylphenidate
(long acting) 6 and older
Cylert* pemoline 6 and older
Dexedrine dextroamphetamine 3 and older
Dextrostat dextroamphetamine 3 and older
Focalin dexmethylphenidate 6 and older
Metadate ER methylphenidate
(extended release) 6 and older
Metadate CD methylphenidate
(extended release) 6 and older
Ritalin methylphenidate 6 and older
Ritalin SR methylphenidate
(extended release) 6 and older
Ritalin LA methylphenidate
(long acting) 6 and older
*Because of its potential for serious side effects affecting the liver, Cylert should not ordinarily be considered as first-line drug therapy for ADHD.

The U.S. Food and Drug Administration (FDA) recently approved a medication for ADHD that is not a stimulant. The medication, Strattera®, or atomoxetine, works on the neurotransmitter norepinephrine, whereas the stimulants primarily work on dopamine. Both of theses neurotransmitters are believed to play a role in ADHD. More studies will need to be done to contrast Strattera with the medications already available, but the evidence to date indicates that over 70 percent of children with ADHD given Strattera manifest significant improvement in their symptoms.

Some people get better results from one medication, some from another. It is important to work with the prescribing physician to find the right medication and the right dosage. For many people, the stimulants dramatically reduce their hyperactivity and impulsivity and improve their ability to focus, work, and learn. The medications may also improve physical coordination, such as that needed in handwriting and in sports.

The stimulant drugs, when used with medical supervision, are usually considered quite safe. Stimulants do not make the child feel “high,” although some children say they feel different or funny. Such changes are usually very minor. Although some parents worry that their child may become addicted to the medication, to date there is no convincing evidence that stimulant medications, when used for treatment of ADHD, cause drug abuse or dependence. A review of all long-term studies on stimulant medication and substance abuse, conducted by researchers at Massachusetts General Hospital and Harvard Medical School, found that teenagers with ADHD who remained on their medication during the teen years had a lower likelihood of substance use or abuse than did ADHD adolescents who were not taking medications.13

The stimulant drugs come in long- and short-term forms. The newer sustained-release stimulants can be taken before school and are long-lasting so that the child does not need to go to the school nurse every day for a pill. The doctor can discuss with the parents the child’s needs and decide which preparation to use and whether the child needs to take the medicine during school hours only or in the evening and on weekends too.

If the child does not show symptom improvement after taking a medication for a week, the doctor may try adjusting the dosage. If there is still no improvement, the child may be switched to another medication. About one out of ten children is not helped by a stimulant medication. Other types of medication may be used if stimulants don’t work or if the ADHD occurs with another disorder. Antidepressants and other medications can help control accompanying depression or anxiety.

Sometimes the doctor may prescribe for a young child a medication that has been approved by the FDA for use in adults or older children. This use of the medication is called “off label.” Many of the newer medications that are proving helpful for child mental disorders are prescribed off label because only a few of them have been systematically studied for safety and efficacy in children. Medications that have not undergone such testing are dispensed with the statement that “safety and efficacy have not been established in pediatric patients.”
Side Effects of the Medications

Most side effects of the stimulant medications are minor and are usually related to the dosage of the medication being taken. Higher doses produce more side effects. The most common side effects are decreased appetite, insomnia, increased anxiety, and/or irritability. Some children report mild stomach aches or headaches.

Appetite seems to fluctuate, usually being low during the middle of the day and more normal by suppertime. Adequate amounts of food that is nutritional should be available for the child, especially at peak appetite times.

If the child has difficulty falling asleep, several options may be tried—a lower dosage of the stimulant, giving the stimulant earlier in the day, discontinuing the afternoon or evening dosage, or giving an adjunct medication such as a low-dosage antidepressant or clonidine. A few children develop tics during treatment. These can often be lessened by changing the medication dosage. A very few children cannot tolerate any stimulant, no matter how low the dosage. In such cases, the child is often given an antidepressant instead of the stimulant.

When a child’s schoolwork and behavior improve soon after starting medication, the child, parents, and teachers tend to applaud the drug for causing the sudden changes. Unfortunately, when people see such immediate improvement, they often think medication is all that’s needed. But medications don’t cure ADHD; they only control the symptoms on the day they are taken. Although the medications help the child pay better attention and complete school work, they can’t increase knowledge or improve academic skills. The medications help the child to use those skills he or she already possesses.

Behavioral therapy, emotional counseling, and practical support will help ADHD children cope with everyday problems and feel better about themselves.
Facts to Remember About Medication for ADHD

* Medications for ADHD help many children focus and be more successful at school, home, and play. Avoiding negative experiences now may actually help prevent addictions and other emotional problems later.
* About 80 percent of children who need medication for ADHD still need it as teenagers. Over 50 percent need medication as adults.

Medication for the Child with Both ADHD and Bipolar Disorder

Since a child with bipolar disorder will probably be prescribed a mood stabilizer such as lithium or Depakote®, the doctor will carefully consider whether the child should take one of the medications usually prescribed for ADHD. If a stimulant medication is prescribed, it may be given in a lower dosage than usual.
The Family and the ADHD Child

Medication can help the ADHD child in everyday life. He or she may be better able to control some of the behavior problems that have led to trouble with parents and siblings. But it takes time to undo the frustration, blame, and anger that may have gone on for so long. Both parents and children may need special help to develop techniques for managing the patterns of behavior. In such cases, mental health professionals can counsel the child and the family, helping them to develop new skills, attitudes, and ways of relating to each other. In individual counseling, the therapist helps children with ADHD learn to feel better about themselves. The therapist can also help them to identify and build on their strengths, cope with daily problems, and control their attention and aggression. Sometimes only the child with ADHD needs counseling support. But in many cases, because the problem affects the family as a whole, the entire family may need help. The therapist assists the family in finding better ways to handle the disruptive behaviors and promote change. If the child is young, most of the therapist’s work is with the parents, teaching them techniques for coping with and improving their child’s behavior.

Several intervention approaches are available. Knowing something about the various types of interventions makes it easier for families to choose a therapist that is right for their needs.

Psychotherapy works to help people with ADHD to like and accept themselves despite their disorder. It does not address the symptoms or underlying causes of the disorder. In psychotherapy, patients talk with the therapist about upsetting thoughts and feelings, explore self-defeating patterns of behavior, and learn alternative ways to handle their emotions. As they talk, the therapist tries to help them understand how they can change or better cope with their disorder.

Behavioral therapy (BT) helps people develop more effective ways to work on immediate issues. Rather than helping the child understand his or her feelings and actions, it helps directly in changing their thinking and coping and thus may lead to changes in behavior. The support might be practical assistance, like help in organizing tasks or schoolwork or dealing with emotionally charged events. Or the support might be in self-monitoring one’s own behavior and giving self-praise or rewards for acting in a desired way such as controlling anger or thinking before acting.

Social skills training can also help children learn new behaviors. In social skills training, the therapist discusses and models appropriate behaviors important in developing and maintaining social relationships, like waiting for a turn, sharing toys, asking for help, or responding to teasing, then gives children a chance to practice. For example, a child might learn to “read” other people’s facial expression and tone of voice in order to respond appropriately. Social skills training helps the child to develop better ways to play and work with other children.

Support groups help parents connect with other people who have similar problems and concerns with their ADHD children. Members of support groups often meet on a regular basis (such as monthly) to hear lectures from experts on ADHD, share frustrations and successes, and obtain referrals to qualified specialists and information about what works. There is strength in numbers, and sharing experiences with others who have similar problems helps people know that they aren’t alone. National organizations are listed at the end of this document.

Parenting skills training, offered by therapists or in special classes, gives parents tools and techniques for managing their child’s behavior. One such technique is the use of token or point systems for immediately rewarding good behavior or work. Another is the use of “time-out” or isolation to a chair or bedroom when the child becomes too unruly or out of control. During time-outs, the child is removed from the agitating situation and sits alone quietly for a short time to calm down. Parents may also be taught to give the child “quality time” each day, in which they share a pleasurable or relaxing activity. During this time together, the parent looks for opportunities to notice and point out what the child does well, and praise his or her strengths and abilities.

This system of rewards and penalties can be an effective way to modify a child’s behavior. The parents (or teacher) identify a few desirable behaviors that they want to encourage in the child—such as asking for a toy instead of grabbing it, or completing a simple task. The child is told exactly what is expected in order to earn the reward. The child receives the reward when he performs the desired behavior and a mild penalty when he doesn’t. A reward can be small, perhaps a token that can be exchanged for special privileges, but it should be something the child wants and is eager to earn. The penalty might be removal of a token or a brief time-out. Make an effort to find your child being good. The goal, over time, is to help children learn to control their own behavior and to choose the more desired behavior. The technique works well with all children, although children with ADHD may need more frequent rewards.

In addition, parents may learn to structure situations in ways that will allow their child to succeed. This may include allowing only one or two playmates at a time, so that their child doesn’t get overstimulated. Or if their child has trouble completing tasks, they may learn to help the child divide a large task into small steps, then praise the child as each step is completed. Regardless of the specific technique parents may use to modify their child’s behavior, some general principles appear to be useful for most children with ADHD. These include providing more frequent and immediate feedback (including rewards and punishment), setting up more structure in advance of potential problem situations, and providing greater supervision and encouragement to children with ADHD in relatively unrewarding or tedious situations.

Parents may also learn to use stress management methods, such as meditation, relaxation techniques, and exercise, to increase their own tolerance for frustration so that they can respond more calmly to their child’s behavior.
Some Simple Behavioral Interventions

Children with ADHD may need help in organizing. Therefore:

* Schedule. Have the same routine every day, from wake-up time to bedtime. The schedule should include homework time and playtime (including outdoor recreation and indoor activities such as computer games). Have the schedule on the refrigerator or a bulletin board in the kitchen. If a schedule change must be made, make it as far in advance as possible.
* Organize needed everyday items. Have a place for everything and keep everything in its place. This includes clothing, backpacks, and school supplies.
* Use homework and notebook organizers. Stress the importance of writing down assignments and bringing home needed books.

Children with ADHD need consistent rules that they can understand and follow. If rules are followed, give small rewards. Children with ADHD often receive, and expect, criticism. Look for good behavior and praise it.
Your ADHD Child and School

You are your child’s best advocate. To be a good advocate for your child, learn as much as you can about ADHD and how it affects your child at home, in school, and in social situations.

If your child has shown symptoms of ADHD from an early age and has been evaluated, diagnosed, and treated with either behavior modification or medication or a combination of both, when your child enters the school system, let his or her teachers know. They will be better prepared to help the child come into this new world away from home.

If your child enters school and experiences difficulties that lead you to suspect that he or she has ADHD, you can either seek the services of an outside professional or you can ask the local school district to conduct an evaluation. Some parents prefer to go to a professional of their own choice. But it is the school’s obligation to evaluate children that they suspect have ADHD or some other disability that is affecting not only their academic work but their interactions with classmates and teachers.

If you feel that your child has ADHD and isn’t learning in school as he or she should, you should find out just who in the school system you should contact. Your child’s teacher should be able to help you with this information. Then you can request—in writing—that the school system evaluate your child. The letter should include the date, your and your child’s names, and the reason for requesting an evaluation. Keep a copy of the letter in your own files.

Until the last few years, many school systems were reluctant to evaluate a child with ADHD. But recent laws have made clear the school’s obligation to the child suspected of having ADHD that is affecting adversely his or her performance in school. If the school persists in refusing to evaluate your child, you can either get a private evaluation or enlist some help in negotiating with the school. Help is often as close as a local parent group. Each state has a Parent Training and Information (PTI) center as well as a Protection and Advocacy (P&A) agency. (For information on the law and on the PTI and P&A, see the section on support groups and organizations at the end of this document.)

Once your child has been diagnosed with ADHD and qualifies for special education services, the school, working with you, must assess the child’s strengths and weaknesses and design an Individualized Educational Program (IEP). You should be able periodically to review and approve your child’s IEP. Each school year brings a new teacher and new schoolwork, a transition that can be quite difficult for the child with ADHD. Your child needs lots of support and encouragement at this time.

Never forget the cardinal rule—you are your child’s best advocate.
Your Teenager with ADHD

Your child with ADHD has successfully navigated the early school years and is beginning his or her journey through middle school and high school. Although your child has been periodically evaluated through the years, this is a good time to have a complete re-evaluation of your child’s health.

The teen years are challenging for most children; for the child with ADHD these years are doubly hard. All the adolescent problems—peer pressure, the fear of failure in both school and socially, low self-esteem—are harder for the ADHD child to handle. The desire to be independent, to try new and forbidden things—alcohol, drugs, and sexual activity—can lead to unforeseen consequences. The rules that once were, for the most part, followed, are often now flaunted. Parents may not agree with each other on how the teenager’s behavior should be handled.

Now, more than ever, rules should be straightforward and easy to understand. Communication between the adolescent and parents can help the teenager to know the reasons for each rule. When a rule is set, it should be clear why the rule is set. Sometimes it helps to have a chart, posted usually in the kitchen, that lists all household rules and all rules for outside the home (social and school). Another chart could list household chores with space to check off a chore once it is done.

When rules are broken—and they will be—respond to this inappropriate behavior as calmly and matter-of-factly as possible. Use punishment sparingly. Even with teens, a time-out can work. Impulsivity and hot temper often accompany ADHD. A short time alone can help.

As the teenager spends more time away from home, there will be demands for a later curfew and the use of the car. Listen to your child’s request, give reasons for your opinion and listen to his or her opinion, and negotiate. Communication, negotiation, and compromise will prove helpful.
Your Teenager and the Car.

Teenagers, especially boys, begin talking about driving by the time they are 15. In some states, a learner’s permit is available at 15 and a driver’s license at 16. Statistics show that 16-year-old drivers have more accidents per driving mile than any other age. In the year 2000, 18 percent of those who died in speed-related crashes were youth ages 15 to 19. Sixty-six percent of these youth were not wearing safety belts. Youth with ADHD, in their first 2 to 5 years of driving, have nearly four times as many automobile accidents, are more likely to cause bodily injury in accidents, and have three times as many citations for speeding as the young drivers without ADHD.14

Most states, after looking at the statistics for automobile accidents involving teenage drivers, have begun to use a graduated driver licensing system (GDL). This system eases young drivers onto the roads by a slow progression of exposure to more difficult driving experiences. The program, as developed by the National Highway Traffic Safety Administration and the American Association of Motor Vehicle Administrators, consists of three stages: learner’s permit, intermediate (provisional) license, and full licensure. Drivers must demonstrate responsible driving behavior at each stage before advancing to the next level. During the learner’s permit stage, a licensed adult must be in the car at all times.15 This period of time will give the learner a chance to practice, practice, practice. The more your child drives, the more efficient he or she will become. The sense of accomplishment the teenager with ADHD will feel when the coveted license is finally in his or her hands will make all the time and effort involved worthwhile.

Note: The State Legislative Fact Sheets—Graduated Driver Licensing System can be found at web site http://www.nhtsa.dot.gov/people/outreach/safesobr/21qp/html/fact_sheets/Graduated_Driver.html, or it can be ordered from NHTSA Headquarters, Traffic Safety Programs, ATTN: NTS-32, 400 Seventh Street, S.W., Washington, DC 20590; telephone 202-366-6948.
Attention Deficit Hyperactivity Disorder in Adults

Attention deficit hyperactivity disorder is a highly publicized childhood disorder that affects approximately 3 percent to 5 percent of all children. What is much less well known is the probability that, of children who have ADHD, many will still have it as adults. Several studies done in recent years estimate that between 30 percent and 70 percent of children with ADHD continue to exhibit symptoms in the adult years.16

The first studies on adults who were never diagnosed as children as having ADHD, but showed symptoms as adults, were done in the late 1970s by Drs. Paul Wender, Frederick Reimherr, and David Wood. These symptomatic adults were retrospectively diagnosed with ADHD after the researchers’ interviews with their parents. The researchers developed clinical criteria for the diagnosis of adult ADHD (the Utah Criteria), which combined past history of ADHD with current evidence of ADHD behaviors.17 Other diagnostic assessments are now available; among them are the widely used Conners Rating Scale and the Brown Attention Deficit Disorder Scale.

Typically, adults with ADHD are unaware that they have this disorder—they often just feel that it’s impossible to get organized, to stick to a job, to keep an appointment. The everyday tasks of getting up, getting dressed and ready for the day’s work, getting to work on time, and being productive on the job can be major challenges for the ADHD adult.
Diagnosing ADHD in an Adult

Diagnosing an adult with ADHD is not easy. Many times, when a child is diagnosed with the disorder, a parent will recognize that he or she has many of the same symptoms the child has and, for the first time, will begin to understand some of the traits that have given him or her trouble for years—distractibility, impulsivity, restlessness. Other adults will seek professional help for depression or anxiety and will find out that the root cause of some of their emotional problems is ADHD. They may have a history of school failures or problems at work. Often they have been involved in frequent automobile accidents.

To be diagnosed with ADHD, an adult must have childhood-onset, persistent, and current symptoms.18 The accuracy of the diagnosis of adult ADHD is of utmost importance and should be made by a clinician with expertise in the area of attention dysfunction. For an accurate diagnosis, a history of the patient’s childhood behavior, together with an interview with his life partner, a parent, close friend, or other close associate, will be needed. A physical examination and psychological tests should also be given. Comorbidity with other conditions may exist such as specific learning disabilities, anxiety, or affective disorders.

A correct diagnosis of ADHD can bring a sense of relief. The individual has brought into adulthood many negative perceptions of himself that may have led to low esteem. Now he can begin to understand why he has some of his problems and can begin to face them. This may mean, not only treatment for ADHD but also psychotherapy that can help him cope with the anger he feels about the failure to diagnose the disorder when he was younger.
Treatment of ADHD in an Adult

Medications. As with children, if adults take a medication for ADHD, they often start with a stimulant medication. The stimulant medications affect the regulation of two neurotransmitters, norepinephrine and dopamine. The newest medication approved for ADHD by the FDA, atomoxetine (Strattera®), has been tested in controlled studies in both children and adults and has been found to be effective.19

Antidepressants are considered a second choice for treatment of adults with ADHD. The older antidepressants, the tricyclics, are sometimes used because they, like the stimulants, affect norepinephrine and dopamine. Venlafaxine (Effexor®), a newer antidepressant, is also used for its effect on norepinephrine. Bupropion (Wellbutrin®), an antidepressant with an indirect effect on the neurotransmitter dopamine, has been useful in clinical trials on the treatment of ADHD in both children and adults. It has the added attraction of being useful in reducing cigarette smoking.

In prescribing for an adult, special considerations are made. The adult may need less of the medication for his weight. A medication may have a longer “half-life” in an adult. The adult may take other medications for physical problems such as diabetes or high blood pressure. Often the adult is also taking a medication for anxiety or depression. All of these variables must be taken into account before a medication is prescribed.

Education and psychotherapy. Although medication gives needed support, the individual must succeed on his own. To help in this struggle, both “psychoeducation” and individual psychotherapy can be helpful. A professional coach can help the ADHD adult learn how to organize his life by using “props”—a large calendar posted where it will be seen in the morning, date books, lists, reminder notes, and have a special place for keys, bills, and the paperwork of everyday life. Tasks can be organized into sections, so that completion of each part can give a sense of accomplishment. Above all, ADHD adults should learn as much as they can about their disorder.

Psychotherapy can be a useful adjunct to medication and education. First, just remembering to keep an appointment with the therapist is a step toward keeping to a routine. Therapy can help change a long-standing poor self-image by examining the experiences that produced it. The therapist can encourage the ADHD patient to adjust to changes brought into his life by treatment—the perceived loss of impulsivity and love of risk-taking, the new sensation of thinking before acting. As the patient begins to have small successes in his new ability to bring organization out of the complexities of his or her life, he or she can begin to appreciate the characteristics of ADHD that are positive—boundless energy, warmth, and enthusiasm.
References and Resource Books
References

1. Still GF. Some abnormal psychical conditions in children: the Goulstonian lectures. Lancet, 1902;1:1008-1012.

2. DSM-IV-TR workgroup. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.

3. Consensus Development Panel. Defined Diets and Childhood Hyperactivity. National Institutes of Health Consensus Development Conference Summary, Volume 4, Number 3, 1982.

4. Wolraich M, Milich R, Stumbo P, Schultz F. The effects of sucrose ingestion on the behavior of hyperactive boys. Pediatrics, 1985; 106; 657-682.

5. Hoover DW, Milich R. Effects of sugar ingestion expectancies on mother-child interaction. Journal of Abnormal Child Psychology, 1994; 22; 501-515.

6. Biederman J, Faraone SV, Keenan K, Knee D, Tsuang MF. Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 1990; 29(4): 526-533.

7. Faraone SV, Biederman J. Neurobiology of attention-deficit hyperactivity disorder. Biological Psychiatry, 1998; 44; 951-958.

8. The ADHD Molecular Genetics Network. Report from the third international meeting of the attention-deficit hyperactivity disorder molecular genetics network. American Journal of Medical Genetics, 2002, 114:272-277.

9. Castellanos FX, Lee PP, Sharp W, Jeffries NO, Greenstein DK, Clasen LS, Blumenthal JD, James RS, Ebens CI, Walter JM, Zijdenbos A, Evans AC, Giedd JN, Rapoport JL. Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Medical Association, 2002, 288:14:1740-1748.

10. Wender PH. ADHD: Attention-Deficit Hyperactivity Disorder in Children and Adults. Oxford University Press, 2002, p. 9.

11. Geller B, Williams M, Zimerman B, Frazier J, Beringer L, Warner KL. Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms, grandiose delusions, ultra-rapid or ultradian cycling. Journal of Affective Disorders, 1998, 51:81-91.

12. The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder (ADHD). Archives of General Psychiatry, 1999;56:1073-1086.

13. Wilens TC, Faraone, SV, Biederman J, Gunawardene S. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics, 2003, 111:1:179-185.

14. Barkley RA. Taking Charge of ADHD. New York: The Guilford Press, 2000, p. 21.

15. U.S. Department of Transportation, National Highway Traffic Safety Administration. State Legislative Fact Sheet, April 2002.

16. Silver LB. Attention-deficit hyperactivity disorder in adult life. Child and Adolescent Psychiatric Clinics of North America, 2000:9:3: 411-523.

17. Wender PH. Pharmacotherapy of attention-deficit/hyperactivity in adults. Journal of Clinical Psychiatry, 1998; 59 (supplement 7):76-79.

18. Wilens TE, Biederman J, Spencer TJ. Attention deficit/hyperactivity disorder across the lifespan. Annual Review of Medicine, 2002:53:113-131.

19. Attention Deficit Disorder in Adults. Harvard Mental Health Letter, 2002:19;5:3-6.
Resource Books

The following books were helpful resources in the writing of this document. Many other informative books can be found at any good bookstore, on a website that offers books for sale, or from the ADD Warehouse catalog.

Taking Charge of ADHD, by Russell A. Barkley, PhD. New York: The Guilford Press, 2000.

ADHD: Attention-Deficit Hyperactivity Disorder in Children and Adults, by Paul H. Wender, MD. Oxford University Press, 2002.

Straight Talk about Psychiatric Medications for Kids, by Timothy E. Wilens, MD. New York: The Guilford Press, 1999.

http://www.nimh.nih.gov/health/publications/adhd/complete-publication.shtml