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Attention Deficit / Hyperactivity Disorder (AD/HD)

Compiled by Josette Portelli B.Sc. (Hons) M.A. (Ling)

 

Overview

The term Attention Deficit Hyperactivity Disorder (ADHD) originates from the fourth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, 1994 (referred to as DSM IV). ADHD is the most recent version of a medical diagnosis that has changed considerably since it was first proposed as a distinct medical condition in the early 1900’s. The term “hyperkinetic disorder” has also been used for the same condition. The condition may exist as Attention Deficit Disorder (ADD) without hyperactivity, for this text ADHD is used throughout to refer to both terms.

The DSM IV lists three ADHD types:

  • Predominantly Inattentive Type (PIT)
  • Hyperactive Impulsive Type (HIT)
  • Combined Type (CT)

 

Features of ADHD

The key features of ADHD are inattention, hyperactivity and impulsivity and display the following behavioural characteristics:

 

Inattention

  • Failing to give attention to detail
  • Careless mistakes in work
  • Difficulty sustaining attention in tasks
  • Easily distracted
  • Difficulty listening when spoken to
  • Unable to follow instructions and complete work
  • Difficulty organising tasks and activities
  • Difficulty engaging in tasks that require sustained mental effort
  • Lose things
  • Forgetful in daily activities

 

Hyperactivity

  • Fidgeting with hands and feet and squirming in seat
  • Leaving seat when expected to remain seated
  • Running around when inappropriate
  • Difficulty playing quietly
  • Always on the go as if driven by a motor
  • Talking excessively

 

Impulsivity

  • Blurting out answers
  • Difficulty waiting for a turn
  • Interrupting and intruding on others

 

Children and adults occasionally display one or more of the above mentioned behavioural characteristics depending on mood, tiredness, boredom, etc. If the features occur persistently, ADHD must be considered.

 

AD/HD and Language Difficulties

Speech and language difficulties can co-exist with ADHD. ADHD can create problems in accessing and using language appropriately. Language is not the root of the problem. The difficulties in language are secondary to the attention difficulties. ADHD can affect short-term memory and working memory and these both have an influence on language and learning skills in general. ADHD can affect sequencing skills and the ability to understand or explain concepts. Semantic skills such as using vocabulary and retrieving words from memory can also be affected. ADHD can also effect pragmatic skills; including having a conversation, maintaining a topic, taking turns and keeping eye contact.

 

Behaviour Management Techniques for Parents and Carers

  • Provide a structured environment with a dependable routine with advance warnings if there will be changes. This helps a child know what comes next.
  • Use a child’s sense of touch (eg tapping on the child’s shoulder or hand to regain attention). This helps the child to focus.
  • Give a child enough time and allow him to go at his own pace.
  • Offer options for problem solving.
  • Give immediate feedback. A child needs to know if what he is doing is right/wrong.
  • Give directions in steps and if need be, one step at a time. Make sure child has understood instructions.
  • Remind child to stop, think and act.
  • Provide short work periods and short term goals.
  • Explain in a different ways or use a symbol if a child fails to understand an instruction, especially use of visual prompts is often very helpful.
  • Praise partial success. Reward improvements and not just perfection or completion.
  • Praise specific positive behaviours.

 

Management of Speech and Language Difficulties

The child with delayed language skills or with difficulties in language needs to be seen by a speech-language pathologist (SLP). The SLP will assess the child to obtain a clear idea of the child’s strengths and weaknesses in language. An intervention progamme will be planned accordingly and areas of deficit will be targeted in therapy. Liaison with parents and school teachers is indicated in order to achieve the child’s maximum potential.

 

References & Useful links

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