Lecture 1: Good to know about ADHD

My husband never got to go to the “Strategies- parenting course for you with children diagnosed with ADHD 4-12 years old”. And he never picks up the information binder I received, so these blog posts will be for him to read in his own language, but I also hope that they will be informative for the parents that have not been offered a course like this. In other words, for parents that suspect their child of having ADHD,  for those who know very little about the disorder, and for those whose child has just been diagnosed. When my son was first diagnosed, and ever since, I have been the most frustrated with the lack of information. That is why I want to share what I have learned. So from the power point presentation:

ADHD means  Attention Deficit Hyperactivity Disorder

The main symptoms are problems with attention, impulsiveness and or hyperactivity. To be diagnosed, the child has to at least have 6-9 symptoms in those fields. They have to have had them for MORE than 6 months, and some symptoms have to have been present since before they were 7 years old. The symptoms must have been observed both in school and at home.

What are the symptoms of inattention?

1) Does not pay attention to details, makes a lot of careless mistakes.

2) Can not remain focused on a task. (Do not confuse it with concentration during playing computer games. These children REALLY can concentrate on computer games more than other children.)

3) Often seems to not listen when directly addressed.

4) Often does not follow instructions, and therefore fails to complete a task, homework and so forth.

5) Has a difficult time organising activities and tasks.

6) Avoids or dislikes to do things that craves mental endurance.

7) Often misplaces things or looses them.

8) Often easily distracted by outer stimuli.

9) Often very forgetful in daily life situations.

Symptoms of Impulsivity:

1) Throws out answers before the person asking questions has finished talking.

2) Has a difficult time waiting his/her turn.

3) Interrupts others.

Symptoms of Hyperactivity:

1) Can not sit still or keep hands and feet still.

2) Often leaves his/ her place in the classroom or in other situations where you are supposed to sit still.

3) Often is running around, climbing, hanging and in grown ups, has an inner restlessness.

4) Has a difficult time playing and doing activities in a calm and peaceful way.

5) Is often perceived as being “on the go” or “speeded”.

6) Talks excessively.

How it will develop is dependent on the environment and the surroundings. Stability and Support are Alpha and Omega! The symptoms vary in intensity with different ages. There is great variety between individuals with ADHD.

3-6 % of all school children have ADHD and another 5 % have ADHD problems of a milder type.

Girls are not as often diagnosed with ADHD because they are more difficult to identify. They are often not discovered until they reach teenage years and they start having serious problems in school. Parents are usually the ones discovering the girls having ADHD since the teachers misread the symptoms. Girls have the same lack of attention as the boys, but they are more introverted and do not have as much of a problem with impulsivity. Thus the teachers find them so well behaved and do not having any problems with them.

What do Attention problems really mean?

1) They can’t concentrate when things are boring and onesided.

2) They can not pay attention to the important parts and weed away the extraneous.

3) They can not keep attentive till a task is finished or till someone has finished speaking.

4) They can not get back to paying attention if they have lost focus.

5) They can not allocate attention in a purposeful way

An example from real life:  My son’s class was going swimming, which of course is a fun activity. When it was about time to leave school for the bus and the council pool, the teacher says “it is time to stand up, get your swim bags and then walk down to the cloak room in an orderly fashion. All of you remember to put on your jackets, beanies and gloves. We will gather in the cloak room and then walk together, two and two to the bus stop and take the bus to the pool…” She continued with the rules, not even realizing that my son had only heard “it is time to go to the pool” and he was off. In record speed he ran down to the cloak room, got dressed and headed for the bus stop. The others had not even left the class room yet, were still getting instructions and when the teacher wondered where my son was, noone knew and panic broke out. Finally one teacher thought of walking over to the bus stop that can not even be seen from the school, and found my son over there, on the way to boarding the bus. He had to be dragged back to school, was balled out and they considered not letting him go to the pool at all.

What does problems with Impulse control mean?

1) They can’t help but reacting on every impulse.

2) They don’t stop and think before they act.

3) They don’t let previous experiences, rules and future consequences guide them.

4) They don’t plan and work towards a goal.

5) They can’t take failure nor control their emotional reactions.

These children don’t like to be controlled but it is exactly what they need. They can not regulate their emotions, they get more angry, more sulky, more happy than children without the disorder.

What does problems with hyperactivity mean?

1) If they are not motivated they can’t mobilise and keep up the energy to finish the task

2) They can not regulate the energy so it will last. They get burned out quickly.

3) They can’t regulate their activity level so it will be just right “lagom” for what they are doing.

4) They cannot “accelerate, put the brakes on and then shift in to the right gear”.

They are very good at accelarating but they lack the brakes completely and since they are “driving” so fast, they do not steer well at all but wobbly.

They can not give themselves feedback, not reflect over their own actions. The speed between thought and action is too quick. That is why they are called “Explosive Children”.

Other things that are typical for these children are the following:

1) They are unpredictable. In other words, they have good days and bad days.

2) Performance is uneven.

3) There is a lack of automatisation. Things that go per automatic, do not do so with these children. Like going out in socks without shoes on, which most people do not do.

4) They have a very difficult time following rules and instructions.

5) Have no sense of time.

6) Can’t keep several things in their heads at the same time.

7) Loose and forget their belongings all over so do not buy expensive things for them.

8) Have a very difficult time organising, planning and accomplishing tasks without help.

9) Dependent and lack maturity.

10) Do not want to be controlled but they need it.

11) Have a difficult time solving problems.

These children often have other problems too in connection with their ADHD like:

Dyslexia and Dyscalculia

Speech problems

Motor problems, clumpsiness

Perception problems

Sleeping problems

Asperger’s syndrome, Tourette’s, Tics

When a child has ADHD, they often get a very low self esteem because they are told too often that they do everything wrong, that they are naughty, that they are stupid… They often have problems with finding friends and become victims of bullies. They often become defiant, aggressive and behave poorly. But also suffer from depression, worry and anxiety.

What are the causes for your child having ADHD? The problem is so complex that there is a lot that the scientists still don’t know about it. The diagnosis has been available since the 1950s. The background is neurological and 80% of it is hereditary. Complications during pregnancy and childbirth are also causes, as is smoking during pregnancy and low birth weight. Deficiencies in the home environment NEVER cause ADHD. Meaning that it is NOT the parents’ fault that the child “behaves poorly”. The child can’t help it! And the only thing the parents can be accused of are passing on genes that have ADHD in them.

Explanatory model for ADHD on different levels:

6) Genetically: Genetic deviations.

5) Biochemistry: Deficiancy/Imbalance of the signal substances dopamin and noradrenalin that control impulses in the brain.

4) Neurobiology: Reduced activity in the frontal lobes and base ganglia-too slow impulse transfer in the areas that control executive functions.

3) Neuropsychology: Deficiancies in executive functions and work memory.

2) Disabilities: Attention problems, Lack of impulse control and regulation of activity level.

1) Symptoms: Typical ADHD ones mentioned above

What is lack of executive functions? They can’t control themselves! To make plans to reach a goal, organise it, act and then evaluate the result of the actions.

What is deficiancy in the work memory? To succeed in doing a mentally demanding task, we have to keep lots of things in our brains at the same time. These children cannot do that. Work memory? One book describes it as them living according to the 4 second rule. The world will go under in 4 seconds. They live like there is no time to loose. There is no yesterday, no tomorrow, just the here and now. So they do not remember what happened at recess at 10:00 a.m. in the morning. They want to see a film over and over again and hear a book over and over again, because they do not get it the first time, they don’t remember it.

What does the problem with the frontal lobes mean? Well, that is 1/3 of the brain and that is where everything is planned. The frontal lobe is the great planner! And the lack of dopamin and noradrenalin? Lack of dopamin means that they have a bigger need for quick rewards. If you tell the ADHD child that “if you save your pocket money for one month, you can buy a box of Lego, but if you want to spend it today, then you can only afford a jojo” then the child will spend the money right away, because he/she can’t wait a month to get the reward! They want instant gratification. The lack of noradrenalin means that they have a very difficult time controlling their temper.

What can be done? We can try to minimize the symptoms and prevent serious consequences of the disorder. They need help both in school and at home. This was presented in latter lectures and I will try to translate and post them as quickly as I can. One thing they need help with is memory training which actually can be done via computers or memory games. They also need social training since things always go too quickly and that is not always accepted by society and friends. Finally they need training in everyday skills.

Something that we have used on our son for four years is Omega 3 capsules. But it has to be the right dosage of omega 3. There are too many brands out on the market and some are not containing the right fish oil. In Sweden, the only one that is the correct one, is Eye-Q. It’s expensive and the Child Psychology Deparment at Lund’s University hospital recommends that one takes 3 capsules a day instead of the 2 recommended. But if it helps, it is worth it. And for us, it has helped a little at least. We can see a definate change, when he has not been on them for a while. I do not recommend any interruption though, since what happens with the omega 3, is that the body builds up a little storage first. It takes 3-6 months to get up on the right level which means that for 3-6 months, the child has to take 6 capsules and then you can go down to the 3/ day. You do not want to look at what it does for your monthly budget. I have chosen to turn a blind eye to it, since it is NOT a fun expenditure.

There are studies being made on cutting back sugar and gluten. We have not got as far as we have wanted on this. Changing a diet over to gluten free is a big thing. The doctor at said department, said that it is a very drastic step to take. She recommended to us to first have a blood test done. If it shows negative for gluten intolerance the child can still have a subclinical problem with gluten, that can not be measured. But the recommendation after that is to take away sugar entirely for a whole month, to see if it has an effect. Then take away lactose for a month. And then, not until then, does one take away gluten for a month. With this, the lecture ended. I hope that this first translated lecture on ADHD can be helpful to some of you out there with questions on ADHD. Feel free to ask me questions. After all, MY son has had the diagnosis for 4+ years and we have tried some things, so I do have some experience of what works.

The final thing in the first lecture was that you do not grow out of ADHD. But the person can learn to live with it and handle the difficulties. There is a heightened risk of psychological and social problems but… with a supportive environment and understanding, your child has good chances of managing quite well in society. Our teacher brought up all the famous people that have had ADHD like Winston Churchill, but also a lot of rap artists. She did bring up Britney Spears but none of us thought that she is a good role model to look up to.

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