Tuesday 2 august 2011 2 02 /08 /Aug /2011 00:58

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What is it? 

Children are naturally active and impulsive. They need to move around their environment freely to explore and learn about the world around them. They often become over excited, over active or display impulsive behaviour frequently. This can leave parents, other carers and the general public slightly confused and concerned about the child when he or she is not conforming to the expected behaviour within our society. Questions about the child's level of activity arise and when this high level of activity begins to interfere with daily life, professional help is often sought.

 

Attention Deficit Hyperactivity Disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness. These symptoms usually show before the age of seven and are seen as a coexistence of attention problems and hyperactivity.  Attention Deficit Disorder (ADD) is a type of ADHD and is characterised primarily by inattention, easy distractibility, disorganisation, procrastination, forgetfulness and lethargy or fatigue. ADD has fewer or no symptoms of hyperactivity or impulsiveness and is more recently not referred to as a seperate diagnosis by medical professionals.

 

Common symptoms of ADHD include:

  •  a short attention span
  •  restlessness
  •  being easily distracted
  •  constant fidgeting

Manny people with ADHD will also have additional problems such as sleep disorders or learning difficulties. However, ADHD has no effect on intelligence. The symptoms of ADHD are especially difficult to define because it is hard to draw the line at where normal levels of inattention, hyperactivity and impulsivity end and where the clinically significant high levels that require intervention begin. However, if it is significantly affecting a child's ability to learn and their ability to complete normal daily tasks, then a diagnosis and intervention should be sought. ADHD is a chronic disorder that affects 2-4 times more boys than girls. It is thought that 30-50 percent of children diagnosed will continue to have symptoms into adulthood. Most adults by this stage have developed coping techniques, so the symptoms are not as marked as they are in childhood.

 

 

  Causes

 The cause of ADHD is unknown, however it has been thought that a number of factors (including diet, genetic as well as social and physical environment) contribute to exacerbate the condition. Genetics tend to be a factor in around 75 percent of all cases whilst environmental factors are thought to be the next major influence. This involves alcohol and smoking during pregnancy, exposure to lead and pesticides, complications during pregnancy and birth (including premature births), infection during pregnancy and at birth all increase the risks.

 

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Diet and the use of artificial food colours have a strong link to ADHD (The Lancet 2007). The study found that certain yellows and reds used in food were the main contributors. A study conducted at Southampton University found that along with food colouring, some food preservatives are also thought to contribute towards ADHD.

 

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The social factors that are thought to contribute to the condition include dysfunctions in family life or inadequate education systems. Some researchers have found that the child's relationship with the caregiver (parent) can be a major influence, but there has been much controversy over this possible factor .

 

Diagnosis

Many of the symptoms of ADHD occur from time to time in all children. However, children with ADHD display a much greater frequency of the symptoms and their lives are significantly impaired to the extent that their friendships and school work are affected. The impairment needs to occur and be observed in different settings for the symptoms to be classified as ADHD. If a child is over active in the playground, but not anywhere else, the symptoms may not be considered ADHD. If a child has the symptoms of ADHD, but continues to form and keep friendships as well as achieve in school, then it is doubtful if they would be diagnosed with ADHD (American Academy of Child Adolescent Psychiatry 27/6/2009).  

 

ADHD is considered a psychiatric medical disorder of which the formal diagnosis is made by a qualified professional in that field. The diagnosis is based on a set number of criteria that can be found listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). ADHD may accompany other disorders such as anxiety or depression. This makes diagnosis difficult and can complicate treatment.

 

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Treatment

The treatment and diagnosis of ADHD has caused controversy since the 1970s. Treatment usually involves a combination of medication, behaviour modification, learning coping techniques, lifestyle changes and counselling. Many children with ADHD will also have sensory processing disorders and this can contribute to their inability to pay attention, focus and concentrate. These children will either withdraw from or seek sensory stimulation like movement, touch, light and sound. They may make loud noises and constantly move, touch and fidget in order to get the appropriate stimulation that they seek. Other children with ADHD may withdraw from loud noises, busy rooms, bright light and not engage appropriately in an activity as expected. They will then be considered to be troublesome and badly behaved in school and in other social settings.

 

Occupational therapists are able to provide therapy programmes that will address the sensory processing difficulties and help the child to attend and learn by adapting the environment and activities. There are several programmes and activities that occupational therapists may use to provide the child with tools and coping techniques for use within school , home and other social environments.   

 

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The Alert Program

This is also called "How Does Your Engine Run" and was created by Mary Sue Williams and Sherry Shellenberger as a means of helping children to learn self regulation. The programme works well with children who have sensory processing difficulties as it teaches the child that their brains are like "engines" that are sometimes running fast and sometimes running slow. The goal is to make the engine run just right. The child learns this by engaging in activities that bring their engine up or down according to their needs at any particular time. Fast engines can be slowed by squeezing balls, dimming lights and listening to relaxing music. Slow/sleepy engines can be perked up with fast music, tickles, dancing and bright lights.

 

Sensory Diets

 Occupational therapists design individual Sensory Diets to provide a child with the type of stimulation that they need to remain focused and able to learn throughout the school day. The diet may include movement activities such as jumping on a trampoline during break time, carrying heavy objects such as books, chairs and heavy school bags. Other sensory activities include squeezing putty, wearing weighted vests for short periods of time, using a scooter board or playing tug of war. These are incorporated into the school day to ensure the child remains alert and focused for learning. The therapist reviews the activities to determine which ones help the child's brain to become more organised at different times of the day.

 

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Brain Gym 

Some occupational therapists use movements from the Brain Gym programme which was created by Paul E. Dennison. Ph.D. The aim of the programme is to improve communication between the left and the right side of the brain using whole body movements such as drawing giant sized infinity signs on a board or touching the left foot with the right hand and the right foot with the left hand whilst hopping. The basis of the Brain Gym theory is that improved communication between the two sides of the brain will decrease hyperactivity and increase focus.

 

Other tools such as Visual Perceptual programmes, teaching strategies and classroom adaptations are facilitated by the occupational therapist who will work closely with teachers and parents. Small tips often work, such as asking a child to repeat the sentence when giving instructions. Keeping classroom materials clearly labeled and in the same place can make a big difference to a child with ADHD when they are trying to organise their thoughts and environment. There are many other strategies that are beneficial to a child with ADHD. The occupational therapist can individually assesses and determin the most suitable ones for the individual child.

 

 

 

Useful links:

 

http://www.add-adhd-treatments.com/ADHD-Diagnosis.html

 

http://youtu.be/WZorX_RkuXg

 

http://www.alertprogram.com/New_to_the_program.php

 

By Sian Eckersley (occupationaltherapyforchildren.over-blog.com)
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