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Psychologist in Sussex, England » AD/HD
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AD/HD


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AD/HD is a disorder characterised by problems with attention, hyperactivity/impulsiveness, or, as is usually the case, both attention and hyperactivity/impulsiveness. The diagnostic criteria are given in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV 1994) published by the American Psychiatric Association.

AD/HD is almost certainly a genetic disorder with a bio-neurological basis. However, AD/HD can be exacerbated by social, psychological and environmental factors. It can be useful to think of AD/HD as a threshold which can be reached by a combination of factors - some of which can be avoided and some of which cannot.

These problems have been recognised and treated for many years, in many parts of the world, including the UK. In the past, European health professionals have often recognised Hyperkinetic Disorder, a similar though more stringent set of criteria (published by the World Health Organisation in the International Classification of Diseases - ICD 10), rather than AD/HD. Increasingly, Hyperkinetic Disorder is used to describe children who are severely hyperactive, while AD/HD is seen as a more inclusive category allowing for a broader range of problems and causes.

It is important to remember that all children have to learn how to control their attention, mood and naturally lively behaviour, but children with AD/HD have considerably more difficulty acquiring self-management skills than others. One of the most misleading aspects of AD/HD is that the children experience distinctly good and bad days, and this can lead adults to believe they can behave well when they want to. Children with AD/HD also tend to behave well when they are being assessed, as they enjoy attention and new situations.

AD/HD is not an ‘all or nothing’ condition, like a broken bone, so much as a continuum along which we all lie. It can be seen as a mismatch between the characteristics of an individual and the demands made upon him/her in certain situations. In our society - particularly in school - it is very important to be able to sit still, listen and work hard even when you would rather be doing other things. We expect children to follow rules, be organised and adhere to a strict timetable. Some children fit naturally into this pattern while others have more problems. For many children with AD/HD, the demands of school conflict so much with their natural behaviour that they simply cannot cope - unless we adapt this environment to meet their needs.

Children with AD/HD often have co-occurring, or co-morbid, problems in other areas, most frequently: speech/language difficulties, dyspraxia, dyslexia, social, emotional and behavioural disorders. AD/HD is unrelated to intelligence and affects children from all cultures and social groups. Estimates of prevalence vary between 2 and 5%, with many more boys than girls being affected.

The Core Deficits

* Attention: Children with AD/HD find it easy to concentrate when they are enjoying themselves - for example with a computer game - but difficult or boring tasks quickly result in problems with getting started and staying ‘on-task’, and it is then they become easily distracted. It can also be hard for these children to change from one task to another, or to tear themselves away from an activity they find interesting or fun. It is important to remember that children with AD/HD do not have a problem with attention per se, but a problem in controlling attention. Problems with attention usually continue into adulthood.
* Hyperactivity: Children with AD/HD - particularly when they are young - are always ‘on the go’, and often remain restless and fidgety into adulthood
* Impulsiveness: Children with AD/HD find it difficult to await their turn in queues, conversations and games, or to work for long term rewards. Professor Edmund Sonuga Barke, (University of Southampton, England) argues that ‘delay aversion’ is the core difficulty underlying AD/HD. The children often act without considering the consequences, saying and doing things which they later regret. Impulsiveness results in social, learning and behavioural difficulties - and a high accident rate!


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