Life can be very hard for children with Attention Deficit Hyperactivity Disorder (ADHD). They are the ones who do not get their work done and who often get in trouble in class for being disruptive. They often struggle with friendships because of their impulsivity. It can be very difficult for these children and their parents to deal with these frustrations. Some of these children release their frustration by becoming destructive or causing fights. Others may turn their struggles into bodily symptoms, like the child who gets a stomach ache every morning before school. Some children keep their anxieties and frustrations inside and try and deal with it on their own.
The most common symptoms of ADHD are inattention, hyperactivity and impulsivity. There is much controversy about the treatment of ADHD. In some countries Ritalin (or other medication) is prescribed as the first step and in others Ritalin is only used as a last resort in severe cases of ADHD. It is important to consider the nutritional and psychological factors that are important in dealing with ADHD.
ADHD is the most common neurobehavioral disorder affecting children. Before a diagnosis of ADHD is made the following needs to be ruled out:
1. Underachievement due to learning disabilities
2. Attention lapses caused by seizures
3. Middle ear infection that causes hearing problems
4. Disruptive or unresponsive behavior due to anxiety and/or depression or dissociative disorder (experiences of feeling detached from yourself)
Importance of emotional and nutritional factors
ADHD is a neurological disorder. There is much debate about the causes for these children’s problematic brain functioning. There has been extensive research indicating that brain activity and brain development can be hugely impacted on by nutrition and psychological factors. The brain is nutritionally very demanding meaning that nutrition is critical for brain development and functioning. Brain activity and development can be impaired because of the lifestyle our children lead. Junk food, chemical toxins (pesticides, pollution, trans fatty acids and deep fried foods) and overheated starchy foods impacts negatively on brain functioning. In contrast with this children need whole foods, essential fatty acids (omega 3), anti-oxidants, healthy protein, enough water, fish, flaxseed, fruit and vegetables. Iron, magnesium and zinc are also important for children’s brain functioning. Research has indicated that these nutritional changes can greatly impact on the functioning of children with ADHD. For some children these nutritional changes has such a great impact that they do not need medication.
It has also been proven that the brain and brain development is sensitive to emotional factors and emotional traumas starting from birth onwards. There is research that indicates that children who are neglected and do not receive love and care is overwhelmed by stress that impacts on their brain functioning and development. These impacts are so severe that they are clearly visible on a brain scan. I do not mean that children with ADHD have been neglected, but I’m indicating how sensitive the young brain is to emotional factors like enforced separation from the mother before the infant is ready for it. Children with ADHD often have high levels of stress hormones in their bodies. This indicates that emotional factors are significant in children with ADHD. Difficult births, early separation from their mothers and other emotional trauma are all factors that must be taken very seriously when we think about these children.
A child with ADHD should be evaluated thoroughly in terms of their emotional development and functioning. Early trauma and losses must be taken very seriously. Often trauma and separation that happens during the first three years are not consciously remembered and yet they can have a major impact on a child’s emotional wellbeing, the level of security that they feel and the level of anxiety that they carry within themselves. The role of holding and containment in early childhood must also be evaluated thoroughly. Infants need holding (physical holding) and containment (the experience that someone will hold you together and make you feel secure when the world feels overwhelming to you) in order to feel emotionally safe and not overwhelmed.
The role of the psychologist:
1. Evaluate the child for any developmental delays and learning problems so that these problems can be addressed if they are present. Most children diagnosed with ADHD do have learning problems that need to be addressed.
2. Conduct a thorough evaluation of all emotional factors, including factors in early development that could (consciously or unconsciously) impact on the child.
3. Evaluate the child for anxiety, depression and possible dissociative disorder.
4. Evaluate the relationships within the family and the quality of attachments.
Emotional help for the child with ADHD:
These children struggle with planning, organization and management of time. They benefit from structure, clear value systems and codes of conduct. Parents can help them plan their day and set small manageable goals.
Because they are impulsive, they don’t think before they act. Parents can help children to STOP and THINK or VERBALIZE before they act. It is helpful if parents help their children to think about what they feel and what the results of their behavior will be. This can help the child to slow down and think. A child often feels more contained when someone verbalizes their feelings and thinks with them about their feelings and behavior.
These children are often overwhelmed and cannot contain their emotions. This means that their emotions can feel overwhelming to them and their levels of anxiety can escalate. Emotional containment needs to come from outside the child because the child struggles to contain him/herself. It does not help if the parents also feel overwhelmed and respond in anger. Even if it is very difficult the parent need to stay calm and think about what is going on.
The parents can contain their child in the following ways:
Very small children often feel contained when they are physically held and soothed by a caring, loving mother who stays calm and does not become angry and abandoning.
Children can feel contained when a parent listens and encourages them to speak about how they feel. The parent should not only focus on the surface communication, but also on the child’s emotions. The parent can verbalize the emotions for the child. The parent needs to communicate understanding (“I understand how you feel…”). The parent must accept the child’s experiences and emotions without judging them. The parent must have a caring attitude towards the child.
Many children do not understand the causes for their behavior and feelings. It is important that parents think about the possible causes for a child’s behavior and verbalize it for the child. This helps the child to verbalize feelings instead of just acting them out. For example when your husband is out of town and your child is particularly difficult you might say: “Mommy can see you are not yourself and I’m wondering if it might be difficult for you that daddy is away”.
Children with ADHD benefit from structure and one-on-one situations. It can be very helpful if parents set enough time aside to provide this care and involvement as often as possible.
When the temper of the child flares; allow everyone to get calm. Serious discussion can only occur during times of composure.
These children often struggle with foresight, meaning that they lack the ability to predict the results of their behaviour. They also often lack hindsight, meaning that they have trouble learning from their mistakes. They can find it very helpful if parents discuss the results of certain behaviours with them. This needs to be done in a loving way.
This is not a contest with your child. You need to find ways to help your child without damaging the relationship. It may be important to allow only one or two playmates at a time so that child doesn’t get overstimulated.
Help the child divide a large task into small steps, then praise the child as each step is completed. Learn to use stress management methods such as relaxation techniques and meditation.
Physical activity or excercise is very important for children with ADHD. Walk to the park and allow them to play.
Homework and the child with ADHD:
Set up a homework and study area for your child. It must be quiet and without
distractions nearby such as a telephone, television or colourful posters.
Schedule daily homework times. Give the child regular breaks and avoid conflict. Be available (if possible) to help your child focus and organize their work.
Do not do the homework for your child. Answer questions when you can and encourage your child. Contain them when they start feeling overwhelmed.
Motivate your child by encouraging, praising and rewarding. Help your child organise assignments e.g. using an assignment time-table on a calendar. Help your child follow directions by reading aloud or breaking them into steps
Team up with teachers. Meet regularly. Know what is expected e.g. with projects, how much time should be spent on homework assignments. Help your child to plan how they can finish projects on time. Discuss any homework problems. Teachers can assist children with desk organizing and planning their tasks. These children benefit from sitting close to the teacher and away from distractions (eg colourful posters). They also benefit from small classes. Teachers can send the child on an errand rather than demands that he sit still all the time. Never keep these children in during breaks as punishment, they need to run around to get rid of energy.
There is great concern about the great numbers of children in our society who are diagnosed with ADHD. We need to continue thinking about their problems and possible ways of dealing with it. It needs to be thought about holistically in an effort to help these children in the best possible way.