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This article explores ADHD. Practical tips and were families can get support from are outlined in this.

Kids health info for parents (RCH fact Sheet)
www.rch.org.au

Attention Deficit Hyperactivity Disorder (ADHD) is a developmental problem which results in poor concentration and control of impulses. It can affect children’s learning and social skills, and also family functioning. It is not an illness. With medical treatment, understanding and care, a child with ADHD canlive a normal life. About 3-5 of every 100 children in Australia have ADHD. It is much more common in boys than girls.

Symptoms and diagnosis
The diagnosis of ADHD must be made by a trained and experienced health professional, using information from both the family and the school. It is important to make sure the symptoms are not caused by something else, which may need different treatment.

Common signs and symptoms are:

  • Inattention
  • Difficulty concentrating, forgetting instructions, moving from one task to another without completing anything.
  • Impulsivity
  • Talking over the top of others, losing control of emotions easily, being accident prone.
  • Overactivity
  • Constant fidgeting and restlessness.

It is important to remember that all young children have a limited attention span and sometimes do things without thinking. A diagnosis can only be made after a range of information is collected – especially by parents. The symptoms must be obvious in most areas of the child’s life. There is no single test. If you are concerned about your child, see your GP who can arrange a referral to a paediatrician, or child psychiatrist to make the assessment.

Treatment for ADHD Medication
At this point, stimulant medication is the single most effective treatment for the symptoms of ADHD. Stimulants became a standard treatment in the 1980s and approximately 1-2% of all Australian children are prescribed stimulant medication. Any side effects can usually be controlled with changes to the dose and strength.

Behaviour strategies
Positive parenting, home and classroom strategies such as keeping structure, boosting self-esteem, building social skills, planning the physical and learning environment all help. Sometimes counseling for the child or the family is also needed.

Key points to remember

  • Children with ADHD need support and understanding from family and teachers.
  • Not all children who are inattentive, impulsive and overactive have ADHD.
  • No single test can diagnose ADHD. Assessment by a doctor or psychologist involves putting
  • together lots of pieces of information to make a diagnosis.
  • Medication, positive parenting strategies, school support and counselling can help most children with ADHD and their families.

For more information

  • Support Group ACTIVE Inc., 247 Flinders Lane, Melbourne, 3000 Tel: (03) 9650-2570
  • Factsheets: ADHD – Stimulant medication ADHD – ways to help children with ADHD Fish oils
  • You and your ADD child, Ian Wallace, Harper Collins 1996.
  • ADHD: The Facts, Mark Selikowitz, Oxford University Press 2004

ADHD and Prematurity Attention Deficit Hyperactive
Very premature children are four times more likely to have behavioural disorders September , 2008

www2.warwick.ac.uk

A team led by the University’s Department of Psychology and Warwick Medical School examined the behaviour of 200 six-year-old children who had been born below 26 weeks gestation, known as ‘extremely pre-term’. The researchers attempted to contact the family of every child born in the UK and Ireland at 25 weeks or earlier, between March and December 1995. The parents of 241 children responded to the study.

The team compared the behaviour of these extremely pre-term children with a control group of a similar age. They used reports filed by parents and teachers to test whether extremely pre-term children had more pervasive behaviour problems (described by both teachers and parents).

The researchers found 30.6% of pre-term children were hyperactive, compared to 8.8% in the full-term group, and 33.3% of pre-term children displayed attention problems, compared to 6.8%. They highlighted a distinction between genders in the pre-term group. Boys born prematurely showed a higher degree of behaviour problems, such as ADHD, and girls experienced more internalising disorders such as anxiety and depression.
The study also showed that extremely pre-term boys were more vulnerable to behavioural problems, and they had a greater impact on parents and teachers than extremely pre-term girls.

Professor of Developmental Psychology at Warwick Medical School, Dr Dieter Wolke said: “In this cohort of pre-term children we found a considerable excess of behaviour difficulties, including problems in a range of domains such as emotion, hyperactivity, attention and peer relationship problems. Parents and teachers agreed these behaviour problems had a considerable impact on home and school life for 23% of the pre-term group.”

Behavior Management

Strategies for Preschoolers (Age 5 and Younger)
To help younger kids with ADHD, these behavior management techniques may be helpful:

  • Provide a consistent routine to the days and structure to the environment. Let them know when the routine is changing or something unusual is going to happen, such as a visit from a relative, a trip to the store, or a vacation.
  • Give your child clear boundaries and expectations. These instructions and guidelines are best given right before the activity or situation.
  • Devise an appropriate reward system for good behavior or for completing a certain number of positive behaviors, such as a merit point or gold star program with a specific reward, such as a favorite activity. Avoid using food and especially candy for rewards.
  • Engage your child in constructive and mind-building activities, such as reading, games, and puzzles by participating in the activities yourself.
  • Some parents find that using a timer for activities is a good way to build and reinforce structure. For example, setting a reasonable time limit for a bath or playtime helps train the child to expect limitations, even on pleasurable activities. Giving a child a time limit for chore completion is also useful, especially if a reward is given for finishing on time.

www.webmd.com

ADHD – What can parents do?
Because ADHD affects so many aspects of life, several strategies rather than a single approach are needed. The following points explain some of the things you might like to try if your child has been diagnosed or has some of the symptoms.

1. Management skills
Living with an ADHD child can be very frustrating but there are techniques that can help you set boundaries, encourage and support your child. All children find it easier to learn responsible behaviour if parents set firm limits and give a clear idea of what is expected, but children with ADHD really need clear instructions and boundaries. Here are some techniques that may help:

Give clear instructions

  • Try to use instructions such as “Please clear your toys up now”, rather than comments or questions. e.g. “Isn’t it time to clear up your toys?” Speak in a normal tone and say exactly what your child has to do.
  • Don’t tell your child to do something if you
  • Are busy doing something else e.g. ironing, washing up, etc.
  • Can’t check it gets done e.g. you are watching TV in another room.
  • Don’t have time to follow up – you need to go out or make a phone call.
  • Don’t really care whether it gets done or not.
  • When talking to your child
  • Keep it simple. If you want several things done, make sure the first task is finished before giving the second instruction.
  • Call your child’s name, so he or she looks at you and pays attention.
  • Make sure noise, games or toys don’t distract your child.
  • Get your child to repeat what you have said so that you know they have listened and understood.
  • Concentrate on your child and don’t get distracted yourself until the task is well under way.

2. Encouragement

Children with ADHD are often in trouble or feel frustrated by things they find difficult. Children cannot improve without positive messages so make sure you remember to encourage them often. Say things like: “I have confidence in you…” and “I like the way you handled that”. As they say ‘An ounce of praise is worth more than a thousand reprimands’. Praise goes a long way.

Good behaviour deserves attention.
Parents of children with ADHD often unintentionally reinforce negative behaviour by paying it attention. It’s really important to encourage good behaviour, and not misbehaviour. Don’t wait for 100% good behaviour before praising, try praising a third of the way through or whenever you catch your children doing the right thing. Notice good behaviour. Say you are pleased.

3. Behaviour modification training

These techniques help children learn appropriate behaviour. They reward good behaviour and take away privileges for bad behaviour. Stickers and charts can be fun and help your child keep track. They are also a way of monitoring progress towards a negotiated reward.

Training time
Children with ADHD need clear structures to help them behave well. But don’t start without teaching your child what you want. When a football team takes the field they have already trained for hours. They have the skills and teamwork to play the game. They know what the coach wants. Tell your child what behaviour is good and bad. Set aside time over a week or a fortnight for ‘training’. Explain consequences clearly e.g. rewards and punishments. Ask your child to make ‘responsibility statements’ so they understand they are responsible for managing their behaviour e.g. “Each day I will put my school bag into my room”, “I will go to bed at 7.30 pm”. Your child needs to agree to a statement for each behaviour being rewarded.

Use sentences like: “I know that you can do (the good behaviour)”.

Children with ADHD need immediate recognition for their achievements such as a choice of stickers for their chart. Some parents find it helpful to have a system of short-term rewards, say a food treat, colouring a picture, 20 minutes on the computer or watching a favourite TV show, building to a reward your child really wants after an agreed target has been reached. In general rewards should be fast, frequent and something your child really wants.

Training a child is like using scaffolding to construct a building
It may be helpful to think of these strategies as rather like building a house. You need to put up scaffolding before a building can take shape. Later the scaffold is removed and the building can stand alone. In the same way, you can show your child how to finish a job. Then let them try, coach them and give feedback. Finally step back and let your child work alone. The scaffold has been removed.

4. Educational strategies

  • Teachers are often one of the first people to recognise that a child may have some of the difficulties associated with ADHD. It is very important to involve your child’s teachers in helping you and your child overcome the problems associated with ADHD.
  • Children with ADHD are easily distracted and struggle with multiple tasks so teachers need to use skills to support and encourage their learning Just like at home, tasks at school need to be demonstrated – “watch this”, “now you try” – and supervised.
  • It often helps children with ADHD to sit at the front of the class so the teacher can remind them of the task if their attention wanders
  • Tasks should not be too hard and need to be broken up into small bits, so that one part can be finished before the next instruction is given.
  • Give fast feedback when each stage is completed and always try to include some praise.
  • These children also respond better when presented with a limited number of choices as they can find too much choice bewildering.
  • At home, they will need support and encouragement to complete their homework.

It is important to remember that ADHD does not cause reading or other learning problems, although it may make things worse. It seems logical to think that starting on medication, which helps a child concentrate and pay attention, will automatically fix problems with reading and other schoolwork. Unfortunately, this is usually not true. The causes of reading and other learning problems are separate to ADHD. Children with ADHD may require special reading programs or interventions to help them catch up. If possible, try to get professional help with reading or learning problems.

5. Caring for yourself
Living with a child with ADHD can be very tiring and demanding. You need to make sure that you get the support you need. Many people find it particularly helpful to contact a support group. Often just talking on the phone with a parent facing similar difficulties is a real help. Call Lifeline on 13 11 14 for information on how to contact a group near you.

Finally, make sure you arrange to have some time for yourself to relax and do things you enjoy. Many of these tips appear very simplistic or rather artificial. In practice they will require seemingly endless repetition and great determination to be consistent. Don’t get discouraged!. These strategies have been shown to be effective so it’s worth persevering.

Useful books and resources

  • Barkley. RA (2001) Taking charge of ADHD:
  • The Complete Authoritative Guide for Parents. Guildford Press ($40).
  • Green. C (2001) Understanding ADHD, Revised edition. Doubleday: Sydney ($25).
  • Grainger. J (1997) Children’s Behaviour, Attention and Reading Problems. Australian Council for Educational Research, Melbourne ($30).
  • Stenhouse. G (2008) Does my child have ADHD? Penguin books.

Useful web sites

ADHD – who can help?
If you are at all concerned about your child’s behaviour and development you can talk to any of the followingprofessionals for support and assistance.

  • Maternal child health nurse
  • General Practioner
  • Paediatrician
  • Preschool / school teacher

Preschool Field Officer (PFO) Program
If you are concerned about your child’s development the PFO is able to assess your child in his or her preschool environment. This program supports preschool teachers, assistants and the child’s family with a range of services that include:

  • Assessment of children with both long term and short term needs in areas such as behaviour, speech, attention, cognitive skills, motor skills and social/emotional development.
  • Providing preschool staff with modelling, support and guidance in developing individual programs.
  • Referrals to specialist services as required.
  • Liaison and consultation with community services and professional groups.
  • Transition to school support.
  • Information to parents regarding preschool and school readiness.

Eligibility
Children attending a State funded four year old preschool.

Victorian support groups:
Attention Deficit Disorder Victoria (ADDVic)

Hyperactive Children’s Association of Victoria – ACTIVE Inc.

The Australian Medicare scheme can be quite difficult for parents to wrap their mind around. There are three schemes in which you may be eligible to gain assistance. You will need to discuss your child’s eligibility with your GP or Paediatrican.

1/ Enhanced Primary Care – (EPC) allows up to 5 partially subsidized sessions for Allied Health Services such as Occupational Therapy (OT) and Speech Therapy within a calendar year. Your doctor must organise a referral through medicare for you to access the EPC www.health.gov.au

2/ Mental Health Care Plan for OT and Psychology only – (MHCP) allows up to 12 subsidized sessions annually. The 12 sessions must be obtained in two six session blocks – each requiring a referral from your GP or Paediatrician. The MHCP is only eligible for a select group of children, commonly with a diagnosis of: Autism Spectrum, Anxiety Disorder, ADD & ADHD amongst others.

3/ Autism Initiatives
Autism Spectrum Disorder (ASD) Intervention Programs and the roll-out of new ASD Medicare items.

Did you know about….
Centre for Community Child Health
The Royal Children’s Hospital, Melbourne
www.rch.org.au

Provides specialist clinical services for children with a range of developmental and behavioural problems. These clinics include:

Appointment Procedures

  • You must have a referral from a doctor. A referral from your GP is valid for 12 months and a referral from a specialist is valid for 3 months. This must be forwarded to the clinic before an appointment can be made.
  • You will be asked if your child has a UR number (Unit Record Number) from the Royal Children’s Hospital. If your child has attended the Royal Children’s Hospital before, they will have a UR number. If your child has not attended the Royal Children’s Hospital before, registration details will be completed at the first visit.

To make an appointment, please fax a referral to the Clinic on (03) 9345 7043 or alternatively:

Phone: (03) 9345 5466
Email: clinic.ccch@rch.org.au

An appointment will then be sent to you in the mail.
NB. Appointments cannot be made without receiving a doctor’s referral first.
ADHD Assessment

Multidisciplinary assessment of children aged 4-8 yrs with ADHD. The children will undergo paediatric, psychology and child psychiatry assessments as well as a school visit. Enquires about eligibility for the ADHD clinic can be made by contacting the co-ordinator on 9345 6662.

Behaviour
Assessment and management of children with ADHD and other behavioural problems.
Communication Paediatric and speech pathology assessment of children with severe language delay, and associated developmental problems.

Learning Behaviour
Assessment and management of children with learning difficulties, behaviour problems and developmental delay including language, motor skills, toileting.

Preschool Development
Assessment and management of young children with developmental problems which may impact on emerging learning and behavioural skills.

School Function Program
Multidisciplinary assessment of primary school aged children with learning disabilities. Paediatric, special education, psychology, and occupational therapy input.

Sleep
Assessment and management of all types of sleep problems in children from infancy to adolescence.

Unsettled babies
Assessment and management of young babies with crying, irritability, and settling and feeding difficulties.

Private consulting clinic
Prof. Frank Oberklaid and Assoc. Prof. Jill Sewell provide specialist developmental behavioural services.

All LLT articles are the sole property of LLT and all contents are copyrighted – Life’s Little Treasures Foundation 2010

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