1.Understanding Autism, Asperger's & ADHD
freecourses.derby.ac.uk/d2l/le/lessons/6656/topics/1159
ADHD is a condition marked by severe inattention, impulsivity and hyperactivity.
2% of adults worldwide.These symptoms tend to cluster together, some people are predominantly hyperactive and impulsive, while others are principally inattentive.
In the past, the same condition has been known as ‘minimal brain dysfunction’, ‘hyperkinetic syndrome’ and, more recently, ‘attention-deficit disorder’ – a term that is still used in North America but seems to refer less to the hyperactive-impulsive nature of the disorder. Likewise, the term ‘hyperactivity’ is often used in everyday conversations to describe overactive children. They essentially describe the problems of children who are hyperactive and have difficulty concentrating.
Hyperactivity and impulsivity, although clearly different entities when specifically defined, are observable behaviours that are practically very hard to differentiate from one another.
Not all children have all the symptoms; Some are affected by inattention more than they are by hyperactivity and impulsivity. Several symptoms have to be present before the age of 12 years.
Three primary subtypes of ADHD: ‘predominantly hyperactive-impulsive type’, ‘predominantly inattentive type’ and ‘combined type’. Combined-type ADHD accounts for the vast majority of all diagnoses of this condition.
Children who show signs of ADHD are often first brought to the attention of the school special educational needs system not because of their problematic behaviour but because of their educational immaturity. Sometimes there is a delay in expressive or receptive language that becomes apparent when they first start primary school.
Inattentiveness is a key characteristic of ADHD :Failure to pay close attention to detail or making careless mistakes when doing schoolwork or other activities and trouble with keeping attention focused during play or school work are reported in people diagnosed with the condition.
Likewise, appearing not to listen when spoken to and failing to follow instructions or finish tasks can cause problems at school and home. These traits are likely to lead the person diagnosed with ADHD to avoid tasks that require a high amount of mental effort and organisation, such as school projects or chores around the home. For example, a child with ADHD may frequently lose their schoolbooks or toys, be excessively distractible and be forgetful.
Likewise, other markers may include procrastination and the inability to begin or complete activities. Practical problems may present, like difficulties with household activities, or there may be difficulty falling asleep due to too many thoughts at night. Symptoms of ADHD such as these can lead a child to frequent emotional outbursts, and they can get easily frustrated as a result.
Hyperactivity and Impulsivity
Equally frustrating to a child with ADHD are the consequences of hyperactivity and impulsivity, which are also markers of the condition. These children are ‘always on the go’ and have poor self-monitored behaviour. They cannot settle down to a task; they are restless, fidgety, and always up and out of their seats. These children are impatient, talk frequently and have difficulty in delaying responses. Behaviours such as fidgeting with hands or feet, squirming in their seats and often leaving their seats can cause problems for the children in the school classroom. Equally, running or climbing at inappropriate times and difficulty maintaining quiet play can lead the children to feel restless. They may have excessive speech and answer questions before the speaker has finished. Other characteristics, such as failing to wait for their turn and interrupting the activities of others at inappropriate times, are often present. In adult life, these traits can present as negative behaviours such as impulsive spending, leading to financial difficulties.
Consequences of ADHD
The child with boisterous hyperactivity and spontaneous behaviour who was so troublesome in the rigidly disciplined setting of school, with time and increasing autonomy, comes to be an extroverted, outgoing person, often channelling the ‘over-activity’ into occupations or sports where these qualities are valued. Individuals with ADHD often have a tenacious and spontaneous character, which can be an asset under some circumstances.
In adulthood, the effects of ADHD can be considerable, leading to disorganisation, failed relationships and impulsive decision-making.
Males show higher rates of ADHD, re up to six times more likely to be referred for assessment than girls are. This may be due to males’ behaviour being expressed in a more visible, aggressive and troublesome way. An exact ratio of these traits may be closer to about three boys to every one girl. Proportionally, girls are more frequently diagnosed with the inattentive form of ADHD than boys are, although this does not mean that all girls have the inattentive subtype and all boys have the hyperactive-impulsive subtype. It is also likely that the symptoms of ADHD go unnoticed more often in females than in males, and so females subsequently fail to be referred for professional assessment. Boys tend to be more disruptive and attract more attention, whereas girls generally may be less obviously affected and present their symptoms more silently.
ADHD is often associated with co-occurring disorders, including disruptive mood, anxiety and substance abuse (Wilens & Spencer 2010). However, the two most frequently occurring comorbid disorders are oppositional defiant disorder and conduct disorder. These behavioural conditions account for many of the most negative behavioural problems associated with ADHD. it is reported that the reading comprehension problems of children with attention difficulties are related to poor word reading and that listening comprehension is particularly vulnerable in children at risk of ADHD (Cain & Bignell 2014).
Conditions that frequently accompany ADHD, such as oppositional defiant disorder and conduct disorder, may cause significant difficulties for the child. In school-age children, these behaviours are characterised by talking back to adults, rejection by peers and failure in school.
The existence of other conditions alongside ADHD does not mean that one causes the other, but they may well make things worse. For example, having a short attention span and anxiety can lead to behaviours that are prone to misinterpretation by others, causing additional problems. Likewise, being always ‘up and on the go’ coupled with social and communication problems can lead to what may be interpreted as being deliberately disrespectful of personal boundaries or authority.
There is some evidence of structural and functional brain differences in people diagnosed with ADHD, which has been described as a condition affecting the ‘frontal’ circuitry of the brain due to associated deficits in executive cognitive functioning: the thinking and processing regions of the brain.
Some people may inherit a susceptibility to developing the symptoms of ADHD from their biological parents, may be infections, viruses or the effects of air pollution that cause problems with brain development while in the womb. Some authors suggest that psychosocial factors play a role in the expression of ADHD as we know it today. No single risk factor explains the condition with sufficient reliability as yet, and opinions are often divided on the precise causes. ADHD, just like autism, is likely to have multiple origins and complex interactions with other conditions.
Follow-up studies of people diagnosed with ADHD suggest that they are far more likely than those without a diagnosis to repeat school years or drop out of school
Children with ADHD are not naughty children; they are children with a disability. Those challenges can range from mild to moderate learning and behavioural difficulties to very severe difficulties that stop them interacting with peers and learning at school.
During the preschool and nursery years, children who are subsequently diagnosed with ADHD report a very short attention span; for example, not being able to listen long to stories. Likewise, moodiness and fine motor skill problems are reported, along with not being interested in playing with other children and poor self-control when frustrated or angry.
Later in infancy and the toddler years, these children can often be highly irritable and cry .ave sleep problems associated with being overactive and restless in the day. They may have difficulty adapting well to changes in the environment, be fussy eaters or have had difficulty nursing and feeding.
The condition is typically diagnosed in the primary school years: It is here that children may fall behind in academic performance and may have trouble following rules and sitting quietly. Likewise, they may find it hard to pay attention and may have difficulty working cooperatively or productively with others for the first time.
At secondary school, these children may be characterised by their academic difficulties, especially with literacy. They may challenge parents’ or teachers’ authority and may have poor self-management or time awareness, leading them to be frequently late or to fail to complete homework. They can be forgetful and easily bored; they may seem impulsive and irritable, and their apparent immaturity can lead them to high-risk behaviours. Many strategies and adaptations to make school life easier to engage with can be made to the child’s environment.
the majority of adults with ADHD do not receive treatment for ADHD but are obtaining treatment for other comorbid mental and substance-related disorders (Kessler et al. 2006).
Of those people who do receive a diagnosis in childhood, some carry at least some symptoms into adulthood, although these may not always be problematic. These may manifest in adulthood as, for example, difficulty with directions; having poor sustained attention; or finding it difficult to shift easily between activities. In adulthood, people with ADHD may find themselves becoming repeatedly distracted, may often lose things or may gain a reputation for constantly fidgeting and interrupting other people. The transition from childhood ADHD to adulthood may be one of adaptation to and accommodation of the symptoms; some people find ways of coping, whereas some may have enduring problems into adult life.
ADHD may manifest in adulthood as, for example, difficulty with directions; having poor sustained attention; or finding it difficult to shift easily between activities. In adulthood, people with ADHD may find themselves becoming repeatedly distracted, may often lose things or may gain a reputation for constantly fidgeting and interrupting other people. The transition from childhood ADHD to adulthood may be one of adaptation to and accommodation of the symptoms; some people find ways of coping, whereas some may have enduring problems into adult life.
As people diagnosed with ADHD pass into adulthood, leave the family home and gain employment, most manage and cope with their symptoms by adapting their occupations and home lives to suit. The long-term outcome for people with childhood-onset ADHD is generally good if the condition is addressed. However, many people with ADHD can have problems into adult life. In a large systematic review of 127 separate long-term studies, it was found that most people with untreated ADHD had poorer self-esteem and social function over time compared with people without ADHD. Treatment for ADHD, either medication or behavioural, was associated with an improvement in outcomes (Harpin et al. 2016).
2% of adults worldwide.These symptoms tend to cluster together, some people are predominantly hyperactive and impulsive, while others are principally inattentive.
In the past, the same condition has been known as ‘minimal brain dysfunction’, ‘hyperkinetic syndrome’ and, more recently, ‘attention-deficit disorder’ – a term that is still used in North America but seems to refer less to the hyperactive-impulsive nature of the disorder. Likewise, the term ‘hyperactivity’ is often used in everyday conversations to describe overactive children. They essentially describe the problems of children who are hyperactive and have difficulty concentrating.
Hyperactivity and impulsivity, although clearly different entities when specifically defined, are observable behaviours that are practically very hard to differentiate from one another.
Not all children have all the symptoms; Some are affected by inattention more than they are by hyperactivity and impulsivity. Several symptoms have to be present before the age of 12 years.
Three primary subtypes of ADHD: ‘predominantly hyperactive-impulsive type’, ‘predominantly inattentive type’ and ‘combined type’. Combined-type ADHD accounts for the vast majority of all diagnoses of this condition.
Children who show signs of ADHD are often first brought to the attention of the school special educational needs system not because of their problematic behaviour but because of their educational immaturity. Sometimes there is a delay in expressive or receptive language that becomes apparent when they first start primary school.
Inattentiveness is a key characteristic of ADHD :Failure to pay close attention to detail or making careless mistakes when doing schoolwork or other activities and trouble with keeping attention focused during play or school work are reported in people diagnosed with the condition.
Likewise, appearing not to listen when spoken to and failing to follow instructions or finish tasks can cause problems at school and home. These traits are likely to lead the person diagnosed with ADHD to avoid tasks that require a high amount of mental effort and organisation, such as school projects or chores around the home. For example, a child with ADHD may frequently lose their schoolbooks or toys, be excessively distractible and be forgetful.
Likewise, other markers may include procrastination and the inability to begin or complete activities. Practical problems may present, like difficulties with household activities, or there may be difficulty falling asleep due to too many thoughts at night. Symptoms of ADHD such as these can lead a child to frequent emotional outbursts, and they can get easily frustrated as a result.
Hyperactivity and Impulsivity
Equally frustrating to a child with ADHD are the consequences of hyperactivity and impulsivity, which are also markers of the condition. These children are ‘always on the go’ and have poor self-monitored behaviour. They cannot settle down to a task; they are restless, fidgety, and always up and out of their seats. These children are impatient, talk frequently and have difficulty in delaying responses. Behaviours such as fidgeting with hands or feet, squirming in their seats and often leaving their seats can cause problems for the children in the school classroom. Equally, running or climbing at inappropriate times and difficulty maintaining quiet play can lead the children to feel restless. They may have excessive speech and answer questions before the speaker has finished. Other characteristics, such as failing to wait for their turn and interrupting the activities of others at inappropriate times, are often present. In adult life, these traits can present as negative behaviours such as impulsive spending, leading to financial difficulties.
Consequences of ADHD
The child with boisterous hyperactivity and spontaneous behaviour who was so troublesome in the rigidly disciplined setting of school, with time and increasing autonomy, comes to be an extroverted, outgoing person, often channelling the ‘over-activity’ into occupations or sports where these qualities are valued. Individuals with ADHD often have a tenacious and spontaneous character, which can be an asset under some circumstances.
In adulthood, the effects of ADHD can be considerable, leading to disorganisation, failed relationships and impulsive decision-making.
Males show higher rates of ADHD, re up to six times more likely to be referred for assessment than girls are. This may be due to males’ behaviour being expressed in a more visible, aggressive and troublesome way. An exact ratio of these traits may be closer to about three boys to every one girl. Proportionally, girls are more frequently diagnosed with the inattentive form of ADHD than boys are, although this does not mean that all girls have the inattentive subtype and all boys have the hyperactive-impulsive subtype. It is also likely that the symptoms of ADHD go unnoticed more often in females than in males, and so females subsequently fail to be referred for professional assessment. Boys tend to be more disruptive and attract more attention, whereas girls generally may be less obviously affected and present their symptoms more silently.
ADHD is often associated with co-occurring disorders, including disruptive mood, anxiety and substance abuse (Wilens & Spencer 2010). However, the two most frequently occurring comorbid disorders are oppositional defiant disorder and conduct disorder. These behavioural conditions account for many of the most negative behavioural problems associated with ADHD. it is reported that the reading comprehension problems of children with attention difficulties are related to poor word reading and that listening comprehension is particularly vulnerable in children at risk of ADHD (Cain & Bignell 2014).
Conditions that frequently accompany ADHD, such as oppositional defiant disorder and conduct disorder, may cause significant difficulties for the child. In school-age children, these behaviours are characterised by talking back to adults, rejection by peers and failure in school.
The existence of other conditions alongside ADHD does not mean that one causes the other, but they may well make things worse. For example, having a short attention span and anxiety can lead to behaviours that are prone to misinterpretation by others, causing additional problems. Likewise, being always ‘up and on the go’ coupled with social and communication problems can lead to what may be interpreted as being deliberately disrespectful of personal boundaries or authority.
There is some evidence of structural and functional brain differences in people diagnosed with ADHD, which has been described as a condition affecting the ‘frontal’ circuitry of the brain due to associated deficits in executive cognitive functioning: the thinking and processing regions of the brain.
Some people may inherit a susceptibility to developing the symptoms of ADHD from their biological parents, may be infections, viruses or the effects of air pollution that cause problems with brain development while in the womb. Some authors suggest that psychosocial factors play a role in the expression of ADHD as we know it today. No single risk factor explains the condition with sufficient reliability as yet, and opinions are often divided on the precise causes. ADHD, just like autism, is likely to have multiple origins and complex interactions with other conditions.
Follow-up studies of people diagnosed with ADHD suggest that they are far more likely than those without a diagnosis to repeat school years or drop out of school
Children with ADHD are not naughty children; they are children with a disability. Those challenges can range from mild to moderate learning and behavioural difficulties to very severe difficulties that stop them interacting with peers and learning at school.
During the preschool and nursery years, children who are subsequently diagnosed with ADHD report a very short attention span; for example, not being able to listen long to stories. Likewise, moodiness and fine motor skill problems are reported, along with not being interested in playing with other children and poor self-control when frustrated or angry.
Later in infancy and the toddler years, these children can often be highly irritable and cry .ave sleep problems associated with being overactive and restless in the day. They may have difficulty adapting well to changes in the environment, be fussy eaters or have had difficulty nursing and feeding.
The condition is typically diagnosed in the primary school years: It is here that children may fall behind in academic performance and may have trouble following rules and sitting quietly. Likewise, they may find it hard to pay attention and may have difficulty working cooperatively or productively with others for the first time.
At secondary school, these children may be characterised by their academic difficulties, especially with literacy. They may challenge parents’ or teachers’ authority and may have poor self-management or time awareness, leading them to be frequently late or to fail to complete homework. They can be forgetful and easily bored; they may seem impulsive and irritable, and their apparent immaturity can lead them to high-risk behaviours. Many strategies and adaptations to make school life easier to engage with can be made to the child’s environment.
the majority of adults with ADHD do not receive treatment for ADHD but are obtaining treatment for other comorbid mental and substance-related disorders (Kessler et al. 2006).
Of those people who do receive a diagnosis in childhood, some carry at least some symptoms into adulthood, although these may not always be problematic. These may manifest in adulthood as, for example, difficulty with directions; having poor sustained attention; or finding it difficult to shift easily between activities. In adulthood, people with ADHD may find themselves becoming repeatedly distracted, may often lose things or may gain a reputation for constantly fidgeting and interrupting other people. The transition from childhood ADHD to adulthood may be one of adaptation to and accommodation of the symptoms; some people find ways of coping, whereas some may have enduring problems into adult life.
ADHD may manifest in adulthood as, for example, difficulty with directions; having poor sustained attention; or finding it difficult to shift easily between activities. In adulthood, people with ADHD may find themselves becoming repeatedly distracted, may often lose things or may gain a reputation for constantly fidgeting and interrupting other people. The transition from childhood ADHD to adulthood may be one of adaptation to and accommodation of the symptoms; some people find ways of coping, whereas some may have enduring problems into adult life.
As people diagnosed with ADHD pass into adulthood, leave the family home and gain employment, most manage and cope with their symptoms by adapting their occupations and home lives to suit. The long-term outcome for people with childhood-onset ADHD is generally good if the condition is addressed. However, many people with ADHD can have problems into adult life. In a large systematic review of 127 separate long-term studies, it was found that most people with untreated ADHD had poorer self-esteem and social function over time compared with people without ADHD. Treatment for ADHD, either medication or behavioural, was associated with an improvement in outcomes (Harpin et al. 2016).