An Overview of ADHD (Attention Deficit/Hyperactivity Disorder)

Grumpy but with ambitions!

[vc_row equal_height=”yes” inverse=””][vc_column width=”1/3″][vc_text_separator title=”TL;DR” i_icon_fontawesome=”fa fa-asterisk” i_color=”turquoise” border_width=”2″ add_icon=”true”][vc_video link=”https://www.youtube.com/watch?v=cx13a2-unjE” align=”center” css=”.vc_custom_1486628060490{margin-top: 0px !important;margin-bottom: 20px !important;}”][vc_empty_space height=”16px”][/vc_column][vc_column width=”2/3″][vc_text_separator title=”THE ESSENTIALS” i_icon_fontawesome=”fa fa-asterisk” i_color=”turquoise” border_width=”2″ add_icon=”true”][vc_toggle title=”What is ADHD?” style=”round” size=”lg” el_id=”1486626954756-3ced01a2-f788″ css=”.vc_custom_1486628196995{background-color: rgba(37,170,237,0.19) !important;*background-color: rgb(37,170,237) !important;border-radius: 3px !important;}”]

ADHD is the current term for a specific developmental disorder seen in both children and adults that is comprised of deficits in behavioural inhibition, sustained attention and resistance to distraction, and the regulation of one’s activity level to the demands of a situation (hyperactivity or restlessness) [1].

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Rates of diagnosis of ADHD in Australia vary between 2 and 9.5 percent of the population [1]. In comparison, 20% of Australians will experience some level of depression in their lifetime [2,3].

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These brain functions are a set of complex mental skills that help you accomplish tasks. They work like an effective senior executive of a company, coordinating big and small groups of employees to attain larger company goals. Failures of these functions in ADHD are similar to an executive who goes on long lunches and sends passive aggressive emails to their staff. The systems don’t work well without good leadership (executive functions). These systems include inhibiting behaviour, focus on long term goals, internal goal directed speech, emotional regulation, and planning and problem solving.

[/vc_toggle][vc_toggle title=”Isn’t this just a fancy way of saying someone is lazy?” style=”round” size=”lg” el_id=”1486628904182-b2b8fc0c-a538″ css=”.vc_custom_1487305704595{background-color: rgba(37,170,237,0.19) !important;*background-color: rgb(37,170,237) !important;}”]Psychologists already have fancy ways of labelling people as lazy with personality measures of conscientiousness. ADHD is much different than being lazy.

ADHD is as real as depression, and our ability to see it within the brain has only improved over time. Many people we work with would give their right arm to make their difficulties as simple as being lazy.[/vc_toggle][/vc_column][/vc_row][vc_row][vc_column][trx_columns][trx_column_item][trx_call_to_action][vc_btn title=”Get relief, clarity, & support in 2017 with psychologist Holly Melrose” shape=”round” color=”vista-blue” size=”lg” align=”left” css_animation=”appear” button_block=”true” link=”url:http%3A%2F%2Fbravehq.au%2Fteam%2Fholly-melrose%2F|title:Psychologist%20Holly%20Melrose%20can%20assess%20and%20treat%20ADHD%20in%20children%2C%20adolescents%2C%20and%20adults.|”][/trx_call_to_action][/trx_column_item][trx_column_item][vc_column_text css=”.vc_custom_1499671286151{padding-top: 10px !important;}”]

Holly is a registered psychologist experienced in the diagnosis and treatment of ADHD in children and adults. She is available for appointments at Brave HQ Monday, Tuesday, & Thursday 9 – 7pm, and Saturday 9am – 12pm

Sheyan is a youth worker who facilitates the 1Up! Gaming Group on Mondays. He is currently completing a Bachelor of Psychology at Deakin University.[/vc_column_text][/trx_column_item][/trx_columns][/vc_column][/vc_row][vc_row][vc_column][trx_block][vc_text_separator title=”FOR THE READERS” i_icon_fontawesome=”fa fa-asterisk” i_color=”turquoise” border_width=”2″ add_icon=”true”][vc_column_text]

Types of ADHD

There are three subtypes of ADHD that are diagnosed based on types and level of symptoms. The diagnosing health professional generally provides a severity rating from mild to moderate to severe to indicate how much ADHD has impacted the person’s life. The impact of ADHD on the person must be clear, and this is why many people may not receive a diagnosis until later in life.[/vc_column_text][vc_empty_space height=”16px”][vc_column_text]

ADHD predominantly inattentive type (ADHD-PI)

[/vc_column_text][vc_column_text]An individual with ADHD-PI  has many symptoms of inattention but not many hyperactive symptoms. Someone with ADHD-PI makes careless mistakes in schoolwork or other work and often does not seem to listen when spoken to directly.[/vc_column_text][vc_empty_space height=”16px”][vc_empty_space height=”16px”][vc_column_text]

ADHD predominantly hyperactive-impulsive type (ADHD-PHI)

[/vc_column_text][vc_column_text]The individual has clear excessive symptoms of hyperactivity and impulsivity without many inattentive symptoms. Individuals with ADHD-PHI will display behaviours like being excessively active, have difficulty sitting still, following their impulses despite previous bad experiences, and acting out irresponsibly at school.[/vc_column_text][vc_empty_space height=”16px”][vc_column_text]

ADHD combined type

[/vc_column_text][vc_column_text]The individual has enough symptoms from both inattention and hyperactivity-impulsivity domains. This is also the most common form of ADHD.[/vc_column_text][vc_empty_space][vc_single_image image=”1481″ img_size=”full” alignment=”center” style=”vc_box_border” border_color=”black”][vc_empty_space height=”48px”][vc_column_text]

Executive Functioning & ADHD

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What are Common Executive Functioning Deficits in ADHD?

  • Failure to inhibit behaviour:  A person with ADHD can find it difficult to refrain from following their impulses, even if they know they will lead to negative outcomes or are not in line with personal goals.
  • Maintaining goals in mind:  Humans vary on their ability to hold information in their mind. Those with ADHD can find it difficult to maintain their memory of the sequence of steps that relate to a short or longer term goal. For example, a person may design a new budget but can’t keep track of how much of their coffee budget has been spent. They may want to lose weight but are likely to forget the steps they should be taking day to day to work towards that goal.
  • Self-talk for self control: Self talk is the voice in our heads that can assist us and guide us with our everyday actions. Often this voice isn’t a strong presence, or is in disagreement with the impulses the person has.
  • Emotional regulation: Emotional regulation is our ability to be aware of and modify our emotions so they stay in line with our long-term goals. Those with ADHD may find their awareness of their emotions is poor. They are then only likely to become aware of their emotions when they are particularly intense and then over-react. Many people can have a lot of difficulty in bringing their emotions back to reasonable levels.
  • Compromised planning and problem solving: Individuals with ADHD often find it very difficult to organise themselves and find solutions to complications in multi-step tasks that aren’t intensely interesting to them. Their thinking can appear to others to be rigid or ‘black and white’, or they may be perceived as overly stubborn.

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What does ADHD look like in Children? See if you can tell:

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Diagnosing ADHD

Health professionals vary in how they diagnose ADHD. Our psychologists use a variety of assessment tools and information gathering techniques depending on the age of the person requesting an assessment. A clinical opinion is formed at the completion of the assessments and a brief report is written. As medications that treat ADHD symptoms are a schedule 8 controlled drug, it is common for referrals to be made to a paediatrician or psychiatrist after diagnosis.

Symptoms must be present before the age of 12, and are always considered within the intelligence, temperament, and family contexts of a person’s life. The symptoms must be excessive for a child’s developmental level. For example, children usually show signs of hyperactivity as they learn to regulate their own behaviours. However, a child with ADHD would show hyperactivity to excessive levels. Read the full article on ADHD diagnosis and how we complete an assessment at Brave HQ.

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Treatment of ADHD

It is important to recognise that untreated ADHD tends to result in growing problems in a person’s life. This can include things like failures or underperformance at school, university, and work, loss of friends from forgetting to return calls, or legal problems from forgotten parking fines. Further impacts include secondary anxiety and depressive disorders, and poor self worth.

Evidence suggests that combined medication and coaching or therapy with a professional experienced in ADHD result in the best results overall [5,6,7]. We focus on making sure our clients understand their ADHD, and use a solutions focused therapeutic approach to remove barriers and create solutions. Often this can include some form of family therapy when it is likely to assist the client to manage their symptoms.

Read the full article on how Brave HQ works with children, adolescents and adults to manage their ADHD and related symptoms of depression, anxiety, and poor self-esteem.[/vc_column_text][/trx_block][vc_empty_space][vc_text_separator title=”REFERENCES AND FURTHER READING” i_icon_fontawesome=”fa fa-asterisk” i_color=”turquoise” border_width=”2″ add_icon=”true”][vc_column_text]

  1. R. A. Barkley & K. R. Murphy (2006) Attention deficit hyperactivity disorder: A clinical workbook (3rd ed.). New York: Guilford Publications.
  2. Magill’s Medical Guide, Online, 2017.
  3. Australian Bureau of Statistics, 2008.
  4. National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Cat. no. (4326.0). Canberra: ABS).
  5. Frodl, T. and Skokauskas, N. (2012), Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. Acta Psychiatrica Scandinavica, 125: 114–126. doi:10.1111/j.1600-0447.2011.01786.x
  6. Prasad, V., Brogan, E., Mulvaney, C., Grainge, M., Stanton, W., & Sayal, K. (2013). How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 22(4), 203-16. doi:http://dx.doi.org/10.1007/s00787-012-0346-x
  7. https://www.ranzcp.org/Publications/Guidelines-and-resources-for-practice/Adult-ADHD-practice-guidelines.aspx

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Stories About Social Stories

[vc_row][vc_column][vc_column_text]Using visual imagery has always been an easier way for me to communicate. I often explain psychological concepts in counselling using analogy and metaphor, such as energy feeling like a rollercoaster, or emotions being like a balloon filling with water. This is particularly useful with children, as they don’t tend to talk about their problems, they act on them.

As many adults know, children can be incredibly resistant to discussion of ‘problems’ where they are the starring character. This is where story telling can play a wonderful role in improving the way adults communicate to children. I use stories in play and personalised Social Stories for a range of children and young people with and without disabilities where traditional ‘talk therapy’ isn’t appropriate.

Communicating using story telling has been useful for my practice in three ways:

1. Clear rules are developed and communicated to the child and parent,

2. Parents learn and start helping the child generalise the story by using consistent language with their child, and

3. What I am teaching the child and parents in sessions can travel home with them.

Carol Gray, a teacher, developed the concept of ‘Social Stories’ in 1991 for use with children with autism. A Social Story is a short, simple story that provides information about a social situation and the appropriate behaviors needed for that situation. It can also be defined as short descriptions of real life situations that help someone understand what they might expect from a specific situation or event, or how to better interpret the circumstances surrounding something they may be experiencing.

Other picture-based approaches commonly used by psychologists include the Picture Exchange Communication System, and Comic Strip Conversations. All approaches have mixed evidence for their effectiveness for autism. This means that there is evidence for their effectiveness, but researchers are still working on figuring out exactly what parts are most effective, and to what extent.

I make social stories on the fly in sessions using Comic Strip Conversations, and formally, using high quality images and tools. Below is a sample from a longer Social Story that were developed for children on the autism spectrum that had difficulty with rigidity around rules.

social-story-rulessoccer social story 1 of 2screen-shot-2016-12-05-at-10-14-10-pm

These documents were developed after a period of time where I get to know a client’s skills and their family. I used a mixture of tools such as ShowMe images and comic making software, which were then placed into a word document with text. You can see that I have clearly communicated specific language that the child and parent can learn and use. The child’s parents can now respond to situations where the child is having trouble being flexible with rules, by communicating the right type of law, rule, or guideline that applies.

Parents and teachers who want to use Social Stories would benefit from considering:

– The child’s reading comprehension skills and interest in visual content,

– The complexity of the information needed,

– To what extent the child thinks rigidly (black and white) or in a concrete (over-simplified) manner,

– The most important concepts they would like to communicate,

– Time limitations, and

– The quality, flexibility of use, and licensing of the images they are using.

Holly is a registered psychologist. She is available for appointments at Brave HQ Clayton Monday to Thursday 10-6pm.


References and further reading:

http://www.showmeimages.com

http://raisingchildren.net.au/articles/pecs_th.html

http://raisingchildren.net.au/articles/social_stories_th.html

http://foa.sagepub.com/content/early/2015/11/04/1088357615613516.abstract

https://www.autismspectrum.org.au/content/social-stories