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ADHD: Defintion and Solution

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ADHD: A Definition and A Solution or What is it and what do you do about it?By Dr. Noel Swanson In the old days ADHD used to be called "minimal brain dysfunction" because people assumed there must be something wrong with the brain that they just hadn't yet been able to identify. Many scientists still believe that.
I have had a number of people asking about ADHD (attentiondeficit hyperactivity disorder).Not surprising, really, since it is such a common concern.So what is it, when should you be thinking about it, andwhat do you do about it?First of all, just as I discussed in last week's article onAsperger's:Click Here To Learn More About Asperger'sIt is not particularly useful to think about it as an 'it'. Just as children range from short to tall, skinny to fat, sothey also range from placid to hyperactive.Since there is such a wide range, at what point to do startto say there is something 'wrong' with the child?There are only two ways we can define "wrong". Either there is a clear, biological, problem that isqualitatively different from normal. Not just a matter ordegree, but of something being broken or disordered (likeasthmas is different from just being short of breath).Or the degree of "abnormality" is so great that it causesproblems of its own accord. Thus being too tall causesproblems (hitting heads on door frames, joint and backproblems, possibly). Being too fat causes problems(diabetes, heart problems, etc). And being too activecauses problems (people don't like the things you do!)So, let's look at these two types of definition. First, isthere any evidence of something biological being "broken"?That is a difficult question. There is evidence thathyperactive children have different brains than placidchildren. Just as there is evidence that tall people havelonger bones than short people. There is even evidence thattaxi drivers have different brains to non-taxi drivers. Butthat still does not answer the question as to whether thereis something "broken", or if it is again, just a matter ofdegree.In the old days ADHD used to be called "minimal braindysfunction" because people assumed there must be somethingwrong with the brain that they just hadn't yet been able toidentify. Many scientists still believe that.Either way, it is actually pretty irrelevant, as we shallsee when it comes to deciding what to do about it.The second question is whether being hyperactive causesproblems beyond that of placid children. The short answeris "yes". And typically, the more "hyper" you are, the moretrouble you get into.So, at the extreme end of the scale, the kids that arereally climbing the walls, it is pretty easy to say thatthey have a "disorder" and to give it a name such as ADHD.But where is the line between normal and ADHD? Come tothat, where is the line between normal and fat, betweennormal and too tall (or too short). And does it depend onwhether you live among the 7ft Masai warriors, or the 4ftpygmies?The line is, of course, arbitrary. We put the line where itseems to be "about right". Usually there is somestatistical reason for it - e.g. being more hyper than 95%of the population. But it also depends a lot on whatsociety is happy, or not, to consider as "normal" childishbehavior.And on that we, as a society, have probably become lesstolerant in the last couple of decades. We now want all ourchildren to sit still and pay attention in class, whereas inpast decades, if they didn't get on with school, then theydidn't go!Now, if your child is getting into problems at school orhome, you usually want to know why? One of the questionsyou might ask yourself, and others, is "is there somethingwrong with my child". The reason you would ask that, is because of the assumption(from the rest of medicine) that if you know what is "wrong"with him, you will then know how to cure or treat him.Hmmm. Let's see how that plays out...So you go to an expert to get a decision as to whether ornot he has something wrong. The doctor has no fancy tests,as there is nothing physical to look for. So she asks somequestions about what, exactly, it is that he does. She mayalso ask the school and other carers for their observations.Then she feels she has to come up with an answer for you. But what does she say?If she says, "Yes, he has something wrong. It is calledADHD", you are then going to want it treated and fixed.But if she says, "No, there is nothing wrong with him", youare going to assume that he is just playing up and needs"more discipline" (ie more punishments).Not only that, but suppose he is just on that arbitraryborderline between "having" it and "not having" it? Whichway should she jump?Both answers cause problems and, really, both answers arewrong.Instead, let's tackle it from a different perspective.Your son is constantly having problems. Everyone can agreeon that. The problems are similar to the list of problemsin the "diagnostic criteria for ADHD", which you can seehere: [please contact me for website address] can probably agree on that, to a greater or lesserdegree.Okay, so now the REAL questions is not "does he have ADHD",but "WHAT DO WE DO TO HELP HIM?"Now that takes us much further!Here is what you can do:1. Learn all you can about ADHD - whether or not he hasbeen given the diagnosis. Why? Because you will thenbetter understand why he does the things he does (my bookwill also help with that).2. Hyperactive children benefit from calm, consistent, firmbut fair management. They don't need diferent disciplinethan placid children, but they do often need it to beenforced much more consistently. Sorting out your parentingtechniques will definitely help. The best way to do that isto use the strategies in my book: [please contact me for website address] The same applies to school. Working closely withteachers is vital, and finding the right teacher for yourchild is equally crucial. School can definitely make orbreak these children.4. If doing the above is not enough, then it may be time toconsider medication. The most common ones are thestimulants (Ritalin, Dexedrine, Adderall). The doctors willprobably require a "diagnosis" before they will prescribe. That's okay - you know that the diagnosis doesn't reallymean anything, but it does give them permission to prescribefor you.You have not failed if you take the medication route. Justas you have not failed if your child has to take an inhalerfor asthma. It is just one of those things, and if ithelps, then use it.But, remember that the medication is NOT a cure. It is NOTa replacement for proper parenting and schooling, and itdoes NOT mean you child does or does not have ADHD - sinceit has exactly the same effect on any child (it is simplymore dramatic the more extreme the child is).You can find more info about the stimulants here: [please contact me for website address] you can see, the real key is to assess your own child'sunique strengths and weaknesses, and to work on these, inconjunction with the school, to achieve the best outcome. If you do that properly, then a formal diagnosis becomesquite irrelevant.HOWEVER, we live in an imperfect world, and some people arejust unable to think in these terms. This is particularlytrue of formal systems such as health and education who willwant a "label" in order for them to decide whether or notthey are going to help you.If that is the case, and the label "fits", then don't beafraid to use it. But it can cut two ways - once your childstarts to think that he "has" ADHD, this, in itself, mayundermine his confidence, as he feels that he is damaged ordisabled in some way.On the other hand, the label might be just the thing heneeds to boost him. Knowing that it is not his fault thathe is so hyperactive may release him from his guilt andsense of failure, and allow him to try again, perhaps, thistime, with medication to help. Either way, hold thediagnosis lightly, and recognise it for what it is - just aconvenient shorthand for a bunch of behaviors.SO: As with Asperger's, think carefully before you go theroute of looking for a label and a diagnosis. It may justopen the doors your child needs. Or it may shut them in hisface. You know your child best. Now read up as much as youcan, and then YOU take charge of helping him to achieve thevery best future. And if that involves doctors andmedicines, well, so be it.As ever, you can pick up The GOOD CHILD Guide as an instantdownload from here: [please contact me for website address] Noel Swanson, Consultant Child Psychiatrist and author of The GOOD CHILD Guide, specializes in children's behavioural difficulties and writes a free newsletter for parents. As both a professional who has worked in both North America and Britain, and as a parent of a teenage son with Asperger's and Tourette's syndromes, Dr. Swanson is uniquely qualified to help parents whose children are struggling with special needs of one sort or another. Having experienced the frustrations of raising such a child, and of battling with the education system to provide him with the support that he needs, Dr. Swanson has made it his mission to help other families who also want to do the very best that they can for their children. He can be contacted through his website: Expert Parenting Advice on Child Behavior Problems. This article is copyright. --«¤»§«¤»--
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7/11/2014 3:57:32 PM UTC