Preparation Tips

The main aspect of an appointment is to provide complete and accurate information so that you get the most appropriate support. The bottom line is talk to GP/specialist as much as possible to get the maximum out of them. So, at first, think of the problems that your child is facing and organize them in your mind. Here are some tips to prepare yourself before attending an appointment.

• Be specific. For instance, avoid speaking ‘some time’; rather tell the exact duration.
• Jot down the symptoms on a paper. This will not let you forget any of them when you discuss them in the appointment, nor will the doctor forget them in determining a solution. However, let me tell you that your GP might not go through each and every piece of information you provide due to lack of time; but might do so after the appointment.
• Ensure that you do not even miss mentioning the minor symptoms
• See if you can take two appointments simultaneously. This is because on an average, a single appointment would last only for eight minutes and that is insufficient to discuss the problems related to ADHD. Do not hesitate to explain the reason of requiring two appointments. If you still could not take two appointments, you simply have to take a few more appointments to discuss all the issues.
• Show all the medicines in the appointment, even the ones which are been taken without any prescription. In short, ensure that you inform about all the medicines being taken by the child having ADHD.
• Know the health status of your relatives, as family history matters a lot in such discussions.

At the First Appointment

It is difficult to diagnose ADHD only with the help of a GP, which calls for the entry of a specialist in the analyzing process. If it is not diagnosing, what happens in the first appointment?

Well, at first, you might be nervous or hesitate to raise the problem of ADHD to your GP due to a fear of bad impression of your child. But, let me tell you that a GP recognizes ADHD as a medical condition with a range of problematic behaviors in childhood and would therefore, be sympathetic; rather than criticizing. You need to kick off the meeting by explaining the abnormalities you observe in your child and your concerns toward them. This is where your preparation will be demonstrated. Once you are done with this, the doctor will:

• Question about your child’s health in general.
• Enquire about any current medication.
• Ask more questions for clarification, for instance, the effects of the problems on the child.
• Investigate with you about the child’s and family’s medical history.
• Conduct a physical assessment.
• Assess the child’s hearing and sight.

The above questions and examinations will help in identifying the exact cause from a variety of causes of ADHD. On the basis of this examination, the GP might suggest a specialist for your child for further assessment and diagnosis. Here, the GP might refer to specialist such as, a pediatrician or a child psychiatrist. This actually is determined by the characteristics of the problems told and to some extent on the availability. For example, if there is a problem with the speech of your child, the GP would refer a speech therapist first.

Questions to a GP

An appointment with a GP is actually a two-way discussion, wherein you would be willing to ask certain questions. Below are examples of questions that you might need clarification.

• What is the next help that I need to seek for?
• Until how much time I need to wait for a referral?
• What’s the exact motive of referring a specialist?
• How do you know that this specialist would be a right choice for my child?

At the Appointment of a Specialist

Diagnosis and an action plan are the two goals of taking a second appointment with a specialist. A specialist here can be a:

• Pediatrician
• Psychologist
• Psychiatrist
• Speech and language therapist
• Occupational therapist

Questions to You

Listed below are the topics related to which the referred specialist will ask questions.

• Child’s medical history
• Family background
• Behavior difficulties (current and previous ones)

Apart from these topics, you may be specifically asked about your child’s behavior using pre-designed questionnaires, also called as rating scales.

Questions to Your Child

To make your child involved in the process, the specialist will ask questions related to the behavior and would let the child speak express his/her feelings about the problems.

Evaluation Methods

Here are some methods that a specialist apply to assess your child.

• Physical Examination
  Here, the specialist physically examines your child and verifies that there is no medical condition responsible for the growth problems, for example, a speaking problem. Based on the conclusion, the specialist might suggest some specific tests, such as blood test.
• Educational History
  Here, the specialist will carefully go through the comments given by the class teacher or school. Sometimes, the specialist might suggest an educational psychologist for further examination.
• Clinical Observation
  Here, the process of examining your child takes place at home, school, or at any other place, other than the clinic. This is because sometimes, the environment of a clinic is such that it can distort your child’s behavior.
• Development Tests
  Here, the specialist tests your child’s developmental skills by implementing physical tests. For example, a test might be conducted wherein a child might be asked to write something that is placed distantly, catch a ball, or explain what was just told to him/her. The results of such testing indicate whether a child can express properly, write correctly, and think and act accordingly.

Final Results

Once all the tests are over, the next step is to diagnose. On the basis of the causes detected, an action plan to treat the same follows up next. In between these two steps, you might have questions to ask. Always ask questions and get a solution to your doubts or confusion to avoid future misunderstanding or anxiousness.

Questions to the Specialist

Listed below are the questions that you might want to ask to the specialist.

• What is the severity of the problem?
• What is the conclusion of your diagnosis?
• Which treatments can be taken? How long they need to be taken?
• Can simple modifications in the lifestyle help?
• Is there is need of medications? If yes, does the child need to take them daily? What can be the possible side effects?
• Until when the medication will show the effects?
• What to do if one of the preferred treatments is not effective?
• Will the detected problems be overcome completely?
• How frequently you will be monitoring my child’s progress?
• Would you be willing to explain the entire thing again to my life partner?

But, as the matter of fact, this is not correct! In short, the relieving truth is ADHD does exist and nobody is at fault or is responsible for this disorder in anyone. The only aspect that the parents have to take care of is how to deal with the ever-increasing demands of such a child. This is because a child with ADHD can put on the weight of fulfilling extra demands.

Such a demanding nature of the child can make you feel besieged due to a feeling of failure in providing full satisfaction to your child. To add to your this pain, you further start comparing your child with your friends and relatives, that they all have normal, well-mannered children; but mine is a twister who fidgets, never heeds anyone, asks too many questions, and talks too much with no proper response in it.

Just because you need to handle such behaviors of your child, proper parenting for such children is a must for which you need help, guidance, and support. So, if you have a strong feeling that you are failing in your parenting, remember this will affect your mind due to tension and behavior towards your child. This will make it more difficult for you to deal with the demands. Your job is more than what the average parents do, but no parents are perfect. So, simply cool down and handle each upcoming, unexpected situation patiently.

Sometimes, you as a parent may think that why I have such a child. At this time, just remember that you are not aware of all the causes for such a child to be there with you. It could be genetically inherited from a close relative, who might never have been diagnosed or naturally at the time of birth.

Beliefs that are Not True

ADHD is not linked with any of the following factors that we might suspect to be.

• Allowing the child to watch TV excessively. In fact, children suffering from ADHD like to watch TV, play fast computer games, and view films. Therefore, you can use these options as rewards for their good behavior whenever exhibited.
• Diet. It is found that a few children, who do not have ADHD, are sensitive to additives. However, if you wish to opt for a special diet, consult a dietitian.
• A working parent. This is certainly not true, as there are many children without ADHD around the world whose parents are working.

Coming to the most important point, it is nothing else but only your parenting style that can help you deal with this disorder. Know that it is quite annoying and hectic to deal with a child who acts immediately before going through any thought process, smashes things, and forgets anything said in 20 seconds. This can make you even hate your child. At this point of time, understand that, “You are dealing with ADHD, not actually with your child!” After all, this is very subtle but a must to digest so that you can prepare yourself for any circumstances for your child’s life.

ADHD – Treat as a Medical Condition

It is generally difficult to identify and comprehend the causes that affect our behavior or mood. Similarly, the causes of ADHD are also not thoroughly grasped. If we consider other problems such as fracture or asthma, their symptoms and effects are clearly visible and understood. So, parents or relatives exhibit sympathy.

But, in the cause of ADHD, the external display of symptoms, i.e., intolerable behaviors make parents and relatives serious rather than being sympathetic. This is because the front person dealing with the child fails to understand the brain chemistry behind these behaviors and assumes simply to be a behavioral problem, rather than an internal disorder. So, ADHD is a medical condition that requires treatment from psychiatrists, pediatricians, or psychologists.

Difficulties that Can Be Encountered while Coping Up with ADHD

As a parent, you will encounter certain difficulties while tackling ADHD. Listed are a few of them.

• Worry regarding the treatment for ADHD
• Social issues
• Lack of time for yourself

Worry Regarding the Treatment for ADHD

Once the diagnosis is done, you might feel some relief as finally, you know what is happening with your child. Later, you might worry about the strong medication being given to your child. Another line of fear can be that the child might always face discrimination and mistreatment from others for the entire life.

Social Issues

If you and the school of the child feel that the help and support to tackle ADHD is not enough, you may need to appeal even though the statementing process is going on. This is because the statementing process itself takes 26 weeks. Such a condition gives rise to the listed below issues.

• What to do you the statement is received? Most schools keep budgets for unique needs, which can help your child temporarily while he/she is in the school. In this case, you need to find out by discussing how and up till what extent will the help be provided and what will be done to handle the child in case the help is not there.
• Will the statement provide sufficient help and support to your child? What if it’s not satisfactory or inadequate?
• How will the teacher/Special Educational Needs Coordinator (SENCO) behave with your child to make him/her feel a part of the society?
• Can the medication be taken at the school?
• What can be done to tackle homework-related issues?

What is most important here is to work in close relation with the school. Also, note that you will be a part of many meetings with the SENCO, class teacher, and possibly the head teacher too.

Lack of Time for Yourself

Going to work, attending meetings, and coping with a demanding child make it difficult for you to get time for yourself. It’s completely acceptable that it is difficult to trust someone else with whom you can leave your child. However, if you know some friend or relative who can understand your child up to maximum possible extent and consistently work upon the child’s improvement level, request him/her to spend some time with your child fortnightly. In this way, you can spend some time for yourself.

Sources of Support

Here is the list of some groups that can provide you with support to deal with children having ADHD:

• Health Professionalists
  Include GP and psychologists.
• Education Workers
  Include school SENCO and a worker from the Local Education Authority (LEA).
• Support Group
  Includes a local group for parents to deal with ADHD or a national group such as ADDISS.

ADHD Causes

Biological and environmental factors are the root causes of ADHD. Out of these, the biological factors are:

• Temperament of the child that is responsible for attitude and personality.
• Genetic conditions wherein if one twin has ADHD, the other also has 80-90 percent chance to have it. According to a recent research, this disorder is more likely to be inherited from males such as fathers and grandfathers.
• Damaged parts of the brain because of shock or pre-birth problems. These regions that are responsible for the development of ADHD are prone to hypoxic damage at the time of birth. Such a damage is caused by insufficient oxygen being supplied to the brain, while on the other hand; the blood flow is reduced.

Listed are the environmental factors that might lead to ADHD.

• Stress due to family conditions
• Educational difficulties

ADHD Symptoms

Here are the major symptoms of ADHD that are usually not mild so that they can be considered under the ADHD disorder.

• Difficulties in Attention
• Hyperactivity
• Impulsivity

Other symptoms can be any or combination of the list below.

• Grand mal or petit mal epileptic seizures, leading to drowsiness, attention impairment, and abnormal behaviour and perceptions
• Difficulty in hearing like deafness or glue ear, making it tough for a child to follow the instructions and forcing him/her to appear as daydreaming (inattentive)
• Reading problems that make it tough to complete jobs or follow the orders
• Obsessive disorder, making people commit odd rituals that preoccupy their thoughts and divert their attention
• Tourette’s syndrome that includes frequent and unintentional body jerks, abrupt outbreak of noise, or swearing
• Autism and Asperger’s syndrome that give rise to problems in understanding and language
• Extended duration of improper sleep that leads to significant low concentration

Difficulties in Attention

Here is the list of symptoms related difficulties in attention, out of which minimum six must be exhibited for at least six months to a remarkable extent keeping in mind the child’s age and aptitude level.

• Falls short of paying and sustaining close attention at work or play
• Makes careless mistakes while playing or working
• Fails to complete the tasks
• Appears like not listening to what is being told
• Fails to follow the instructions
• Fails to finish the homework or daily tasks
• Fails to organize tasks and activities
• Avoids activities wherein continuous mental effort is needed
• Forgets basic things that are mandatory for completing an assigned task or activity, such as pencil, rubber, notebook, or item related to play.
• Is easily distracted
• Fails to remember while performing daily activities

Hyperactivity

Here is the list of symptoms related hyperactivity, out of which minimum three must be exhibited for at least six months to a remarkable extent keeping in mind the child’s age and aptitude level.

• Runs around
• Excessively mounts over things.
• Feels restlessness (normally in adolescents or adults)
• Excessively noisy while playing
• Finds it tough to involve silent activities during free time
• Gets up from the seat in the classroom or in other situations wherein being seated is predicted
• Fiddles with hands or feet
• Fidgets on the seat

Impulsivity

Here is the list of symptoms related impulsivity, out of which minimum one must be exhibited for at least six months to a remarkable extent keeping in mind the child’s age and aptitude level.

• Utters answers without waiting for the questions to be completed
• Fails to stay in queues
• Fails to wait for the turn in games or group plays
• Interrupt others, such as intruding into others’ conversations or games
• Speaks too much without proper response

Difficulties Accompanying ADHD

There are many other difficulties along with which ADHD occurs often and whose union leads to problematic behaviors. These include revealing bad temper, sleep disorders, and clumsiness. Listed below are the other behavioral problems that take place with ADHD.

• Confrontational defiant behaviour, wherein the child exhibits anger, argues, refuses to obey their elders, and intentionally irritates others. This is observed in around 60 percent of the victims.
• Conduct disorders (destructive and deceitful behavior), wherein a child lies, breaks rules, or steals. This is observed in around 25 percent of the victims.
• Dyslexia, wherein a child finds it difficult to learn, calculate, and write. This is observed in around 25-30 percent of the victims.
• Severe depression, which is observed in 33 percent of the victims.
• Anxiety disorders, which is observed in 30 percent of the victims.

Diagnosis

A medical diagnosis needs to be done for ADHS. A doctor who is a child or adolescent psychiatrist, paediatrician, paediatric neurologist, or GP performs the diagnosis. Contribution of other professionals like psychologists, speech therapists, teachers, and health visitors is of a great benefit for the examination of a child with the probability of having ADHD. The diagnosis is performed by gathering different information, as there is no single test for this.
Listed below are the types of information gathered during the diagnosis phase.

• History of symptoms
• Medical history
• Past psychiatric history
• Educational history
• Child’s temperament and personality
• Family history
• Social background

History of Symptoms

This kind of information involves being aware of the exact nature of the difficulties being faced, the time when they were initially observed, the conditions due to which they occur, and the causes that relieve them.

Medical History

One of the risk factors that matters here is the mother’s health. Information regarding whether the mother’s health not good or was too young during the time of delivery, does she have the habit of smoking or drinking, and had the mother undergone extended or complicated labor is collected.

The occurrence of fragile-X syndrome, fetal alcohol syndrome, G6PD deficiency, phenylketonuria, and generalised resistance to thyroid hormone in the past or present are also taken into account. Not only this, but also accidents, operations, chronic disorders such as epilepsy, asthma, and heart, liver, and kidney disorders are considered.

Any medication been taken by the child or is currently taking is of great relevance.

Past Psychiatric History

Investigation is done to identify any mental problem that the child might have. This can aid in ruling out the symptoms of depression or anxiety.

Educational History

Enquiry is done regarding their learning ability and difficulties and how they behave with their peer groups and teachers.

Evaluation of the Child’s Temperament and Personality

The child’s temperament and personality along with that of other family members is enquired. Further, the type of relationships within the family may also be examined. Discussion on how parents manage the child’s behaviour is done here. This will actually make parents feel that this is an unexpected interference. However, the assessor would not pin point anyone. A tip for parents here is not to feel that they are cause of ADHD in their children.

Family History

The parents’ mental and physical health along with those of the family members is of utmost relevance.

Social Background

This includes collecting information regarding housing area, poverty, and social support that have an impact on the child’s behaviour on a large scale.

ADHD Treatment

A guidance or advice from a psychologist along with the diagnosis results would be of great help to treat ADHD. It’s a difficult task to live with a child having ADHD. Therefore, both parents and teachers must try to deal with the child’s problematic behavior. Some ways of management are:

• Create a daily schedule for the child.
• Be clear, specific, and reasonable in your instructions. For instance, instead of telling the child to ‘behave’, say ‘play Snakes and Ladders quietly for 30 minutes’.
• Be steady in the handling the child
• Avoid troublesome or disturbing elements in daily routine. For example, switch of the radio during their homework time.
• Plan for such programmes that are focused at increasing the span of the child’s concentration.
• Speak face-to-face with the child and avoid talking with other children simultaneously.
• Provide rewards (stickers, toys, money, etc.) consistently to strengthen proper behaviour.
• Allow sanctions (loss of rewards, no T.V. etc.) for unpredicted behaviour.
• Opt for psychological treatments such as cognitive therapy and individual psychotherapy.
• Provide social skills training.

Prescribed Medicines

According to a U.S. research, medication is the ideal choice for ADHD. The common and effective medicines prescribed for ADHD are amphetamine-like stimulants, methylphenidate (Ritalin) and dexamfetamine (Dexedrine).

Ritalin aids in decreasing the intensity of hyperactivity and impulsiveness and in increasing the child’s attention. The positive signs in your child due to Ritalin are less aggressiveness, compliance with instructions, better memory. Many parents have informed that Ritalin has greatly improved their child’s behaviour. However, on the other hand, Ritalin has critical negative effects on the cardiovascular and nervous systems. Therefore, it is recommended only for children of 6 years and above and until a month if there is not improvement.

Probable Outcome

Nearly half of those affected by ADHD start living a normal life at an early stage of adulthood. However, a considerable number of children will face problems even in their adulthood. These problems might be depression, related to attention, and antisocial behavior.