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I had just attended a resourceful seminar held by Mothers of Preschoolers(MOPS) International to be one of the beneficiaries of the highly applauded and workable technicalities that MOPS have continuously spewed forth to give mothers encouragement and support as concerns the challenging task of raising children as well as getting a firm grip on the ever elusive parenting principles. Credit to the presentations put forward in the simplest language forms that are fully comprehensible to mums and dads everywhere, I got wonderful training on the biblical perspectives and the foundational principles that are invaluable to young parents like me. Exuberant and beaming with a new leaf of life, the three day seminar came to a stop and all participants had to pack and head home to put all that they had learned into a practical experience.
Just after dinner; my daughters favorite of grilled chicken, pasta and veggies, my husband headed to the golf course top hit some balls together with our oldest son Dane who is fourteen years old leaving me with Eva our six year old daughter. As mother and daughter engaged in those little niceties, I expertly reviewed her excursions when I was not around because for the past three days I had not missed anybody like I had missed her.
As a parent I had almost given up on Eva who was never heeding any instructions whatsoever. Eva had never finished her work as his older brother used to do at her age. She did no mind, she always did what she wanted no matter how much dad and mum spoke against it. Ever while devouring her favorite meal, she would use her fork for a few seconds then the next instance her fingers would be deep in food messing up everything. There are times when she could be attentive, but distractibility always seemed to win most of the times. Always sleeping late and waking up extremely late or very early and in most days frequently awakening in the middle of the night, Eva was a problem and a very big problem for that case. Even though considerably bright, Eva had an unevenness in learning abilities that could not easily be explained.
Always in incessant motion like a motor, drumming her fingers, constantly fidgeting her fingers and shuffling her feet, she pulled toys from the shelf with interest, played with it for a second and discarded it on the floor without seeming to care that the toys should be returned to the shelf. In the car she would be wildly chasing nothing from the back seat to the front seats. In school she was the chatterbox, talking incessantly, encircling the classroom, siting down for a minute only to stand up, clown and jostle. As parents we often became enraged at the teacher’s reports that Eva could not just pay attention in class, hopeless but angry at the same time we knew that something had to be done or our house would soon degenerate into chaos. If there are three characteristics that could be used to describe this young petite girl then they are impulsiveness, hyperactivity and inattention. Just as I was recounting what could have transpired to force the exhibition of these characteristics, a long drawn thought came to mind. Could Eva be suffering from Attention-Deficit Hyperactivity Disorder(ADHD)? It was time to contact the family behavioral neurologist for a conclusive diagnosis.
Early the next morning I got a confirmatory diagnosis that was done in accordance to the DSM-IV criteria which looks at six or more of a set of symptoms of inattention that have presented for a duration of at least six months before progressing to disruptive behaviors that are inappropriate for that developmental level. . Basically, Attention-Deficit Hyperactivity Disorder(ADHD) can be described as a neurobiological developmental disorder that affects 3-5% of children. Symptoms start to exhibit before seven years of age. Symptomatically, the disorder exhibits as a persistent pattern of inattention and impulsiveness that may be accompanied by hyperactivity in some cases. The disorder is chronic and children diagnosed with ADHD are likely to continue to exhibit the same symptoms even in adulthood. However, coping mechanisms can be effectively marshaled to compensate for the impairment. However, despite the fact that the disorder is classified as a behavioral disorder, I was informed that it does not necessarily imply the presence of a neurological disease.
A detailed analysis of literature concerning ADHD yielded four other classifications, for instance; disruptive behavior disorder, conduct disorder, oppositional defiant disorder and antisocial disorder. The most common symptoms exhibited by a child suffering from Attention Deficit/ Hypersensitivity Disorder(ADHD) are; Inattention as the child gets easily distracted , not finishes her work, day dreams and has difficulty in listening.
The second symptom is impulsiveness where the child acts before thinking of the consequences of their actions, displays signs of disorganization, has a tendency to interrupt conversations and is unable to concentrate on one activity hence jumps from one activity to another without any apparent underlying reason. Finally, the child may or may not show hyperactive signs like restlessness(NIMH 2008). Children with ADHD are unable to sit still, have a restless sleep and are always squirming, fidgeting and climbing on things. In most cases, such children also profoundly exhibit learning disorders and are often poor in arithmetic, spelling and reading(Wender 2000). In the case of Eva, climbing on every conceivable thing be it tables, chairs, sink, and window sill has added her a couple of dents and scars on her once once smooth deeply freckled face.
While almost all people diagnosed with ADHD exhibit many of these symptoms, the behaviors do not develop to a point where they are completely unable to perform their duties or studies without interference. These behavioral characteristics are the major impediments to a normal life for those with this disorder but they are not the only problems. Coupled to these, many other co-existing conditions can be diagnosed separately and managed through specific regimens of treatment. In this list of associated co-existing conditions are the conduct disorder, oppositional defiant disorder, mood disorders, anxiety disorders, obsessive compulsive disorder and primary vigilance of disorder.
However, the disorder is not a matter of life and death there are affirmations to the effect that many children seem to outgrow these behavioral characteristics and hence the disorder itself but the reasons behind such a development are not known. The acquisition of coping skills are adolescents mature into adulthood offsets these childhood impairments.
So what are the causes of ADHD? Several factors have been incriminated in the development of this behavioral disorder but specific causes are not yet known. These causes range from genetic factors to the environmental to the social factors. Some studies have been able to demonstrate that a majority of ADHD cases are caused by genetic factors. In fact it is believed that almost three-quarters of all cases have a heritable origin (Learner& Wigal 2008; Barkley 2006). ADHD arise from a combination of so many genes. Most of these genes affect the dopamine transporters. Genes incriminated in the development of this disorder include the dopamine receptor D4, dopamine transporter, monoamine oxidase A, dopamine beta-hydroxylase, catechoamine-methyl trasferase, 5-hydroxytryptamine 2A receptor, serotonin transporter promoter(SLC6A4), dopamine beta hydroxylase gene(DBH Taq1), 5-hydroxytryptamine 1B receptor (5-HT1B), the 7-repeat allele of the DRD4 gene, and the 10-repeat allele of the DAT1 gene(Roman 2004; Swanson 2000; Smith 2003). Due to the broad selection of targets, the disorder fails to comply with the traditional model for the classification of genetic factors in disease. All the genes have been found to play a role even presently research has been unable to single out a single gene that makes the major contribution.
These hyperactive-impulsive-inattentive behaviors have also been attributed to a host of non shared environmental factors. Alcohol consumption and smoking behavioral characteristics of the mother during pregnancy have also been incriminated in the development of these behaviors in the early life of the child. Parents who smoke expose the unborn to nicotine which causes hypoxia to the fetus in the uterus. Complications associated with alcohol consumption and smoking such as premature birth have also been pointed out as possible causative factors of ADHD(BBC 2005; BBC 2006;Barkley & Murphy 2005)
Even though social factors have been incriminated in the development of ADHD, there are no conclusive evidence to suggest that they indeed play a role in the development of these behavioral disorders. However, since children with ADHD have problems of attention and consequently the formation of meaningful relationships either between themselves and the other children or with teachers and parents, this lack of relationship directly influences attentional and self regulation abilities of the child. Lack of relationship also accounts to emotional abuse and violence that these children are often subjected to by other children or adults. Moreover social construct theories also show that apart from this disorder being biologically relevant it exists as a personality trait of the patient and should therefore not be viewed as an abnormal pathology(Lerner & Wigal 2008).
Parenting a Child With Attention Deficit/ Hyperactivity Disorder(ADHD).
To offer an effective and a fulfilling parenting experience to a child with Attention Deficit/ Hypersensitivity Disorder, I learned that there are five basic principles that are necessary for such an experience;
At the onset everything seemed insurmountable, but with the support of Dane(Eva’s older brother) and my husband I believed that no any single parental strategy is impossible if you have a will to pursue its success. My first stop was at the offices of Northern County Psychiatric Associates to get an insight on the basics of medication among those diagnosed with ADHD. However, owing to the controversies of medicating this disorder, I was duly instructed to report the next day in the company of the child so that she could be evaluated before any treatment regimen is instituted. Eva received prescriptions of Ritalin as an initial step in medication. To ensure that the rigid prescription instructions would be heeded to I underwent an indoctrination aimed at developing effective communication strategies with such a child. In case she refused to respond to Ritalin medications, I was advised that there are a wide array of combinations that have the capacity to control the symptoms but these combinations together with other secondary medications are only necessary upon a thorough monitoring of the initial phase of treatment to assess success of failure.
In addition to starting this initial phase of treatment, I instructed to accept the diagnosis and avoid the period of uncertainty and hopelessness that defines families that have just received news of diagnosis. There are cases where news of an eventual diagnosis acts as either a relief after so many years of experimenting with unworkable strategies or a crushing blow for families that realize that care for the child is likely to extend into adulthood. That experience of loss is detrimental to both the parents and the child’s development. The classic stages after diagnosis involve denial, morning, anger, grief and acceptance. I was extremely lucky to have the benefit of health professionals who continually instructed us as parents to cultivate patience and believe in our own power as the mother and father of the girl to carry through with any therapeutic intervention. Moreover, parents should never be too quick to pathologize the behavioral disorder.
To ensure that strategies taken are carried out to their full implementation, community support becomes utterly crucial. Withdrawal from the community support structure at such a time is detrimental and should be avoided since the community has a direct association with the child in question it is necessary for them to possess a primary understanding of the predispositions of the child’s behavior as she grows up with other children in the community.
After going through acceptance of the condition, the next step is behavioral planning. In the home environment, the structure ans behavioral planning are quite helpful. Parents should avoid too complex plans that look very good on paper but very difficult to implement. Even if such plans show an initial success they usually do not hold in the long run. Therefore, for a behavioral plan to be successful it should be simple, consistent and consist of frequent rewards for good behaviors. For instance, for a child with ADHD, a weekly reward for good behavior may not mean any much. If the child accepts to engage in the fulfillment of a long term larger reward,. Like concentrating on her studies, the parents should ensure that the child receives tokens with each incremental step taken towards the larger goal. Such impulsive behaviors cannot just cease immediately. Plans that focus on immediate cessation of disruptive behaviors are doomed. Measures of incremental success with each passing day are desirable.
In cases where the child refuses to take heed, parents should resist the temptation to use corporal punishment to gain the child’s attention. In fact any form of violence against the child should be avoided at all costs because due to their impulsive nature they may be tempted to imitate such acts while disregarding personal responsibility for the actions they commit.
For hyperactive children, childproofing as a behavioral plan should be adopted to ensure the safety of such children. Impulsivity makes these children to climb trees, play with power tools or power connections or sockets and get into medicine cabinets. Hyperactivity and the consequent motor activity gives them the ability to run very fast. For example in a shopping mall, such children may dart from one shelf to the other spilling things, sliding on the floor or darting out into the streets. Since they act without having a thought for the consequences accidents are commonplace but some accidents can be fatal. Childproofing is necessary so that at any given time, the parents know exactly the position of the child. Locking of dangerous or breakable materials way from the grasp of such children is a basic intervention that can successfully prevent minor injuries and further losses of cutlery. Together with installing these physical barriers, the children should be indoctrinated to make them take full responsibility for each and every action. As the child advances in age hyperactivity is most likely going to decrease but impulsivity increases bu even adults who were hyperactive as children have been found to possess high levels of activity even in adulthood.
At the base of these childproofing strategies is the understanding that the child desires to move. For a beneficial strategy, we made sure that we designed a safe and acceptable way to allow the child to move. Such a secret signal that the child understands makes it easier to assess whether communication is achieving the desirable effect. Additionally, to channel the excessive energy, a more complex but intellectually challenging task is helpful not only in the reduction of the moor activity but also improving times spans of attention(Boyles & Constadino 1999). In the park, the parent can design some imaginary boundaries or alternatively rope off an area in which the child is allowed to move. These plans are more influential if the parent recognizes and understands the behavioral patterns associated with ADHD and planning ahead to prevent their re-occurrence in a future situation.
It is obvious that in the implementation of these plans, the other sibling will feel less important and less cared for. Parents can avoid this by keeping their needs in mind as well as including them in helping their ADHD sibling overcome the behavioral disorder. With respect to educational and legal rights of such a child parents should always have a positive attitude. It is only in such a scenario that such children may succeed in getting special education in public education facilities. Since the educational institution is heavily reliant on accurate information in deciding whether the child satisfies conditions for a special educational plan, parents should be very helpful with both the medical and past records that support such a move.
Parents should never strive alone as there are so many organizations working to ensure that such children receive help. Children and Adults with Attention-Deficit Disorder(CHADD) is a national non profit and tax-exempt organization that provides education, advocacy and far reaching support to individuals diagnosed with ADHD. Membership to CHADD is simple and all you have to do to belong to a network of parents or individuals with experiencing problems of ADHD to help you meet the everyday challenges, get up to date information, join support groups and contribute to programs available to local chapters you only need to visit their local offices or log onto their website (www.chadd.org). CHADD gives access to all forms of information regarding the management of relationships, workplace issues, time management, diagnosis and treatment of ADHD. For the wide range of valuable information or services a family can only subscribe to the payment services for a fee of $ 45.00. From individual membership to educator membership to professional membership to student membership and lastly to organizational membership the financial costs range from $45.00, $45.00, $110.00, $35.00, $300.00 respectively. Local services can be accessed from any part of the country.
Upon membership, parents can also also consult LDW(Learning Disabilities Worldwide) to analyze the educational options for students or children with ADHD. Moreover, free newsletter subscriptions also enable members to receive up to date information on helping individuals with Attention Deficit Hyperactivity Disorder lead healthy and meaningful lives.