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ask an Expert: ADHD Educator

Dave Pughe-Parry is the founder of Living ADDventure™ an independent organization committed to helping people who have - and people who live alongside ADHD. Dave advocates and practices a multi-disciplinary methodology in dealing with this complex and often bewildering condition. ADHD is the most prevalent of all psychiatric conditions, affecting close to 10% of any population.

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Q. What are the symptoms for ADHD?

A. The symptoms to diagnose ADHD are laid down in the DSM IV (The Diagnostic and Standards Manual version 4). Doctors must use this to diagnose children and adults who are suspected of having the condition.

The DSM V will be published in 2013 and will include symptoms for the Inattentive Type - who are predominantly female, and more accurate symptoms for adults. But until that date, the DSM IV, with it's flaws, must be used as it remains the best and only validated tool available.

SYMPTOMS OF INATTENTION
a. often ignores details; makes careless mistakes
b. often has trouble sustaining attention in work or play
c. often does not seem to listen when directly addressed
d. often does not follow through on instructions; fails to finish
e. often has difficulty organizing tasks and activities
f. often avoids activities that require a sustained mental effort
g. often loses things he needs
h. often gets distracted by extraneous noise
i. is often forgetful in daily activities

SYMPTOMS OF HYPERACTIVITY-IMPULSIVITY
Hyperactivity

a. often fidgets or squirms
b. often has to get up from seat
c. often runs or climbs when he shouldn't
(in adults, feelings of physical restlessness)
d. often has difficulty with quiet leisure activities
e. often "on the go", as if driven by a motor
f. often talks excessively
Impulsivity
g. often blurts out answers before questions have been completed
h. often has difficulty waiting his turn
i. often interrupts or intrudes on others

Of course, this list is very generalized. In fact, everyone probably experiences these feelings at one time or another. In order to be diagnosed, these symptoms must meet other important criteria as well:

  • symptoms must be present in two or more settings (such as work and home) 
  • the individual must show "clinically significant impairment" at work or school or with other people
  • the individual must not suffer from another mental disorder that could explain the symptoms

It is worth noting that everyone will display some ADHD symptoms at some point, and may even do so consistently. This does not mean that they have ADHD!

It is also very important to understand that hyperactivity on it's own is NOT and indicator of ADHD. A person - child or adult - can be hyperactive nature and not have ADHD.

As a rule, everyone should avoid at all costs putting labels on people, or placing them in neat little boxes. Leave the diagnosis to professionals!

Best wishes
Dave Pughe-Parry


Q. "How would I go about / who would I go to, to have my child assessed correctly for ADD? - hyperactivity is not a factor. I found a list of symptoms online & according to those symptoms listed he has displayed quite convincingly nine of them! Looking forward to your response."
- Lynne

Dave replies: This is such a good question, one that I love giving an answer to - so here goes... There is no test for ADHD. This complex condition is diagnosed by the following people only - no one else:

  • Paediatricians
  • Psychiatrists
  • Neurologists
  • General Practitioners
  • Psychologists
For you as a parent the best thing to do is get hold of some standard diagnostic forms like the 'Connors' or the 'Copeland'. I use the Copeland forms with permission. You can get these forms from me on dave@ladd.co.za 
 
Normally these forms are filled in by the child's teacher and passed onto the doctor. I have found that a single form does not always provide an accurate picture. Getting this part of the process right is vital, as an incorrect diagnosis at this stage could be very detrimental to the child, and even follow them through to adulthood.

What I like to do is to get each adult that knows the child well, and all the teachers that interact with the child, including sports coaches and other extra-curricular instructors to fill in the forms. This provides not only a more accurate picture of the child, but a huge amount of other data that we as coaches can teach parents how to use to improve ADHD impairments.

A great source of information are the grandparents. This is where we often learn what works well with the child, not just what is wrong. It's this vitally important information that I feel is missing from the standardized tests, which, after all were designed to find out what's wrong, not what's right.

I can analyze these forms, to see whether further investigation is required. The completed forms should be taken to one of the medical professionals listed above for diagnosis.

It's the diagnosis and the treatment that causes so much trauma and even anger with parents. Let's face it, no parent likes to be told there is something wrong with their child. If the diagnosis indicates ADHD or co-occurring condition is present, keep a calm head. The goal is to do what is right for the child, and dismissing a diagnosis out of hand doesn't help, but's another question all together.

There is no single treatment that works for ADHD completely. A multi-modal (or multi-disciplinary) treatment is by far and away the most effective treatment for the is complex and sometimes baffling condition.
 
Always remember that ADHD when managed effectively is a wonderful gift. Look at great ADDers such as Richard Branson, Albert Einstein, Winston Churchill, Whoopi Goldberg, and Rick Warren, to name just a few.

Q. "What guidelines can you give me in the mornings to get my daughter ready for school. How involved should I be in the dressing, hair, toothbrush routine. Its an absolute nightmare in the mornings. She drinks Ritalin 8h00 in morning after big breakfast. She has been diagnosed."

Dave replies: The most stressful time of the day in any family - ADHD or not - is the period from waking up to getting to school/work. In an ADHD household, the problems are magnified many times over. Yet this doesn't have to be like this. Here are some guidelines and tools to make this time a happy and productive one. First some context points from the child's point of view:

  • For us ADDers, this is the most important time of the day as anything that happens in this period will stay with us for the rest of the day. If we get shouted at, we will be unhappy the whole day. We dread this time because we know we will get into trouble
  • We struggle to get going in the morning. We are sluggish and it takes a good while for any clear thoughts to appear in the fog. Some ADDers are not like this.
  • If we have had a nightmare or a happy dream, we will spend time analyzing that dream. We dream vividly, in high-definition TV, with full surround sound, and the sub-woofer! It's like the dream was real!
  • At that time we have no idea what we are going to do that day, we probably don't even know what day it is. 
  • We do know that we will probably get into trouble sooner or later, so we are anxious. 
  • We know that Mom is going to shout because we have forgotten our lunchbox and shoes at school, or we have no clean school clothes, and those we do find are too dirty to wear - Mom shouts when she sees those clothes, and asks if we have no shame or respect, or something else. This is an unhappy time.

What can you as a parent/spouse understand, and do, to make this time better?

  • When it comes to ADHD, there is no "one-size-fits-all" answer or approach. Each ADDer is individual and unique. Here's a good illustration: "It is said that all true psychopaths have bright blue eyes. BUT, not all people with bright blue eyes are psychopaths." Take what we say here and apply and/or adapt it to your circumstances. Not all of these tools and guidelines will work for everyone, but most of them will work for most ADDers, most of the time.
  • Know this, believe this and imprint it on your heart - NO ADHD child get's out of bed in the morning and plots how to make your life a misery! While we may do that, we DO NOT plan it, we are too befuddled at that time to think about those things anyway.
  • Give the medication 30 minutes before the SCHEDULED wake up time. Set your alarm to half-an-hour before you would normally wake your child up, give them either the long-acting or a short acting Methylphenidate, then let the child go back to sleep until the normal wake up time. When they wake up now, the medication is working and they can focus far more - they will have more confidence. You should then provide medication for the last period of the evening before going to sleep.
  • Before going to sleep the night before, the child must make sure that the school bag is packed, and that clothes - uniform and sports clothes - are ready and available.
  • Have checklists A4 sheets laminated and stuck to prominent places on a wall with everything that needs to be done on each day. This may mean five different checklists. The child must physically tick off each item when it is done - just looking at the list and saying to self, "done that, done that," is no good. The physical ticking off is the most important point of structure as it builds a track record of success in the mind of the child.
  • Make sure the child is INVOLVED in the creation of the lists.
    • Question, what do you need to look like at school? You can have a little game dressing up in the uniform in front of the mirror of what they should look like when they go to school. You can also take photographs of how they should look, print it out and stick it next to the To-do list. Visual references for ADHD children are wonderful!
    • Answer, I must look clean and tidy.
    • Question, how do you look clean and tidy?
    • Answer, I must brush my hair.
    • Comment, good answer, let's write that on the checklist, and so on
  • Reassure the child that if they are battling, they must ask for your help. Don't go in and take over. The message then to your child is that they are useless and can't do anything! Ask if they need your help, don't tell them you need your help. Praise them for asking for help.
Q. "Do you believe that bed wetting is related to ADD or ADHD?"

Dave replies: 
Doctors and researchers have been unable to prove definite links between ADHD and bed wetting. But it stands to reason that it's a natural fit for ADHD children to wet their beds more than non-ADHD kids. This is because one of the symptoms of ADHD is impulse control.

It would not be wrong to say that more children who have ADHD will wet their beds than children who don't have ADHD, despite there being no proven studies.

It would be completely untrue to say that all children who wet their beds have ADHD!

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