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ADHD

 

ADHD is a neuropsychiatric disorder that results in impaired ability to concentrate, impulse control and regulation of activity level. 

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ADHD stands for attention deficit / hyperactivity disorder and is taken from the DSM diagnostic system. In the ICD diagnostic system, the condition is called hyperkinetic disorder. For the sake of simplicity, we use the term ADHD here. ADHD is a neuropsychiatric developmental disorder that is characterized by disorders related to regulation of concentration, attention, activity level, impulse control, and which also has a lot to say for the regulation of motivation and emotions. 

 

One of the most common child psychiatric diagnoses 

ADHD / Hyperkinetic Disorder is the term for one of the most common conditions in mental health care for children and adolescents. ADHD, which is the diagnostic term in the diagnostic manual of the American Psychiatric Association, called DSM (and stands for Attention-Deficit / Hyperactivity Disorder), while the World Health Organization in its diagnostic manual, ICD, uses the term Hyperkinetic Disorder. 

ADHD is characterized by a remarkably high level of activity, impulsive (ill-considered) actions and difficulties with concentration and attention, seen in relation to what is expected based on age and situation. A subgroup of ADHD has little, or only mild, degree of hyperactivity and impulsivity, but significant difficulty concentrating and paying attention. The prevalence among school-age children is estimated to be from 3-5%. The symptoms must have appeared before the start of school, and lasted over time (more than 6 months). They should be able to be seen in different situations such as home, kindergarten and school, but not necessarily in new surroundings, one-on-one situations, or by self-chosen activity. 

The difficulties must be of such a nature that they have led to a disability in the child in order for a diagnosis to be made. The diagnosis is usually made in the specialist health service. Often there are additional difficulties such as behavioral problems, emotional problems, learning difficulties, language deficiencies, motor awkwardness, etc. It is not uncommon for parents to struggle in their interaction with the child. Other developmental disorders, mental, behavioral or familial difficulties do not rule out ADHD. 

It is well documented that ADHD involves a risk of skewed development. Most people need various interventions over a long period of time, e.g. information, parent counseling, facilitation measures in kindergarten and school and any medication. Individual, family or group therapy may be relevant in relation to additional difficulties. 

It is important that children and young people with various levels of ADHD-related difficulties are detected early so that the necessary interventions can be implemented. This must be combined with a generous concept of normality. The key players in capturing children and young people with difficulties, including ADHD, are parents, the kindergarten / school and the primary health services and the school health service. 

 

Symptoms of ADHD

what is adhd

We can divide the symptoms of ADHD into two main areas.

 

Inattention

  • Often fails to be focused on details or makes careless mistakes in school work or in other activities
  • Often has difficulty keeping attention when performing tasks or toys
  • Often do not seem to hear when they are spoken to
  • Often does not follow instructions in full and is unable to finish schoolwork, complete routine work or other tasks
  • Often have difficulty organizing tasks or activities
  • Often avoids or dislikes tasks that require persistent thinking, such as schoolwork or homework
  • Often loses things needed to perform activities, such as books, pencils, toys or tools
  • Often easily distracted
  • Often forget

 

Hyperactivity and impulsivity

  • Often tingles with his hands and feet or twists in the chair
  • Often leaves their desk in the classroom or in other situations where they are expected to sit at the desk
  • Runs or climbs when not needed. Young people may not do that, but they may feel constantly restless
  • Often has trouble playing quietly and calmly
  • Are usually on the go or act as if they were powered by an engine
  • Are often very talkative
  • Often bursts out with the answers before the questions have been completely asked
  • Often have difficulty waiting for their turn
  • Often interrupts or interferes with other people's conversations or games

Source: NHI

 

ADHD and self-regulation

ADHD is a complicated disorder. A good post on help by Cecilie Jahreie who focuses on The ADHD brain 5 main challenges point out:

ADHD is perhaps one of the most misunderstood diagnoses we have. It is a developmental disorder that involves a different way of using the brain, and which gives rise to many strengths and many challenges. 

Fortunately, it has been increasingly recognized that ADHD can manifest itself in different ways, and that a prototypical understanding of ADHD as "the hyperactive boy who always disrupts teaching" is not necessarily representative of everyone with ADHD. One perspective that may be helpful is to say that self-regulation is a key to understanding ADHD. Jahreie describes the ADHD condition as follows: 

Having ADHD is like a lamp with a partly destroyed cord, it stands and switches on and off due to a poor power plug.

 

Causes of ADHD

Several large studies have pointed out that heredity plays a significant role in the development of ADHD. The results from the world's largest study about ADHD, where researchers from Bergen were involved, concluded that ADHD is biologically rooted. Jan Haavik at the University of Bergen said:

We show that some people have a higher genetic vulnerability to ADHD (...) and we hope this can change the view of the condition. It's not about bad upbringing or attitudes.

These findings support a previous consensus statement which was given by a number of prominent researchers on ADHD. They emphasize: 

In the media, one can sometimes get the impression that there is deep scientific disagreement about what ADHD is and what causes ADHD. Such a disagreement is not real, according to leading researchers in the field. There is extensive scientific support that ADHD is a real disorder that is primarily due to hereditary conditions, the researchers believe.

As with other complicated conditions, environmental impacts are also important and will affect the prognosis. In addition, difficult living conditions can sometimes be disguised through behaviors and challenges that may be wrongly interpreted as ADHD, something that calls for a nuanced understanding when meeting children and young people who are struggling in their lives.  

 

Treatment of ADHD

Treatment of ADHD includes a number of measures (source: NHI): 

 

  1. Information about ADHD
  2. Treatment with drugs
  3. Facilitation of conditions at home, at school, at work or elsewhere
  4. Social security benefits
  5. Other social assistance and support measures
  6. Treatment of other concomitant (comorbid) conditions

 

Facilitation of ADHD

In other words, facilitation measures are an integral part of "treating" ADHD. Some key principles for facilitation for students with ADHD includes:

  1. Good understanding of what ADHD entails
  2. Close monitoring
  3. Good classroom management
  4. Good structure
  5. Having few adults to relate to
  6. Always a "plan B"
  7. Visual plans
  8. "Help questions" that sharpen focus
  9. Strengthened parent-school collaboration

Russel Barkley is one of the world's foremost experts on ADHD, and has published a number of studies on ADHD. He emphasizes a number of measures which can help compensate for the difficulties that result from the condition and to prevent additional problems.

 

Help for additional difficulties

Ofte there are additional difficulties (comorbidity) such as behavioral problems, emotional problems, learning difficulties, motor awkwardness, etc. It is not uncommon for parents to struggle in their interaction with the child. Other developmental disorders, mental, behavioral or familial difficulties do not rule out ADHD. As additional difficulties are common in people with ADHD, it must also be emphasized that many children with ADHD need separate interventions that are directed at these additional difficulties.

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Written by

ove heradstveit

Ove Heradstveit

Psychologist, specialist in clinical community psychology. PhD.
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