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Helping Children with ADHD
Philip is quite a challenge at home and at childcare. During circle time, he blurts out irrelevant information. He is in constant motion, even when an adult is next to him trying to calm him down. Even though many four-year-olds are impulsive, sometimes Philip is exceptionally impulsive to the point of threatening his health or safety. For example, on a recent field trip, Philip broke away from the group and ran across a busy highway. This happened so fast that Philip was on the other side of the street before his teacher could catch him. On another occasion, he took a pair of scissors and attempted to stick them in an electrical outlet. At home, Philip was able to open a child-proof medicine bottle and swallow some of his grandmother's high blood pressure medicine.
Does Philip have ADHD? To answer this question, we must first look at what ADHD is. Attention Deficit Hyperactivity Disorder (ADHD) is diagnosed by a pediatrician or physician using the criteria established in a book called the Diagnostic and Statistical Manual--IV of the American Psychiatric Association, usually referred to as DSM-IV. Some children may have Attention Deficit Disorder (ADD) without hyperactivity. A future Healthy Childcare article will focus on ADD.
There are four categories of ADHD described in DSM-IV which include: (1) attention deficit/hyperactivity disorder, predominantly inattentive type, (2) attention deficit hyperactivity disorder, predominantly hyperactive/impulsive type, (3) attention deficity/hyperactivity disorder, combined type (referring to numbers 1 and 2 above), and, (4) a miscellaneous category for children who do not meet the criteria for the first three categories. This still does not tell us if Philip has ADHD because many of the signs of ADHD are normal signs in very young children. To accurately diagnose ADHD, a pediatrician must first consider the child's age and the circumstances in which he appears to be existing symptoms of ADHD.
Here are just a few of the signs to look for to determine if a child might be ADHD. They are divided into three groups which include including inattention, impulsiveness, and hyperactivity.
Inattention
- Child is easily distracted.
- Child does not listen well.
- Child often fails to finish tasks.
- Child has problems concentrating.
Impulsiveness
- Child has difficulty waiting in line or taking turns.
- Child frequently blurts out irrelevant information.
- Child moves from one activity to another quickly (without finishing any tasks).
- Child often acts impulsively without thinking about it.
Hyperactivity
- Child cannot stay in seat.
- Child moves about all the time (even in his sleep).
- Child fidgets.
- Child is in constant motion, running or climbing excessively.
- Child wakes up often during the night and moves about.
While this list includes warning signs that teachers should look for, most of these characteristics are typical of all young children, with the exception of waking up often during the night and moving about. It is still difficult to determine whether Philip has ADHD. He is still very young and there may be many other contributors to Philip's behavior. He may not be hyperactive as much as he is "activity hyper." That means that he may be asked to perform tasks at home or school which are inappropriate for his age.
For example, if Philip is asked to sit still for long periods of time or is expected to complete several work sheets in a short period of time, he may not be developmentally ready to perform this task. Thus, his inability to concentrate may be due to his immaturity rather than a sign of ADHD. Before referring Philip for an evaluation, his teacher should consider very carefully what she has been asking him to do and consider if it is age appropriate.
Even if Philip is eventually diagnosed with ADHD and prescribed medication such as Ritalin, his teacher will need to modify classroom behavior to ensure his health and safety. Medication for Philip will not be a magic cure. A proper environment is needed to help him learn how to control his attention, impulses, and activity level.
Here are just a few ways Philip can be helped:
- Work very closely to develop a home/school partnership. The best outcomes for Philip can only occur when the home and school work together as a team for his health and safety.
- Develop a behavior modification plan for Philip with the family's help. A program which seeks to modify his behavior will only be effective if the parents are involved in implementing and supporting the program.
- Find ways to accommodate Philip's high activity level. Philip needs opportunities to constructively channel his energy. This can be done by having a safe place in the room for Philip to be active. This might include a rocking horse or punching bag where Philip can release his energy when needed.
- Extend Philip's attention by allowing him to move from one activity to another within a particular theme or topic. For example, if the class is studying trains, Philip can paint a picture of a train, put together a train puzzle, make a train with clay, look at a book about trains, and actively play with a toy train. Therefore, Philip is encouraged to focus his attention on the topic (trains), but is allowed to move at appropriate times from one activity to another when he finishes a task.
- Try to look at Philip's activity level as a strength. Most of us have said, "If we could just bottle the energy of a two-, three-, or four-year-old, we could do so many things." It is important to treat Philip's energy as a strength to encourage positive mental health. Children like Philip often pick up signals from parents or teachers that they are different, which in the long run could influence self-esteem and mental well-being.
Most of all, remember that Philip is still very young. The younger the child, the more difficult it is to determine ADHD and to predict what the future will hold for children like him. Our job is to make sure we protect both his mental and physical health and assure that he can be a boy in a safe and friendly learning environment.
By Jerry Aldridge, Jerry Aldridge is Coordinator of Early Childhood Education, University of Alabama, Birmingham.Resources
The National Attention Deficit Disorder Association
993 Johnnycake Ridge Rd, Ste. 3E, Mentor, OH, 44060
440-350-9595, www.add.org.
The American Academy of Pediatrics, 800-433-9016, www.aap.org
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