Therapy in L.A.

  article of the month
September 1998
by Alan M. Solomon, Ph.D.

Johnny is an eight year old third grader who frustrates adults. Although bright, his school work is often incomplete, sloppy, or not turned in at all. He blurts out in class, makes little noises and has much difficulty standing in line without annoying his classmates. Or he may disrupt playground games. He is also constantly in motion: moving around the room, being restless in his chair, playing with small objects, or having a body part in motion. Johnny’s teachers/parents comment: "He can do the work when he tries," or, "He has such good ideas, but doesn’t follow through," or, "He concentrates when he is playing a videogame, so why not in school?"

Is this a lack of motivation? Is he lazy? Is there a lack of structure in the classroom or home? Or is there another phenomenon at work: Attention Deficit Hyperactivity Disorder (ADHD)?

ADHD is a real disorder that has a basis in the brain. Recent research studies show that 5 to 10% of all children experience ADHD, as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV, 1994). This manual is a guide used by professionals to diagnose children’s psychological and behavioral difficulties. Another study found that children with ADHD have brains that are 4% smaller than children without the difficulty. Two specific areas of the brain (the prefrontal cortex and the caudate nucleus) are less active. These parts of the brain have to do with controlling voluntary motor activity and speech regulation. Thus, ADHD children are likely to be more active and less self-controlled, compared to children without ADHD.

Children with ADHD often have difficulties in three basic areas:

· fails to give attention to details or makes careless mistakes
· has difficulty sustaining attention
· does not seem to listen when spoken to directly
· does not follow through on instructions or finish chores
· has difficulty organizing taskes and activities
· avoids tasks that require sustained mental effort
· loses things necessary for tasks and activities
· is easily distracted
· is forgetful in daily activities

· fidgets or squirms in seat
· leaves seat when remaining seated is expected
· runs about or climbs excessively when it is inappropriate
· has difficulty playing quietly
· Is "on the go" or seems "driven by a motor"
· talks excessively

· blurts out answers
· has difficulty waiting his turn
· interrupts or intrudes on others

Children with ADHD have six or more difficulties with inattention, and/or six or more difficulties with hyperactivity/impulsivity combined. Since these difficulties occur "often", they may not occur at times, such as when a child is particularly interested in an activity (like when Johnny plays videogames), or when an activity is very carefully structured (like Johnny getting help one-on-one with homework). The problems must be apparent in more than one setting, at school and at home for example, and they must clearly impair the child’s performance, as compared to what is expected for his age. ADHD can be mild, moderate or severe.

How can a psychologist help? First, and most important, with a thorough evaluation. The evaluation collects information on a child’s history and his family history (often other family members have similar behaviors). Formal psychological testing identifies strengths and weaknesses in intellectual skills, academic abilities, possible learning disabilities, and emotional/social areas. With these comprehensive results, the psychologist can make recommendations regarding school programming, individual help, parent/family help and possible medication to be considered by a medical doctor (psychologists can’t prescribe medication). Strengths are important to produce a balanced honest picture that does not focus only on negatives, and to develop ideas of how to help a child compensate by using his talents. Only a psychologist with expertise and experience in evaluations should be consulted.

ADHD often occurs with other difficulties: learning disabilities, emotional-behavioral problems, peer relationship stresses, family disorganization or risks of drug use. Several kinds of help, from different kinds of professionals may be needed for a significant period of time- psychologists, educators, psychiatrists.

With a skilled evaluation by a psychologist and the help that follows, Johnny and children like him have a good opportunity for progress in school, better social-emotional development and greater success when they reach adulthood. This help depends on recognizing ADHD as a real phenomenon.

Dr. Solomon, Ph.D. is a psychotherapist working in Torrance. He is a member of the Independent Psychotherapy Network.

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