JOURNAL OF THE NATIONAL ACADEMY FOR CHILD DEVELOPMENT
Volume 10, No. 2, 1996, 8
Your ADD/ADHD Child
John M. Jaquith, M.Ed.
What is ADD and ADHD? Essentially, both of these are labels
that describe symptoms. In fact, a list of symptoms is used
to identify such children. A child receives a label based
on prolonged occurrences of eight or more, out of a possible
fourteen, symptoms before the age of seven. These symptoms
have been identified as:
- Often fidgets with hands or feet or squirms in seat.
- Has difficulty remaining in seat when required to do so.
- Is easily distracted by extraneous stimuli.
- Has difficulty awaiting turn in games or group situations.
- Often blurts out answers to questions before they have
been completed.
- Has difficulty following through on instructions from
others.
- Has difficulty sustaining attention in tasks or play activity.
- Often shifts from one uncompleted activity to another.
- Has difficulty playing quietly.
- Often talks excessively.
- Often interrupts or intrudes on others.
- Often doesn't listen to what is being said.
- Often loses things necessary for tasks or activities at
school or at home.
- Often engages in physically dangerous activities without
considering the possible consequences.
The label ADD refers to those children
who are experiencing attention problems, but who are not hyperactive
or impulsive. Such children display a variety of symptoms
that can be related to inefficiencies in different areas of
their development. Fortunately, developmental problems can
be identified, addressed, and often eliminated.
In the development of tactility, there
are two common areas where problems can occur. The first one
involves the ability of an individual to appropriately process
sensations of light touch, pressure and pain, the other involves
proprioception. Proprioception refers to one's knowledge of
where his body is in space. If an individual has not completed
developing his proprioception, his brain is not likely to
know specifically where his body is. Symptoms include: bumping
into things, fidgeting or squirming around, and to a degree,
engaging in physically dangerous activities without considering
the consequences.
To determine if your child has a problem
with tactility, ask yourself these questions. Does my child
exhibit the above mentioned symptoms? Does she have a high
threshold for pain (i.e., not knowing where she got bruises
on her arms and legs after playing outside)? Is she inappropriately
ticklish (not ticklish at all or so ticklish that she can't
stand to be touched)? If you answered yes to any of these
questions, your child may not have completed all of the developmental
levels dealing with tactility. These problems can be corrected
by providing specific tactile stimulation in order to complete
all of the levels of tactile development.
Processing (both auditory and visual)
is another area that is often found to be underdeveloped.
An individual's auditory and visual processing affects their
short-term memory. If a child has low processing, it may appear
that he is not listening to what is being said. The reality
is that he is unable to process the information completely.
Other symptoms that occur related to short-term memory/low
processing include the following: difficulty following through
on instructions from others, inability to remain in one's
seat, easily distracted, difficulty waiting for ones' turn
in game situations, problems with sustaining attention or
shifting attention from task to task, difficulty playing quietly,
and losing things necessary for task completion. Children
with low processing can be identified by using a simple technique.
To check your child's auditory and
visual processing levels, you will need to administer a digit
span test. To do this auditorily, dictate a sequence of numbers
to your child. Say them slowly and in a monotone B about one
second apart. For example, say: "6-4-3-7." Then
have your child repeat the numbers back to you in the same
order. If she can correctly repeat four numbers in a row,
try a sequence of five, then six, and so on. Take note of
the sequence length she is able to complete without making
a mistake. To test your child's visual processing, show her
sequences of numbers on flashcards. They should be on 3x5
cards, written in dark solid ink, and shown to your child
for approximately three seconds. After three seconds, put
the card down and have the child repeat the numbers she saw
on the card in the same order. Begin with a sequence of three
or four numbers and increase the sequence size using new numbers
and cards. Take note of how long of a sequence she can do
correctly. A three-year old should be able to complete sequences
of three numbers (both auditorily and visually), a four-year
old should be able to complete a sequence of four, a five-year
old five, a six-year old six, a seven-year old seven, and
adults should be able to complete a sequence of seven or more.
If your child has low processing skills, you can help increase
her skills by practicing the digit spans daily, thus increasing
the brain's ability to process information.
Long-term memory problems may also
be an issue with children who have received a label such as
ADD or ADHD. This is related to a concept known as dominance.
Almost everyone is either right-handed or left-handed. In
order for the brain to take in information as efficiently
as possible, it is helpful to consider if a child is right
or left eared, eyed, and footed.
How can you know which is your child's
dominant eye, ear, or foot? This process involves gathering
a great deal of information. We'll start with the hand. Which
hand does your child write with? Does he write with this hand
all of the time? Which hand does he use to perform other functions
with? Which hand does your child use to eat, throw a ball,
or brush his teeth with? Is he doing all of these activities
with the same hand? If so, which one? If your child does all
or most activities with a single hand, it is probable that
he has established a dominant hand.
It is fairly easy to observe the foot
because it is similar to the hand. Watch your child to see
which foot she uses to kick a ball. Observe your child hopping
on one foot. Which foot did she use? The foot used most often
should be recorded. Also, note if the foot she uses changes
consistently. Once you have gathered information about the
child's hand and foot, the eye and ear can be assessed.
We all engage in two types of visual
activities. They are referred to as near-point and far-point
activities. When visual activities occur close to us (i.e.
reading and writing), they are called near-point activities.
When visual activities occur at a distance (i.e. watching
t. v. or riding in a car), they are called far-point activities.
There are several different ways to assess which eye your
child is using to take in information.
To assess far point activities, have
your child stand across the room from yourself. Point at your
child using your index finger with your arm extended. Instruct
your child to point back at you in the same way, so that it
looks like his finger is touching yours. Observe which eye
the child is using to line up his finger with. Have the child
switch hands and repeat the exercise. Which eye is the child
using to line up his finger with? Does your child switch between
eyes? Record this information along with your previously gathered
information on the child's hand, foot, and near-point visual
activities.
Gathering information about your child's
auditory dominance is also a matter of observation. Have your
child stand directly in front of a door in your home. Next,
have someone on the other side of the door say something softly
"through" the door. Encourage your child to "lean
in and listen carefully" to what is being said. Observe
which ear the child is using to listen at the door. Try this
a number of times and record what you see.
Once you have gathered this information
it is time to examine it all. Notice which side of the body
is used for each activity. Does your child use the left hand,
left eye (for near and far point), left ear, and left foot?
Or does your child use everything on her right side? Is there
a mixture (for example, right hand and foot, but left ear
and mixed visually)? To use our brains efficiently, we must
have an established dominant side. If there is a mixture of
some kind, then the brain does not receive, process, store,
and utilize information in the most efficient way possible.
Impulsive behavior is another symptom
that is commonly seen in children with the ADD or ADHD label.
Traditionally, it has been treated with drugs. Two commonly
prescribed drugs are Ritalin and Dexedrine. These drugs are
prescribed to affect the chemical make up of the brain (more
specifically, they raise dopamine levels). The objective is
to reduce the impulsivity of the children. An alternative
to medication is to take a look at what is causing the impulsivity,
and then eliminate it. Many times food sensitivities are found
to be an issue.
Food sensitivities are generally not
as obvious as allergies, so they are often referred to as
hidden problems. Symptoms of food sensitivities can include,
but are not limited to: congestion of the nose and throat
(which can be accompanied by headaches and postnasal drip),
impulsivity, distractibility, hyperactivity, and a short attention
span. Trying an elimination diet may be an avenue for families
who suspect food sensitivities in their children. Speaking
to someone familiar with food sensitivities is a good place
to start. There are some other sources listed at the end of
this article that may help.
Addressing problem behavior is often
another major area of concern for children who have been given
labels such as ADD or ADHD. Establishing a positive environment,
implementing a solid daily structure, and providing appropriate
feedback are all very important components of a successful
behavior plan. Depending on the child, it is sometimes necessary
to eliminate certain negative behaviors before it is possible
to establish a positive environment.
The key to eliminating behaviors is
to establish a consistent plan of action. A consequence to
the behavior you are trying to eliminate should be thoughtfully
chosen and consistently administered. The consequence should
be one that a parent feels will work best for their particular
child. Prolonged time out is one method that has worked well
when implemented consistently. Negative token economy systems
(where a token is lost every time the behavior occurs) have
also worked well. In this system, once all of the tokens are
gone the child's day is over. Another alternative is to positively
reinforce a behavior that is opposite and incompatible to
the one you are trying to eliminate. For example, a child
can not be doing his chores and be on the floor throwing a
temper tantrum at the same time.
Once the negative behaviors have been
eliminated, a positive environment needs to be established.
A positive environment is one in which four positive statements
are given for every one negative. It is interesting for parents
to test this out on themselves. For a period of time everyday,
keep track on a piece of paper how many negative statements
you make compared to how many positive statements you make.
Most of us fall short of the optimum positive environment,
but you can use this test as a starting point. Continue improving
your positive to negative ratio until you have succeeded in
creating a positive environment in your home.
Implementing a daily structure is also
important for any expert schooling their child. First, establish
a routine that you will follow each day or week. Next, go
over this schedule with your child so that he can expect what
the day will hold for him. Your child can be involved in the
process of developing the schedule, provided that the overall
control of a child's schedule stays firmly with the parent.
It is important to remember that while
the identification of labels such as ADD or ADHD is accomplished
by looking at a list of symptoms, these symptoms are not the
actual problem. It is essential to look at what is really
causing these symptoms. Once the root causes are identified,
they can be addressed, and hopefully eliminated. The way to
address and eliminate the causes is through specific stimulation.
The National Academy for Child Development
(NACD) is an international organization that exists to gather,
evaluate, and disseminate information and procedures relative
to human development. NACD has conducted over 50,000 individual
evaluations and designed 50,000 homeschool programs over the
past sixteen years. It empowers parents with the knowledge,
techniques, and expertise that enables them to assume primary
responsibility for their children's maximum growth and development.
NACD provides families with individualized home programs that
serve as homeschool programs for children with labels like
ADD, ADHD, Learning Disabled, Autistic, Mentally Retarded,
Down Syndrome, Gifted. NACD also serves other families who
are committed to serving their children in whatever ways they
feel are best.
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References
Doman, Child Management
Journal of the National Academy for Child Development (1983)
Vol.3, No.1
Doman, Food Sensitivities
Journal of the National Academy for Child Development (1984)
Vol.4, No. 2
"Guide to Child Development and
Education: Miracles of Child Development" by Robert J.
Doman Jr., NACD (1986)
"Guide to Child Management"
by Robert J. Doman Jr., NACD (1986)
"Guide to the Parent Teacher"
by Robert J. Doman Jr., NACD (1986)
Is This Your Child?: Allergies and
Your Family
Dr. Doris Rapp
2757 Elmwood, Kenmore, NY, 14217
716-875-5578
Why Your Child Is Hyperactive
Dr. Benjamin Feingold
The Feingold Association of the United States
P.O. Box 655, Alexandria, VA, 22306
703-768-FAUS
Reprinted from the Journal
of the National
Academy for Child Development
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