Increased awareness of attention deficit hyperactivity disorder (ADHD) has led to more new cases being identified in recent years, but misconceptions about it persist.
ADHD is a neurobiological condition that affects one’s academic learning and social behavioural development in varying degrees of severity.
About 5 to 8 per cent of children and young people, and 2 to 3 per cent of adults have it, said Associate Professor John Wong, the head and senior consultant of National University Hospital’s (NUH) department of psychological medicine.
ADHD can also occur with other problems such as anxiety and learning difficulties such as dyslexia, which tend to affect structured learning and its outcome.
ADHD is the top mental health condition seen at Institute of Mental Health’s (IMH) Child Guidance Clinic. From 2012 to last year, the clinic saw an average of 645 new cases with ADHD a year – not including cases seen in the private sector and those undiagnosed.
Adjunct Associate Professor Ong Say How, chief and senior consultant at IMH’s department of child and adolescent psychiatry, described an ADHD child as one who is often disorganised, forgetful and lacking the ability to focus or obey instructions. He behaves impulsively and is constantly restless.
Some people think the ADHD child will outgrow it. But the symptoms often persist into adulthood.
ADHD is caused by a delay in maturation involving parts of the brain responsible for attention control and behaviour inhibition. These are in the pre-frontal cortex, which is the last brain area to develop fully. “This is why some ADHD symptoms may decline slightly with age. But the biological deficits largely remain.
Dr Lim said: “It is common for ADHD symptoms to be misconstrued as “naughty” behaviour. Even after diagnosis, parents and teachers often need plenty of convincing before realising the symptoms are not wilful or deliberate.”
There are three types of ADHD – those who are predominantly inattentive, those who are predominantly hyperactive-impulsive and those with a combination of the two.
Dr Lim said those who are predominantly in the attention deficit domain do not display hyperactive behaviour and are often well behaved in school.
Adults may not realise that they are having problems concentrating in class and are not fulfilling their potential academically.
Dr Ong said ADHD is highly treatable. Those with mild ADHD may just require behavioural therapy and environmental adjustments.
Adjustments could include having a timetable to remind them to do things. In school, these children can sit in front of the class and not near the window where they may look out.
Dr Ong said if the child is so hyperactive that he cannot learn in school, medication may be needed.
Prof Wong said: “When left untreated, a child tends to under- achieve in his academic learning, leading to poor self-esteem from negative attention and scolding from parents and teachers.”
The lack of control in impulsivity may evolve into risk-taking and anti-social behaviour, frequent aggressive outbursts and violent behaviour, and lack of friends and social support, he said.
The good news
The good news is, many people with ADHD learn to cope well.
Some even go on to achieve greatness. American swimmer Michael Phelps, who has won 22 Olympic medals, including 18 golds, is one such person.
Tips for parents
Dr Wong Hui Yi, senior clinical psychologist, department of child and adolescent psychiatry, Institute of Mental Health, shares these tips:
1. Provide structure at home.
Draw up a timetable with sufficient and reasonable periods for study, rest and play.
ADHD children have a short attention span and are easily distracted. Instead of allocating one hour of homework time, break it up into shorter and more manageable periods of 15 minutes each, with a break of, say, five minutes between each period.
You can also use a timer and show the child how much time he has for each period.
2. Keep it simple.
Children with ADHD struggle when they get too much information, especially when it is given verbally. Break down complicated, multi-step instructions or tasks into smaller, more specific and simpler steps.
Call him by his name and make sure he is looking at you, then tell him what you want him to do. Check to see if he understands what you have told him. You can ask him to repeat what you have just said.
3. Employ visual learning.
Kids with ADHD tend to respond to more visual and experiential ways of learning. Use diagrams, models and examples in real-life settings.
For instance, for a math problem, draw a diagram to show him how it is done.
4. Develop self-esteem.
Tune in to your child’s interests and strengths.
If he’s interested in science, for instance, take him to the science centre or to the park.
Assign him small tasks at home and praise him for the effort put in. For example, if he helps out with the laundry, praise him for doing it.
By Joyce Teo, The Straits Times, 12 July 2016