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ADHD: Inattention, Impulsivity, and Hyperactivity

Attention-deficit hyperactivity disorder (ADHD) and other attention related behavior problems are characterized by symptoms of impulsivity, emotional outbursts, hyperactivity, inattention, loss of focus, forgetfulness, and disorganization. These symptoms may be present all at once or may only appear occasionally, depending on the situation. ADHD first appears in childhood and can cause significant academic difficulties. Children with ADHD often have problems completing assignments, staying still in class, and following directions. They tend to be singled out by their peers because of their unruly behavior and may have challenges making friends. ADHD can be managed through behavior modification, therapy, and/or psychotropic medication. Many children learn how to live quite productively with their ADHD by the time they are adults, however others may face challenges with ADHD into adulthood. 

Controversy Over ADHD Diagnosis

The diagnosis of ADHD, especially in children but also in adults, has increased dramatically in the past years and received a great deal of public attention. In particular, the medicines commonly used to treat ADHD-like behaviors are prescribed so frequently that in nearly every classroom in America, at least one or two students will be taking such a medication. Add to this the ambiguous nature of the behaviors listed as symptoms for an ADHD diagnosis, and it is easy to understand why ADHD and the associated treatments are quite controversial.

 

How do we know if the difficulties we face are a mental disorder, or just the result of trying to put square pegs in a circular hole? Our society expects a great deal of regimentation and routine from us, especially in a public school or a workplace; for some people, this expectation is irritating but manageable, and for others it may actually feel natural. But for yet others, it may feel virtually impossible to follow strict routines, focus on tasks that are not entirely enjoyable or stimulating, and avoid giving in to perhaps more natural impulses such as runinging, playing, talking when one feels like talking, and allowing one’s attention to go wherever it goes.

 

Common questions people facing an ADHD diagnosis might ask include:

  • Does my child really have a disorder, or is it just that school is boring because she is so smart and creative?
  • Is my child’s hyperactivity really a problem, or does he just have a lot of energy because he is young?
  • Must I medicate my child to make him behave in school, or can I teach him some relaxation skills, put him in a smaller classroom, or change his diet to accomplish the same thing?
  • How do I know if my trouble focusing is a big enough problem to warrant treatment?

 

Distinguishing High Energy from ADHD

One way to distinguish between a person who is overly energetic or creative for the regimentation of school or most jobs and a person with diagnosable ADHD is to discover whether the attention problems and impulsivity occur only in one or two situations, or happen in every context of that person's life. If a child cannot sit through math class, but has no trouble watching a two hour movie in one sitting, can carry on an intelligent conversation with an adult, and loves to play chess, ADHD is probably not an appropriate diagnosis. On the other hand, if impulsive, frantic behavior is present at school, at play, out shopping with mom or dad, talking on the phone, at the dinner table, and during bedtime stories, ADHD may be present.

 

How Therapy Can Help ADHD

Psychotherapy is effective for the treatment of the symptoms related to ADHD because it addresses behavior modification. Children and adults with ADHD can have a difficult time regulating their emotional and behavioral response to situations. Learning effective coping strategies is one way that these individuals can gain control over their symptoms. Therapists can also help people design a plan for organization and prioritization, key areas of difficulty for those with ADHD. When the client begins to feel like an active participant in their recovery, they become empowered and their confidence and self-esteem, which are characteristically low for people with ADHD, begin to grow. Goal setting, reward and consequence, and emotional regulation are other areas that are addressed during psychotherapy for ADHD.

 

Even if ADHD is not diagnosed, difficulties concentrating at school or at work can be very troublesome--no matter if we blame “the system” or the person with the attention challenges. Therapy, with or without medication, can help children and adults learn to stay more focused, manage impulses, and discover what learning and working environments and aids can help increase their attention. A therapist--especially one with a specialization in attention issue or school concerns--can work with parents, teachers, and the child in question to fine tune the learning environment to better suit the child’s learning style and needs. A therapist can also help discover whether attention issues are really the root of the problem, as in many cases learning disabilities, anxiety, anger, problems at home, or other emotional or cognitive challenges can be masked by a child’s acting out. Children can always explain their inner experience to adults; therapy can help uncover the true nature of the child’s inappropriate or troubling behavior.

 

 

The Medical Model and ADHD

In many cases a person diagnosed with ADHD will be prescribed medications by a doctor or psychiatrist to control and manage their symptoms.

 

Play Therapy for Hyperactive 12 Year Old Boy- Case Example

Brian, 12, is brought to therapy by his parents who are their wit’s end with Brian’s behavior. He cannot finish his homework, he ignores directions often, he is loud, careless, and barely sits still. They want to “try therapy before putting him on medication.” Through play therapy, the therapist begins to uncover some deep anxiety in Brian. The therapist discovers that in class, Brian is actually quite well behaved. The therapist also discovers that Brian’s father is angry quite often, and tends to yell at Brian over even the smallest infractions. The therapist raises the issue with Brian’s parents, and as Brian’s father begins to acknowledge his anger problem and learns new ways to deal with his son, Brian’s anxiety, and the acting out that results from it, subsides.

 

6 Year Old Girl with Learning Difficulties - Case Example

Erica, 6, is seen in school by a counselor because she cannot seem to stay focused. While she is very compliant with school rules, she fails to complete any assignments unless closely assisted by an adult for the duration of the work. The school counselor refers her to a psychiatrist who prescribes a medicine for ADHD, but Erica’s work does not improve. Finally, she is brought to a therapist, who decides to rule out a learning disability. A specialist is brought in and discovers that Erica is dyslexic, which makes schoolwork very difficult for her. She is taken off her medication, and, instead, a specialized learning plan is created in a collaborative effort between her family, teachers, and school counselor.

 

Adult Male with Difficulty Concentrating for Long Periods - Case Example

Dave, 27, has always had difficulty in school, finding it hard to pay attention for long periods, and always feeling restless. As a professional, the same troubles occur at work, and it is threatening to cost him his job. The therapist teaches Dave some relaxation skills and engages Dave in some techniques for expanding his attention span; they help, but are inadequate. A referral to a psychiatrist results in a prescription that helps Dave increase his ability to focus significantly. Dave does not want to stay on this medication forever, though, and continues to work with his therapist to increase his attention span through mental skills training.

 

Resource Related to ADHD

 

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Last updated: 09-30-2014

     

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