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Attention Deficit Disorder in Children:
Developmental, Parenting, and Treatment Issues
by
Pamela Darr Wright, LCSW

"In approximately half of the cases, onset of the disorder is before age four." trust
DSM-IV (American Psychiatric Association)

Introduction
The Infant: Developing Trust

The Toddler: Tolerating Separation
The Pre-School Child: Individuation, Identity, and Self-Concept
The Elementary School Child: Consolidation Stage
How to Help

Introduction

Human growth and development, with the requisite learning of skills and mastery of cognitive and psychosocial tasks, unfolds in endlessly fascinating, complex patterns. If the child is to develop a healthy personality, then he or she must learn how to test reality, regulate impulses, stabilize moods, integrate feelings and actions, focus attention, and plan.

When an attentional problem is present, with the hallmark symptoms of distractibility, hyperactivity/restlessness, and/or impulsivity, the child’s ability to master some or many of these tasks will be more difficult. Complicating the situation is the fact that many children with attentional problems also have other learning problems.

The parental role has always encompassed difficult periods when parents feel confused and worried about how well they are fulfilling their responsibilities. Raising a child with Attention Deficit Disorder can be exceedingly frustrating, emotionally draining, and expensive.

In many instances, the child’s ADD-related problems cause ongoing problems in the parent-child relationship that can set the stage for an unhappy, guilt-ridden relationship between the child, parents (and siblings) that may persist, sometimes through life. The strain from raising these ‘difficult kids’ takes a toll on many marriages, especially when parents differ in their approach to the child.

Complicating the family situation is the fact that Attention Deficit Disorder is often genetically transmitted from one generation to the next. Thus, we often find an ADD child being raised by an ADD parent who was never diagnosed and who has a very limited understanding of why the child is having problems (which may, incidentally, mirror problems that the parent himself experienced as a child).

The Infant: Developing Trust

During the first several months of life, the infant faces several critical developmental tasks, including learning how to regulate and calm him/herself and how to use the senses to learn about the world and the people in it.

However, the most critical psycho-social task faced by the infant relates to the development of trust; the infant must learn that his/her needs will be reliably met by parents/caretakers. In developing trust, the infant also learns that he/she is dependent on parents/caretakers to meet all needs — for food, warmth, safety, comfort — for survival.

The ability to organize sensations and to feel tranquil may pose problems for babies who are later diagnosed as having attentional deficits. These babies are often described as "hyper-excitable", "colicky", "irritable", and/or "unsoothable" by their parents.

These infants are often very active, easily distracted, and over-reactive to stimuli. Their behavior may appear to be chaotic or unpredictable. They may also be extremely sensitive to sensations — visual, auditory or tactile. Parents’ efforts to soothe these babies with words, songs, or stroking may be met with tensed muscles, arching back, and loud crying.

Not surprisingly, parents often respond to a ‘difficult’ baby with confusion and alarm. The inter-relationship between nurturing parent(s) and child is critical. When parents have a child with whom they cannot cope, they usually assume it is their "fault"— that they are failing as parents. These feelings of failure can set the stage for problematic, guilt-laden parent-child interactions that continue through life.

The Toddler: Tolerating Separation

The second psychosocial developmental stage faced by the young child is that of separation. The separation process occurs in gradual steps, occurring from about nine months to three and a half years.

During this period, the child develops the ability to hold a mental image of the parent in his mind. He begins to explore and learn about his environment and tolerates longer periods of separateness from significant parenting figures. As the child accomplishes the task of separating, a strong sense of autonomy and confidence develops.

The toddler is also beginning to connect feelings and behavior. He is learning to take the initiative to get his needs met. He is developing ideas and concepts, along with awareness that objects have functions (i.e. cups are to drink from, refrigerators hold food).

The youngster is beginning to accept limits which helps him to learn what he can and cannot do. As a correlate, he needs to learn to tolerate frustration. Finally, he needs to learn how to recover from the stress of disappointments and adapt to changes in his environment.

These developmental tasks can present significant problems for children with attentional deficits.

Typically, these youngsters have difficulty tolerating frustration and may be emotionally over-reactive. Parents describe them as "all-or-nothing" children who have difficulty calming themselves. They tend to "fall apart" easily, dissolving into tears of frustration when needs or wants are not met immediately.
 

The Pre-School Child: Individuation, Identity, and Self-Concept

girl with teddy bear"Who am I?" asks the pre-school youngster, as s/he experiments with wildly different roles and identities.

This child tends to be unpredictable, volatile, and charmingly affectionate — while also learning to be disarmingly adept at manipulating the environment and the significant others within it! Children between the ages of three and six have a well-earned reputation for learning how to "divide and conquer" to get their wants and needs met.

Not surprisingly, pre-school youngsters often have great difficulty distinguishing between reality and fantasy. As they try on different identities (teacher, policeman, father, mother), their ability to think magically is an asset. Nothing is impossible when you are four or five!

As the child begins to develop a solid identity, the self-concept is also emerging. Each child’s self-concept consists of images and beliefs about the self, including easily-verifiable facts ("I am a girl", "I have black hair") and less-verifiable but strongly-held beliefs and image about the self ("I am smart/dumb", "I am lovable/unlovable", "I am good/bad").

During the pre-school years, the common behavioral signs exhibited by many children with attentional deficits — high activity levels, poor persistence, interpersonal/peer group problems, and difficulty modulating behavior and impulses, with aggression, tantrums, silliness, bossiness, and impulsivity, are often beginning to create problems for the youngster.

The child may be fearful, confused, manipulative, or avoidant. Attention deficit and other learning disabilities are strong contributors to the emergence of over-anxious disorders of childhood, including school phobias.

Since a diagnosis of Attention Deficit is usually not made until after the child enters school, the atypical ways that these children react and respond during the first years of life are perplexing and distressing to parents and other family members.

Confused parents often send strong disapproving messages to the child that he can behave and stay under control if he tries hard enough. Concerned family members often criticize both child (for being bad) and parents (for being ineffective), creating even more stress between parents and child.

The Elementary School Child: Consolidation Stage

girl runningAs the child shifts from pre-school to elementary school, he consolidates the gains made during the previous stages (i.e., basic trust, separation, and individuation). The major psychosocial tasks of childhood have been dealt with, freeing the latency-aged child to focus his energy on learning in school along with the development and refinement of interpersonal relationships.

The school, as the vehicle for teaching academics and social skills, now occupies a central role in the child’s life. Vast amounts of factual data must be learned. The child must learn how to read, write, do arithmetic, be a good friend, and be a good student. The elementary aged youngster’s tasks include learning how to relate appropriately to adults (aside from parents) and children (who are not siblings).

After entering the educational system, the child with attentional deficits often begins to struggle. The child may lag behind his peers, academically and socially.

ADD youngsters often have "social deficits" in that they have difficulty accurately interpreting and processing social information and cues. This "social deficit disorder," coupled with impulsivity, may lead to the development of socially unacceptable behaviors.

Paradoxically, many children and adults with Attention Deficit Disorder are also exquisitely sensitive to feedback from others. As the child becomes aware of his differences from others, is shunned or teased by peers, is criticized by teachers for being unable to remain in control, the child begins to develop a negative self image, low self-esteem, depression and anger.

What significant others (parents, teachers) tell the child about himself has a powerful impact on his developing self-concept. The child begins to view himself as he is viewed by others. Told repeatedly that he "could do better if he would only try", he begins to feel that "I am worthless because I cannot always control my behavior." Sadly, these negative feelings about the self often persist through life.
 

How to Help

Attention Deficit Disorder is a neurobehavioral disorder that causes multiple problems for children. Typically, the child with ADD will experience difficulties in several areas of life, including learning, peer relationships, self-esteem, mood, behavior, and family relationships.

Medication helps to relieve many symptoms of distractibility and hyperactivity in about 75% of children. Most children are treated with psychostimulant medications (Ritalin, Cylert, Dexedrine). Others respond to a carefully titrated blend of antidepressant medication and/or psychostimulants. There are other medications which are used less frequently but also with good effect.

Therapy or counseling is useful in helping the child and family deal with ADD-related problems. If therapy is indicated, it is important that parents select a professional who is knowledgeable about ADD and its impact on both child and family.

Depending on the child’s problems, therapy may include a variety of interventions, including social skills training, compliance training with parents, psychosocial education of parents and child, anger management training, cognitive therapy to improve self-esteem and mood, and family therapy with parents and siblings.

Living with a child with ADD/ADHD can offer special charms and delights. These children can be very perceptive and sensitive to the plight of others. They are intensely curious, creative and inventive. Many are very affectionate.

Most of their ‘problems’ arise from the fact that they process emotional and intellectual information somewhat differently from ‘normal’ children. Our culture places great value on conformity, especially in the training and education of children. If the child with ADD is raised and educated with an appreciation of his or her uniqueness and strengths, then that child can grow up into a healthy, productive adult.

NOTE: This article is for information purposes only and is not to be substituted for medical advice from the professional of your choice.



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