What ADHD is and what it is not
ADHD is described through three groups of manifestations: inattention, hyperactivity and impulsivity. The ratio of these components is different for different children, which is why they look different.
- Mostly inattentive type - the child is quiet, “has his head in the clouds,” loses things, does not complete the task. Such children, especially girls, are noticed later than everyone else and are often considered simply lazy
- Predominantly hyperactive-impulsive type - cannot sit still, jumps up, interrupts, answers without listening, jumps in line
- Combined type - a combination of both groups of signs, occurs most often
СДВГ — это не следствие вседозволенности и не признак низкого интеллекта. Многие дети с СДВГ отлично соображают и обладают широким кругозором, но не могут удержать внимание на неинтересной задаче и организовать собственные действия. Именно поэтому оценки в школе часто оказываются заметно ниже реальных способностей.
How it manifests itself at different ages
- Preschooler: excessive mobility, inability to sit quietly even while doing an interesting activity, frequent falls and injuries, violent reactions, difficulties in the kindergarten group
- Junior schoolchild: does not listen to instructions, loses and forgets things, is distracted by any sound, homework lasts for hours, careless mistakes when knowing the material, a school bag forgotten at school
- Adolescent: Overt hyperactivity usually decreases and is replaced by internal restlessness; disorganization, procrastination, forgetfulness, conflicts, impulsive decisions come to the fore
- At any age: difficulty completing tasks “in several steps”, poor sense of time, emotional outbursts and rapid cooling down
The key difference from normal childhood mobility is its persistence and prevalence. Symptoms occur not only at home or only at school, but in at least two different settings, persist for at least six months and really interfere with study, communication and family life.
How is a diagnosis actually made?
- Подробная беседа с родителями: как протекали беременность и роды, как ребёнок развивался, когда впервые появились трудности, как он спит, как ведёт себя дома.
- Информация of школы или детского сада — обязательная часть. Диагноз требует подтверждения, что трудности проявляются не в одной обстановке.
- Стандартизированные опросники, заполняемые родителями и педагогами отдельно.
- Наблюдение за ребёнком и беседа с ним, оценка внимания, речи, эмоционального состояния.
- Неврологический осмотр и, при показаниях, дополнительные исследования.
- Оценка соответствия критериям: симптомы начались до 12 лет, сохраняются не менее 6 месяцев, присутствуют минимум в двух сферах жизни и значимо нарушают функционирование.
Диагноз СДВГ невозможно поставить за один пятнадцатиминутный приём и тем более по онлайн-тесту. Более того, в кабинете врача, в новой и интересной обстановке, ребёнок с СДВГ нередко ведёт себя образцово — и это ничего не опровергает. Достоверную картину даёт совокупность данных от семьи, школы и специалиста.
What must be excluded
There are a number of conditions that look like ADHD. To miss them is to spend years working on the wrong problem.
- Lack of sleep and breathing disorders during sleep - snoring, adenoids, apnea. A child who doesn't get enough sleep doesn't become lethargic, he becomes disinhibited
- Iron deficiency and anemia
- Hearing and visual impairment - a child who cannot hear the teacher well appears inattentive
- Thyroid diseases
- Absence seizures are short seizures with freezing that can easily be mistaken for having your head in the clouds.
- Anxiety disorder and depression in a child
- Dyslexia, dysgraphia and other learning difficulties
- Autism spectrum disorder
- Difficult family situation, bullying at school, recent psychotrauma
What really helps
Help for ADHD is always comprehensive and built around the environment, not around the requirement to “try harder.” A child with ADHD is not lazy - he needs external support where internal regulation is still lacking.
- A clear and predictable daily routine, the same on weekdays and, if possible, on weekends
- Splitting tasks into short steps with breaks: a long task is perceived as impossible
- Visual cues: lists, schedule on the wall, timer, school preparation checklist
- Immediate and specific feedback - praise immediately and for a specific action, not at the end of the week
- Adequate sleep and separate work with sleep disorders
- Regular physical activity really improves concentration, and swimming, wrestling, and team games also provide structure.
- Limiting screens wisely, especially in the hour before bed
- Interaction with school: a place at the first desk, permission for short motor breaks, additional time for written work
- Behavioral therapy and parent training in behavior management techniques
- Drug therapy - for severe manifestations and only as prescribed by a doctor, with assessment of the effect and tolerability over time
The emotional state of parents deserves special attention. Raising a child with ADHD really requires more effort, and constant criticism from teachers and relatives increases the feeling of guilt. Understanding the nature of the condition relieves much of this tension and changes the tone of family communication.
What not to do
- Punish for manifestations of the condition itself - for a forgotten notebook, a lost shift, the inability to sit
- Deprive of sports and walks as punishment: movement for such a child is not entertainment, but a way of regulation
- Expect that the child will “outgrow” without any support, and wait, losing school years
- Make a diagnosis using an online test or on the advice of friends
- Discuss the child’s problems in front of him in the third person
- Replace behavioral work and establishing a routine with only courses of drugs “to improve attention”
- Require long periods of immobility during lessons - short approaches with pauses are more effective
СДВГ действительно меняется с возрастом: у части подростков внешняя гиперактивность заметно уменьшается. Но трудности с организацией, планированием и удержанием внимания у многих сохраняются и во взрослом возрасте. Разница в том, что ребёнок, которому помогали, приходит во взрослую жизнь с работающими стратегиями, а не с убеждением, что он неудачник.