Attention Deficit Hyperactivity Disorder

ADHD refers to a cluster of learning and behaviour problems that cause a child to underfunction for intellect and underbehave for the quality of parenting they receive. These problems are believed to be caused by a subtle difference in the fine tuning of the normal brain. This difference appears to be related to a slight imbalance in the brain’s message transmitting chemicals, the neuro-transmitters and mostly affects those parts of the brain which control reflective thought.

There are two main parts to ADHD:

1. Attention Deficit & Learning (problems of executive control)
   

   • Inattention: Poor attention span and concentration, works best with one-to-one supervision, easily distracted, easily bored, daydreams, inconsistent work output, flits from task to task, becomes too over-focused on one part and misses the big picture.
     
   • Short–term memory: Forgets instructions, loses focus, reads but does not remember, difficulty with mental arithmetic.
     
   • Disorganisation: Forgets homework books, misjudges time, loses things, procrastinates, poor prioritisation, variable performance, poor planning.

    

2. 2. Hyperactive/Impulsive Behaviour (poor self control of behaviour)
   
   • Impulsiveness: Speaks and acts without thinking, interrupts, calls out in class, impatient, low frustration tolerance, may appear aggressive, difficulty putting the brakes on behaviour, rushes carelessly through work, accident prone.
     
   • Demanding: Unaware when to let a matter drop, generates tension, seeks attention, difficulty backing off.
     
   • Social Clumsiness: Misreads social cues, intrudes, overpowers, bosses, wants things their way, acts silly in a crowd.
     
   • Overactivity: Restless, fidgety, taps, fiddles, touches, over-charged, difficulty sitting still.

Most children have a mix of both parts 1 and 2, but some have one of these in isolation. A small group are inattentive only, which leaves them daydreamy and drifty. This dreamy form of ADHD has a strong association with specific learning difficulties, particularly dyslexia.

These two main ADHD parts can be affected by the presence of comorbid conditions. Comorbid refers to associated problems which are not caused by ADHD but coexist. Over 40% have Oppositional Defiant Disorder where they say ‘no’ on principle. A similar percentage have a specific learning difficulty (such as dyslexia, language delay, weakness in mathematics, poor handwriting etc). Other comorbidities are Conduct Disorder, Tic Disorders, Depression or Anxiety, Obsessive Compulsive Disorder, Bipolar Disorder, and Asperger's Syndrome, and poor co-ordination.

This mix of ADHD and other conditions is influenced by parenting and support in the child’s home and school environments.

If it is not recognised and treated, children are in danger of alienation from family, school and friends and underachieving in relation to their potential ability. Many end up permanently excluded from school with little or no education. With every passing year and the constant lowering of self esteem the child is vulnerable to developing emotional, psychological, psychiatric or social problems. Research is beginning to show that a large percentage of children passing through the juvenile courts may have ADHD. Research in the adult prison service has revealed similar statistics. Many addicts of alcohol or substance abuse have an underlying problem of ADHD and research has shown that for some it is an attempt at self medication.

Adults

ADHD is still a relatively unknown and misunderstood neurobiological syndrome, genetically inherited in most cases, affecting approximately 2-5% of the population. The core symptoms are most evident during childhood but it is now known that they continue into adulthood for a significant percentage. ADHD in adults is often a ‘hidden disorder’ in which symptoms are often obscured by problems with relationships, organisation and holding down a job. Many adults diagnosed with ADHD are first recognised as having problems with impulse control or substance abuse.

Adults who are living with the condition, and especially those who are undiagnosed and untreated (the majority), may be experiencing a number of problems some of which stem directly from the disorder and others which are the result of associated adjustment patterns, such as: distractibility, forgetfulness, low self-esteem, procrastination, relationships, restlessness, mood swings, anxiety, depression, substance abuse or addiction.

There is no one ‘ADHD personality profile’. Some persons with ADHD can concentrate if they are interested while others have difficulty under any circumstances. Some seek stimulation while others avoid it. Some become oppositional, ill-behaved and antisocial, others became ardent people, pleasers, gregarious. Yet others become introverted and withdrawn. The symptoms of ADHD can be variable and situational or constant and unremitting.

The above information has been reproduced with the kind permission of ADHD North West. For full information and advice contact:
ADHD North West, 1 church Court, Bolton-le-Sands, Carnforth, Lancashire, LA5 8EB. Tel: 01524 822887 – email: worrall@ecosse.net

Semantic Pragmatic Disorder

History

Semantic Pragmatic Disorder was first defined by Rapin and Allen in the literature on Language Disorder in 1983. The group identified at the time were seen to show some Autistic signs as well as certain semantic pragmatic language problems.

In babyhood many of the children either were seen to be perfectly behaved or conversely cry more than usual. As the children grew older speech difficulties became more prominent and learning language was seen to be very difficult. Indeed some of the parents thought their children were deaf because of the lack of reaction to speech. The problems were recognised around the 18 month to two year range.

Children would often ignore their names when called but clearly recognise the door bell or telephone. Children did respond to speech therapy, therefore by the age of four many children appeared to be functioning on a superficial level.

Listening and Understanding Language

Today we have more understanding of SPD, we know now that the disorder is more than just understanding words, it is a communication disorder.

Children with SPD find it difficult to focus their listening and are easily distracted, they may often find loud noises distressing. Many children with SPD will only communicate when someone is directly in front of them or they are touched to get a reaction.

Children will in many cases be able to understand comments such as "put the green pen on the table" because the children often do not have trouble with visualizing shapes, sizes etc. Where a child with SPD would have a problem is with concepts such as "that was good of you" or "are you going there later".

Talking

Children will often have difficulty with talking even though the parents may not recognise so. This is because although the children may talk fluently, their Pragmatic Difficulties may mean they are not conversing in a normal way. Children with SPD will often memorise their speech rather than actually learn what the words mean. The children will say a lot more than they actually understand.

There will be a lot of copied social phrases in speech of a child with SPD but very little in terms of feelings and how people actually think. The delayed social development in people with SPD will often mean that at a conversational level they will be much more interested in themselves because they have little understanding of their conversational partner.

Understanding How Others Think

A child with SPD will find it extremely difficult to see the world through the eyes of others. Therefore children recognised to have SPD are often said to not have a theory mind. They have an inability to describe peoples thoughts and intentions. They will have difficulties with the abstract.

Creative Play

Children with SPD will have difficulty with creative play. Children generally at around 18 months will be able to switch from the abstract to the concrete ie pretending a toy cup is a telephone, they will understand that the toy cup is a cup. Children with SPD find this kind of abstract thought and play difficult, a tower of bricks will always be a tower of bricks. As a result of this children with SPD will easily become bored of toys and rather play with practical things like machines or even stacking and tidying their toys.

Motor Diffiulties

Some children with SPD will have problems with motor control, they will find things such as handwriting difficult. Things such as physical activity and team games will often be problematic.

Memory Skills

Often children with SPD make up for their lack of communication skills with a brilliant memory although this is not always the case. Some children will be able to remember family events long after their relatives have forgotten.

A paper prepared by Heathlans Language Unit Staff for parents and teachers involved in the care of children with Semantic Pragmatic Difficulties