ADHD

2023 – What is ADHD

Presented by :
By Laurène Lahierre – Clinical psychologist, specialised in Neuropsychology

It is quite common for parents to come to the consultation with the main complaint of concentration problems and strong agitation present in their child. Often the school alerts the parents to these difficulties. Is it really ADHD?

How to diagnose this disorder and how to support the child and his entourage on a daily basis?
What is ADHD?

ADHD is a neurodevelopmental disorder diagnosed by a physician, child psychiatrist or neuropediatrician. This doctor can rely on clinical observations and assessments that enter into an overall assessment to make the diagnosis.
It is expressed in 3 forms depending on the symptoms present:
inattention:
– predominance of attention deficit
– hyperactivity/impulsivity: motor restlessness, hyperactivity of thought
– mixed

ADHD is to be differentiated from ADD where hyperactivity is not present.

Most of the time, the characteristic difficulties in the person with ADHD are a lack of retained information, obviously maintaining attention which is difficult, poorly planned actions, acting impulsively and therefore low resistance. automatisms and the temptation of the present moment.

Normally, before making a diagnosis, the doctor takes the time to observe the possible evolutions in the person. Especially since the signs of hyperactivity and inattention are non-specific signs, i.e. they are signs that can be found in other pathologies.

1 ) How to detect ADHD?
The investigative work begins with the observation of several symptoms.
The professional will measure the symptoms of inattention, those of hyperactivity and those of
impulsivity through various questionnaires which will make it possible to note the behavior of the person on a daily basis, in his environment (at home, at school, during extra-curricular activities, etc.).

For inattention, the professional will need to know if the child has a habit of making careless mistakes, if he has difficulty focusing his attention on work or even during an activity that he likes it if he seems elsewhere when you talk to him, if he doesn’t listen to instructions, if he has trouble getting organized or is easily distracted, for example.

For hyperactivity, the professional will direct his questions around the patient’s inhibition or
control capacities. Generally he will seek to know if the patient has a tendency to move his hands and feet often, to squirm in his chair, to get up often when he is supposed to remain seated, to run and to climb everywhere in inappropriate situations (motor impatience in the child and adult)or find it difficult to sit still in games and hobbies.
Finally for impulsiveness, does the child often answer before the end of the question? Does he
have trouble waiting his turn? Does the child have difficulty controlling his gestures and words
and if he favors the immediacy of feedback which could give him pleasure, but also a reprimand, against a moment of patience which could prove expensive even if ultimately it would be more
certain.

Tip: This purely clinical investigative work can be accompanied or supplemented by the evalua-
tion of attentional and cognitive abilities in order to give a snapshot of the cognitive functioning of the person in the situation of evaluation and to be able to compare the performances to a slice age, regardless of parents’ expectations and regardless of the school’s level of requirement. Yes
the child can compensate in an evaluation situation but not everyone is able to compensate so it will be interesting to see the performance in an evaluation situation.

2) How to accompany a child and his parents?
As with most neurodevelopmental disorders, you must already know what you are talking about and that the people directly concerned know what their strengths and weaknesses are in order to understand their own mode of operation, no longer feel guilty in the event of failure and continue.

The same is true for the surroundings. For example, it is unfair to punish a child with ADHD when he has difficulty sitting in his chair. So those around you also need to understand how the child works in order to be able to adapt.

In the recommendations, it would be a question of reducing the number of instructions: “Look at me and listen to what I say”, that makes two instructions whereas it would be enough to give the instruction without insisting on the fact that the child is looking at you . When giving instructions, emphasize the important words. Keep in mind that attention is like a battery that discharges when you use it. So everyone needs to recharge their batteries by controlling the periods when they are solicited and thinking about resting too. At school level, it is also possible to be able to claim accommodations that will help the student to be able to work in better conditions and to highlight all the skills without the ADHD being harmful.

Concrete solutions that make it possible to observe an improvement in attentional capacities in
children, if the latter is motivated and receptive, are cognitive remediation sessions and social
skills groups.

Cognitive remediation is neither more nor less than the re-education of the brain. The goal is to be able to increase a person’s deficient abilities by relying on those that are efficient in order to provide the best strategies to apply to perform a task effectively. This improvement in performance leads to better self-confidence if the patient becomes aware of what he is working on. Several models of cognitive remediation exist, it is preferable to opt for models where there is an exchange between the patient and the practitioner and not models where the patient is alone in front of a computer. These work on the short term because it is stimulating but the patient ends up dropping out because it is always the same thing, the feedback is always the same and does not replace that of a person and the programs are too different from the reality. It is also important for the practitioner to take the time to talk with the parents about what is being worked on in the session in order to promote the transfer of what has been learned into the child’s daily life.

Social skills groups are groups where the professionals who supervise the group work on the
codes of communication in society but also sometimes the management of emotions with the
children. These groups can be very beneficial because they are times when concepts are worked
on in groups, so the child can compare himself with others while being in an environment other than school where criticism is by definition the most difficult. . These times allow children to feel understood because they interact with children who have similar difficulties and thus allow them to get out of possible isolation. This dynamic is rarely experienced as working time as such and the children are therefore happy to come and do not see it as a constraint. These groups also help to restore everyone’s confidence. There are also various support programs for those around you, such as the Barkley program, which provides tools to better understand the functioning of your child and to value him when necessary. The program does not cure the child’s disorders but tends to want to concretely help to improve the quality of life and communication within the family home. This is an interesting program if, as parents, you want to be helped to find pleasant moments with your child.

Tip: It is important to keep in mind that parents have freedom of choice of practitioner. It is always recommended to find out as best you can to make sure that the professional who sees you will really take the time to understand the child and the parents’ complaint.

In this sense, and this is paradoxical, however, structures or firms that are too “specialized” oriented in ADHD should be avoided at first because they tend to see everything through the prism of ADHD and do not want to admit that there may be something else that is causing the child to have attentional dysfunction.

Trust yourself as parents. The professional relies on your observations and needs you to understand the child. If the diagnosis is wrong or the management is incorrect, the parents realize this.

3) Drug treatment
This is often what most parents fear, and rightly so. It is important to know that a consultation with a doctor is not equivalent to automatic treatment. If so, then the doctor did not take the time to explain things properly.

Only a doctor can recommend drug treatment. To recommend means to advise and not to im-
pose. If the drug is recommended, it is important that the doctor takes the time to explain what

the treatment consists of (dosage, desired effects, side effects, etc.).

Generally the treatment alone will not really be effective on the work provided. It makes the person more available to the advice of the adults around them so that the person concerned can apply this advice. Most of the time the treatment may not be taken every day but it is still important to discuss it beforehand with the doctor and especially to inform him if you wish to stop the treatment.

The drug treatment must therefore almost always be supplemented with the care necessary to
work on the deficient functions or the areas to be improved. It is a crutch on which the child leans to move forward and which can also relieve the parents as well as the teaching staff.
Tip: If as parents you are not comfortable with the idea of giving your child medication, it may be useful to stay focused on the child’s own difficulties and daily suffering. . As parents, you manage your child’s difficulties like adults, but your child manages them more or less well like a child.

He is the target of ridicule and criticism from his peers and he is the one who is struggling or failing in school. You have to be transparent with the child and explain to him why it might be wise for him to take treatment and ask him for his opinion even if he is not the one who decides. Hence the importance of multidisciplinary care and good quality communication between the child, the parents and all the stakeholders.

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