What is Attention Deficit Hyperactivity Disorder?
Attention Deficit Hyperactivity Disorder (ADHD) is a condition characterised by symptoms of Inattention, Impulsivity and Hyperactivity. ADHD is divided into three subtypes; in-attentive, hyperactive impulsive, and combined type (inattentive symptoms and hyperactive impulsive symptoms). The above symptoms need to be present before the age of seven and present in more than one setting in order for a diagnosis to be given.
The 1998 National Survey of Mental Health and Wellbeing reported that 11.2 per cent of Australian children aged six to seventeen years have ADHD. It is important to note that the criteria used in this survey may have inflated the results. Other sources (including DSM-IV) report rates of 3-5% in school aged children.
Approximately 70% of individuals with ADHD will have a second psychiatric condition, for example Intellectual Disability, Anxiety, Depression, Oppositional Defiance Disorder (ODD) and low self-esteem. They will also have extremely poor social, memory, organisation and motivation skills, have enormous difficulties with their relationships and are often in conflict with parents, school and in adulthood- the work place thereby requiring intervention across the lifespan. Furthermore, research suggests that boys often present with ADHD and anger (externalise) and girls present with ADHD and anxiety (internalise).
Due to the pervasive nature of ADHD, intervention and support is never the sole responsibility of one professional. It requires collaboration between a multi-disciplinary team of professionals primarily including but not limited to parents, school, Clinical Psychologist, Speech Pathologist, General Practitioner and Developmental Paediatrician.
The role of the psychologist is broad and can include the initial diagnostic process, family support and direct
intervention with the parents, direct intervention with the individual with ADHD, as well as consultation and collaboration with other professionals. Educational programming with school staff is also important to help the generalisation of skills and classroom behaviour management.
Cognitive Behavioural Therapy Intervention
Whilst treatment needs to be uniquely tailored to the individual in light of their specific presentation there are core components that the treatment should cover:
- Parent-training Programmes
- Social Skills Training
- School based behavioural intervention
- Co-morbid symptoms need to be addressed
The importance of early recognition and intervention for children with ADHD is now well understood. It generally encompasses an intervention for the parents (Parent-Training), child (Social Skills Training, specifically organisational skills, social skills with peers, problem solving, self-control, listening skills and dealing with and expressing feelings) and school (teachers should receive training about ADHD and its management and provide behavioural interventions in the classroom). Current research states that parents and teachers have a key role in helping children put systems in place across multiple settings.
As parental stress and other issues relating to family breakdown are consistently indicated with ADHD, associated intervention for supporting families and siblings are increasingly being recognised as important factors in intervention within this specific population.
Australian guidelines state that medication should always been considered as part of the treatment plan for ADHD. Research has shown that pharmacological treatment is successful in managing the symptoms of ADHD, however for the management of the co-morbid symptoms a combined pharmacological and cognitive behavioural approach is beneficial.