ABSTRACT
Attention deficit hyperactivity disorder (ADHD), attention deficit disorder (ADD), hyperkinetic disorder HKD, hyperkinesis, minimal brain dysfunction, minimal brain damage (MBD), and disorder of attention, motor control and perception (DAMP) are some of the terms used for a syndrome characterized by persistent over-activity, impulsivity and difficulties in sustaining attention (American Academy of Child and Adolescent Psychiatry, 1997b; Barkley, 2003; Gillberg, 2003; Kutcher et al., 2004; Nolan & Carr, 2000; Schachar & Tannock, 2002; Taylor, Sergeant & Doepfner, 1998; Warner-Rogers, 2002). Children with such difficulties were first described in modern medical literature by George Still in 1902. Throughout this chapter, preference will be given to the term ‘attention deficit hyperactivity disorder’ (ADHD), since this is currently the most widely used term. A case example of a child with ADHD is presented in Box 11.1. ADHD is a particularly serious problem because youngsters with the core difficulties of inattention, over-activity and impulsivity can develop a wide range of secondary academic and relationship problems. Attentional difficulties may lead to poor attainment in school. Impulsivity and aggression may lead to difficulties making and maintaining appropriate peer relationships and developing a supportive peer group. Inattention, impulsivity and over-activity make it difficult for youngsters with these attributes to conform to parental expectations, and so children with ADHD often become embroiled in chronic conflictual relationships with their parents. In adolescence, impulsivity may lead to excessive risk taking with consequent complications such as drug abuse, road traffic accidents and dropping out of school. All of these risk-taking behaviours have knock-on effects and compromise later adjustment. As youngsters with ADHD become aware of their difficulties with regulating attention, activity and impulsivity, and the failure that these deficits lead to within the family, peer group and school, they may also develop low selfesteem and depression. In light of the primary problems and secondary difficulties that may evolve in cases of ADHD, it is not surprising that for some the prognosis is poor. For two-thirds of cases, the primary problems of inattention, impulsivity and hyperactivity persist into late adolescence and
Box 11.1 Case example of ADHD: Timmy, the motorboat
Referral. Timmy, aged six, was referred for assessment because his teachers found him unmanageable. He was unable to sit still in school and concentrate on his schoolwork. He left his chair frequently and ran around the classroom shouting. This was distracting for both his teachers and classmates. Even with individual tuition he could not apply himself to his schoolwork. He also had difficulties getting along with other children. They disliked him because he disrupted their games. He rarely waited for his turn and did not obey the rules. At home he was consistently disobedient and according to his father ran ‘like a motorboat’ from the time he got up until bedtime. He often climbed on furniture and routinely shouted rather than talked at an acceptable level.
