WHAT ARE THE MOST COMMON SYMPTOMS OF ADHD (ATTENTION DEFICIT HYPERACTIVITY DISORDER) IN SCHOOL-AGE CHILDREN?
Children ages six to twelve with clinically diagnosed ADHD typically display most (but seldom all) of the following.
Inappropriate activity, either too much or unrelated to the task. The child may be fidgety, getting up out of his seat, knocking things off his desk, or playing with books or pencils, doodling, making paper airplanes, and so on.
Impulsive behavior, making quick and perhaps aggressive responses to other children, reacting impulsively to stimuli in the classroom or talking incessantly and out of turn, unable to restrain himself. He may also be impulsive in his work, rushing to answer a question or finish a task without focusing on what is needed, thus often making impulsive errors, ignoring instructions, and handing in inadequate and too little work.
Poor attention-focusing. This may lead him to daydream in class, to not be able to concentrate on the task at hand, and to make impulsive or hyperactive responses to try to compensate.
Extreme distractibility. He may respond to every possible distraction and be unable to sustain attention for more than a few minutes.
Falling behind academically, even when his intelligence may seem more than adequate.
Poor organizational skills, losing work and books, not doing homework, a chaotic desk and backpack.
Behavioral problems, which may result from some of the above problems, but which may also be the main area that affects the teacher and classmates. Some of these children may turn to others in their distractibility and impulsivity, trying to get them to talk or play with them, or they may act impulsively and aggressively in response to feeling humiliated or rejected. In an attempt to enhance their social standing, such children may try to act as the class clown or may openly defy the teacher in the hope of being admired by peers. Or, feeling frustrated and a failure, they may react angrily and lose all motivation to try to please or comply.
Low self-esteem, related to the child’s sense of failure, conclusion that he is dumb, and his experiences of peer rejection.
Difficulty in adapting to change. Parents may notice that their child’s behavior worsens when a change of activity is needed, such as getting ready to leave the house for school in the morning, or preparing for bed at night. There may be an element of perseveration in this, i.e., once having started an activity, it is very difficult to stop it and to shift attention onto something else. This may have a neurophysiological basis. But also it is possible that anxiety about a change, about the unfamiliar, or about leaving the safety of home can act as a disorganizing stimulus. Whatever the cause these children are often extremely inflexible and this can be very disruptive to a family’s life.
By the time Peter (described above) reached first grade, his symptom picture was a rather typical example of how ADHD can impact on a child’s school experience. He attended a fairly traditional school that required him to sit at a desk, face the teacher, and listen carefully to instructions. His day was punctuated by changes in activities, including leaving the classroom for music, gym, library, and science periods. His teacher soon found that these requirements were all very hard for Peter.
He could not stay in his seat, but would get up and wander around the room, often only finally settling down in the reading corner, where he would curl up on a pillow on the floor and read a book while rocking himself. He rarely could follow instructions given to the whole class, though once the teacher or her assistant came over to him, perhaps gently laid a hand on his shoulder and then went over with him what was required, he could often begin the task. However, as soon as the teacher walked away, he would become distracted by other activity in the room and seem to forget about his task. When the class had to end an activity and line up to move to another part of the school for another activity, he would become hyperactive and anxious and at times openly defiant, leading to punishments and time-outs which did not seem to help him contain himself.
It became essential for his teachers to understand his difficulties and to plan special approaches to him, which, fortunately, they were willing to do. But it meant that often his needs had to be given special consideration, just as, at home, his disruptive behavior and special needs meant that the family life often had to center around him. This a frequent complaint made by parents of school-age children with ADHD: “He needs so much attention. We have to structure the whole family’s life and schedule around him. It is just not fair to the other children!” This is an unfortunate fact of life for a family living with ADHD. However, it is possible to make that extra input and focus much more effective and worthwhile.