Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder has been one of the leading reasons families seek consultation at child psychiatry clinics over the past decade. It has become one of the topics most researched by child psychiatry specialists, and its causes, symptoms, long-term course, relationship with other illnesses and treatment are among the most thoroughly investigated conditions.

Attention Deficit Hyperactivity Disorder is a psychiatric disorder that presents with excessive movement, attention problems and difficulty delaying wishes (impulsivity). Publications of the American Psychiatric Association report that it is seen in 3-5% of school-age children.

For a child, adolescent or adult to be said to have Attention Deficit Hyperactivity Disorder (ADHD), these symptoms must have begun before the age of seven and must have persisted for at least 6 months. These symptoms must be more severe than expected in a typical child and must be present in many areas, such as school, home and peer relationships, affecting daily life.

For example, if your child is uncontrollable and very active at home but can sit in their seat at school, this may lead us to consider internal family dynamics, such as difficulties with setting limits. The fact that symptoms begin in the early stages of life and are only partly affected by the environments your child is in should alert you that this is a situation that must be carefully examined from the standpoint of structural factors and ADHD.

Attention Deficit Hyperactivity Disorder can be examined in three subgroups, based on its symptoms.

Hyperactive-Impulsive Type

Inattentive type

Combined type

Hyperactivity symptoms often begin to appear from the earliest years of life. Some families may recall that the child was already very active in the womb. These are generally children who are restless in infancy, may have feeding problems, have sleep problems, and whose angry outbursts are difficult for you to bring under control. The first thing to distinguish is that not every active child is hyperactive. Some children may have a naturally high level of activity.

The activity of an active child who is not hyperactive is coordinated, purposeful and sustained. In Attention Deficit Hyperactivity Disorder, however, the activity is arbitrary. One mother described her child this way: "He runs the most during a football match, but not after the ball." The more restrictive the environment and the more attention that needs to be focused, the more the child's activity increases.

One of the most important symptoms of Attention Deficit Hyperactivity Disorder is acting without thinking. For example, running into the street after a ball, blurting out the answer before a question is finished, interrupting, or saying whatever comes to mind first. These children are harder to discipline. Because they cannot listen to what you say, they also do not know what is being asked of them. They rush to decide without gathering enough information or taking time to review it. As a result, they fail in their decisions and answers. This is not due to a lack of intelligence, but to a lack of attention and patience.

In preschool children, families often say that their children never stay still, are always on the go, and are very difficult to stop. Families often feel inadequate with these children and may have difficulty controlling their own anger. In fact, beyond their misbehavior, these children, who are deprived of positive feedback in most situations because of their structural difficulties, begin to develop the roots of feelings of inadequacy at an early age, and at a young age they encounter their families' anger. This anger carries over into their personal lives in the future. In group and rule-based games, these children may be more hyperactive, aggressive and disruptive.

They often cannot evaluate the consequences of their own behavior. In other words, they have difficulty learning lessons from what they have done. For example, they struggle with social matters such as waiting their turn and sharing; they cannot tolerate losing, and if they do not get what they want, they may quit the game or start a fight. Because of behavioral impulsivity (inability to control oneself), they may often have accidents and may also harm the people around them. Their difficulties in restraining their impulses lead to rejection by friends and exclusion from games, and gradually the child's self-confidence decreases, which can pave the way for depression. Their apparent indifference to the social and moral consequences of their behavior, and their lack of respect for others' feelings and belongings, is in fact related to difficulties in distinguishing right from wrong.

The symptom of Attention Deficit Hyperactivity Disorder that often goes unnoticed in early childhood and that mainly shows itself in school years as disinterest in studying and the failure that accompanies it is attention deficit. Families often say that the child perceives very well in areas that interest them, but that this is not the case when it comes to lessons. As a result, these children may be blamed for being lazy and irresponsible. Parents often become angry with their children, usually thinking that they are not really trying. In such a case, the first thing to do is to determine whether the child is experiencing difficulty in this area. The feeling of "I am unsuccessful" that the child develops as a reaction makes the situation even harder, as it becomes an additional problem the child must cope with. Your children, who have moved from the enjoyable fields of play to school desks, now have a harder time. They are now expected to take in information, store it, and bring it out when needed and in the right place.

Many of the characteristics needed for a child's adjustment to school and success there, such as sitting in class, focusing attention, following rules, controlling internal reactive behaviors, being organized, helping classmates and building good relationships, are structurally lacking in children with Attention Deficit Hyperactivity Disorder.

Since they must first focus on the material in order to take it in, the fact that this happens in crowded classrooms under the conditions of our country is an even greater obstacle for them. Children with attention problems experience this with greater distress, because it is structurally very difficult for them to focus on what they hear and see. Yet expectations of them are high. Therefore, it is quite understandable that their interest in lessons is low given this difficulty. Things become even harder as the grades progress.

Because these children have difficulty focusing on a particular subject, while they try to pay attention, other thoughts, images and sounds distract them. When you talk to your child about a subject, you may often find them asking a question about something unrelated.

When you say "focus," it usually does not work. They have difficulty completing homework. There may be many reasons why they get up from the middle of a lesson. They may not be able to look after their belongings at school and may often lose things. They may have trouble managing time, and completing a task is often very difficult and takes a long time. Their handwriting may be poor; frequent spelling mistakes, incomplete writing and letter confusion may be seen while writing.

Cognitively, there are no intelligence differences from other children in terms of learning, but they are unsuccessful in tasks that require attention. Their auditory memory may be weaker than their visual memory, so it may be necessary to repeat instructions several times. Attention deficit symptoms are often children whom teachers describe as constantly late, unable to organize themselves, losing their belongings, daydreaming, unable to finish their work, unable to follow the lesson, disorganized, talking while the lesson is being taught, or preoccupied with other things.

You could compare attention deficit accompanied by impulsivity to an orchestra full of the greatest and most talented artists, but one without a conductor, out of control. Brilliant ideas may arise, but continuity and completion of the process are difficult. Your child grows up by receiving feedback from you and their surroundings, through experience, and develops a stance and outlook on life. As parents, the first thing you need to do is recognize early that there may be a problem somewhere. We look at the present and the future with what we have learned from our past experiences and what we have felt.

In our early childhood years, our relationships with our families and friends form the framework of our current relationships. Traces of our present working life are shaped during school years. Research in this field has shown that the likelihood of other psychiatric problems developing in later years is much higher than in healthy groups. For example, in about one third of children with Attention Deficit Hyperactivity Disorder, alcohol or substance use disorder, antisocial personality traits, depression and anxiety disorders were observed in later years. If you are in doubt that your child has Attention Deficit Hyperactivity Disorder or behavioral problems, do not reassure yourself by asking, "Will it pass soon?" If you observe these symptoms in your child, consult a child and adolescent psychiatrist. Because time is truly important for our children.

On School Underachievement

If I don't say anything, the lessons don't even come to mind

Unsuccessful

Irresponsible

Unwilling

They could do it if they wanted to, but they don't want to

These sentences are often voiced in some homes. In fact, before saying all of this, the possibility that there may be problems somewhere should be considered. During the learning process in school, many parts of our brain are working actively.

The subject will be focused on, and information will be filtered through the attention filter. (Attention system)

The information received will be stored for later recall. (Memory system)

The stored information will be expressed in writing and verbally. (Language system)

With the motor system, the fingers will be able to hold a pencil.

With the higher thinking system, the brain will perceive the question asked, go through a process of judgment, draw appropriate answers from the existing knowledge store, and the information received will be able to be put into practice.

As a result of all these, feedback from family, friends and teachers will become a source of motivation.

Looking at the situation from this perspective, it is actually not easy at all. Each system works both for the development of abilities and for the continuity of the system. However, if there is a problem in any one of them, performance drops. If a child is struggling, the desire to work decreases. And when a child who is already struggling is also blamed by their family for being irresponsible, motivation decreases accordingly.

In shaping a learning profile;

Intelligence level,

Structural disorders (attention deficit hyperactivity disorder, specific learning disability),

Family life and stress level,

Cultural factors - the value placed on success,

Friends - finding a place in the group,

Health (vision and hearing defects, etc.),

Emotions (unhappiness, level of anxiety),

The educational environment play an important role

​Child and adolescent psychiatry investigates where this difficulty may originate.

The conditions we most often encounter are;

Attention deficit hyperactivity disorder

Specific learning disability

Intellectual disability

Major depression

Anxiety disorders.