Distinct types of ADHD, its symptoms and method of compensation

Mental health is a term often used by many to imply the absence of mental disorders therefore inferring that the individual has reached an appropriate acceptable balance in all aspects of their life. It's how we think, feel and behave.

In fact, according to WHO (2014), mental health is: '... a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.' WHO also stresses that mental health 'is not just the absence of mental disorder.' Mental health can affect every aspect of our lives and sometimes even our physical health.

“ADHD is a neurodevelopmental disorder affecting 5% of children and adolescents and 4% of adult across ethnic, racial, gender, and socioeconomic lines in Europe and around the world (Clark, Carr-Fanning, & Norris, 2011).” There are three types of Attention deficit/hyperactivity disorder. There’s the hyperactive-impulsive type, the inattentive type and the combined type. ADHD rarely looks the same in any two students. The first signs of ADHD are generally diagnosed in primary school - when a child's lack of focus, forgotten homework, or behavioral issues draws teachers' attention.

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Symptoms used to be mistaken for mood disorders, anxiety, or silliness are finally being recognized as ADHD later in life - commonly when parents recognize themselves in their child's symptoms. People with ADHD have different levels of neuro transmitters which alter their behavior. These individuals with predominately hyperactive have changes to their dopamine transport gene. Thus affecting the dopamine levels in the brain.

Individuals predominately inattentiveness have changes to their norepinephrine transporter gene which affects the levels of this neurotransmitters in the brain. There are various medications that target these neurotransmitters. Stimulants such as Ritalin and Adderall help increase dopamine levels while those who are predominately inattentive take Strattera which increase the neuron transmitter norepinephrine.

Since there are two distinct types of ADHD, the Hyperactive and the inattentive type there are a number of symptoms for each type of ADHD. The Hyperactive/Impulsive Type is usually identified in students by some of the following; they are most likely to fidget with or tap hands or squirms in their seats. They tend to leave their seats in situations where they are expected to remain seated and often find a need to go for a run sometimes even outside the classroom. They are often unable to play or engage in leisure activities quietly and are seen as always “on the go,” acting as if “driven by a motor” mainly because they are unable to or uncomfortable being still for extended time. They tend to talk excessively and often blurt out answers in class because they have difficulty waiting their turn. They often interrupts or intrudes on others.

On the other hand the Inattentive Type is apparent when the students do not give a close attention to details and make careless mistakes in schoolwork and other activities. They frequently have difficulty sustaining attention in tasks or play activities and probably daydream during lessons. They would often seem with their minds elsewhere while directly spoken to. They do not follow through on instructions and fail to finish schoolwork, chores, etc.

They struggle to organize tasks and activities like managing sequential tasks or keeping their school belongings in order. Hence they often have messy, disorganized work which is never ready on time. They hate engaging in tasks that require mental effort and to their utmost to avoid them. They often lose their school stationery and other school materials. They are easily sidetracked by irrelevant stimuli and are often forgetful in daily activities such as doing their chores, running errands and other responsibilities

A child may be diagnosed with ADHD only if they exhibit at least six of nine symptoms from one of the mentioned above, for a period of at least six months in two or more settings. What's more, the symptoms must interfere with the child's functioning or development.

“The condition is best understood as a bio-psychosocial condition, which means that it is medical in origin, but it is affected and influenced by the environment and the social and emotional aspects of the person and situation (Cooper, 2001)”.

The brain is involved in everything we think, feel, and do so ADHD affects many, if not all, aspects of a person's life. However, ADHD is not a single entity. Rather, it varies across people and fluctuates with age, development, and environmental demands. In addition, the situation is further exacerbated by the fact that individuals with ADHD demonstrate behaviours beyond the core symptoms (Harrison et al., 2010).

According to DuPaul and Stoner (2004) the core symptoms act as a 'magnet' for other difficulties which can be more detrimental than the characteristics associated with the ADHD. In fact children with ADHD are more likely than others to also have conditions such as Learning disabilities, Anxiety disorders, Depression, disruptive mood dysregulation, Oppositional defiant disorder, conduct disorder, Bipolar disorder or Tourette syndrome.

Risk factors

A person with ADHD will have socializing problems because to their inattentiveness others might thing they are not interested. They often struggle in the workplace due to a number of factors such as poor organizations skills, concentration problems, keep deadlines for work completion and have a poor respond to rigid authority.

For these reasons they tend to have fewer career achievements hence often change their jobs frequently and may simple quit out of boredom. Adults with ADHD are more likely to engage in sensation seeking activities such as substance abuse. They are also more likely to have problems related with their less than desirable driving.

Aetiology (theories which explain the disorder e.g. biological, cognitive etc.)

ADHD is a brain-based, biological disorder not caused by bad parenting, too much sugar, or too many video games. Various studies reveal that a child with ADHD is four times as likely to have had a relative also diagnosed with the condition.

Although diagnoses of ADHD are based on behavioural symptoms of inattention and/or hyperactivity/impulsivity, evidence suggests that children with ADHD also display a number of cognitive weaknesses in areas that are needed for the student’s daily functioning both at home and in school. Studies indicate that children with ADHD often have problems in executive functions, their working memory and a slower speed of information processing when compared to their peers. It is important to note that many of these cognitive processes are often correlated. For instance, problems in working memory can negatively affect other executive functions, or slow processing speed may reduce one's ability to recall and organize information.

Strategies and services which support the student and their family at an individual and school level

For students with ADHD establishing a supportive and structured classroom is essential to boost their self-esteem, hence encouraging to learn while still enforcing discipline. That is why it is important to establish rules and routines for them to follow within the classroom. With input from students, establish short, simple classroom rules and state them in a positive way not stating what the student can not to but what s/he should do. This will help students stay on task. The routines should and could be used for all students in class like always having the homework/task at hand written on the board.

Strategies may include providing a visual time table and a reward chart because ADHD students are highly receptive of visual cues. The class LSE could check with the student with ADHD at the end of the day to make sure they understand what is required of them for homework and that they takes all the necessary material with them in order to complete the tasks. Children with ADHD require more guidance than their peers because of their delayed maturity, forgetfulness, distractibility, and disorganization. If the use of an LSE is not an option teacher could opt to use the buddy system where a more responsible classmate could help remind the student with ADHD of homework and classwork.

Another strategy which could easily be adopted by the teacher is to monitoring the student’s progress and develop a plan for him/her to adopt if they fall behind, for example offer a concession for the student to submit his/her work a few days after the rest of the class to help them get back on track. Students may be given more time to finish their classwork, extra time during tests, shorter or segmented writing tasks, which will help keep the student motivated and confident.

It is very important that in class potential distractions are minized as possible, therefor it is vital to have some sort of order even in the class decorations. It’s a good idea to have the students with ADHD sit infront of the class because this will help them stay focused and follow instructions related to the lesson. The use of positive peer model is also an effective way to reduce challenging behavior. Another important aspect is to prepare the students for transition, so a few minutes before changing lesson or class the students should be warned of what is going to happen, in order for the student to prepare accordingly and get less frustrated. Student with ADHD need to be given plenty of time and reminders to cope with the situtuation especially if it is a school trip or any other activity which is outside of their routine.

Students with ADHD will benefit if at the end of the day before going home their school bag is checked to make sure all of the necessary textbook and workbooks needed for the homework are there and that homework is propely listed in the school diary or on the school platform. This could be done by the class LSE or by a more mature student. Students will also benefit a  lot if they are allowed movement preferably something useful or which has a reason, like allowing the student to go to the bathroom or get a glass of water from the office.

Since sometimes this is not possible students can be allowed to play with fidgeters given that they are quite and not too distracting such as a squeeze toy. It is also important that student with ADHD are allowed to take their break even if they are still not finished with their classwork. Letting them take the break with the rest of the class will help them keep the usuall routine while at the same time with the use of play (physical movement) will help promote the student’s focus for the coming lesson.

It is very important for the LSE to built a positive relationship with students and provide frequent positive feedback and praise thoughout the completion of a task. When the student does well in a task, the task could be posted on the class bulletin board hence getting more positive feedback from the rest of the school. This will encourage the students to improve and do better. On the other hand repremending the student is best avoided and instead use different strategies such as questionining. Therefore if you notice the answer of a particular task is not correct, the LSE could ask the student “Do you think that’s correct?’ this will help correct the student without him/her feeling repremended.

On the other hand misbehavior needs to be dealt with not only in class but also at home. This is why communication with the parents/guardians of the child is of utmost importance because it will help reinforce the lessons learned in class not only in terms of behaviour but also accademically. This is why the LSE could either use the student’s diary or set up a communication book to comunicate with the parents on a daily basis, thus informing the parents/guardians of what the student’s needs. This will guide the parents/guardians on how to help the student with completing the homework, or unfinished classwork, help the child organize his work in the necessary folders, and prepare all the necessary material for the next school day. Instead of using a communication book LSE could opt for the use weekly reports.

In regards to school work students with ADHD should only be assigned work that match their skill level hence avoiding tasks that are too long or too difficult for them to complete. Given student a choice about the tasks at hand has proven to be a benecial strategy because they tend to produce better quality work and are less grumby about the task.

Other strategies may include the use of hand-on learning where the students learn things first-hand and the use of role playing games which will help them learn about social aspects of their lives.

Stigma of mental illness and how it can be addressed by schools and policies

While I believe nowadays the Maltese Society is more accepting of Mental illness, there are still some issues about how individual persons relate to mental illness among their families and friends. The impression is that the Maltese tend to avoid talking about, or owning up to the presence of Mental Health issues in the family. Although awareness around mental health issues has improved, the stigma and discrimination that people with mental health problems and their families face, is still high.

This is mainly due to social perceptions of mental health problems and the misconceptions about people with mental health problems continue to prevail not only in the media but also within professional and educational settings as well as in the health sector mainly due to lack of knowledge. That is why in Malta a number of awareness campaigns were launched in 2018 to help increase awareness and better inform the public thereby reducing the stigma related to mental health.

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