h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Entry: Challenging Behaviour in Children (working title) - A10345790
Author: Naim [69/100] - U290

I've got all the facts I want to into this entry, but I don't think it looks quite right, and I'm not sure about my 'conclusion'. I didn't want to leave it with just a list at the end and then nothing more.

There are other ways to 'diagnose' a child with ADHD, my son wasn't checked for learning disorders prior to his diagnosis for instance, but I am very impressed with this method and wanted to get it out there. I have mentioned it's not the only way that doctor's diagnose, so hopefully that's covered.

Writing it this way means there is also help for those children who may not have other problems, but need help other ways.

I'll go through this later adding internal and external links, which might lead to another section on where to seek help.

oops, forgot to change the title before I submitted it.

hmmm. You've chosen a tough one here. I like it, and I think it's best I leave off commenting from a professional standpoint.

I like what you have put into the Entry as it is VERY difficult to keep such a topic concise, subjective and generalised.

I do however think it is worthwhile adding something regarding Autistic Spectrum Disorders in the 'What it 'isn't'' section perhaps. But like I said, I don't want to say too much, otherwise I'll end up suggesting your Entry reads like an information leaflet from the DH. Which it shouldn't.

I'll keep an eye on it as it runs throuh PR and add suggestions where I can.

MJ

I didn't know you were in 'the' profession. I know nothing about the Autistic spectrum, although I did wonder it J was autistic in the two or three years before he got his diagnosis due to his liking of routines and strange way of wanting them to go on even if we'd already done it some other way - ie we went out every morning, came home and had lunch. Some days we'd have lunch out, and he'd throw a wobbly because we didn't have lunch when we got in...

Anyway, I did mention medical conditions - would it come under that? Just as an example? Obviously the behaviour wouldn't go away with an autistic child though. Hmmm...

It's a tough call. No doubt you've reams of lit on ADHD. Give me some time to rifle through my 'portfolio' (the boxes under my bed) and I'll see what more I can add. But again, I feel that what you've written could lend itself more to a 'I'm a parent, here's what I learnt and how I coped' kind of Entry, rather than a 'everything you need to know about children who drive you crackers' type

Ok, we'll see how it goes.

On reading through it I spotted loads of types and even the odd missing word, so I'll go through the entry again when I'm less googly-eyed from staring at the screen. I can't do it now, I have to wash up.

Ah, the wonders of take-away when you can't be bothered cooking and washing up. Here love, let me put those cardboard boxes in the bin

Oh, do try Aloe Vera Washing Up Liquid, it's great on the hands!

"I know nothing about the Autistic spectrum"

Ehh. I suggest you go down to your local library and seek out a copy of the DSM IV in the reference section. That is the government manual that doctors use to write diagnosis.

Many Asperger's Syndrome children were originally diagnosed as OCD or ADHD.

http://www.bbc.co.uk/dna/h2g2/alabaster/A7512167

I've known many adults who were diagnosed as ADHD. Their behavior is never really "cured" but often rechanneled into more productive pursuits.

Yet, having said that, ADHD, as with OCD and Autism, has a spectrum. The label is used to diagnose many disparate sorts of behavior.

And there is one factor I don't think you mentioned. Environment.
ADHD doesn't just pop up out of nowhere. There is very often a very close family member who has it, too. Many adult ADHD cases are not diagnosed until one of their children or nephews or nieces are taken in to the doctor.

Also keep in mind that some doctors, such as the one my daughter experienced when she was 8, are quick to toss a diagnosis of ADHD as well as a prescription of Adderal.

I would probably make it clear in the title that this entry isn't really about challenging behaviour in children in general -- it's about challenging behavior in the context of ADHD.

A few other things.

ADHD and Hyperkinetic Disorder are not exactly the same things. Hyperkinetic disorder is the same thing, clinically speaking, as ADHD-Hyperactive-Impulsive Type. It is most definitely *not* the same thing as ADHD-Inattentive Type.

I also think that someone reading your entry might gain a rather distorted view of how ADHD is properly diagnosed -- and to me, this is especially concerning because this is a misperception that is perpetuated throughout the media. In order to truly be considered ADHD, the clinician needs to determine that these symptoms for the child are

1) developmentally inappropriate, and not within the norm for their developmental level (not necessarily the same thing as age), and
2) seriously interfering with the child's ability to function in multiple domains (i.e., not *only* in school), and
3) have met the above criteria continuously for at least 6 months.

Obviously, there are a good number of kids who are diagnosed with ADHD who don't meet these criteria. There are kids who probably do meet this criteria, but who are diagnosed with ADHD without the clinician really going into this much detail. And there are definitely kids who meet this criteria who aren't diagnosed at all -- especially girls and children with the Inattentive subtype.

Also, some other things that should be made clear, in regards to the "other causes" you list -- it's not always straightly an either or. There *are* cases in which ADHD should not be diagnosed, because the symptoms are completely attributable to another cause. But even in kids who truly do have ADHD, things such as sleep problems, social problems, grief, etc., can and do worsen the symptoms. The same is true for just about any medical disorder.

Oh, and I'd probably also add a general category for other psychiatric and neuropsychological disorders to your "other causes" list -- conditions such as anxiety, depression, bipolar disorder, aspergers/PDD, OCD, and PTSD can mimic ADHD in children, but these children will generally not respond nearly as well to regular ADHD treatment.

Oh, and the diagnosis technically requires 2 or more settings, not 3 or more as your entry states. And I'd also add to that section that the symptoms need to be apparent by the age of 7, even if it is being diagnosed much later.

Hmm. What were you diagnosed with, Mikey?

Hi Naim ,

My immediate impression, I do hope you find some of this useful.

Your title suggests that you are going to talk about different causes of challenging behaviour in children but you then go on to concentrate on ADD/ADHD. There are many reasons for challenging behaviour: a physical disability or any other source of frustration, bullying, or any other source of adversity, hypersensitivity, overactive imagination, abuse, etc. So my first point would have to be that I think you need to address the title.

In terms of ADD/ADHD, I think you need to start off with the DSM IV before you do anything else. It is the tool for diagnosis but you are perfectly right in saying the diagnosis is subjective. DSM IV is not an absolute tool. It can identify a child with thyroid insufficiency, a hearing impairment and even undiagnosed diabetes as an autism spectrum child. I would actually name some of these conditions in your entry as it is essential that a child has a full medical check up as well as the requisite Ed Psych, Occupational and Speech and Language Assessments that are part of the educational statementing process in the UK.

You need to differentiate between ADD and ADHD. It is important you get the terminology right. ADD is the inattentive disorder and ADHD is by defintion the "hyperkinetic" disorder you describe however it is only one sub type. The term "spectrum" has been used in the reviews. In effect, all of these and their subtypes (ODD, PAD etc) are on a spectrum and are autism subtypes of one strength or another. They are neurological disorders. Thus the name Autism Spectrum Disorders for the lot of them. There are many others, as well as associated disorders such as Tourette's Syndrome etc.... let alone the issue of growing up with it (not fun).

My only real criticism is an odd one, perhaps. You don't mention the good side of having an ADDer child: the cuddles, the generosity, the communication, the imagination and creativity, the energy. An ADDer child, compassionately raised, can fly and take us with him for the ride. Perhaps a useful exercise here would be to identify soem famous ADDers

This is a huge topic, Naim, I think you are immensely brave to tackle it. I suggest you have a look at adders.org and alternativementalhealth.com for some additiional resources.



W

It's not actually true that ADD is the inattentive disorder and ADHD is the hyperactive disorder. ADD is simply the older name for the diagnosis, and ADHD the newer one, which is split into subtypes -- Inattentive, Hyperactive-Impulsive, and Combined.

And the DSM-IV is actually pretty clear with all diagnoses that medical causes should always be ruled out -- it's not a matter of "the child has ADHD if they meet these criteria" but rather "the child may have ADHD if they meet all these criteria *and* the symptoms cannot be adequately explained by another cause".

With respect, Mikey, we're splitting hairs. You will find the correct umbrella term today is AD/HD which comprises (among others) ADD and ADHD (see CHADD.org). This is not yet a scientifically proven area area and the DSM IV is *not* an absolute diagnostic tool. It is a subjective psychiatric diagnostic tool. That means that the same child can attend two different psych clinics and be diagnosedusing DSM IV and walk out with two different diagnoses.



Ref: ADD vs. ADHD http://add.about.com/cs/addthebasics/a/add.htm

"ADD Without Hyperactivity"
by Eileen Bailey,
Your Guide to Attention Deficit Disorder.

(For the purposes of explanation, this article will refer to girls having ADD and boys having ADHD. However, this is not to mean that girls cannot be hyperactive and boys cannot have ADD without hyperactivity. It is used for simplicity in explanation only.)

Much has been written about ADHD, and the majority of it conjures a picture in our minds of Dennis the Menace, the little boy that gets into everything, knocks over anything that can possibly fall, talks incessantly and jumps onto rather than sits down on the sofa.

We all know the child well, and at the stores we think we can spot the child with ADD. It is the little boy running up and down the aisles, the one whose mother looks exasperated and apologetic for her child’s behavior. But how about the little girl walking so quietly next to her mother, seeming to be shy and withdrawn but extremely polite, afraid to speak up and during a conversation looks confused and lost.

ADD and ADHD can both be difficult and cause distractibility, forgetfulness, disorganization, difficulty following rapid conversations, and low self esteem. Both can cause difficulty in completing school work and assignments in a timely manner. Either can affect an individual’s ability to keep track of their belongings or to keep track of time.

However, there are some major differences between ADD and ADHD. Bev Price, on her website, lists some important characteristics of both.

ADD Characteristics:

Sluggish
Honors other’s boundaries
Obedient
Underassertive
Overly Polite
Docile
Modest
Shy
Socially Withdrawn
Bonds with others but doesn’t attract friends
ADHD Characteristics

Physically Hyperactive
Impulsive
Intrusive
Rebellious
Bossy
Irritation
Show Off/Egotistical
Attracts friends but doesn’t easily bond
More prone toward Oppositional Defiant Disorder or Conduct Disorders
Since girls with ADD are many times very polite and quiet, their ADD may go unnoticed and undiagnosed for years. They may silently struggle and are many times very sensitive to criticsm and very emotional, causing a great deal of inner turmoil. While their hyperactive counterparts seem relatively untouched by stress around them (although this may not be true), bouncing around as if nothing mattered, the girls with ADD have a very low tolerance for stress and can become even more withdrawn, feeling as if they are not good at anything.

Continue to Page 2 for information on helping individuals with ADD.

Continue to Page 3 for information on helping yourself, as an adult with ADD.

For further information, also see Is ADHD Worse than ADD?"


Like I said, Naim. Good luck with this

W

The DSM-IV is not a diagnostic tool, per se -- it's the diagnostic criteria which diagnostic tools use as their basis. Yes, different doctors can come to different conclusions -- I can't think of anywhere I said otherwise -- but that's because they are a variety of ways to interpret both the criteria and the patient's history and symptoms, on beyond the simple fact that some doctors ask better questions than others. And ADHD and AD/HD are simply different abbreviations for the exact same term -- Attention-Deficit/Hyperactivity Disorder. ADHD is the preferred term in most literature today, whereas AD/HD was the more commonly used abbreviation in the 90s. But as I responded above, it would be factually inaccurate to claim that ADD is the term for the intattentive subtype, that's simply not the case. Yes, there are plenty of places in the popular media today where the terms are misused, but I don't see any reason why we should encourage that here when the terminology currently used in the entry is more correct.

And no, about.com is not a good resource for scientifically accurate and up-to-date information. And so you know, it's a violation of the House Rules to copy and paste articles, song lyrics, etc, as it is an issue with international copyright laws.

OK, Mikey, I see I have stepped out of line. I apologise to you for upsetting you and to Naim for disrupting this thread.

Ok, first thing I've done is had a go at changing the title to see if that fits better. I was considering it a working title anyway.

Most of my information in this entry came from the ADHD conference I went to earlier this week.

I don't want to mention a family history as there is already enough factors that make this hard to diagnose. There is still a lot of umming and ahhing over whether this is a disorder of children only, as the adult brain reacts differently to a child brain as it matures, or could it be another disorder, etc

I have mentioned that doctors do deal with cases differently, although at the conference I went to, more parents were having a hard time getting a diagnosis - that may be cultural, as I've heard that the percentage of children diagnosed with this is higher in the USA.

"ADHD and Hyperkinetic Disorder are not exactly the same things."

I don't think I said it was? I was talking about labels, rather than actually what they are. Let me know if that's not clear.

Mikey your list of criteria, I've mentioned most those at the end of the article. Number 1 I'm not sure what you mean - that's something that's not used in the UK - or it has never been mentioned to me in all this time.

"anxiety, depression, bipolar disorder, aspergers/PDD, OCD, and PTSD" Are these covered by my 'medical problems'? I can tweak it to say that if it's only a medical problem then the symptoms will clear up, rather than they will go away which will cover your point. At the moment yes I agree it looks as if ADHD can't hide behind a medical problem (which obviously it can).

In the UK, yes it's three settings or more, not 2, again that's a cultural thing I think. My son was actually assessed in four, because his dad doesn't live with us.

Wilma -

DSM IV - I'n no idea what this is. I disregarded the mention of any 'tests' in this entry because I have been told that they were developed for research, not diagnosis and that they can't diagnose - although they can help to confirm a diagnosis.

I think Mikey has already mentioned, and in the article I do state that ADHD has taken over from the ADD name that we used to use here (although some people still use it I noted at the conference). But I have stated that treatment and support shouldn't be dependant on the 'label' the child has. My son isn't hyperactive at all, but he's definitely got impulse control issues.

As for the good side, cuddles etc, my son wouldn't even enjoy a cuddle when he was a baby. He will now give me a quick 2 sec hug, but that's it. It's one of the reasons I thought he might have been autistic...

I've added this paragrpah to the top:

Much of the information in the entry has been gathered by the UK parent of a child diagnosed with ADHD and so is dealing with challenging behaviour every day. Some of this behaviour is related to the diagnosis, other behaviour is not. This entry hopes to make some 'plain English' sense of the information given out by specialists in the field. The author has no medical qualifications and simply seeks to help other parents.

I think part of this is that there's a difference between the minimum the diagnostic criteria require and the assessments that occur in different places. The DSM-IV is the official manual of psychiatric diagnostic criteria, and is the one that defines what ADHD is and is not. While the DSM-IV is the product of the American Academy of Psychiatry, it is indeed used internationally, and these days a good deal of international input goes into the development.

Here is a link to the DSM-IV criteria for ADHD
http://www.mentalhealth.com/dis1/p21-ch01.html

The other listing of diagnostic criteria comes through ICD-10, which is used more in Europe, and includes these diagnoses:

* F90?thread="/h2g2/forum/90" >F90.1 Hyperkinetic Conduct Disorder

However, as I mentioned above, this diagnostic group does not include the children who fall under ADHD-Inattentive Subtype. The ICD-10

For comparison, here is the ICD-10 criteria
http://www.mentalhealth.com/icd/p22-ch01.html

Of note, it also has the requirements that the 1) the symptoms be developmentally inappropriate, and 2) they occur in more than one setting. That first issue isn't necessarily something that doctors will come right out and say, but it is indeed something they are always supposed to look at -- basically, it just means that the behavior you use to diagnose ADHD in a 12 yr-old might be considered completely normal in a 5 yr-old. And while most docs will try to collect data from as many settings as is feasible before diagnosis, only two settings are required (most often home and school, as some young children simply don't spend time in more places than that) for either of the sets of criteria.

But because ADHD and Hyperkinetic Disorder aren't truly the same grouping (although they clearly overlap quite a bit), the term ADHD truly does refer to the DSM-IV criteria. Not only does the hyperkinetic disorder diagnosis exclude children with the inattentive subtype of ADHD, it also includes what in the US would be called oppositional defiant disorder (which goes beyond hyperactivity into hostile and intentionally disruptive behavior).

Oh, and the DSM-IV wasn't developed for research purposes, it was developed for clinical use. Now, there are any number of diagnostic tools out there that are based on the DSM-IV criteria -- some of those are of no use outside the research setting, and some are much more useful clinically. The mostly commonly used clinical diagnostic tool in the US is the Conners.

And I would mention the psychiatric disorders separately from the medical disorders -- both from the doctor's role and from the parent's experience, trying to puzzle out ADHD is a very different thing when other psychiatric disorders are present.


Mikey

"only two settings are required (most often home and school, as some young children simply don't spend time in more places than that) for either of the sets of criteria. "

Well, as I've said, here in the UK, it has to be three or more.

Thanks for your explanation, I did have to read it a couple of times because of the big words! Not a complaint as such, but it leads me to think that I haven't got a tight enough focus for my entry at the moment. I started it and put it into PR in the same day, which is unusual for me, so I think I'll take it out of PR until I've worked out what I want.

At the moment I just want to say, no no no you've totally misunderstood what I've talking about - but because I want to say it to nearly everyone in the thread, I realise the issue is with the entry. So thanks for your comments and I'll have a really good think and then a fiddle before I put it back in again.

Thanks!

In case you're just being polite and feeling genuinely put-upon, I will proffer the news that I spent almost two years and five editions on an entry on Buddy Holly that I ended up pulling out of PR and putting it into the Workshop.
Sometimes PR is a gas, and sometimes it is a chore.
Keep trying!