The full and most effective treatment of AD/HD is the multi-modal approach. Too often there is a diagnosis and possible medication but no other interventions offered.

Multi-modal approach:

·  Medical

·  Educational

·  Behavioural

·  Emotional support for young person and family
All of the above are essential in the treatment of AD/HD

MEDICAL

TEENAGE ADD/ADHD

SYMPTOMS (taken from the DSM-IV diagnostic criteria)

INATTENTION

1    Often ignores details, makes careless mistakes.

2    Often has trouble sustaining attention in work or play.

3    Often does not seem to listen when directly addressed.

4    Often does not follow through on instructions; fails to finish.

5    Often has difficulty organising tasks and activities.

6    Often avoids activities that require a sustained mental effort.

7    Often loses things he/she needs.

8    Often gets distracted by extraneous noise.

9    Is often forgetful in daily activities.

HYPERACTIVITY

1    Often fidgets or squirms.

2    Often has to get up from seat.

3    Often runs and climbs when they shouldn't (in adults, feelings of physical
     restlessness).

4    Often has difficulty with quiet leisure activities.

5    Often 'on the go', as if driven by a motor.

6    Often talks excessively.

IMPULSIVITY

7    Often has difficulty waiting their turn.

8    Often interrupts or intrudes on others.

 

The patient needs to exhibit at least six of the symptoms for inattention OR at least six of the symptoms of the combined hyperactivity-impulsivity list.

 

The above is the standard criteria for all AD/HD patients. The symptoms do change to a degree with age, or rather, display themselves in a different manner.

For example physical hyperactivity can show itself as agitation in Teens & Adults (we seldom see adults climbing trees and swinging from rafters). Depression and anger become a concern in adolescence and unless identified and treated, can be a major problem through teenage years.

Below I have listed the areas that need addressing with our Teens:

6    Low self-esteem can lead to anger and a feeling of uselessness. Often Teens      will give up rather than accept a challenge and fail.

7    Organisation skills often have not been learned therefore relatively simple      tasks become major obstacles and the Teen is more likely to give up.

8    Mood swings can become extreme and we need to teach ways of
     self monitoring & coping with these. Depressions can become serious and are
     usually preceded by high energy levels. These high energy periods lead to a
     type of burnout where the Teen can get physically run down, particularly if lack
     of sleep is involved.

These symptoms vary in degrees and can be far less severe if intervention has been put in place prior to adolescence.

From early childhood it is vital that ADDers have positive input and a good sense of self worth. Unfortunately with Teens where the diagnosis has come late, these symptoms are more severe. However it is not impossible to correct but requires immediate input by all involved. Remember, 10 years of negativity cannot be undone overnight, but it is possible over time.

ADD FACTS

·    Medical Condition with a neurological base. Has been recognized since 1940s.

·    Strong Genetic Link.

·    Not due to inadequate parenting or Absent Dad Disorder.

·    70% will carry traits through to adult life.

·    Clinical diagnosis: Multi disciplinary assessment is the most effective.

·    ADD can exist without hyperactivity.

·    Although it is strongly a male disorder 4:1 it could be possible that it remains      undetected in girls.

·    Often comes with other disorders.

·    AD/HD effects 3-5% of the population. Approximately 200,000 people in New      Zealand. Concern for under diagnoses in New Zealand.

Obtaining a diagnosis:

A multi-disciplinary assessment is preferable involving a team approach. This team should consist of a Psychiatrist, Paediatrician, Psychologist and in some cases a Social Worker. A multi-disciplinary assessment is best obtained through your local Child and Adolescent Unit.
Referrals can be made by your GP or school (sometimes both is very effective). This service is free through the Public Health System.

If a referral is declined then a private assessment may be necessary. This can be done by a Paediatrician or Child Psychiatrist. Contact your local support group for names of Specialists in your area.

Remember:

·    A thorough assessment is required to discount any other causes of symptoms.

·    As the diagnosis of AD/HD is based on a clinical assessment, all past
     information is relevant such as school reports and family history. Make sure
     you have this information with you at the initial appointment.

THE MEDICATION

·    Ritalin is mainly used in the treatment of AD/HD.

·    Ritalin is non addictive (out of the system within 4 hours).

·    Use of Ritalin does NOT lead to drug problems. Quite the opposite has been
     shown In long-term research.

·    Ritalin not only improves impulsive behaviour, but also helps with
     concentration and retention of information.

·    Teenagers describe Ritalin as 'putting things into perspective' and liken it to a      person who is short sighted, putting on a pair of glasses - everything becomes    clear!

THE AREAS I HAVE FOUND RITALIN IMPROVES

·    In adolescence, Ritalin helps to level the mood swings eg. depression, anger.

·    Helps in the process of making the right decisions.

·    The youth that I have worked with do not 'react' in the extreme way of an
     ADDer if on Ritalin.

·    Help the youth to take responsibility for their actions.

·    They are able to think things through before they act.

·    Often handwriting improves.

·    Level of work produced increases. They are able to complete work to a good      standard.

     There are alternative medications such as dexamphetamine. If Ritalin is      ineffective or there are side affects, ask your Specialist for other options.

In 2001 the Ministry of Health released the 'National Guidelines for the Diagnosis and Treatment of AD/HD'. A copy of this document is available on the Ministry of Health's website: www.moh.govt.nz - A MUST HAVE!

EDUCATIONAL:

Those with AD/HD have learning difficulties regardless of IQ. Many have visual and auditory processing difficulties. AD/HD can be accompanied by dyslexia or dyspraxia, therefore for ADDers to do well at school they need assistance.

An educational assessment can clarify areas of difficulty in learning and assist school in implementing the correct interventions.

Here are some suggestions on how to work with your school:

HOW TO WORK TOGETHER

The best treatment of Attention Deficit involves the liaison of agencies and family.

Here are some ideas on how to achieve this:

·    A meeting needs to take place at the school between teacher, special needs
     co-ordinator, parents, support person and a member of the medical team.
     (Usually a psychologist).

·    The aim of this meeting is to determine the needs of the child. Address the
     problem areas and develop strategies that can be followed through
     at home and school.

·    This is best achieved in an I.E.P (Individual Educational Plan) where these      concerns and strategies can be recorded and held on file for future reference.

·    To be effective two I.E.Ps should be held each year so that the improvements
     can be identified and to help intervene as difficulties arise.

·    As Attention Deficit is an ongoing condition, the I.E.Ps should continue through      school years.

·    These meetings help to inform teachers who may not be aware of the child's      difficulties.

·    They give the family a clear picture of what is happing at school and to
     exchange strategies that work at home.

·    The medical team are able to get a better knowledge of what is working and
     what needs to be improved.

·    A home book is a good way of encouraging communication between home and      school on a daily basis. However we need to make sure that the youth      understands that this is not a daily report.

·    These books are not for negative comments. We need to take note of the good      days as well as the difficult days to try and see a pattern.

·    In college this liaison becomes difficult due to so many teachers, however it is
     not impossible.

·    I advise parents to find a supportive person within the college to communicate      with. It may be a dean, form teacher, special needs co-ordinator or a
     counsellor. The main thing is that the youth has a good rapport with this
     person and feels comfortable to talk to them.

·    Confidentiality is very important to these children.

·    The label MUST not be mentioned in front of peers or adults.

·    We need medication reminders that aren't embarrassing.

For Teachers

·    Teachers need to build their support when working with several of these
     children. Don't feel awkward asking for advice. There are a number of
     agencies that can help. Your local support groups have a lifetime of hands-on
     knowledge and the medical team are only too happy to suggest strategies
     or act themselves if things are difficult.

·    Liaison is vital as teachers are often the first to see behaviour that could be of
     a concern, such as depression. In these cases you are able to comfortably
     bring it up with the parents and doctors. Or write letters to support the
     parents concerns. It is by working together that we can help these children.

·    Lastly; enjoy their humor! It is completely over the top and zany, but it is a gift.      Use your humor when working with them. It is the best way that I have found      to defuse the most difficult of situations.

ASSISTANCE WITHIN THE SCHOOL SECTOR

OBLIGATIONS OF SCHOOLS AND B.O.T.s

Taken from Ministry of Education January 2002 booklet

The Government's special education policy affirms the right of every student to learn in accordance with the principals and values of the Education Act 1989, the National Education Guidelines (NEGs), which include the National Education Goals, the Foundation Curriculum Policy Statements, the National Curriculum Statements and the National Administration Guidelines (NAGs), as well as the Special Education Policy Guidelines.

Here are some relevant sections from the NEGs and NAGs:

National Administration Guidelines

The administration guidelines also have implications for the education of children with special needs. They provide direction in six areas of school operations.

·    Curriculum requirements and student achievement

·    Documentation and self-review

·    Employer responsibilities

·    Financial and property management

·    Health and safety

·    Administration

This means each board, through the principal and staff, is required to do the following for students with special education needs.

NAG 1, iii - on the basis of good quality assessment information, identify students and groups of students:

a)    who are not achieving;
b)    who are at risk of not achieving;
c)    who have special needs;
        and identify;
d)    aspects of the curriculum which require particular attention;

NAG 1, iv - develop and implement teaching and learning strategies to address the needs of students and aspects of the curriculum identified in iii above.

NAG 2, iii - report to students and their parents on the achievement of individual students, and to the school's community on the achievement of students as a whole and of groups (identified through 1, iii above) including the achievement of Maori students against the plans and targets referred to in 1 above;

NAG 5, i - provide a safe physical and emotional environment for students;

NAG 5, ii - comply in full with any legislation currently in force or that may be developed to ensure the safety of students and employees.

The Government's initiatives that provide support for Students with Moderate Special Education Needs are:

Resource Teachers: Learning and Behaviour (RTLB)
Specially trained teachers who support and work within school setting to meet the needs of students with moderate learning and/or behaviour difficulties. These positions are managed by a cluster of schools.

Resource Teachers: Literacy (RT:Lit)
Specially trained teachers who support and work in schools, assisting staff to meet the needs of students with reading and writing difficulties. This initiative is not specific to special education. It is part of the National Literacy and Numeracy Strategy.

Special Education Services (now known as GSE)

Special Education Services provides specialist services to children in early childhood and school students with special education needs, and to their schools, parents, caregivers and family, whanau.

SES has specialist teams which focus on early intervention, services for students with ongoing resourcing needs, sever behaviour difficulties, and those with a high need for communication support.

Specialist Education Services staff include:

·    Speech-language therapists

·    Special education advisers

·    Advisers on deaf children

·    Occupational therapists

·    Physiotherapists

·    Registered psychologists

·    Kaitakawaenga

·    Early intervention teachers

·    Behaviour, Communication and other Education Support Workers.

The Government is changing the structure for specialist education provision. Specialist Education Services will integrate with the Ministry of Education in February 2002 and the name will be changed from SES to GSE

Individual Education Plan (IEP)
A programme developed for students with special education needs outlining goals, strategies, resources, support and monitoring and evaluation required to enable the student to meet those goals, over a defined period. It should be reviewed at least twice a year.

Special Education Grant (SEG)
A grant provided to all schools to assist students with moderate special education needs. The amount is based on the school's decile rating and roll size.

If you are having difficulty, here are some agencies you can contact:

Ministry of Education The ministry provides advise and advocacy for families and schools.

Youth Law Provides free legal advise for young people. (Handy when dealing with suspensions )

Human Rights Commission if you feel your child's right to an education have been denied contact the Commission for advise.

Teenadders Inc. Just Email us with your concerns.
Your local support group For local support groups in your area click on resources

INTERESTING FACTS

·    Ten per cent of the population may have learning problems.

·    Learning difficulties often run in families.

·    Learning difficulties are not related to intelligence.

·    Learning difficulties occur in any social or economic environment.

·    Learning difficulties are not caused by hearing or vision impairment.

·    Many famous and talented people had learning difficulties, for example
     Leonardo da Vinci and Albert Einstein.

·    Learning difficulties are sometimes called "The Hidden Handicap" - they are
     real problems which require remedial action.

HOME:

HOW TO LOOK AFTER YOURSELF
WHILE PARENTING AN 'ADDER'

Many families are in the same situation with their teenage ADDers, but what main issues affect the outcome of these Teens?

Firstly there needs to be a strong supportive family base. This, in my opinion is the most important factor and possibly the hardest to achieve. There are many obstacles thrown at families who are parenting ADDers and all of them can affect the foundation of the family and in some cases the marriage. Becoming aware of the challenges helps us to cope in a way that is beneficial to all.

We need to cope with:

·    Living with such an unpredictable personality.

·    Avoiding being pulled into conflict.

·    Negative attitudes and judgment of those outside the family, even as close as      extended family at times.

·    Always having to challenge the education of our children.

·    Exhaustion through the constant physical and emotional demands of the ADDer.

·    Affects on siblings.

·    The pressure of having to be a dedicated, positive parent 100% of the time!

When looking at this list, and I have shortened it, is it no wonder we feel tired and at times helpless and full of hopelessness! This burnout is to be expected and as with our Teens, we need to be able to monitor ourselves so that we can intervene before reaching this point.

I feel that parents of ADD children need to parent far more affectively than any other parent, therefore it makes sense that we also need more timeout and good solid stress release strategies that are ready to put into place when needed.

1. It is vital to have time away from family as an individual.

2. It is important for partners to have time together where you are able to enjoy
    each others company without any family stresses.

3. For the other siblings, time is needed as a family unit. Sometimes this is
    better done with the absence of the ADDer. (There are many people in your
    family that have needs of their own).

4. One-on one time is needed with the ADDer and each parent. to keep
    positive relationships flowing.

How do you get time out?

If you have a supportive partner and extended family this is not hard to achieve. However for those of you that are parenting on your own or without family support it can be extremely difficult. There are several suggestions: Carer Support can be used to get someone in to mind your household so that you can get a break or for someone minding your ADDer in their home.
You qualify Child Disability Allowance from WINZ which can help towards this as well. When your Teen stays the night at a friends house use this time to do something special for yourself.

What to do with the time:

Make sure it is something humorous and light. Do not surround yourself with others negativity. It is important that the people you know add something positive to your lives rather than burden you with their problems.
We are all guilty of this at times, taking on others worries. I am not saying that you shouldn't care but at the end of the day parenting any child with Special Needs is a very stressful long term commitment.

When you are having time out you need to remove yourself from the AD/HD! AD/HD can be all consuming and dominate every area of your life. You need to be able to let go of it for a while. Support meetings are a good environment to 'let it all out', where you are amongst those that understand and don't judge. However when you are having a break you need a complete break so that you can see that life goes on without the ADD.
If you have an interest, particularly a creative one, make sure that you take the time to develop it. Whether it is gardening, art, music, sports etc it is important that you keep these interests going. How many things have you put aside or not attended because you felt that you had enough to deal with? Anything positive is worth making the effort for.

You need to have ideas into place for when you are starting to feel stressed. Write some down and refer to them when you feel you need to.(Can be simple things like running a bubble bath, poor a glass of wine , grab a good book and lock yourself in the bathroom!)

Remember: if we can't keep a sense of humour, our Teen will suffer
if we can't stay positive when no-one else is, our Teens will suffer
if we don't look after ourselves, who will take care of our Teens

PARENT TIPS

Skills required:

·    Sense of humour. Enjoy both yours and theirs. You'll need this!

·    Don't react!! Learn how to walk away rather than over-react.

·    When having a serious conversation with your child, timing is very important.      Do more listening than talking!

·    Give consequences that you CAN follow through.

·    Don't make promises idly! AD/HD can be devastated by disappointment.

·    You must make time for yourself and time with the other members of your
     family. AD/HD's needs can over shadow the family unit to the point of
     stress on the marriage.

·    Work together as a couple in developing strategies that work. There needs to
     be a consistency.

·    Have the ability to say at least one positive thing to your young person each
     day. This can be a real challenge some days but it becomes easier with
     practice. The aim of this is to stat looking for the good instead of reacting to
     the negative.

·    Keep things in perspective. AD/HD can't, so you have to do this for them until
     they can learn this skill.

If in conflict here are some problem solving tips:

·    When the battle becomes a war, step back! Take time out to gain perspective
     and address the issue later in a calmer way.

·    Allow natural consequences! Unfortunately AD/HD learn from their mistakes
     and sometimes they need several lessons.

·    Authoritative parenting does not work! We need to be flexible and have      acceptance of their limitations. The worst thing that we could do is to set goals      that will be impossible for them to achieve. Realistic expectations.

·    COMPROMISE! 'Yes you can on the conditions that……'. 'How can we meet each      other half way?' When you have done this then you can…...!'

Recipe for success:

A Good Medical Team

A Positive School Environment

Support for Families and Youth

Liaison to enable all of these are working together

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Teenadders Inc
P.O. Box 54
592b Whangaparoa Rd, Stanmore bay
Ph:09-424-2880 Fax 09-424-2894 Mobile 027-309-6442
Helensville Office: 09-420-9362
Email: info@teenadders.org.nz