Hyperactivity and Problems with Attention

Definitions

• Hyperactivity is described as having excessive energy and physical movement, which may disrupt other people or the person's own learning and work.
• Impulsivity is when someone suddenly acts on thoughts or ideas without thinking through the consequences.
• Attention in this context refers to the ability to concentrate or focus on one thing without being easily distracted.
• Attention-Deficit/Hyperactivity Disorder (ADHD) is a formal diagnosis in which individuals display a persistent pattern of inattention and/or hyperactivity and impulsivity. It has three recognized subtypes:
  • Inattentive type, characterized by an inability to complete multi-step tasks, a tendency to lose and forget things, and difficulty listening.
  • Hyperactive type, characterized by always being "on the go," talking excessively, and having difficulty sitting still. This type also includes impulsivity.
  • Combined type, which includes both inattention and hyperactivity.
• Individuals with ADHD:
  • Show more frequent and severe inattentive or hyperactive patterns than normal for their age group.
  • Experience difficulties because ADHD interferes significantly with their daily functioning.
  • Encounter difficulties in more than one setting (e.g., at work/school and at home).

People who struggle with hyperactivity, inattention, and/or impulsivity do not behave differently than their peers intentionally. However, their symptoms are often seen by peers, supervisors, and teachers as behavior problems instead of unintentional symptoms of a disorder.

There is no one certain cause of ADHD. Evidence suggests that ADHD is caused by biological factors that affect brain activity. ADHD is not caused by factors of poor parenting, family problems, poor teachers or schools, too much TV, or too much sugar. It is possible that factors like these influence the severity of ADHD signs and symptoms.

Evidence suggests that if one family member has ADHD, there is a greater chance that another member will also have ADHD.

Be sensitive about using the ADHD diagnosis as a way tolabela client with ADHD. If we define people solely by labels like ADHD, we can cause them to feel abnormal and like an outcast. As a result, people (especially children) with ADHD often consider themselves to be stupid, weird, or afailure. For other clients, they may not challenge themselves to grow because they think the label means they can't (e.g., "I have ADHD, so I can't do that."). Symptoms of ADHD can affect people in different ways, so be sure to encourage your clients to develop healthy skills that work within the limits of their situation.

When screening or treating clients with ADHD, remember that one client with ADHD may not be like another. First, people with ADHD are as unique as people without ADHD. Second, the severity of symptoms can vary based on the person's age and developmental level.

ADHD can be comorbid with other conditions.

• Some children with ADHD will develop learning problems. See Chapter D-11: Learning and Cognitive Disorders.
• Hyperactive behaviors in children may be associated with Conduct Disorder and/or Oppositional Defiant Disorder. See Chapter D-25: Conduct Problems in Children and Youth or Chapter D-26: Conduct Disorder.
• Teens and adults with ADHD may experience periods of anxiety or depression. See Chapter D-9: Anxiety and Worry and Chapter D-8: Mood Disorders (Depression & Bipolar).

Symptoms of ADHD will often get worse when the demands and stress at work, school, or home increase, especially during periods of major change. See Chapter D-19: Transitions of Life, Family, and Community. Work with the client, caregivers, family, and/or work or school environment to reduce stressful situations. Remember to obtain a Release of Information if needed.

Children with ADHD can display symptoms at a very young age. Often these symptoms become most noticeable when the child starts school. Children with ADHD are more likely to drop out of school if they do not receive early intervention. They are also prone to self-degrading thoughts and beliefs and may label themselves as failures.

The most effective treatment for ADHD is a combination of medication (when necessary) and counseling to help children learn coping skills and adaptive behaviors.

Symptoms related to inattention tend to be persistent throughout childhood, adolescence, and into adulthood, while symptoms related to hyperactivity and impulsivity tend to diminish with age.

School-aged children may benefit from special accommodations via a 504 Plan or IEP at school to help them manage problem behaviors.

Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.

Releases of Information ( ROIs ) that are current or updated before getting information about the client from other sources.

Client history related to attention, hyperactivity, focus, and hyperfocus at school, work, and home, comorbid diagnoses, and...

Treatment Plan, if one is already in place.

General Concerns

• Experiences depression
• Appears to withdraw from others
• Has a difficult time in social settings
• Gets into trouble frequently due to not paying attention, following directions, or staying on task
• Has low self-esteem

Hyperactivity

• Fidgets or squirms when seated
• Has a difficult time staying seated
• Gets up frequently to jump or run around
• Runs or climbs excessively when it’s not appropriate to do so
• Has difficulty playing quietly or engaging in quiet activities
• Is always “on the go”
• Talks excessively

Impulsivity

• Appears impatient
• Has difficulty waiting his own turn
• Blurts out answers before a question has been completed
• Frequently interrupts or intrudes upon others to the point that it causes problems in social settings (such as work or school)
• Initiates conversations at inappropriate times
• Touches others in ways that irritate them, such as poking their backs, in order to get their attention or release energy
• May be labeled as "lazy" by his employer, teacher, parents, or peers
• Does things that seem poorly thought out

• Has difficulty completing multi-step tasks
• Does not seem to be listening when spoken to directly
• Often loses things
• Is forgetful
• Appears to be a poor listener
• Misses important details during a conversation
• Has trouble finishing work assignments, projects, homework, or other tasks
• Shifts back and forth between different topics or tasks
• Appears messy or disorganized
• Is forgetful in daily activities (e.g. miss appointments, forget to bring lunch, or forget to do work tasks or homework)
• Procrastinates (i.e., put things off until the last minute)
• Has difficulty prioritizing and organizing thoughts, actions, or steps to complete a task (i.e., have poor executive functioning skills)
• Easily becomes distracted by internal and/or external stimuli that most people can filter out, such as background noises, visual objects, or movement

General concerns

• Has the client been through any recent changes or transitions? For example:
  • Death in the family or community
  • Divorce or separation (of parents or self and partner)
  • Formation of a blended family
  • Change in residence
  • Incarceration of a family member
  • Substance abuse by self or family
  • Pregnancy and birth by self or partner
  • Family reunification
  • Changing schools or graduating from school
  • Changing or losing a job
  • Problems with peers (e.g., bullying)

Emotional concerns

• Does she feel sad or hopeless?
• Had she had an irritable or angry mood lately?
• Does she become easily frustrated?
• Has she stopped doing things she used to enjoy?
• Has she become withdrawn?
• Does she often feel overwhelmed?
• Has she ever had thoughts of suicide?

Behavioral concerns

• Does he have trouble sleeping?
• Does he have trouble concentrating?
• Has he been getting into fights with others?
• Does he get easily distracted when attempting to complete important tasks, such as chores or homework?
• Does he avoid family and/or friends?
• Has he used alcohol or drugs?
• Has he been performing poorly in school?
• Has he skipped school?
• Has he unintentionally broken items because he is curious how they work?

Routinely review Chapter C-4: BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

Specifically, you may consider starting with behavioral interventions to support increased focus, attention, and task completion. One approach is called Contingency Management. This essentially rewards or positively reinforces desired behavior. This strategy can be used with youth and adults. However, it can require some external support from family members or a clear and structured plan for the individual client to self-administer a reward (e.g., picking up a favorite coffee drink after getting ready for work on time). Other strategies to support people who experience hyperactivity and/or distraction include:

• Time management/personal scheduling strategies (calendar reminders on smartphones or computers can be very helpful).
• Breaking tasks into small one- or two-step blocks (encourage parents to give one or two directions at a time).
• Helping clients learn what type of environment helps them focus (e.g., do they benefit from total silence, background noise, music, etc.).
• Developing routines and organizational strategies.

Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.