ADHD

What is Attention deficit/hyperactivity disorder (ADHD)?

Attention deficit/hyperactivity disorder (ADHD) is a developmental disorder characterised by difficulties with concentration, attention and impulse control which impact on the person’s day-to-day life.

About 2 to 3% of adults are diagnosed with ADHD. While ADHD begins in childhood and symptoms typically improve as children get older, about 15% continue to have ADHD as adults.

Symptoms:

The key signs and symptoms of ADHD cover two main areas of difficulty; inattention, and hyperactivity/impulsivity, although in adults hyperactivity and impulsivity may be less obvious.

Inattention

• Difficulty concentrating

• Difficulty staying focused

• Forgetfulness

• Trouble organising tasks and activities

• Tendency to lose things.

 Hyperactivity/ Impulsivity

• Fidgeting and restlessness

• Difficulty sitting for long periods of time

• Difficulty engaging in quiet activities

• Difficulty waiting for a turn

• Acting or speaking before thinking things through.

For a person to be diagnosed with ADHD, they must currently have several symptoms, symptoms must have started before the age of 12, and difficulties must be present in two or more settings (such as at home and at work).

There are three types of ADHD, depending on the main difficulties the person is experiencing. These are:

• Predominantly inattentive:

  The person mostly has symptoms of inattention, rather than hyperactivity or impulsivity.

• Predominantly hyperactive-impulsive:

  The person mostly has symptoms of hyperactivity and impulsivity, rather than inattention.

• Combined:

  The person has symptoms of both inattention and hyperactivity-impulsivity.

Causes

Genes

There appears to be a strong genetic component to ADHD. ADHD runs in families and having a relative with the disorder is one of the strongest risk factors.

Neurobiological factors

In adults with ADHD, research has found some differences in areas of the brain and brain activity that relate to short term memory, the ability to focus, and the ability to make choices.

Differences have also been found in brain activity associated with attention and self-regulation, that is, the ability to focus attention, as well as manage emotions, thinking and behaviour.

Environmental factors

Certain environmental factors might also play a role in the development of symptoms of ADHD. These include:

• Pregnancy and birth factors:

  Maternal smoking, alcohol and substance misuse, and stress during pregnancy, as well as infant low birth weight and prematurity are all factors linked to ADHD.

• Early life relationships and opportunities to learn:

  Growing up in a family with high conflict, or without good opportunities to learn skills for self-regulation, attention and concentration can lead to difficulties in these areas.

• Certain environmental toxins:

  Toxins such as lead can affect brain development and behaviour.

Treatment

Assessment is done by team of professionals -GP, psychiatrist, and psychologists.

Using medication in combination with psychological strategies is likely to lead to the best outcomes.

Tips to improve focus and attention

Decrease distractions

Set up your work space to be free from distraction - away from the door (where people come and go), away from the window (and distractions outside), and make sure your workspace is free from clutter, electronic media, and other distractions. 

Get organised

Use time management and organisational strategies to streamline your day. To help get more organised, you can:

• set goals

• write to-do lists, and use these to plan and prioritise tasks for the day

• use a diary and set reminders for jobs that need doing

• group similar tasks that can be done together.

Break tasks down into smaller chunks

Smaller tasks are easier to complete, easier to organise and are less overwhelming. They are also more easily done while your mind is fresh and before your concentration wanes.

Include breaks in activities and tasks

Breaks after work is completed can help you to refocus on the next task.

Use problem-solving

Effective problem-solving includes defining a problem you want to work on, brainstorming solutions, selecting a solution and trying it out, and reviewing the outcome.

Anxiety

Difference between stress and anxiety:

Stress is often described as feeling overloaded, wound-up, tense and worried, and occurs when we face a situation we feel we can’t cope with.

While stress is usually referred to as a negative experience, not all stress is bad.

Some stress can be helpful, motivating us to get a task finished, or spurring us to perform well. However, if stress is ongoing or the stress response continues over a long period, the effects of stress can impact negatively on our physical and mental health. This could result in anxiety

Causes of anxiety:

Genes

Certain anxiety disorders appear to have a genetic component, with some anxiety disorders running in families.

Biology

Some anxiety disorders might have a basis in how the brain processes and responds to stress and physical arousal, and how the body releases stress hormones such as adrenalin.

Thinking style

Patterns of thinking characterised by anticipating the worst, persistent negative self-talk, difficulty accepting uncertainty and low self-esteem are often linked to anxiety.

Sensitivity to your body’s physical responses, such as increased heart rate, and misinterpreting these physical symptoms as indicating something catastrophic might also increase the risk of developing certain anxiety disorders.

Coping strategies

Unhelpful coping strategies, such as a tendency to avoid situations that trigger the person’s anxiety, rather than facing such situations, can increase the risk for developing an anxiety disorder.

Stressful life events

Stressful events such as a marriage breakdown, work or school deadlines, and financial hardship can act as a trigger for the development of an anxiety disorder.

Early life stress and trauma can also increase the likelihood of developing an anxiety disorder later in life.

 There are different types of anxiety disorders:

Generalised anxiety disorder (GAD)

Generalised anxiety disorder is characterised by persistent and excessive worry, often about daily situations like work, family or health. This worry is difficult to control and interferes with the person’s day-to-day life and relationships.

Specific phobia 

Specific phobia involves extreme anxiety and fear of particular objects or situations. Common phobias include fear of flying, fear of spiders and other animals, and fear of injections.

Panic disorder 

Panic disorder is characterised by the experience of repeated and unexpected panic attacks – sudden surges of overwhelming fear and anxiety accompanied by physical symptoms such as chest pain, heart palpitations, dizziness and breathlessness. In panic disorder, these panic attacks come ‘out of the blue’ with no apparent trigger.

Agoraphobia 

Agoraphobia involves intense anxiety in situations and places where the person feels it would be difficult for them to get out quickly or get help if needed. This includes situations such as using public transport, being in a lift or a cinema, standing in a queue, being in a crowd, or being outside of the home alone.

Obsessive compulsive disorder (OCD) 

Obsessive compulsive disorder presents in people as recurring, persistent and distressing thoughts, images or impulses known as obsessions (e.g., a fear of catching germs), or feeling compelled to carry out certain repetitive behaviours, rituals or mental acts, known as compulsions (e.g., handwashing). Some people with OCD have both obsessions and compulsions. These thoughts and behaviours can take over a person's life and, while people with OCD usually know that their obsessions and compulsions are an overreaction, they feel they are unable to stop them.

Social anxiety disorder 

Social anxiety disorder is characterised by severe anxiety about being criticised or viewed negatively by others. This leads the person to avoid social events and other social situations for fear of doing something that leads to embarrassment or humiliation.

Tips to manage anxiety

Check your self-talk

When we are upset and anxious we sometimes say negative things to ourselves. Unhelpful self-talk might include things like, “I’m hopeless”, “I’m going to be terrible at this”. Negative self-talk gets us down, can increase anxiety and can get in the way of us achieving our goals.

Notice what you say to yourself and work on more helpful, calming and encouraging self-talk, such as, “I am coping well given what I have on my plate”, “This stressful time will pass”, or “I got through it last time”.

Keep things in perspective (Certain questions to ask your self)

When we are worried and upset it is easy to see things as worse than they really are, and to start anticipating all sorts of problems down the track. Take a step back and look at one of your worries in the bigger scheme of your life. Ask yourself:

• am I getting ahead of myself, assuming something bad will happen when I really don’t know the outcome?

• is the outcome certain to happen, possible, or quite unlikely?

• if the worst were to happen, what could I do about it?

Sometimes thinking about how you would cope, even if the worst were to happen, puts things into perspective.

Don’t let anxiety stop you from doing things

Try not to avoid situations which trigger your anxiety, but work on facing these situations. If this seems too difficult, get the help of a psychologist or other mental health professional to work out a plan for facing your fears and increasing your confidence, step-by-step.

Practise relaxation, meditation or mindfulness

Practising relaxation, meditation and mindfulness on a regular basis will allow your body and nervous system the opportunity to routinely settle and readjust to a calm state.

Look after your health

Exercise, diet and other health behaviours can help support you to manage anxiety, so it is important to:

• make sure you are eating well

• get regular exercise

• avoid using alcohol, tobacco and other drugs to cope when you are finding things difficult.

 Autism Spectrum Disorder

What is Autism Spectrum Disorder?

Autism spectrum disorder (ASD) is a developmental disorder that begins in early childhood and continues across the lifespan. Children with ASD demonstrate delays and differences across two main areas of functioning:

• Interacting and communicating socially with others

• Displaying behaviours or interests that are restricted, repetitive or fixated.

Some children with ASD display many of the signs across these two areas of difficulty, whereas others display only a few.

As children with ASD grow older, the signs may change but the major areas of difference remain the same. In addition, about 65 per cent of children with ASD have an intellectual disability, and a small percentage demonstrate above average intelligence.

The needs of children with ASD therefore vary enormously; some require high levels of support, lifelong care and supervision, while others grow up to be independent adults.

Research suggests that ASD affects around 1 in 100 people. ASD is more commonly diagnosed in boys than in girls — at a rate of four to one, though research suggests girls may be under-diagnosed.

ASD affects each child differently, but all children can be helped through appropriate intervention.

Symptoms

Social interaction and communication:

Social differences revolve around the give-and-take of normal social interactions, non-verbal social communication, and skills in developing, maintaining and understanding relationships.

Communication skills can vary greatly between children with ASD; some children may have little if any speech, while others may have well-developed language skills. However, those that do have language skills often find it difficult to communicate effectively. They may say odd or inappropriate things, make blunt or impolite comments, talk about a specific topic for long periods of time with no awareness that others have lost interest, or say things that are not relevant to the current conversation.

Differences with non-verbal communication include difficulty in making and maintaining eye contact, and understanding non-verbal communication of others such as facial expressions and hand gestures such as pointing.

Some people with ASD seem quite aloof or detached from others, but this is not the case for all people with ASD, with some being quite affectionate and fond of company. People with ASD do often tune out when others are talking to them, or appear not to listen, especially when the conversation does not involve their favourite topic of interest.

Behaviour and interests:

People with ASD can have a very narrow or unusual set of interests, or they may play in a repetitive way. They may know everything about a certain topic and talk about it constantly, want to watch the same television show over and over, or focus their play on a single toy.

They often show limited imaginative play, but may use toys and other objects in unusual ways, such as lining up objects, focusing on the spin on the wheel of a toy car, or watching the light shine off various things. Some children with ASD engage in unusual behaviours, such as hand-flapping or rocking, which is usually a sign of excitement or agitation. Many experience difficulties coping with change, but do better when they are prepared ahead of time for changes in routine.

Causes

There is unlikely to be a single cause of ASD, and it is likely that environmental, biological and genetic factors may play a role. ASD is more common in people with intellectual disability and other developmental disorders.

Assessment

Assessment of ASD is typically conducted by a multidisciplinary team of allied health professionals. This team usually includes a paediatrician or child psychiatrist, a psychologist, and a speech pathologist. Sometimes other professionals, such as an occupational therapist

Usually your GP would make the referral to a paediatrician or child psychiatrist. If the paediatrician or child psychiatrist believes your child may have ASD, they may then refer your child to a psychologist and any other health professionals for additional assessment, diagnosis, and intervention.

Parents, family, and other carers play an important role in the assessment and treatment of a child.

As part of the assessment, the psychologist asks the parent about the child’s development, their strengths and difficulties, and their behaviour. The assessment often involves obtaining background information such as family history, as well as current information. The psychologist is likely to observe your child in different settings such as at home, at preschool or school, or in childcare to better understand their behaviour and how they interact with others.

The psychologist may also conduct assessments of your child’s learning, language and communication, and various day-to-day skills typical of children their age.

Treatment

Research shows that treatments focusing on changing behaviour and improving skills produce the best results for children with ASD.

These approaches address multiple problems common
to ASD such as delays and differences in language, social skills, communication, cognitive functioning and play.

Most interventions focus on increasing desirable behaviours and decreasing undesirable behaviours, and improving social behaviours, communication, play skills, coping skills and connection with others.

In each of these approaches, parents and carers have a central role in intervention. If your child receives intervention, you would be involved in therapy sessions to learn ways of practising skills at home with your child. Psychologists and other health professionals in your team can also work with your child’s educators to develop consistent ways of supporting learning and behaviour at home, preschool or school.

As early intervention leads to better long-term outcomes, it is important to seek help early and follow up on recommendations made by the health professionals in your team.

Tips for supporting children with ASD

Use your child’s strengths

Many children with ASD have a range of strengths. Some children with ASD may be particularly skilled at music, maths or another activity, or they may have a lot of knowledge around a particular area of interest. Try to harness these skills to motivate and stimulate your child’s learning and communication by showing interest in their activities and to foster interaction and communication.

Use your child’s special interests to increase motivation in other areas

Children with ASD can have a small number of intense interests and seem quite unmotivated to engage in other important activities. Rather than focusing on diverting your child’s attention from these specific areas of interest, see if they can be used as a springboard for strengthening your engagement with your child, for expanding your child’s interests and increasing your child’s motivation for other activities.

• Share their interests: Play alongside your child, following their lead in their play. Talk about your play and make observations about what your child is doing, and what
  you are doing. Your observations will help your child make connections over time between their perspective and yours. Playing alongside your child can also help them learn to take turns and to experience shared delight.

• Gradually include minor variations in the play to help expand your child’s imagination and tolerance for minor changes. Introduce changes that are not too far from your child’s original idea and which make sense around the theme of your child’s play. For example, your child may enjoy the sensory experience of throwing objects in the air and watching them fall back down. You might join this play by bringing a range of safe objects such as soft balls, feathers, and balloons and noting your child’s reaction to this expanding play.

• Incorporate their special interest, toy or game into other activities. For example, a child may have a particular interest in Thomas the Tank Engine. The characters from these stories can be used to help your child engage in counting activities, learning colours, and even social stories where the characters are used to act out certain social interactions. Your child’s desire to engage in these activities may also help them finish off less enjoyable tasks, so as to move on to their preferred activity.

Use visual aids and reminders

Children with ASD are often helped to understand routines and activities with visual timetables and visual reminders of the steps to complete tasks. For example:

• Create activity boards or step-by-step reminders for activities or routines that your child needs help with, such as making lunch or packing their school bag.

• Create reminders and step-by-step guides using written words for children able to read, or using photos or pictures to describe steps.

• Prepare your child for changes:

  Changes to daily routines can be difficult for children with ASD, so where possible, prepare your child for any changes. This might include changing teachers when teachers are away, or changes to daily routines that can happen from time to time.

• Involve your child in social activities:

  Being involved in social activities can help your child learn social and play skills from other children and adults. There are a range of programs you can consider, from social skills groups specifically developed for children with ASD, to social- and activity-based groups such as Scouts and Guides. Your council may have information about group activities in your local area.

Depression

What is depression?

Everyone feels sad, moody or low from time to time. Depression, however, is a serious mental health issue where sadness, flat or low mood, or a sense of ‘emptiness’ is prolonged lasting weeks, months and sometimes years.

 A person may be depressed if, for more than two weeks, they have experienced either (or both) of the following:

• a sense of sadness, emptiness or low mood for most of the day, nearly every day

• a loss of interest or pleasure in almost all activities, even ones usually enjoyed.

For a diagnosis of depression, a psychologist will look for specific symptoms that impact on a person’s daily life. Some of these include changes to their appetite and sleep, lethargy, worry and negative thinking patterns.

In addition, five or more of the following symptoms must also be experienced on a daily or near daily basis in the same period:

• significant and unintended weight loss/gain or change in appetite

• insomnia/hypersomnia

• psychomotor agitation/retardation

• fatigue or loss of energy

• worthlessness or inappropriate guilt

• impaired concentration or decision-making

• recurrent thoughts of death, suicidal ideation, a plan for suicide, or an attempt at suicide

• Symptoms must cause clinically significant distress or impairment in daily functioning

• These symptoms can be assessed using a combination of client self-report, report from others, and observations by the psychologist

Tips to improve mood:

Check your self talk

We can sometimes say negative things to ourselves when we are upset. Unhelpful self-talk might include things like, “I’m hopeless”, “Why should I even bother?”, or “I’ll never get all this work done”. Negative self-talk can make our mood worse by reinforcing how bad we feel, and stopping us from using helpful coping strategies. Constructive self-talk, on the other hand, can help us to cope with life’s difficulties.

Notice what you say to yourself and work on more helpful, calming and encouraging self-talk, such as, “This is a rough period but it will pass”, “I will use this time to look after myself”, or “Regardless of how I am feeling, I am always a worthy person”.

Keep things in perspective 

When we are upset, it is easy to see things as worse than they really are, and to start anticipating even more problems down the track. Take a step back and look at something that is upsetting you. Ask yourself:

• am I getting ahead of myself, assuming something bad will happen when I really don’t know the outcome?

• is the outcome certain to happen, possible, or quite unlikely?

• if the worst were to happen, what could I do about it?

Sometimes thinking about how you would cope, even if the worst were to happen, puts things into perspective.

Get active 

Make a list of things that you usually enjoy. It might include activities like light exercise, reading, meditating, listening to music, or spending time with a friend. Then, write down a list of things that are important to you that would give you a sense of achievement – things that would feel good to get done. This might include household chores, errands, work tasks or study. Now, take your weekly schedule and make time each day to attend to a task from each list. It is important to set realistic goals and then work towards achieving them.

Practise relaxation or mindfulness 

Practise relaxation, meditation, or mindfulness on a regular basis to allow your body and nervous system to routinely settle and readjust to a calm state. Mindfulness in particular has been shown to help people to respond to difficult emotions without feeling overwhelmed by them.

Look after your health 

Exercise, diet and other health behaviours can support recovery from depression, so it is important to:

• make sure you are eating well

• get regular exercise

• avoid using alcohol, tobacco and other drugs to cope when you are finding things difficult.
  

Seek help 

GP

A medical check-up with a GP is also important to see if a health issue might underlie your symptoms. A GP or other medical specialist might also offer advice and assistance where medication might be of benefit.

Seeing a Psychologist

If you are depressed or think you might be, a psychologist may be able to help. Psychologists are highly trained and qualified professionals, skilled in diagnosing and treating a range of mental health concerns, including depression. A psychologist can help you to identify and address factors that might be contributing to your mood or other symptoms.

If you are depressed or think you might be, a psychologist may be able to help. Psychologists are highly trained and qualified professionals, skilled in diagnosing and treating a range of mental health concerns, including depression. A psychologist can help you to identify and address factors that might be contributing to your mood or other symptoms.

All information has been sourced from the Australian Psychological Society APS 2021. Information provided is for informative purposes only.