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Definitions of Conditions What is ADHD? Attention Deficit Hyperactivity Disorder (ADHD) is the most common childhoodonset behavioural disorder. Those affected have a greatly reduced ability to maintain attention without being distracted, to control what they're doing or saying (because of impulsivity) and to control the amount of physical activity appropriate to the situation (that is, they're restless and fidgety). ADHD is also called attention deficit disorder (ADD) or hyperactivity. The disorder shouldn't be confused with normal, boisterous childhood behaviour. The cause of ADHD has not yet been fully explained. One theory is that it may be due, in part, to an imbalance of neurotransmitters (chemicals that transmit nerves signals in the brain). Another explanation is based around one of the main problems in ADHD – that the brain seems to be unable to filter the huge amount of stimulation we receive every minute of every day from the world around us. So the person is bombarded with all sorts of information and cannot pick out what is relevant and what should be ignored. Rather than giving things too little attention they may pay too much attention to too many things, and so lack focus. The main six brain functions affected are : Flexibility - changing from one topic or idea to another Organisation of thoughts and ideas Planning - thinking ahead, setting goals Using memory effectively -. taking in, storing, and then retrieving information Keeping emotions separate to logical reasoning Appropriate inhibition - acting after thought and consideration An affected child is easily distracted and can't process information at a normal rate. Brain scans suggest that in ADHD the frontal lobes of the brain, which normally carry out functions such as inhibition, are less active than normal and processes such as decision making may not be carried out so well. There may be also be imbalances in the brain chemicals noradrenaline and dopamine. January 2012 1 Definitions of Conditions However, this is a generalisation - brain research shows a variety of different problems in ADHD, with individuals showing their own pattern of behaviour. Genetic or hereditary factors are important - usually a parent or close relative also has the condition. Twin and genetic studies show several genes are likely to be involved. Evidence of brain dysfunction has been found in brain-imaging studies. Asperger’s Asperger’s syndrome is one of the autistic spectrum disorders, which can cause communication, social and emotional problems, which can lead to isolation and emotional problems. Because there is a wide range of severity and symptoms, the conditions are collectively known as autistic spectrum disorders. Symptoms vary from so mild that the person can function as well as anyone else around them, to so severe that they are completely unable to take part in normal society. People with Asperger’s syndrome are usually more mildly affected than those with autism. In fact, many people with milder symptoms are never diagnosed at all, and some argue that Asperger’s syndrome is simply a variation of normal rather than a medical condition or disorder. Even so, many people with Asperger’s syndrome (or their family) find it causes particular problems getting on with daily life and this can result in isolation, confusion and other difficulties, all of which could be defined as 'disease'. There are three main aspects to Asperger’s syndrome: Difficulty with communication - although they may be able to speak fluently, sometimes there are difficulties judging or understanding the reactions of those they are talking to. Common problems include: Failing to notice the body language of others. Appearing insensitive to the feelings or views of the listener. Continually talking, unaware of the listener's interest. Appearing over-precise in what they say. Taking comments literally (for example, misunderstanding jokes, metaphors or colloquialisms). January 2012 2 Definitions of Conditions Difficulty in social relationships - people with Asperger’s syndrome often enjoy or want to develop social contacts but find mixing with others very hard. In particular, they have problems with: Understanding non-verbal signals such as body language, gestures, facial expressions and tone of voice. Obsessions with objects, interests or routines which tend to interfere further with building social relationships (this is known as stereotyped or repetitive behaviour). Lack of imagination and creative play - children with Asperger’s syndrome are often of average or above intelligence, and may be particularly good at learning facts and figures. However, they may also lack imagination and find creative play or thinking in the abstract very difficult. This means they may be particularly good at topics such as Maths or History, but struggle with subjects such as philosophy, religious education or creative arts. Autism People with autism are usually more severely disabled, while those with Asperger’s syndrome tend to be more able, although this isn’t always so. Because of the range of severity and symptoms the conditions are collectively known as Autistic Spectrum Disorders. They affect more than 580,000 people in the UK. The main three symptoms are: Difficulties with social interaction - being unaware of what's socially appropriate, finding chatting or small talk difficult and not socialising much. People with autism may appear uninterested in others and find it very difficult to develop friendships and relate to others, while those with Asperger syndrome are more likely to enjoy or want to develop social contacts but find mixing very difficult. Problems with verbal and non-verbal communication – those affected may be able to speak fluently or, more commonly in autism, may be unable to speak at all. There may also be difficulties understanding gestures, body language, facial expressions and tone of voice, making it difficult to judge or understand the reactions of those they are talking to, or to empathise with people's feelings. As a result they may unintentionally appear insensitive or rude to others. They may also take others comments very literally, and so misunderstand jokes, metaphors or colloquialisms. January 2012 3 Definitions of Conditions Lack of imagination and creative play - such as not enjoying or taking part in role-play games. They may also find it difficult to grapple with abstract ideas. There may be overriding obsessions with objects, interests or routines which tend to interfere further with building social relationships (this is known as stereotyped or repetitive behaviour). These behavioural difficulties can cause a great deal of stress for members of the family. Babies who develop autism later may appear normal at first and reach the usual developmental milestones, including early speech. But as they grow into toddlers, they may fail to develop normal social behaviour and speech may be lost. As a child grows, the typical difficulties of autistic spectrum disorders are: Repetitive behaviour and resistance to changes in routine. Obsessions with particular objects or routines. Poor coordination. Difficulties with fine movement control (especially in Asperger’s syndrome). Absence of normal facial expression and body language. Lack of eye contact. Tendency to spend time alone, with very few friends. Lack of imaginative play. Treatment and recovery There is no specific cure or particular medical treatment for autism, but much can be done to maximise a child’s potential and this is key to managing the condition. Appropriate specialist education, speech, language and behavioural therapy are all important. There are many different approaches (for example, the Lovaas method is an intensive behaviour therapy approach, while the Son-Rise programme is focussed on relationships in Bexley there is the Early Bird programme similar to the Son-Rise Programme). Other interventions are based around theories about possible causes of autistic spectrum disorders – these may for example involve using foods and supplements, or medicines, which might affect the mechanical, physical and biochemical functions of the body. While many people feel they've achieved good results with some of these interventions, none of them is a cure-all, and many lack scientific evidence to demonstrate their benefits. January 2012 4 Definitions of Conditions Others claim dietary changes or alternative remedies have helped, but these, too, are mostly unproven. Medication is sometimes recommended when it's felt to be of benefit to the child, for example to control seizures, depression or other symptoms. As the precise events that lead to autistic spectrum disorders aren't yet known, it isn't possible to prevent them. Neither is there yet a simple screening test to identify people carrying genes that might increase susceptibility to autism. Degenerative eye problems A degenerative eye disease is a collective term for a disease that affects the various parts of the eye, including the retina, cornea, iris and macula. The common prognosis is a progressive loss of central vision. The diseases of the eye can be classified as inherited, associated with another medical condition, caused by a virus and cancer. Common and disease-specific symptoms are associated with each eye malady. Stargardt's disease is an inherited disease that affects children and young adults. Blurry or distorted vision, the inability to see clearly in a well lit setting, difficulty recognizing familiar faces and the loss of the ability to see colors are the presenting symptoms of this disease. Retinitis pigmentosa is a rare inherited eye disease. This disease is a slow and progressive degeneration of the retina. Early symptoms include poor night vision and a narrowing of the field of vision. As the disease progresses, central vision is diminished, and peripheral vision is minimized. The type 1 herpes simplex virus is the cause of stomal keratitis, which is an infection of the layers of the cornea, and iridocyclitis, which is an inflammation of the iris and the surrounding tissue. The common symptoms are inflammation of the cornea, sudden or severe eye pain and blurry vision. January 2012 5 Definitions of Conditions Dyspraxia Developmental dyspraxia is an impairment or immaturity of the organisation of movement. It is an immaturity in the way that the brain processes information, which results in messages not being properly or fully transmitted. The term dyspraxia comes from the word praxis, which means 'doing, acting'. Dyspraxia affects the planning of what to do and how to do it. It is associated with problems of perception, language and thought. Dyspraxia is thought to affect up to ten per cent of the UK population and up to two per cent severely. Males are four times more likely to be affected than females. Dyspraxia sometimes runs in families. There may be an overlap with related conditions (see below). Other names for dyspraxia include Developmental Co-ordination Disorder (DCD), Perceptuo-Motor Dysfunction, and Motor Learning Difficulties. It used to be known as Minimal Brain Damage and Clumsy Child Syndrome. Statistically, it is likely that there is one child in every class of 30 children with Dyspraxia. We need to make sure that everyone understands and knows how best to help this significant minority. There is an overlap between dyspraxia and other developmental problems such as dyslexia. Dyspraxia and dyslexia overlap and often co-exist in the same person. Dyspraxia is an impairment of the organisation of movement that is often accompanied by problems with language, perception and thought. Dyslexia is primarily a difficulty with learning to read, write and spell and is often accompanied by other problems such as poor organisational skills. The pattern of difficulties experienced by a person with dyspraxia may vary widely as with dyslexia. There may also be overlaps with conditions such as ADD (Attention Deficit Disorder), ADHD (Attention Deficit Hyperactivity Disorder), Asperger's Syndrome and Dyscalculia (difficulty with mathematical concepts). Some people with dyspraxia have tactile defensiveness - they are over-sensitive to touch. Others may have verbal dyspraxia, which causes difficulties with speaking and pronunciation. People with dyspraxia often suffer from low self-esteem. They may suffer from depression, have mental health problems and experience emotional and behavioral difficulties. January 2012 6 Definitions of Conditions What is dyslexia? Dyslexia is the result of problems with the way the brain processes words and sequences such as numbers or days of the week . Dyslexia comes from the Greek language meaning 'difficulty with words'. It's a symptom of a number of different information processing disorders in the brain. Because there are so many different possible underlying problems (many of which have yet to be understood fully) dyslexia is hard to closely define because it affects children in many different ways. However, the basic problem is a difficulty learning to read, spell and write, despite adequate intellect and teaching. Causes of dyslexia Dyslexia is caused by differences in the areas of the brain that deal with language, which aren't yet fully understood. Several areas in the brain interact in a complex way to coordinate the manipulation of words needed for reading, writing and spelling, so the features of any one person's dyslexia will depend on which areas are affected and how. There may be problems, for example, receiving sensory information through vision or hearing, holding it or structuring it in the brain, or retrieving it later, or there may be problems with the speed of processing information. Brain-imaging scans show that when dyslexic people try to process information their brains work differently to those without dyslexia. This has nothing to do with intellect - people with dyslexia show a normal range of intelligence. Inherited or genetic factors are important in dyslexia and other family members are often affected. Who's affected by dyslexia? About four per cent of the population have severe dyslexia, while a further six per cent experience mild to moderate problems. January 2012 7 Definitions of Conditions Symptoms of dyslexia Dyslexia may become apparent in early childhood, with difficulty putting together sequences (for example, coloured beads, days of week, numbers) and a family history of dyslexia or reading difficulties. Toddlers may jumble words and phrases, forget the names of common objects, have problems with rhyming or show slightly delayed speech development. They may have never crawled (even if walking early) and have problems getting dressed, putting shoes on the right feet and clapping rhythms. At school, children may lack interest in letters and words, have problems with reading and spelling, put letters and figures the wrong way round, be slow at written work and have poor concentration. These problems persist as the child grows up, with poor reading, writing and spelling skills, which can erode their self-esteem. Dyslexia treatments Dyslexia should be diagnosed after testing by a psychologist or specialist dyslexia teacher. There's no cure, but recognition that a child has a problem (especially, if possible, the specific processing disorder relevant to the individual) and appropriate teaching methods can help a great deal. It's vital children are diagnosed and given the help they need. Other approaches can help, too. In cases linked to visual differences, coloured overlays and lenses can lead to improvement because they may stop the letters from 'dancing on the page' (a common complaint). . January 2012 8 Definitions of Conditions Oppositional defiant disorder (ODD) Oppositional defiant disorder (ODD) is a disorder where children have disruptive and oppositional behaviour that is particularly directed towards authority figures, such as parents or teachers. Children with ODD are constantly defiant, hostile and disobedient. They don’t like responding to instructions or taking orders from others, and they actively refuse simple requests. Sometimes they eagerly blame others for their own mistakes, can lose their temper easily, and act in an angry, resentful or touchy manner. Oppositional: hostile or confrontational action or behaviour. All children occasionally react in this way on a bad day or if upset by a situation, and many teenagers go through troublesome times. But children with oppositional defiant disorder are like this all the time, making them very hard to deal with. Symptoms The key behavioural symptoms of ODD are negative, hostile and defiant behaviour. For ODD to be diagnosed, symptoms have to have been present for at least six months and involve four or more of the following: often loses temper often argues with adults often actively defies or refuses to comply with adults’ requests or rules often deliberately annoys people often blames others for his mistakes or misbehaviour often touchy or easily annoyed by others often angry and resentful often spiteful or vindictive. To be classified as ODD, the behaviour also has to have caused a significant degree of disturbance to home, social or school life. These types of problem behaviours are typically directed towards parents and teachers, plus others in authority. Coping with a consistently disruptive attitude can be extremely frustrating and physically, mentally and emotionally exhausting. ODD is common in children with ADHD, however many of the same general approaches to parenting and behaviour management can be used in either disorder. How common is it? Co-morbidity: when two or more conditions exist at the same time. For example, oppositional defiant disorder can exist alongside ADHD. In the general population, ODD is believed to affect about 16 per cent of people. It’s common for it to co-exist with ADHD, especially as children get older. January 2012 9 Definitions of Conditions In fact, figures suggest between 35 and 50 per cent of those with ADHD also have oppositional defiance disorder. What causes ODD? It's not clear what causes ODD. It may be caused by biological factors, such as the makeup of a child’s temperament and possibly through a neurological imbalance in the brain. But ODD is also affected by parenting styles. A child brought up by parents who are constantly hostile, confrontational and forceful has an increased risk of ODD. How is it treated? Oppositional defiant disorder is generally not treated with medication in the UK, but with a behavioural approach. Treatment is likely to encourage talking to your child and helping him to acknowledge his behaviour. It will also focus on ways of using praise to improve behaviour and address the issue of control - one of the things ODD children strive for. Treating ODD with ADHD If ODD exists alongside ADHD, treatment for ADHD often needs to get underway before ODD can be tackled. It’s worth noting that if your child is being treated for ADHD and ODD, sometimes ADHD medication can make some of the ODD symptoms appear worse. This is because ADHD drugs help children become more focused and predictable, but it can make ODD symptoms such as irritability more focused, too. Although ADHD can be treated well, getting ODD under control can take some time and a lot of hard work. Based on a text by Dr Dan Rutherford, GP Behavioural, emotional and social difficulties (BESD) What are behavioural, emotional and social difficulties? Behavioural, emotional and social difficulties - BESD - is an umbrella term to describe a range of complex and chronic difficulties experienced by many children and young people. Also known as SEBD or EBD, recent English government figures suggest that around 150,000 children in mainstream and special school suffer from BESD. Characteristics of BESD The SEN Code of Practice describes BESD as a learning difficulty where children and young people demonstrate features of emotional and behavioural difficulties such as: being withdrawn or isolated disruptive and disturbing January 2012 10 Definitions of Conditions being hyperactive and lacking concentration having immature social skills or presenting challenging behaviours arising from other complex special needs The term behavioural, emotional and social difficulties (BESD) covers a wide range of special educational needs. It includes children and young people with: emotional disorders conduct disorders/hyperkinetic disorders (including attention deficit disorder or attention deficit hyperactivity disorder [ADD/ADHD]) Children and young people whose behavioural difficulties may be less obvious, for example: those with anxiety who self-harm have school phobia or depression those whose behaviour or emotional wellbeing are seen to be deteriorating Whether a child or young person is considered to have BESD depends on a range of factors, including the: nature frequency persistence severity and abnormality of the difficulties and their cumulative effect on the child or young person's behaviour and/or emotional wellbeing compared with what might generally be expected for a particular age. Characteristics of a young person affected by BESD therefore depend on the severity and nature of the difficulties the young person is experiencing. Some young people will appear withdrawn, passive and depressive while others may be extroverted, excitable or aggressive. Some will seek ways to lessen their emotional turmoil and may turn to other destructive coping mechanisms, such as self-harm or substance misuse. The young person's behaviour may challenge parents, carers, teachers and authority figures outside of acceptable social bounds. There are different ways people with BESD may express themselves. Personal: they may have low self-esteem, are depressed or withdrawn Verbal: they behave in a threatening manner, arguing with peers and carers and swear excessively Non-verbal: they will not observe rules, skip school, be disruptive, be aggressive or be violent Work skills: they will be unable or unwilling to work without direct supervision, they struggle to concentrate or complete and follow through on tasks and instructions January 2012 11 Definitions of Conditions BESD and learning difficulties Children who suffer from BESD struggle to overcome trust issues which makes forming relationships with peers and adults incredibly hard. The nature of BESD means that those who suffer from it face barriers in their educational and social development, and as such, in legislative terms, are classed as having 'learning difficulties'. Learning difficulties can arise for children and young people with BESD because their difficulties can affect their ability to cope with school routines and relationships. Pupils with BESD cover the full range of ability; however their difficulties are likely to be a barrier to learning. Learning difficulties and behaviour difficulties are often in a two-way relationship with each other. For some pupils, behaviour difficulties may frustrate access to the curriculum, for example if aggressive behaviour leads to exclusion from some classroom activities or from the school. For others, a learning difficulty may lead to or worsen behavioural and emotional difficulties, for example, a child who has difficulty in grasping the basics of literacy or numeracy may withdraw from lessons or try to divert attention away from the learning difficulty by disruptive behaviour. What causes BESD? Underlying reasons for BESD can encompass both 'within child' factors and external factors. There is not an automatic link between BESD and a specific social factor, however there is evidence that prevalence varies according to sex, age, health and income. Incidence of BESD is higher in socially deprived inner city areas and affects more boys than girls. Children who have other learning or development difficulties, such as speech and language problems are also more at risk. Early childhood experiences can have a major impact on later development, with the lack of a positive attachment to an adult being seen as particularly detrimental to some children. Parents are the biggest influence on a child's development. Social circumstances can also impact on development. Children who experience family difficulties, including parental conflict, separation, neglect, indifference or erratic discipline, are more likely to develop BESD. For further help For parents: Young Minds Parent Information Service www.youngminds.org.uk 0800 018 2138 January 2012 12