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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
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
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.
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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 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).
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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.
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.
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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
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.
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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
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.
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Definitions of Conditions
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
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
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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.
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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
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).
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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.
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.
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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
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
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
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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
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:
severity and
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
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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
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
0800 018 2138
January 2012