Early last year John Terry's son teetered on the brink of permanent exclusion from school. Now he has a place at university. His father charts his remarkable 18-month journey away from ADHD, while (right) Mich le Hitchcock looks at the condition and its management
ADHD is not new. Thirty years ago it was probably known as "minimal brain dysfunction" - a term used for children with behavioural signs without neurological evidence.
It is considered to be a persistent and complex neurological condition which begins in the pre-school years. Its main features are difficulties in paying attention combined with a high level of activity and impulsive behaviour. It can co-exist with a range of more specific difficulties, including speech and language delays and disorders, difficulties with literacy, numeracy and motor co-ordination. Before diagnosis, clinicians consider neurological damage with similar symptoms to ADHD, such as head injuries, meningitis and some types of epilepsy.
Ritalin, the drug most commonly given to ADHD children, is a stimulant which, used in small doses, is thought to modify behaviour and thinking. Side-effects include reduced appetite and disturbed sleep.
Diagnosis of the condition is usually made by a consultant paediatrician or psychiatrist, often following a referral from the family's GP. For school-age pupils, the special educational needs co-ordinator (SENCO) can play a key role in sending all professional information to the GP. Discussion about a pupil between the SENCO and educational psychologists, behaviour and learning advisory teachers, is recommended but should only take place with parental consent. These support services can accept referrals and over time a pupil may be seen by more than one team.
Motivation, time and a consistency of practice by teachers, assistants and dinner supervisors in partnership with the child and parents are key factors in addressing the needs of ADHD children in school. Some will need individual help; good strategies include active participation in learning, helping them develop self-pacing skills, ensuring that the learning content is appropriate, has variety and is interesting, and helping them to develop collaborative skills.
Many children who are labelled ADHD have particular skills in creative areas. Enthusiasm, curiosity, intensity of emotion and quick application of skills, which may all be intensified, can be used to raise the child's self esteem and motivation.
Management strategies must include a flexible classroom layout, lesson organisation, general organisation and behavioural management. Possible classroom distractions should be minimised and a distraction-free independent work area is helpful at certain times. Pupils with ADHD should work alongside their peers as far as possible, particularly those peers with good study skills.
When planning lessons, you must consider factors such as providing outlines, key concepts and vocabulary beforehand, varying the pace of lessons and, where possible, interspersing seated tasks with more physical activities. Short achievable targets should be set and rewarded promptly. Collaborative learning, particularly those that assign each child in a group a specific role or piece of information required to complete the task is helpful.
Behaviour strategies should be task-orientated and centre on task completion. Negotiating techniques are useful to support this.
Monitoring and review of progress has great significance following an ADHD diagnosis. Information should be shared regularly with the pupil, parents, school staff, GPconsultant and other outside agencies. A key person should be identified within school to collect and pass on the relevant information.
* During 1997-98 in Somerset, a large working party with membership from education, health and social services, the voluntary sector and parents met regularly to develop an ADHD information pack. It contains two pull-out sections detailing policy, information and recommended practices, as well as photocopiable single-sheet recommended strategies for schools, divided into key stages 1 and 2, and key stages 3 and 4.
It is available for Pounds 12 from Mich le Hitchcock, principal educational psychologist, special education department, County Hall, Taunton, Somerset TA1 4DY.