ADHD, Combined type

adhd - Children with ADHD

attention-Deficit/Hyperactivity Disorder, combined type is the most commonly diagnosed subtype of ADHD. This means that he demonstrates both symptoms of inattention and hyperactivity, possibly in different contexts such as at school or home, or at different times, depending on the demands on him.

Regarding symptoms of inattention, he tends to find it difficult to focus his attention on the tasks or behaviors you want him to do, such as school work, homework or doing chores. he does not pay close attention to details, makes careless mistakes, is untidy with his work, and is often late with assignments. Once engaged with a task, he has difficulty sustaining attention on that task. Instead, he is easily diverted to more interesting activities. Thus, efforts at completing tasks are likely to appear disorganized and inefficient. To learn more about how this happens read: ADHD is a Conditioned Attentional Avoidance Loop based defense skill not a deficit

In relationship to school, he is likely to have difficulty organizing assignments, tasks and activities. he is likely to arrive at school missing school assignments, books and other school materials, claiming to have forgotten or lost them.

Listening and remembering are problems. Learning new things is difficult and frustrating for he. When given several things to do, he often only remembers the first couple and forgets the rest. He does not listen well and appears Inattentive and distracted when parents or teachers try to get he to listen to them. Comments such as “He cannot listen” or “ he is in his own little world” are likely common. In contrast, this inattentiveness is generally not present when he is listening to someone such as a playmate, or engaged in some activity, such as a TV show or computer game, that he is interested in. To learn more about how this happens read: The tyranny of he can not makes sure he will not

In class, he may sit quietly and superficially appear to be working. Because he has difficulty processing oral or written instructions, he may miss enough that he does not understand what he is supposed to do. This leads to mistakes and poor grades because instructions were not followed. Academic subjects that require sustained attention, such as reading comprehension and math, are particularly vulnerable. The problem is that individual words do not have much meaning. To understand what he reads, he must be able to keep phrases, sentences and paragraphs in short term memory.

All of the attentional and behavioral problems above are often misunderstood as a skills deficit. While this is sometimes the case, it is more likely to be attributable to stress and anxiety. Whether it is remembering a teacher’s or parent’s directions, or remembering complete phrases while reading, his attentional resources, ie. working memory, are being drained by emotional arousal. In the example of reading, he has poor comprehension because no one can comprehend well when they read one word at a time. Likewise, learning math requires he to memorize mathematical operations such as multiplication tables or formulas. To do math requires him to hold a series of operations and facts in short-term memory. This is impossible for him when emotions are draining attentional resources. As a consequence, his struggles with these subjects are often misunderstood as a learning disability rather than a sustained attentional problem. Until attention is improved, strategies to improve skills alone are seldom helpful.

An example of how the above dynamics play out, is that struggling to stay on task is so much work for he that he tries to avoid anything in which he has to focus attention, such as school work, homework and chores, for as long as possible. It is easier to “space out” or make excuses for hours to avoid simple schoolwork and homework tasks that adults perceive as simple.

Homework can turn into “homework help Hell” for both you as parents and for he. Often children with this diagnosis forget to write down assignments or leave them at school. No book or the wrong book is brought home. Homework usually takes far longer than it should and the quality may be poor. Both you and he are likely to be frustrated by the end of homework time and dread the next bout of homework. For help dealing with homework help Hell read this: Homework problems and solutions

He also has times where he is not just “spaced out”, but hyperactive or impulsive. He tends to act before thinking about the consequences of his behavior. He tends to be physically restless and fidgety, moving his hands and feet. When required to sit still, he is likely to squirm in his seat.

During hyperactive times in the classroom, he is likely to be constantly on the go. He is often out of his seat, roaming around. He fiddles with whatever is at hand, such as pencils, papers and other materials. He often talks to peers when he should be quiet. he may blurt out answers before questions have been completed or he has been called on.

Socially, he may be impatient and inclined to interrupt others’ activities and conversations inappropriately. Waiting his turn in conversations, in the classroom, or in games is difficult. Being quiet during meals, lessons, riding in the car, or listening to a story may also be difficult.

On the playground, he may engage in excessive, inappropriate running and climbing. Disruptive behavior and intrusiveness may result in peer rejection and conflict both in the classroom and at home. His emotions are likely to be expressed without restraint and may be acted upon by hitting or taking others’ property. To learn more about how this happens read: Social skills deficit is usually skills inhibition by anxiety rather than Aspergers Syndrome

The consequences of the social rejection that he may suffer can can be severe. For an example read:

Rejection massively reduces IQ and increases aggression

His excessive activity is a behavioral reflection of his internal tension and discomfort. He may refer to this feeling as being “bored” rather than uncomfortable. He is likely to deal with feelings of agitation and discomfort by projecting the cause of his negative feelings onto others, rather than of his own doing. This can lead to aggression, oppositional behavior, adolescent delinquency and substance abuse later on. “It’s not my fault…” is a common theme. Since hyperactive behavior is difficult to overlook, such behavior is often maintained by feedback loops with others that provide reinforcing attention. To learn more about how this happens read: ADHD is learned attentional avoidance of bad feelings rather than a neurological disorder