Let's talk about concentration difficulties...
GENERAL INFORMATION & SYMPTOMS
Concentration is always a controversial topic with a lot of different opinions. There is a lot of information available on concentration and this page is by no means comprehensive.
The school environment creates multiple challenges for children with attention deficit disorder since they need to - sit still, listen quietly, pay attention, follow instructions, concentrate. These are the very things that children with ADD/ADHD struggle with.
We differentiate between three sub-types namely:
- Predominantly inattentive presentation: sufficient inattentive but insufficient hyperactive-impulsive symptoms are present.
- Predominantly hyperactive-impulsive presentation: sufficient hyperactive-impulsive symptoms inattentive but insufficient inattentive symptoms are present.
- Combined presentation: Individuals who showed at least 6 inattentive and 6 hyperactive-impulsive symptoms.
Core symptoms (DSM-V)
The 9 inattentive symptoms
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The 9 hyperactive-impulsive symptoms
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Individuals younger than 17 must display at least 6 of 9 symptoms to warrant a diagnosis of ADHD. Clinical experience has shown that the most effective treatment for ADD/ADHD is a combination of dietary intervention, medication, the necessary supplementation, therapy and/or counselling to learn coping skills and adaptive behaviours, as well as academic accommodations for children and students with ADD/ADHD.
GENERAL RECOMMENDATIONS FOR PARENTS
1. General parent guidance
- Self-image & motivation motto: Just keep on trying your best and never give up.
- Discuss and set routines, tasks, rules and subsequent consequences.
- First time club rewards system. Make a rewards chart with no more than 3 – 5 expectations/ tasks – he can for example get a star if he completes it without you reminding him and then after for example 10 stars he can choose a reward. It can be for each star he gets R1, or he can play 1 minute on IPAD for every star, or he can choose a family activity he wants to do for example drink milkshake with family et cetera.
- Guidelines on disciplining child. Discipline must be realistic and achievable for the child and the parent – so rather use shorter discipline time and be consistent.
- Rather give “Do this” instructions instead of “Don’t” instructions for example “Keep your feet on the floor” instead of “Don’t climb in the tree.”
- Traffic light – Red: Stop everything; Orange: Continue slowly, think and plan activity; Green: Safe, free to continue.
- Instruction: Make physical contact, eye contact, let him repeat instruction.
- Deep pressure is calming: hands on head and press down, chair push-ups, horse kicks, tight hugs, wheel barrow walking, trampoline et cetera.
- Emotions: All emotions are allowed but not all actions. Verbalise child’s emotions and give acceptable choices to express their emotions.
- Sleep routines are very important.
- Limit technology use.
- Set good examples at home.
- Encourage socialisation: invite a class mate over, therefore they build up healthy social relationships that can be carried over to the classroom.
- Give acceptable choices in everyday tasks.
2. Work speed & completion of tasks
- Set routines & let him know if it’s going to change.
- Give set amount of time to finish work, do extra work if finished before that time.
- Use of two clocks or egg timer.
- Motor planning: Break tasks down to smaller instructions, ask child to explain process.
3. Read a lot.
- Read with child so that he can get the right example.
- Ask questions about the story / pictures.
- Ask him to repeat the story.
4. Try fidget toys like disc’o’sit, tangles, fidget foot bands to help him with modulation and concentration.
5. Look at supplements and diet in general.
6. Monitor concentration difficulties & make appointment at developmental paediatrician/ neurologist if concentration problems continue after diet changes and supplements are implemented. It’s important to remember that a child’s concentration varies according to his interest in the activity and to the amount of distractions around him. This is some of the reasons why concentration is usually more of a problem at school as at home. The classroom teacher can therefore usually give a good record of your child’s concentration.
GENERAL RECOMMENDATIONS TO THE TEACHER
1. Seating in the classroom:
- Do not place learner directly in front of the window or door.
- Seat the learner where possible in the front and in the middle of the class (otherwise on the side) or in front of the teacher's desk.
- Seat the learner if possible next to a quiet student.
- Make use of a disc'o'sit (rubber cushion).
2. As a general rule of thumb, a child should be able to sustain their focus or attention for 2 to 3 minutes for every year of life, so a 3 year old should concentrate for approximately 6 to 9 minutes et cetera.
3. You might have heard the saying: “If your bum is numb, your brain is dumb.” Children need movement to stay focused. Recent research suggests that physical activity increases the levels of the neurotransmitters dopamine and norepinephrine; these chemicals play a key role in sharpening focus and increasing attention.
4. Quick movement breaks between activities for example:
- Use a signal like a bell or whistle, let the whole class stand up, do an action and then quickly sit down.
- 5 chair push-ups.
- Clap a rhythmic pattern and get the children to repeat it.
- Use movement songs and rhymes, especially songs that you can cross over the body’s midline.
- Play a quick round of Simon says.
- Get them to look at the room and memorise where things are, send them away and move one object and they must come back and identify what/who was moved.
- Get learners to close their eyes and listen to all the noises they can hear and ask them to identify the noises.
- Make use of midline crossing activities for example cross over clapping pattern, clap leg with opposite hand et cetera.
5. Deep pressure is usually calming, let learners put their hands on their heads and push down on their heads for 10 counts and then stretch their arms up or use chair push-ups.
6. Traffic light system. Red: Stop everything; Orange: Continue slowly, think and plan activity; Green: Safe, free to continue.
7. Try to make eye contact or physical contact for example holding shoulder while giving instruction.
8. Set up reward system if it is not in place yet for example get a star if work completed. He can get a reward if everything has a star at the end of the week.
9. Have an unobtrusive cue set up with the student, such as a touch on the shoulder or placing a sticky note on the student’s desk, to remind the student to stay on task. Therefore the learner are not getting excessive attention in the classroom, but is still reminded to stay focused on the task.
10. Use of fidgets like disc’o’sit, tangles, stress balls, fidget foot band, playing with tubing, pipe cleaners, doodling, chewing gum et cetera. Fidgets are mindless activities you can do while working on a primary task. We’re not talking about wriggling in your seat - fidgeting is more intentional.
11. Beat the clock - set a timer or use an egg timer.
12. If possible, work on the most difficult material early in the day.
13. Use visuals: charts, pictures, colour coding.
14. Break down large tasks in smaller parts.
15. Set up “safe zone” in classroom – place where learner can go when over stimulated till he gains control over himself. A small tent might be nice but anything like a pillow with maybe a teddy and some fidget toys will be perfect. It might be disruptive in the beginning but work wonders in the long run. Teach children to recognise symptoms of over stimulation so that they can go to safe zone before they have a meltdown. Set up definite rules for example quite in safe zone, timer for how long they can stay et cetera.
10 STEPS BEFORE MEDICATION
Please note that ADHD refers to Attention Deficit Disorder with or without Hyperactivity.
This article gives a broad approach to what can be done for children with ADHD before commencing medication. Bear in mind that there is a definite place for medication in the treatment of ADHD, and it has helped many a child through a crisis. However there is a lot more that can be done to help these children before commencing the drug route. Genetic and environmental factors are some of the factors to be considered.
Step 1: Hydration
Most people are chronically dehydrated simply because they don’t drink enough water:
•Drink filtered water
•Use water from glass or stainless steel containers.
•Avoid sterile or distilled water, avoid plastic bottles
•Avoid sweetened fruit juices, and eliminate colas.
The bottom line is: drink more water.
Step 2: Methylation
Homocysteine levels provide a measure of the body’s methylation process which is the body’s ability to maintain chemical balance.
•High homocysteine levels can affect the brain contributing to depression, poor concentration, poor memory, sleeping problems, mood swings and anxiety.
•There is a strong genetic component, especially in the SA population.
Treatment requires B-vitamins: Folic acid B3, B6, and B12.
Step 3: Glycation
Stable sugar levels are the key to brain health. Glucose is the most important brain nutrient but too much of it damages nerve cells. It can cause inflammation in the brain and this is called glycation.
•Around 50% of nutrient intake should be complex, slow releasing, and carbohydrates.
•According to research excess white sugar and refined carbohydrates can lead to low IQ, bad behaviour, depression, eating disorders and learning disabilities.
Normalise sugar levels by excluding most sweetened breakfast cereals, sweetened fruit juices, colas, fizzy drinks, biscuits and high energy sweets. Eliminate food chemicals and preservatives. More than a 1000 of these compounds have been indicated as active anti-nutrients. Natural is always better. See good carbs, bad carbs.
Step 4: Lipidation
The human brain, on average, consists of 80% water. The dry weight of the brain is 60% fat; and these should be good fats rather than bad fats. Research shows that what you think and what you feel totally depends upon the amount and type of fats eaten on a daily basis.
•Trans fatty acids are the really bad fats for the brain. They are chemically altered fats and become embedded in the cell membranes.
•Hydrogenated fats are bad.
•Cut down drastically on all bad fats.
•Saturated fats are important but should be less than 10% of the total fat intake.
•Omega 3 is a good fat and provides EPA and DHA.
Symptoms of insufficient good fats include:
•Chronic thirst, dry unmanageable hair, brittle soft nails, ear and sinus infections, memory and concentration problems as well as vision problems.
At least have 2 – 3 fatty fishy meals a week.
Step 5: Supplements
We are not getting sufficient nutrients from the foods we eat. Organic supplements are best as they come from whole food products.
Supplementation should include:
•Most important: a well-balanced multivitamin in the morning.
•B vitamins (including folic acid) taken morning and evening.
•Lecithin E (Lecithin combined with Vit E). Phospholipids improve insulation around brain cells. Can use up to 5g per day.
•Omega 3 - EFA’s. High dosages to be divided into morning and night servings.
•Antioxidant supplementation - not enough antioxidants in fruit and vegetables alone.
•Calcium Magnesium and Vit D – divided dosage morning and evening.
Supplements do not replace healthy eating, they are added to the diet. Supplements are not medication – they are what the body needs to grow and maintain.
Step 6: Allergies
Children are eating up to 5kg artificial additives every year. These can cause reactions in the body and children with ADHD are 7 times more likely to have reactions. 90% of children with ADHD are likely to have food allergies. The most common foods can be tested by using the IGg food sensitivity test profile.
Step 7: High Stress Levels
These are linked to the inability to adapt and cope with situations. Children with ADHD are more likely to be in trouble with parents, teachers and others.
•This causes excessive stress which affects adrenal hormone levels which also affects brain function – especially forgetfulness.
Help these children with:
•avoiding intake of sugars, refined carbohydrates
•well-structured home environment
•using natural stress relief products eg GABA
Step 8: Sleep Hygiene
Adequate sleep is vitally important for brain health. Not getting enough sleep is another stressor to the body.
Have a good sleep routine:
•Regular bedtimes – going to sleep and waking up at regular hours.
•Have regular hours of sleep
•Keep sugar levels even.
•Ensure that your balance of vitamins and minerals contain B6 and zinc
•Take regular exercise
•Use natural sleep agents – e.g. take Calcium-Magnesium supplements at dinner time.
•Limit technology before sleeping time.
Step 9: Colon Health
A healthy colon – a healthy child – a healthy brain.
There are 10x more bacteria in the large intestine than there are cells in the body. Problems arise when these flora are abnormal. We need the correct colon bacteria as well as adequate water for normal colon function.
Leaky gut syndrome can cause food sensitivities.
90% of serotonin is manufactured in the colon. Insufficient serotonin can cause depression and anxiety.
Chronic constipation can be auto intoxicating and lead to many problems. Regular bowel movement and a normal gastro-colic reflex is important for long term colon health.
Children need colon training:
•Teach regular bowel habits.
•Need enough water
•Less refined sugars and refined carbohydrates.
•Have enough omega 3 EFAs and supplements
•Probiotics – Prebiotics and digestive enzymes.
Step 10: Psychology and Behaviour
ADHD is a stressor and a challenge affecting every area of a child’s life. Be very careful with labelling affected children. Remember they are very special individuals.
•Use behaviour therapy to change certain behaviours by increasing the frequency of acceptable behaviour with rewards and positive feedback.
•Consider your attitude to children with ADHD.
•What is your belief system and what is that of your children.
•What confidence do you have in children with ADHD.
We raise these children with no self-belief and no confidence, and forget the exceptional qualities and talents of individuals with ADHD.
When using their creativity and natural drive ADHD people are often more adapted to the modern day lifestyle, often coping better in the work place. Others are starting to see them in different ways which acknowledge their strengths, and new labels are emerging such as “Latent Entrepreneur Personality Type”, acknowledging that ADHD is not a deficit or a disease.
Changing a few things in the life of ADHD kids can prevent the damaging labels, maintain self-esteem, and help them to be normal well-functioning adults.
Extracted from a talk by Dr Hein Badenhorst
CONCENTRATION & FIDGET TOYS
Recent research suggests that the body affects the brain as much as the brain affects the body. In his recent book, Spark, John Ratey, M.D., shows that physical activity increases levels of the neurotransmitters dopamine and norepinephrine. Both chemicals play a key role in sharpening focus and increasing attention.
It’s true that many people are successful only when they do one thing at a time, but for adults and children with concentration difficulties, the opposite is usually true. Children with concentration difficulties may actually concentrate, focus and stay better on task with a little foot-tapping, gum-chewing or fidgeting.
Intentional fidgets allow you and your child to self-regulate in a controlled, constructive manner. An effective fidget doesn’t distract you from your primary task because it is something you don’t have to think about.
Experiment with a variety of strategies and encourage your child to try different fidgets. Here are just two examples:
Tangles are based on the concept of infinity and continuous motion. Technically, it is a series of 90-degree curves, connected and able to pivot at each joint. It has no beginning and no end - just continuous motion!
A Tangle is more than just a toy. This "Magic in the Motion’ that you feel when you play with a Tangle is truly therapeutic and calming to the soul! Tangles have endless uses and serve a variety of different purposes. It can be a puzzle, a movable sculpture, a desktop toy, a fidget, a brain tool or an anti-stress device. The possibilities are limitless!
What do Tangles do?
- Tangles help with self-regulation and therefore have a calming effect.
- Tangles encourage focus, attention and active listening.
- Tangles offer a hands-on experience.
- Tangles are fun to look at, fun to hold, fun to twist, turn and manipulate.
- Tangles bring out creativity and imagination.
- Tangles are silent and therefore do not disturb or disrupt others.
- Tangles are appealing to all ages, to boys and girls alike and even adults.
- Tangles are safe, reusable and affordable.
When is the best time to use a tangle as a concentration aid?
- During circle time when the teacher is reading story and children need to sit still and listen.
- While teacher is explaining the next work and children need to sit still and focus on the explanation and instructions.
- When finished with work and waiting for next instruction from the teacher.
- At home while studying.
CLASSIC TANGLES AVAILABLE @ R30 (COURIER NATION WIDE)
Fidget foot bands
Fidget Foot Bands are a continuous loop of stretchy band you place around the chair legs to keep fidgeting feet busy. Kids have fun and stay more focused as they push, pull, or kick these stretchy fidgets with their feet. These one-piece quiet foot fidgets are great for classrooms and home. It is stretchy and can fit around different size chairs.
How to use it:
- Place fidget foot band around the front legs of any chair.
- Child place feet behind the foot band and pull forward against the resistance. This keeps busy feet occupied and provide deep pressure. Deep pressure is known to have a calming effect and therefore helps to keep them focused.
FIDGET FOOTBANDS AVAILABLE @ R45 (COURIER NATION WIDE)
BIBLIOGRAPHY & RESOURCES
Some helpful resources: