ADHD in “The Boy from Hell” by Alison Thompson

The book The Boy From Hell by Alison Thompson (2013) tells her story as a mother raising her son Daniel. Daniel's mother explains, as a baby Daniel was irritable, moody, and inflexible. As a young child Daniel's mother describes Daniel as having a lot of energy, noisy, and destructive. When Daniel was a toddler him and his mother attended a group but Daniel was often disruptive and he would have temper tantrums. The temper tantrum would go on for hours and started if he did not get his way, was tired, or was frustrated.

In nursery school Daniel often had tantrums, difficulty sitting still, and often shouted out answers. Daniel's teacher recommended to his mother that she talk to Daniel's doctor about his behavior. When Daniel was six years old he was diagnosed with Attention Deficit Hyperactive Disorder (ADHD). In his early years of school Daniel had an Individualized Education Plan however his teachers were still concerned. Daniel was still having difficulty concentrating, he was disobedient, and aggression. Being in a large class Daniel often found many distractions. Being in a large classroom Daniel also had difficulty getting help from the teacher because there were so many students and only a few teachers. The school decided that Daniel should receive one-on-one support in class and anger management sessions. As Daniel's aggression increased the school decided the best way to handle the situation was to send Daniel home when he was aggressive. Toward the end if the year Daniel had a tantrum in which he threw chairs across the classroom almost hitting a teacher. As a result of the tantrum Daniel was suspended for two weeks. During this time the school decided that Daniel would get better help if he attended a different school.

After leaving his old school Daniel started attending a small unit designed for children who cannot be in mainstream education for any type of reason. Daniel continued to be aggressive and violent in class. Daniel also frequently would have meltdowns in which he would kick and throw objects at his teachers. Daniel had difficulty staying organized and his mother would set out his clothes in the morning and would prompt him in getting ready because he would often get distracted and began doing something else. The school soon referred Daniel for another assessment when he was seven. At this time Daniel was diagnosed ADHD with secondary Oppositional Defiant Disorder (ODD) with autistic traits. The doctor was hesitant to prescribe Daniel medication at first because he was so young. However Daniel became more aggressive and violent and was continuing to have tantrums. The doctor then prescribed Daniel Ritalin. Taking the Ritalin improved Daniel's behavior and teachers began to describe him as cooperative and participating in activities. At this time Daniel started attending a small school with an Autistic Support Unit, which Daniel attended one morning a week. Since the medication was wearing off by afternoon Daniel began to take a does at lunch to help him stay focused the whole day. Daniel's meltdowns and aggression continued which lead the doctor to increase his dose of Ritalin. The doctor also recommended a parenting class for his mother and anger management for Daniel. Daniel's mother explained that the parenting class helped her a little but was not the techniques were not appropriate for children with any psychological condition. Daniel was eventually placed in a school for children with emotional and behavioral difficulties. The school used a reward system, which worked for Daniel, and he improved both academically and behaviorally.

The book included a section from Daniel's sister perspective of growing up with a sibling with ADHD. Daniel's sister said that she often felt like she had to hold back on things she wanted to say because she did not want Daniel to get angry with her. She also talked about how she often wanted to include Daniel in activities with her friends but decided not to because she did not want them to say something that would make him angry. Daniel's sister said that Daniel often had a unique perspective on things and made family life more fun. Daniel's sister believes that having Daniel as a brother has made her more understanding of anyone with a psychological disorder.

Daniel explained that living with ADHD was difficult for him at times. However he believes the medication helped him to be more in control and made him less fidgety. When he was younger Daniel felt like he missed out on some experiences because he often did not have a friend group. Daniel went on to attend college, which made sure he had tutors who knew his difficulties. Daniel has been successful in college and his social life has grown significantly.

A diagnosis of ADHD is given when there is consent pattern of inattentive and/or hyperactivity which interferes with a person's functioning or development (Weis, 2018). Daniel displayed many of the inattentive symptoms mentioned in the textbook. One of the inattentive symptoms is difficulty maintaining attention on a task (Weis, 2018). Daniel had difficulty staying focused in school and at one point was getting one-on-one support to help him remain attentive during class. Another symptom Daniel displayed was not following though on instructions (Weis, 2018). Daniel's mother explained that some mornings when Daniel would be getting dressed she would go into his room and see him with one leg in his pants because something distracted him. A third symptom is difficulty organizing tasks and activities (Weis, 2018). Daniel's mother explained Daniel's difficulty with sequential tasks and often needed prompting to complete tasks. Another symptom is avoiding, disliking, or unwilling to do tasks that involve constant mental effort (Weis, 2018). Daniel often gave his mother and teachers a difficult time in completing schoolwork and homework. Another inattentive symptom is being easily distracted by unrelated stimuli (Weis, 2018). Being in a large class Daniel was often distracted by the other children and other objects in the classroom. Another inattentive symptom is often forgetting daily activities (Weis, 2018). Daniel's mother often had to remind Daniel to do his chores and sometimes even to keep eating his dinner when something would distract him. Daniel also displayed many of the hyperactive and impulsivity symptoms of ADHD. One of the symptoms is fidgeting and moving around in one's seat (Weis, 2018).

When Daniel was younger his mother explained that he had difficulty staying in his seat and would often jump up and down in his seat. Two other symptoms include leaving one's seat when one is expected to remain seated and runs and climbs in inappropriate situations (Weis, 2018). In school Daniel would often jump out of his seat and would run around the classroom. Another symptom is not being able to stay still for an extended period often described as being on the go (Weis, 2018). Daniel's mother described Daniel as having a lot of energy and always restless. Another symptom is answering questions before the question is completed (Weis, 2018). In school Daniel would often blurt out answers before the teacher could finish the question. Another symptom is difficulty in waiting for one's turn (Weis, 2018) Daniel's mother described how Daniel had difficulty in playing board games and would often have tantrums when he had to wait for another person's turn. Daniel experienced these symptoms before he was twelve years old and in two settings. ADHD runs in families and children are more likely to have the disorder if a biological parent has it (Weis, 2018). ADHD runs in Daniel's family as his father had ADHD. Some problems that are associated with ADHD are peer rejection and sleep problems (Weis, 2018). Daniel and his mother both said that Daniel did not have many friends in school. Daniel's mother also said that Daniel often had difficulties sleeping.

An effective treatment for ADHD is psychostimulants, which Daniel was prescribed. The medication helped to improve Daniel's academic performance and reducing his behavioral problems. Another treatment often used is Behavioral classroom management, which involves monitoring appropriate behavior and administering positive reinforcement for the positive behavior (Weis, 2018). The classroom environment is set up to bring about appropriate behavior and a report card is sent home to help parents also reinforce the appropriate behaviors (Weis, 2018). The small school that Daniel attended for children with emotional and behavioral difficulties followed this intervention. Daniel's behavior was monitored and he was given positive reinforcement when he behaved appropriately. Daniel's mother also received reports on Daniel's behavior at school. Daniel's treatment was unexpected in that it did not include any intervention to help social functioning. Daniel's mother mentioned that Daniel was having difficulty with academic work and engaging in extracurricular activities. The Challenging Horizons Program is designed to increase a person's academic performance and engagement and performance (Weis, 2018). The afterschool groups teach middle school student's organization and social skills (Weis, 2018). Daniel had difficulty in both these areas and this likely would have been beneficial to include in Daniel's treatment. One of the potentially effective treatments for ADHD is working memory training. Working memory-based training is a computer program that can be administered at home and is designed to help improve a child's working memory (Weis, 2018). Daniel's treatment did not include anything to try to strengthen his working memory. However Daniel likely would have benefited from trying working memory training since he had a lot of difficulty remembering to complete chores and sometimes to even finish eating.

Many youths with ADHD develop conduct problems like ODD. A diagnosis of ODD is having an angry/irritable mood, argumentative/defiant behavior, or vindictiveness (Weis, 2018). Starting at a young age Daniel's mother described Daniel as having a difficult temperament, which often contributes to childhood onset conduct problems. Daniel's mother described Daniel's mood as unpredictable. Daniel often would easily get annoyed when things did not go his way, which would turn, into tantrums. Daniel himself explained the difficulty he had in controlling his temper. He explained that when he was annoyed at someone he felt the anger controlled him and he could not stop it. Daniel's mother also described him as refusing to comply with requests and only wanting to do things he wanted to do. Daniel also often would argue with authority figures. Daniel would often name call or talkback to an adult when he would get frustrated. The argumentative-defiant behavior dimension, which Daniel presents, is associated with ADHD (Weis, 2018) Daniels' symptoms are moderate since they are present in two settings at home and at school (Weis, 2018).

Medication Daniel was taking for his ADHD also reduced his other behavioral problems including his oppositional and defiant behaviors. Daniel's mother was recommended to go to a parenting class she found the class not that helpful as it was not meant for children with a psychological conditions. Also recommended was Daniel attend anger management, which did not help. The treatment was inconsistent with evidence-based treatment for younger children with conduct problems with the lack of parent involvement. Parent Management Training is an evidence-based treatment for young children with conduct problems (Weis, 2018). In this treatment a clinician teaches the parent to interact with the child in an adaptive way and to avoid coercive interactions with their child (Weis, 2018). Having Daniel's mother participate in this type of training could have helped her learn new skills to help her manage Daniel because she explained she was having difficulty when Daniel would have larger tantrums. Studies on the effectiveness of parent training for children with ADHD have demonstrated positive outcomes (Atamanoff Gambert, 2007). The results have shown an increase in children's compliance, parents using appropriate commands, knowledge of appropriate parenting techniques, and use of positive parental statements (Atamanoff Gambert, 2007). Many of the studies conducted have focused on administering individual parent training however the few studies of group parent training have yielded promising findings (Atamanoff Gambert, 2007). Daniel and his mother likely would have benefited if parent training was included in his treatment.

Taking the personal experience of Daniel there could be many misleading ideas. One of the misleading ideas is that children with ADHD are also violent. Daniel was diagnosed with both ADHD and ODD and his symptoms were consistent with both diagnoses. Daniel also displayed the combined presentation of inattention and hyperactivity-impulsivity ADHD however not every child will have the same presentation. Some children could have predominately inattentive presentation or the predominantly hyperactive/impulsive presentation. With the different presentations of ADHD means that children can different symptoms and may not look anything like what Daniel experienced. The doctor also believed that Daniel demonstrated some autistic traits, which likely exacerbated his social interactions. Children with ADHD can face peer rejection but the presentation will likely not look exactly like Daniel's experience.

My final analysis of the book is that it gives a good description of a child with both ADHD and ODD. Many of the symptoms that Daniel's mother describes are not just ADHD, which the cover says the book is about life with a child with ADHD. I would recommend this book to a parent who has a child with ADHD and ODD. Daniel's mother did a good job describing Daniel's symptoms as well as giving advice to parents that have a child with ADHD. Daniel's mother also includes Appendix that includes the DSM criteria for ADHD and resources. Daniel's mother also interjects Daniel's story to included information about working with the school system. Since Daniel is from the United Kingdom this information would be best for someone that also lives there. I also thought that included Daniel's and his sister's perspective was a good way to get an understanding how they viewed either have ADHD or having a sibling with ADHD.

The text and research information had consistent information. The text gave a lot of information about the presentation of the symptoms for the different diagnoses. The text also gives a lot of information about associated problems especially with ADHD. The text also describes many evidence-based treatments for younger children as well as adolescents for both ADHD and ODD. The research journal article gave good information about different studies done to examine the effectiveness of treatments with children and adolescents with comorbid ADHD and ODD.

Reading The Boy From Boy, the textbook, and the research journal article I got more detailed knowledge about ADHD and ODD. Reading the story from a mother's perspective gives a more real example of what life is like living with a person with that disorder than just reading about disorders in a textbook. I also thought that reading from the different perspectives of the different family members gave an even better picture.

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