Understanding Hyperactive Children

Some people suspect that a large proportion of children abused by their parents may be hyperactive, because such children frequently behave in ways that frustrate and anger parents. There are also those who suggest that many of the kids risking their lives in motorcycle drag racing on the streets may also be hyperactive, because high speeds are very satisfying to these young people.

Hsiu-hsiu has only limited concentration and somewhat deficient manual dexterity, so the wood blocks topple to the floor before they get very high.

What is a "hyperactive child"? Some people have a general idea, but no real understanding; most know nothing at all. For a long time now, the illness of hyperactivity has been met with neglect and misunderstanding, not only harming hyperactive children, but also planting the seeds of a potential crisis for society.

What kind of child is, after all, "hyperactive"? The word itself means "excessively active." Some parents describe their children as "motors"-- endlessly turning. And some parents describe hyperactive children as being like the legendary monkey king Sun Wukong--hard to handle.

Motorized child

Hsiao Li is emotionally unstable and her reactions are extreme. She is usually laughing raucously or crying hysterically. In school, when she isn't out of her chair running around, she is hitting or bothering the other children around her. She can't sit still, changing positions every few minutes. And she has a poor attention span; in an hour, she only writes about 20 Chinese characters. In exams, she usually skips entire sections or pages.

Li-wei is always falling down and running into things, suffering one injury after another. In three years of school, his head alone has endured two serious blows, one suspected of having resulted in a concussion. He frequently engages in startling behavior. When his father brought him to the office, in just a brief time Li-wei had climbed onto a desk and stepped on a computer and then clambered onto a bookshelf. When Mom takes him out, he is liable to race across the street without looking out for traffic, causing his mother to shriek. Once his aunt took him to the post office; when she turned away for just a second, he jumped on the service counter and stuck his head through the window to see what the people inside were doing.

Hsiao Li and Li-wei are hyperactive children.

Spare the rod, spoil the child?

Many people have the misconception that hyperactive children are produced by excessive leniency or by poor parenting.

One set of grandparents said that it was simply "criminal" how their daughter-in-law had raised their eldest grandson to be so "bad." One teacher suggested that hyperactivity is just an excuse parents use for a failure to control their children.

Faced with such a lack of understanding, one mother grumbled, "You think these children are raised this way?! Let me tell you, it would certainly be no easy feat to produce a hyperactive child!"

Most parents of such children, unaware that their child is hyperactive, pass through a stage of hitting and disciplining the children severely.

Ho Shan-hsin admits that on more than one occasion she found herself simultaneously hitting her child, crying to herself, and yelling, "How could I have a child like you? For you I've given up my job to stay home and work at raising you, but still this is the way you are. How can you face me?!"

"At first I felt very frustrated. He had been taught for so long at nursery school, and been instructed at home for so long, how could my own child be this way?" So says Chen Yueh-tsu, who thought her child was impervious to discipline. Yet, she continues, she could strike the child until her own hand was numb, and still he would act completely capriciously.

In fact, for hyperactive children, who are less physically sensitive than other children, hitting and yelling are completely useless. These children can't concentrate, act capriciously, and fail to accept anything they are taught not because they have been spared the rod, and not because they haven't been raised properly. Rather, "there are some slight defects in their brains."

Ill, not mischievous

As early as the late 19th century, the medical community had discovered hyperactivity, unpredictable behavior, and an inability to concentrate in people who had suffered injuries to the brain or the central nervous system. Yet it is only in the last three decades that there has been systematic research into this syndrome.

The medical community has continually revised the definition and name of this illness. First it was "minimal brain dysfunction," then "hyperkinetic condition," and now "attention deficit/hyperactivity disorder" (ADHD). Chiu Yen-nan, a neurologist at National Taiwan University Hospital, lists the three main outward signs of a hyperactive child: extreme restlessness and inability to be still; inability to sustain concentration; and unpredictability and capriciousness. In addition, there are several collateral symptoms--hyperactive children tend to be learning impaired, accident-prone, uncoordinated with small objects, and so on.

What causes the illness? Medical reports suggest that a tendency for it may be passed along genetically. In addition, Dr. Chiu says that brain damage may result from such factors as a lack of oxygen in the process of delivery, infection in the womb, or extreme jaundice early in the infant's life. Such damage can lead to problems with the brain that add up to "ADHD."

Purposeless activity

Statistics from other countries indicate that the prevalence of hyperactivity is about 5-10%. Ouyang Juei-lin, a doctor at the Taipei Municipal Hospital for Women and Children who specializes in brain functions in children, conducted a questionnaire survey of parents of primary school-aged children in the Kaohsiung area. She found that as many as 30% of children inclined toward hyperactivity. (See table.)

Dr. Ouyang suggests that one reason the survey results are much higher than studies abroad is that Taiwan has so little space for its large population that parents may have lower tolerance for restlessness in children. "Hyperactivity" is correspondingly more pronounced.

Leave aside for the moment the question of whether there really is a higher percentage of hyperactive children in Taiwan than in other countries. Even using the generally accepted figure of 5%, there would be 300,000 hyperactive kids among Taiwan's six million children.

That so many hyperactive children have remained hidden in the general population may be because people have treated them as "mischievous," and, as many people think "mischieviousness is a sign of intelligence," the child's behavior is not considered to be a serious problem.

Dr. Ouyang points out that, whatever the superficial similarities between hyperactivity and mischieviousness, they are fundamentally different. While both types of kids are excessively active, the naughty child's behavior is purposive and filled with vitality. The hyperactive child, on the other hand, is just doing aimless and unproductive "busywork." Moreover, the merely troublesome child is perfectly capable of staying focused on activities in which he or she has a real interest. Afflicted children, however, cannot sustain concentration on any activities.

Impossible and unable

Though they have brain damage, hyperactive kids remain unaffected in terms of intelligence. Chiu Yen-nan points out that there is no difference in intelligence between hyperactive and non-hyperactive children; both groups include the full range from gifted to handicapped.

It is said that Jackie Chan had a learning impairment as a child, and got poor grades. He may very well have been a hyperactive child. Today he is an international film star. Dr. Norman Wang, director of the Agape Counseling Center, is an adult with a limited ability to concentrate. Wang, who holds a doctorate in clinical psychology, says that under ordinary circumstances he in unable to concentrate more than 20 minutes out of an hour, which greatly affects his academic as well as personal life. He says that while medications and biological feedback treatments can improve concentration, they are no cure. Yet he has been able to earn a PhD. Obviously, then, hyperactivity does not necessarily imply low brainpower.

It is precisely because intelligence is unaffected that the behavior of hyperactive children is so unfathomable and distressing to so many people.

Off to one side, a few children are scurrying about playing, and one of them bumps into Li-wei. Li-wei immediately turns around and punches him. Though it was made clear after the fact that the child did not intentionally run into Li-wei, the damage had already been done.

Wu Hsien and a group of children are playing billiards. Wu, with his poor physical sensitivity and control, whacks the ball much too hard, causing it to fly off the table. An adult off to the side yells, "You idiot! What if you killed somebody?!" His Mom Ling Shih-ying knows that the child did not do it on purpose, but simply has poor control. Yet in front of others Ling has no choice but to discipline him in order to show that she is a good parent.

The mother of one hyperactive child says anxiously, "If my child were simple-minded, maybe that would be all right, but his intelligence is normal in every way. I'm really afraid that when he grows up he will make mistakes, and do something harmful to others." This is a worry that many parents of afflicted children have in common.

They aren't playing Chicken Little. Among the general public, there is little understanding of, or attention paid to, hyperactivity. Many hyperactive children are simply labeled as "bad kids."

Chiu Yen-nan states that reports from abroad indicate a higher rate of criminal behavior among hyperactive children. Therefore, if these children are not handled properly and given help, they will not only get themselves and their families in trouble, they will create problems for society. "This is a group of kids that needs help and deserves special attention," Dr. Chiu concludes.

In search of a cure-all

Many parents react with disbelief and denial when first told that their child is "hyperactive." When they finally face reality, they then expect there to be some miracle cure.

Frustratingly, there is still no drug that can completely cure ADHD. However, says Chiu Yen-nan, there are ways to help children adjust and to prevent the condition from deteriorating.

Currently most hyperactive children are treated with medications, behavior modification, psychological therapy, and interpersonal training. These various approaches are complementary. As for the "sensation coordination training" currently popular, this is only a form of rehabilitation. It is perhaps helpful in improving dexterity, but is no cure for the whole syndrome.

One frequently used medication for hyperactive kids is "Ritalin." It is a stimulant for the central nervous system. The vast majority of hyperactive children placed on this medication can concentrate and sit still for two to four hours. Under these circumstances, education and other forms of guidance and training can proceed much more easily. But Ritalin has side effects--it may slightly impair appetite and affect growth. And many parents worry about addiction developing with long-term use.

Although the ingredients in Ritalin are similar to amphetamines, there is no danger of addiction if used as prescribed, says Chiu Yen-nan. Also, the impact on growth is very slight, and most children catch up to their peers after coming off the medication. "Children on hyperactivity meds are like handicapped persons with crutches. Some can throw their crutches away after a while, while others must use crutches all their lives. Either way, a person who needs crutches cannot do without them." Dr. Chiu adds that denying a child medication because of a few minor concerns will only make life that much more difficult for the child.

Just grow up?!

There is a logic behind the use of medications at certain stages. As the brain develops and the nervous system matures, defects decline. Self-control increases with age, as does the impact of cumulative learning experiences. Some hyperactive children improve as they get older. However, there are also those whose juvenile hyperactivity persists into adulthood.

Ouyang Juei-lin notes that the amount of activity of hyperactive kids decreases as they grow older. But there is little improvement in terms of ability to concentrate or capriciousness. Be that as it may, after hyperactive children leave the structured school environment, their hyperactivity is correspondingly less noticeable. Most hyperactive people are able to find suitable jobs after entering the working world.

Although the problems of hyperactive people may not be so pronounced after they grow up, the maturation process is very rough. Due to a lack of understanding about their illness, they are often hit or yelled at by their parents. Unable to concentrate in school, they frequently fall behind. As they behave strangely and unpredictably, they have difficulty in interpersonal relations. Labeled by schools as "bad," they find themselves--if not tossed around from school to school--then relegated to the rearmost desk in the classroom and left to fend for themselves.

Looking for a port in a storm

Hsiu-hsiu, a hyperactive child, has been kicked around like a football from the time he first entered school. His mother moved three times, from the Taipei suburb of Hsinchuang all the way out to Taoyuan County, in search of a kindergarten that would accept her son. Finally, a relative who runs a kindergarten reluctantly agreed to accept the boy.

Li-wei, now in third grade, has changed primary schools three times. A few weeks after entering school, it was necessary to take him out of school for a year because of severe adjustment problems. On only the third day after being enrolled in the experimental Forest Primary School, he fell and had to be sent to the hospital. It was only when he entered the small class system at the Tianyuan Experimental School that he found a teacher and principal willing to accept and cope with his behavior, and he was able to settle into a program. But this year the teacher left the school, and the principal was given a different job; Li-wei thus transferred again so as to be at the same school as the principal.

Lin Huei-wen, who herself teaches in a high school, is disheartened by Taiwan's educational environment. When she went to school to talk to the teacher about her hyperactive son, the teacher said, "Even lions and tigers can be tamed with whips. I can't believe we won't be able to get your son straightened out." As a result her son spends most of his time standing in the back of, or outside of, the classroom as punishment.

One frustrated parent got in an argument with the teacher. The teacher couldn't put up with the hyperactive boy, but, fearing that using corporal punishment would put his pension at risk, the teacher told the boy to hit himself in the face.

Chiu Yen-nan points out that hyperactive children are frequently subjected to strict discipline. Yet, not only is this of no use to the child, it will worsen his or her behavior. A vicious circle can develop.

Troublemakers?

In the eyes of teachers and classmates, accident-prone hyperactive children are "eternal troublemakers." Constantly criticized and excluded, hyperactive children suffer serious harm to their character development and self-esteem. Li-wei once said to his mother, "I'm really a rotten person. How could I be so messed up? I want to kill myself!"

In fact, parents do not necessarily want teachers to go easy on their hyperactive children. They just want the teachers to show appropriate forbearance and give the children the opportunity to release some of their energy.

One day Li-wei said to Ho Shan-hsin, "Mom, other children get called up in front of the teacher if they eat something in class even once. I only get called up if I eat three times." Ho was deeply moved when she heard his, for it meant the teacher was showing appropriate patience with Li-wei's condition.

However, though one might be lucky enough to run into such a teacher, in the existing educational system one cannot deliberately seek them out. Wang Ta-ting, a professor in the Department of Special Education at Taipei Municipal Teacher's College, points out that prior to last year there was no special training for teachers in how to handle hyperactive children. Last year the college sponsored five or six seminars on the subject to try to make up for the gap.

Nevertheless, "distant water is of little use in putting out a fire right here." A few seminars can have about as much impact as "a glass of water on a roaring blaze." Recently, some anxious parents have convened several public seminars in an effort to guarantee their children's right to an education.

"Hyperactive children have the right to an education, but other children also have the right to an education." Noting that currently hyperactive children are scattered at random in schools and classes, Wang Ta-ting unflinchingly identifies the key problem: A hyperactive child can eat up a disproportionate amount of a teacher's time that could be spent instructing other children. Yet, from the point of view of hyperactive children, putting them in a corner to fend for themselves is no solution.

Wang points to a recent study of "mixed, inclusive" education done by the US Department of Education in 1994. In the study, children from special education classes were placed in normal classrooms. Virtually all types of special-ed kids were successfully integrated into normal classes, with one exception--hyperactive children.

Wang argues that the ideal situation would be to establish "resource classes for hyperactive children." Hyperactive children having a hard time adjusting could first stay in these resource classes until they showed improved functioning and learning impairments were eliminated. Then, accompanied by a special-ed teacher, they could transfer to a regular class. The special-ed teacher would continue to provide guidance until the child had adjusted.

Wang suggests, "Hyperactive children could be steered toward more physical education. Not only would this allow them to do what they naturally want to do, they could develop in a more productive direction."

His idea fits in well with Li-wei's own experience. In class Li-wei was selected as "phys-ed class leader." When asked what he wants to be when he grows up, he says without giving it a second thought, "a gymnast."

Hyperactivity treatment DIY

Special education reforms in schools cannot be implemented in a single bound. Yet parents who might want to educate their hyperactive children themselves don't know where to begin. Taiwan has never had much information available on hyperactive children, and parents often feel isolated and helpless, not knowing what will be best for the child.

Chen Chi-yu, himself a pediatrician, feels as confounded as any other parent of a hyperactive child. Chen says it has been seven years since confirming that his son "has a problem." "For the last seven years, I have had the feeling of being lost in the ocean looking for help. Once in a while, with great effort, I find a piece of driftwood to hang onto, but in the end it always proves too fragile and I have to move on and start looking all over again." His experience has been one of incessant disappointment, with no practical assistance.

Over the long term, many parents have devised their own "do-it-yourself" methods of raising their hyperactive children. Ho Shan-hsin is one example of such a parent.

Ho keeps a chart posted on her refrigerator for grading the behavior of Li-wei and his younger brother. The chart has six categories: paying attention, thinking before doing, staying close to God, showing love to family, self-motivated improvement, and reading.

Ho explains that these may seem fairly simple tasks for an ordinary kid, but they are very difficult for a hyperactive child. Therefore, Ho sets relatively relaxed standards for Li-wei. For example, if Li-wei restrains himself from hitting his brother, but instead runs to Mom to complain, he gets points for "thinking before doing." She also will give him points for "paying attention" if he can sit and watch TV for a while. When Li-wei accumulates enough points, he gets a prize of his own choosing. Ho states that since implementing this behavior modification system half a year ago, she has seen clear improvement in Li-wei's conduct.

Chen Chi-yu and his wife have adopted the "tag-team" approach. If after ten tries their son still does not understand "one plus one equals two," they will try 20 times, or 100 times. When one parent gets to the limits of his or her patience, the other takes over. In this way they can avoid angry outbursts they would later regret.

Meanwhile, Ling Shih-ying manages her son's behavior by awarding him his favorite special treat (video games) or withholding the best-loved part of his daily routine (having his Mom tuck him in to bed).

Focus on the good points

"Every day I pray that God will give me the love and patience that I need for that day to face my child," says Ho Shan-hsin. She does not ask for much, just enough for one day. Even still, she often feels that her love and patience have been exhausted. Once Li-wei (who frequently walks away and gets lost) disappeared in Hong Kong. Ho had the momentary impulse to escape from her troubles, and blurted out to her husband, "If he's lost, then he's lost!"

"This is an extremely trying experience. Parents have no choice but to accept it," says Chen Chi-yu. He adopts cooking rice as a metaphor for raising a hyperactive child: You cannot just turn on the cooker and expect your rice to be ready in a couple of minutes. And even after the indicator pops up to tell you that the rice is done, you still have to wait before you can get the rice out. "It's not something you can hurry along," he concludes.

Ironically, while the parents of most handicapped children have society's sympathy and applause, the same is not true for parents of hyperactive children. Indeed, as their children appear perfectly healthy on the outside, not only do the parents get little support, they have to bear the burden of being seen as "unable to bring up their kids properly."

Fortunately, many of these parents who have struggled in isolation for so long have begun to seek support and assistance. Several families with hyperactive children are banding together to form an ADHD association. Besides providing for mutual support, assistance, and sharing of experiences among families, the association also hopes to draw on the combined power of all the members to increase understanding, concern, and help for hyperactive children in society at large.

Many people may ask, "What is the best way to relate to a hyperactive child?" Wang Ta-ting avers that the best way is to focus as much as possible on his or her good points, and ignore as much as possible the shortcomings.

Even in a moving car, hyperactive children can't resist acting out.

How do you feel today, my little friend? Li-wei points to the "happy" picture to answer the photographer.

Biological feedback devices, which have been used to improve the concent ration of F-16 pilots, are now helping hyperactive children concentrate. The computer beeps immediately when the subject gets distracted.

Long misunderstood, the families of hyperactive children are banding tog ether to seek support and assistance from society.