Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition which causes three groups of behavioural symptoms:

• Inattentiveness (a short attention span and easily distracted)
• Hyperactivity (on the go and fidgeting)
• Impulsivity (difficulty in controlling behaviour)

The condition is broken down into three subtypes:

• ADHD inattentive type: child finds it hard to pay attention
  but is not hyperactive or impulsive. Girls often suffer this form. They can
  appear quiet or dreamy. This type of ADHD may be under-identified
• ADHD hyperactive impulsive type: child is mainly
  hyperactive and impulsive
• ADHD combined type: child has all three symptoms. This is
  the most common subtype

The three groups of symptoms can cause the following range of behaviours:

Inattentiveness

• a short attention span
• making careless mistakes
• appearing forgetful and loosing things
• unable initiate, organise and complete tasks
• unable to stick to tedious tasks
• unable to listen to instructions
• unable to carry out instructions
• flitting from one activity to another

Hyperactivity

• difficulty in sitting still
• constant fidgeting
• unable to settle to tasks
• excessive talking

Impulsivity

• acting without thinking
• unable to take turns
• interrupting conversations
• no sense of danger
• breaking rules
• taking unnecessary risks

More information

ADHD is the most common behavioural disorder in the UK. It is estimated to
affect approximately 5% of school children and is 3-4 times more likely in
males. Symptoms begin to show in early childhood and often become more
noticeable when the child starts school. Diagnosis is most usually made
between the ages of 6 – 12 years

ADHD can affect anyone regardless of intelligence, ethnic group, social class
or family background. It is not the result of ‘bad parenting’ although it can
carry this sigma. Having a child or teenager with ADHD presents many
challenges and parents/caregivers should be recognised for their efforts in
dealing with the condition, as it can have a great impact on family life

Over time symptoms (particularly hyperactivity) may improve as the brain
matures. This is because an adult brain is more easily able to recognise and
control behaviour. However, it has been suggested that up to 60% of those
affected can suffer persistent impulsive behaviour and lack of focus well into
adult life

ADHD need not be a barrier to success but it raises the risk of
under-achievement at school, leading to difficulties in accessing further
education and employment. It can also lead to mental health problems. Because
of this early recognition, diagnosis, treatment and sympathetic support are
very important.

Causes of ADHD

The exact cause is not understood, but it is currently thought that both
genetic and environmental factors play a role. Risk factors include premature
birth and maternal smoking/drug/alcohol abuse in pregnancy.

The brain and ADHD

The brain is the centre of all life and thought. It allows us to understand
the world by taking information in through the senses and directs us to
respond to this information. The brain is made up of millions of cells
(neurons) which communicate with each other and with nerves in different parts
of the body. Neurons are separated from each other by tiny gaps (synapses).
Communication takes place when electrical messages pass between neurons after
the release of chemicals (neurotransmitters) into the gaps. Neurotransmitters
are needed for all brain activity including a set of processes known as
‘executive function’

Executive Function

Executive function enables us to be effective and efficient, as well as
creative and productive. It is responsible for:

• Attention and focus
• Organisation, planning, prioritizing
• Starting tasks and completing them
• Memory
• Self-monitoring
• Impulse control

Studies have shown that executive function can be impaired in ADHD. This may
be due to low levels of certain neurotransmitters (dopamine and
noradrenaline). These low levels mean that insufficient messages reach the
areas of the brain which control executive function.

Related Conditions

Because the brain is such a complex organ it is not uncommon for children with
ADHD to also suffer with other conditions known as co-morbidities. Examples of
co-morbidities include:

• autism
• learning difficulties
• genetic disorders
• epilepsy
• anxiety
• depression
• tic disorder
• sleep problems
• conduct disorder

For a story book to share with your child about their condition please click here.

Diagnosis of ADHD

Many children go through phases of being restless or inattentive. This is normal and does not mean they have ADHD. Diagnosis of ADHD can only be made by a specialist doctor (paediatrician/psychiatrist), and involves taking a detailed history, making observations and gathering information from home and school by use of reports and questionnaires. Diagnosis is only given when a strict set of criteria (DSM-5) are met:

• a presentation of 6 or more symptoms of inattentiveness or six or more symptoms of hyperactivity and impulsiveness. The type of ADHD diagnosed depends on the number of symptoms from each group
• the symptoms have to have started before the age of 7 years
• the symptoms have to have been continuously present for at least 6 months
• the symptoms have to be present in at least 2 settings (for example home and school)
• the symptoms have to significantly affect the ability to function on a social or academic level
• the symptoms cannot be accounted for by any other developmental disorder or condition

Treatment of ADHD

There is no cure as such for ADHD.  The first line of treatment involves using behaviour strategies both at home and at school.  Children with ADHD respond best to structure and clear boundaries, together with reward systems for positive behaviour. These strategies must be consistent and rely upon good communication and team work between all adults who have responsibility for the child.

If symptoms do not improve and have a significant impact on educational progress, homelife or self-esteem, medication may be used to treat the condition alongside behavioural strategies.  Medication helps to correct the chemical imbalance in the brain by increasing the amounts of certain neurotransmitters.  For more information refer to Medications for the Treatment of ADHD.

All children and teenagers, including those with ADHD, benefit from a healthy lifestyle.  Parents/caregivers are encouraged to help their children/teens make wise lifestyle choices to help them reach their full potential.  Refer to Lifestyle Tips for Children/Teenagers with ADHD for guidance.

Talking about ADHD

Children with ADHD need to know about the condition, but only when they are ready.  A rough guide would be between the ages of 7 – 9 years, but this is dependent upon on their level of maturity, learning ability and whether there are co-morbidities present.

When talking about ADHD it is important to use words children will understand. Describe the condition in positive terms, placing emphasis on strengths rather than weaknesses.  Children with ADHD are frequently creative and enthusiastic.  They also have the ability to focus extremely well on things which interest them.  Let them know that having ADHD is not a bad thing and they are not alone.

For help in communicating with children about ADHD see Support and Further Information.