Attention deficit hyperactivity disorder affects an estimated 5% of children worldwide, but what actually is it? And how can we better support children in getting a diagnosis and the treatment they need?
Attention deficit hyperactivity disorder (ADHD) is a condition usually identified in childhood, and most of the time it shows as disruptive, fidgety or highly energetic behaviour. This is often noted at school or at home, and can leave parents feeling exhausted by trying to keep their child occupied and out of mischief.
Left untreated, children can suffer with mental health issues such as depression and anxiety, and are likely to experience problems in their later years and adulthood. But when identified early, and with good support, this is less likely.
What are the symptoms?
Symptoms tend to fit into one of three types:
Inattentiveness (also called attention deficit disorder) includes:
– Short attention span and lack of concentration
– Easily distracted
– Forgetful and disorganised
– Fails to finish homework or other tasks
Hyperactivity and impulsiveness includes:
– Unable to sit still
– Fidgety
– Unable to settle with tasks
– Talks excessively
– Unable to wait their turn
– Blurts answers before questions finished
– Interrupts
– Little or no sense of danger
A combination of these elements
Common myths
Behaviour in children varies greatly and can be categorised in simple terms as normal, troubled or troubling. However, as adults we all have a picture of what is good behaviour and what is bad behaviour and we tend to use this as rule of thumb. The behaviours associated with ADHD can be subtle, but occur in a range of situations so while people may misunderstand the condition, it’s worth remembering the following:
• ADHD is classed as a developmental disorder and is a medical condition.
• Girls get ADHD, although it occurs more in boys.
• ADHD does not discriminate, and it occurs in all social groups.
• Understanding and support is required to help both the child and parents.Tough love regimes can make things worse.
A diagnosis of ADHD takes time, and it is not uncommon for a diagnosis to be made six to 12 months after being referred. While this can be frustrating, it is important to eliminate other causes of behaviour that could look like ADHD. The process is like an assessment and has three key stages:
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A consultation, which will be carried out by a healthcare professional who could be a psychologist, psychiatrist, paediatrician, or a specially trained nurse. The idea is to understand what has been happening up until now at home and in school, and clarify what the problems are. There are usually two consultations to do this, and they can last between one and two hours.
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A medical, which is carried out by a doctor and is to rule out any other underlying physical conditions that might be causing the behaviour. If ADHD is diagnosed and medication is required, it provides a good baseline of the child’s physical condition.
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An observation, which is usually carried out in the home/social setting, and in the educational setting. It often includes other developmental and literacy assessments.
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There is no test for ADHD, so it is important to get an accurate assessment. At the outset, it may take some time to convince the GP that your child’s behaviour should be reviewed. Often, schools can be the first to notice the symptoms of ADHD, and may be able to help in progressing an assessment.
What is the standard treatment?
There are two main treatment options:
- Therapies aim to support the child with ways of managing the behaviours. These tend to be used before medication and require time, practice
and patience. The main approaches are counselling, psychotherapy, cognitive behavioural therapy, behaviour therapy, and family therapy.
However, not all of these approaches may be available in your area through the NHS. What is important is the quality of the relationship between the therapist and the child. The therapist should have some experience in working with ADHD or other behavioural-based issues.
- Medication that is designed to support concentration. There are presently five types of medication, which are prescribed at low dose and, if required, gradually increased to find the dose that works. All medications have side effects, and you should discuss medication treatment thoroughly with the doctor.
The five medication types are:
– Methylphenidate
– Dexamfetamine
– Lisdexamfetamine
– Atomoxetine
– Guanfacine
What causes ADHD?
There are several factors which contribute to the chance of having ADHD but there is no single cause. There is a link with the structure and functioning of the brain, as it tends to run in families and children at risk will be those with low birthweight or premature, epilepsy or brain damage.
Helpful hints
Managing behaviour without having coping strategies is stressful for everyone involved. To help, here’s some advice:
• Rules and boundaries should be clear, few in number, with defined consequences of poor behaviour.
• Be consistent and firm in applying rules. Changing them makes it difficult for kids to learn and adapt.
• Reward good behaviour with immediate praise, and by paying them attention.
• Let some things go; know which behaviours are intolerable, manage these and ignore the others.
• Break tasks into small chunks. This will help concentration. You can build up the size of the chunk as concentration increases. Be patient.
• Routines and structures help to keep them on track. Changes and additions should be introduced slowly.
• Being busy is good. But you don’t need to cram their schedule with after-school activities though, just keep them stimulated.
• Exercise is a good way to expel surplus energy. Structured exercise such as swimming can help to develop skills, movement and attention.
• A healthy diet and structured meal times can be helpful. Certain foods and drinks can overstimulate, such as sugar, caffeine, additives and processed foods, so be careful.
• A good night’s sleep is essential. Establish a routine, such as an extended storytime, gentle music, or a warm bath. The secret is to get them relaxed and settled.
There are many sources of information, help and advice on ADHD, but a good place to start is by visiting nhs.uk, as well as local groups, schools and your GP.
Simon Mathias is a psychotherapist, writer, speaker and expert in behaviour. He has a particular interest in ADHD and works with children, families and adults. He can be contacted on Counselling Directory.
