Attention Deficit Hyperactivity Disorder (ADHD) involves excessive activity, problems with attention span and impulsive behaviour.In some children problems are concentrated in one area and a diagnosis of Attention Deficit Hyperactivity Disorder Predominately Inattentive (ADHD- PI or simply Attention Deficit Disorder) or Attention Deficit Hyperactivity Disorder- Hyperactive Impulsive (ADHD- HI) is given.
ADHD is thought to affect between two and five per cent of school children and the condition is much more frequently diagnosed in boys.
Experts used to believe symptoms disappeared in adolescence but in recent years research has suggested that problems continue into adulthood in up to half of cases.
Does my child have ADHD or is he just lively?
Children are naturally active, easily distracted and sometimes badly behaved. Exhausting though this may be for their parents, exuberance, thirst for new things and the testing of boundaries are part of normal childhood.
In a child with ADHD however the activity levels, concentration problems and impulsivity are excessive for the child's age, do not abate and cause problems in day to day life.
The condition may come to light when a child begins school and finds the restraints and expected levels of concentration more difficult than other children. A child with ADHD will have similar problems at home as at nursery or school. Diagnosis is usually made between the ages of three and seven.
Signs that a child may have ADHD include:
The child seems forgetful, distracted or disorganised, takes a long time to begin tasks and struggles to complete them.
The child may be restless, fidgety and struggle to sit still. They may be very noisy and excessively talkative.
The child may appear to do things without thinking, struggle to wait for a turn in a game or queue and frequently interrupt conversations.
At school the child may be under-performing and struggling with work and organisation. There may be a lack of attention to detail and frequent apparently careless mistakes.
The child may frequently get into trouble and have problems with friendships due to impulsivity and hyperactivity.
How is ADHD diagnosed?
Parents should discuss their concerns with their doctor, or the child's school who may arrange for an Educational Psychologist to observe and meet the child. A definitive diagnosis is made by a paediatrician or child clinical psychologist after referral from the GP.
There is no simple medical test for ADHD so assessment is on the basis of observation, a detailed medical and family history, reports from teachers and parents and specialist tests highlighting difficulties with attention and behaviour.
The doctor will seek to establish whether the child's behaviour is outside the norms expected for their age and intellectual ability, and also rule out any other causes for their difficulties (for instance autism spectrum disorder, hearing or visual problems or depression).
What causes ADHD?
Doctors do not yet know what causes ADHD. It used to be dismissed as the result of bad parenting or excessive TV watching or video game playing, but while these things can aggravate the symptoms in some children with the condition, experts now believe the most likely causes are a chemical imbalance in the brain and a genetic predisposition.
Siblings and children of people with ADHD are more likely to develop the condition. Premature birth, low birth weight and complications in pregnancy and birth which could affect the development of the brain are also thought to be linked with increased risk of ADHD.
How is ADHD treated?
There is no cure for ADHD but early diagnosis and appropriate support or treatment can make a huge difference to the child (and family's) quality of life and success.
Without the right support children with ADHD often perform poorly at school, struggle with relationships and employment and have an inflated risk of suffering from depression.
However with the appropriate treatment and support children with ADHD can lead very successful and happy lives.
Choosing the right way to help a child with ADHD should be based on the needs of the child and how severely their condition affects them (it can vary from mild to severe). Options include behavioural and cognitive support, practical lifestyle changes and medication. For many children a combination of approaches works well.
Behavioural techniques might include family therapy focussing on management techniques and individual counselling for the child focussing on changing behaviours.
Families often find simple changes at home such as allowing plenty of exercise, eating healthily, implementing routines and rewarding good behaviour can make a positive difference.
At school simple changes can be made once the child's needs and difficulties have been recognised. Teachers might seat a child further from distractions or other children or closer to the front of the classroom. Helping a child with ADHD to start tasks and breaking down activities into more manageable chunks can also boost progress.
For some children medication works very well, and while many parents have reservations about giving their children medicines for ADHD, many find it an invaluable way of allowing their child to get the best from school and home life. Your GP should be able to advise you about pharmaceutical options.
What parents say:
Tanya, mother of Luke, nine, says:
"We had our son assessed after the school suggested ADHD. I had often wondered about Luke's behaviour – his excessive energy, running into things, talking excessively and loudly, pacing around when he spoke and so on. The tests never really concluded anything – they thought maybe mild ADHD.
The thing I found very helpful though was a course of family play therapy sessions. The therapist would observe us playing and interacting and suggest coping mechanisms and tools to help deal with certain behaviours and situations which I use a lot.
"The best thing I learnt was to try and understand why the child might be doing something - to put yourself in their shoes and try and think like a child really. Also I learnt to appreciate that when their vocabulary and ability to express themselves isn't fully developed, the way they act can be the only way to show how they're feeling. Luke is quirky, and I try to celebrate that, but ultimately as a parent I think you know when you need to seek help. If your child seems unhappy with life, then that's probably the time to examine why that might be."
Alison, mother of Dan, 15, says:
"Dan has come such a long way. Getting his medication right and finding a good school for him as well as his own growing maturity and awareness of his difficulties have made things so much better for him. I feel very hopeful.
"Before he was diagnosed when he was almost seven, he had already been excluded twice from school.
"I had seen a paediatrician when he was in nursery because his tantrums and aggression were clearly unusual but it had not been conclusive. It was obvious to me though that he desperately needed help. He would be so upset after a meltdown.
"Lots of family outings were ruined by outbursts. Often a short bad burst totally overshadowed the happy bits. We tried to understand what was happening though and got better at judging when things might go wrong.
"Dan uses lots of tricks to improve his attention and memory. He has lots of lists and we put reminders on his phone – even for things like brushing his teeth and showering.
"I would advise a parent whose child is diagnosed with ADHD to find out as much as they can about it and get support from others who have been there – in person or online. It's important not to feel alone. I would also ask them to try and not be overwhelmed by the hard bits. It is too easy to forget the good times but your child can make such a lot of progress. I am hugely proud of Dan."