Core symptoms of ADHD are hyperactivity, difficulty concentrating and acting impulsively (such as doing things without thinking through the consequences).
ADHD refers to a pattern of behaviour that affects a child in most situations and is evident from an early age. The condition often becomes apparent when a child starts school and teachers may notice that a child finds it hard to sit still, struggles to pay attention, or blurts out answers in class.
ADHD can have a big impact on both school and family life without appropriate treatment.
What causes ADHD?
There are many theories about what causes ADHD.
It tends to run in families, suggesting a genetic risk. However, the inheritance is likely to be complex and there is no one gene that causes ADHD.
There are also likely to be environmental factors that increase the risk of a child developing ADHD if they have a genetic predisposition.
There may also be structural brain differences or differences in the actions of certain chemicals in the brain (neurotransmitters).
Previous theories about diet causing hyperactivity are not supported by recent research.
ADHD is between four to seven times more common in boys than girls.
Without appropriate treatment, young people with ADHD are at increased risk of developing anti-social behaviour. As many as a third will also have another developmental problem, such as a language disorder.
How is ADHD normally diagnosed?
There are no specific tests used to diagnose ADHD. The diagnosis is made through detailed history taking, observation and by use of standardised questionnaires and sometimes psychological tests.
In order to make a diagnosis, a thorough assessment should be carried out by a specialist, such as a paediatrician or child psychiatrist.
It is important to rule out other conditions that can look like ADHD. Similarly, ADHD is often associated with other issues, including language problems, conduct disorder and specific learning difficulties. It is therefore important to have a professional assessment to check for these.
A diagnosis of ADHD may be considered but will not usually be confirmed until a child is around six years old and starts school. The input of teachers as observers in a structured school environment is crucial and it is good practice for teachers’ observations to be incorporated in to an assessment.
Professionals may also carry out a school observation as part of the assessment to see how the child behaves both in the classroom and playground settings.
There are some standards for diagnosing ADHD, agreed internationally. All three of the following core symptoms should be present in multiple settings (at home and at school). They are:
A child or young person with attention deficit would show many of the following for at least six months:
- does not pay attention to detail or makes silly mistakes when working and playing
- does not finish jobs or is not able to pay attention for long periods while playing (they may be able to play games they enjoy for long periods, such as computer games)
- does not seem to listen to instructions
- does not carry out instructions or finish tasks
- is disorganised and loses things
- avoids things that might take some effort over a long period of time, such as homework or hobbies
- is easily distracted and forgetful
A child or young person who is hyperactive would show most of the following for at least six months:
- is always on the go, rarely sitting down quietly
- very noisy when playing even during quiet play
- does not stay sitting, even during sit-down activities
- fidgets a lot when sitting
A child or young person should show one of the following for at least six months:
- gives answers to questions before the question has finished
- has trouble waiting in line or taking turns during play
- interrupts others’ conversations or games
- talks a great deal in inappropriate settings and does not realise social boundaries
A child suspected of having ADHD should be observed with other children of a similar age.
If the child seems to be showing more behavioural difficulties than the others, ask the following questions:
- Does the child have a shorter attention span than other children of the same age? For instance, while a story is being read does the child leave before the end while the others stay and listen?
- Is the child always restless, fidgety, on the go and out of their seat at mealtimes? Do the school give similar reports?
- Is the child very impatient and unable to wait their turn in a queue or game?
- Is the child very excitable and impulsive? Does the child suddenly do things such as darting into the road without thinking about whether it is safe?
If the answer to these questions is yes, consult the child’s GP, who can refer them to a local specialist for further assessment.
How is ADHD normally treated?
With appropriate intervention, children with ADHD can lead normal lives. The main treatments are behavioural management and medication, while other approaches may also be helpful.
One type of medicine which can be prescribed for ADHD is called methylphenidate (brand name Ritalin®). This has been proven to be effective in managing symptoms of ADHD.
There are other related medicines that also work well, such as dexamphetamine or atomoxetine. These medications should only be prescribed by a specialist following thorough assessment, and require regular monitoring to check for improvements in symptoms and avoid any side-effects.
Another way to help manage the condition is organisation. This might include having a set routine which can make a difference to how a child or young person with ADHD copes with everyday life.
As part of this, clear boundaries should be set so everyone knows what behaviour is expected. Any instructions to the child must be very clear. Give concrete instructions rather than abstract ones. For example, say ‘put the toys in the box and put the books on the shelf, please’ rather than ‘tidy your room please’.
Reward schemes for appropriate behaviour can also be very successful (such as using sticker charts).
It is often recommended that parents of a child with ADHD attend a parenting course to help them learn specific skills to manage behaviour.
Talking therapies are also a popular choice of treatment and there are many different types of talking therapies that may help.
Parents may benefit from meeting with a psychologist to discuss behavioural management approaches for their child.
Family therapy involves the whole family and tries to find new and better ways of dealing with any problems so that living together becomes easier.
If the child needs help for depression, anxiety or other related problems, they might benefit from individual therapy such as cognitive behaviour therapy (CBT). CBT deals with the way a child or young person is thinking and then how they react to these thoughts.
Children and young people with ADHD may struggle at school due to their symptoms and may feel ‘left behind’ by their classmates. In these cases learning support can be arranged.
Arranging learning support with the school through an Individual Education Plan can make a huge difference. It is best to discuss this with the class teacher or special education needs co-ordinator (SENCO) at the school.
Some children with ADHD have additional learning difficulties. If these are suspected, they may need to be investigated by requesting for a psychologist to carry out further tests with the child (psychometric testing).
There is no cure for ADHD but the above interventions can help a young person to manage their symptoms.
What happens next?
Living with someone who has ADHD can be exhausting. Parents often say that they feel worn out just from making sure a child with ADHD does not get into trouble.
Going out and about might be difficult if the child is constantly ‘on the go’ and does not understand the ‘rules’ that come with social occasions.
Siblings may also find it hard if much attention is focussed on their brother or sister, and as they grow older, might feel embarrassed by their behaviour.
All these feelings are normal. It is important to remember that the child or young person is not necessarily behaving badly on purpose.
For children with ADHD, getting through school can be problematic. They may get into trouble if their condition is not fully understood, and their symptoms prevent them being able to learn effectively. This can have long-term consequences, so the earlier the condition is recognised the better.
ADHD is best viewed as a chronic neurodevelopmental disorder – a child will need the right treatment and support to ensure they are able to make the most of their education and life in the long-term.
Most symptoms of ADHD get better with developmental maturity. However, it can persist into adulthood in approximately 10 per cent of cases and many people will continue to require strategies to manage their symptoms.