Attention deficit hyperactivity disorder

The best description of ADHD is that a person who has this condition shows disruptive behaviours which cannot be explained by any other psychiatric condition and are not in keeping with those of the same-aged people with similar intelligence and development. These behaviours are usually first noticed in early childhood, and they are more extreme than simply 'misbehaving'.

People with ADHD have difficulty focusing their attention on completing a specific task. Additionally, they can be hyperactive and impulsive and can suffer from mood swings and “social clumsiness”.

ADHD develops in childhood and is most commonly noticed at the age of 5. Research suggests that 80% of children diagnosed with ADHD continue to experience symptoms during adolescence and 67% continue to have symptoms into adulthood.

There is no specific test for ADHD but it is important that a psychiatrist or paediatrician makes a diagnostic evaluation. If you suspect that your child, or a child you know has ADHD, you may wish to alert their parent or teacher so that s/he can be referred early and so that the condition can be identified. This will enable treatment to be started to help the child achieve their full potential.

Symptoms of ADHD

The symptoms of ADHD are:

  • Inattention
     People who are inattentive have a hard time keeping their mind on one thing, and may get bored with a task after only a few minutes. Focusing deliberate attention to organising and completing routine tasks may be difficult.
  • Hyperactivity
    People who are hyperactive always seem to be moving around, they can't sit still, they may dash around or talk incessantly. Sitting through a lesson can be an impossible task. They may roam around the room, squirm in their seats, wiggle their feet, touch everything, or noisily tap a pencil. They may also feel intensely restless.
  • Impulsivity
     People who are overly impulsive seem unable to stop their immediate reactions or think before they act. As a result, they may blurt out answers to questions or make inappropriate comments, or run into the street without looking. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit out when they are upset.

A child or adolescent who appears to be depressed and exhibits ADHD-like symptoms that are very severe, with excessive temper outbursts and mood changes, should be assessed by a psychiatrist with experience of bipolar disorder (also known as manic depression), particularly if there is a family history of the illness.

The symptoms of ADHD (impulsivity, hyperactivity and inattention) are not seen to the same degree in all people with this condition. As a result doctors recognise three types of people with ADHD:-

  • the predominantly hyperactive-impulsive type
  • the predominately inattentive type
  • the combined type.

There is also a fourth type, which does not fit into any of the three categories and which doctors classify as ADHD not otherwise specified.

Causes of ADHD

ADHD has multiple causes. However the evidence so far shows that it is not caused by poor parenting, rather, it is caused by a complicated combination of factors. These include genetic, physiological and environmental factors.

Genetic causes
Most differences in the severity of symptoms are due to genetic factors, so it is a significant factor. For example, if the child with ADHD has an identical twin, the likelihood that the twin will also have the disorder is about 90%.

Physiological causes
The brains of children with ADHD have been shown to be consistently different from those of children without the disorder. Overall brain size is generally 5% smaller in affected children than children without ADHD. While this average difference is observed consistently, it is too small to be useful in making the diagnosis of ADHD in a particular individual. Also there are differences in brain activity between people with ADHD and those without it. In people with ADHD, the brain areas that control attention appear to be less active, suggesting that a lower level of activity in some parts of the brain may be related to difficulties sustaining attention.

Other research has suggested that in a small percentage of cases, ADHD can be due to injury (during development) to specific regions of the brain. For example, use of alcohol or tobacco during pregnancy, premature delivery with associated minor brain bleeding or accidental head injury after birth, could all cause ADHD-like symptoms.

Environmental causes
ADHD is not associated with purely social factors such as poor parenting (child management), family stress, divorce, excessive TV viewing or video game playing, or diet, although some of these factors make a pre-existing condition worse.

How is ADHD treated?

Most experts agree that the most effective way to treat ADHD is with a variety of different approaches.

Behavioural interventions

  • Family therapy focusing on management strategies
  • Individual therapy focusing on changing behaviours

Medication
Psychostimulant medications, including methylphenidate (Ritalin) and amphetamines (Dexedrine, Dextrostat, and Adderall) are by far the most widely researched and commonly prescribed treatments of ADHD. Stimulant medication may work on areas of the brain shown to be underaroused in children with ADHD, increasing nervous activity to more normal levels.

Stimulant drugs, when used with medical supervision, are usually considered quite safe. When drug reactions do occur, they are usually related to dosage and are always reversible. Side effects associated with moderate doses are decreased appetite and insomnia. These effects occur early in treatment and may decrease with time. 

Antidepressant medications may be used as a second line of treatment for children who show poor response to stimulants, who have unacceptable side effects, or who have additional conditions.

American research has indicated that the two most effective treatment types for primary school children are a closely monitored medication treatment and a treatment that combines medication with intensive behavioural interventions, such as:

  • School-based intervention which can include: Help with reading, spelling, maths and organisation
  • Speech therapy
  • Physical education therapy
  • Counselling
  • Social skills training - many children with ADHD have difficulty socialising, as they don't recognise the more subtle rules of communication so they frequently make mistakes and are teased by other children. In social skills training, children are taught in groups to think how their words and behaviour affect those around them.
  • Coordination training - since many children with ADHD have coordination problems, there are a few therapies that specifically help develop coordination (known as sensory-motor integration). Some children receive this therapy in schools.
  • Diet - some parents see an improvement in their child's behaviour when the following foods are removed from the child's diet:
    caffeine – found in chocolate, coffee and some fizzy drinks, some cordials
    artificial colourings
  • Parenting support - Support for parents is a vital component in the combination of therapies advised to tackle the disorder. It is particularly important as services to diagnose and treat ADHD are seriously under funded and overloaded.
    Although children with ADHD have unique problems, many of the principles of parenting still apply, as children / individuals with ADHD in particular need consistent discipline and a structured lifestyle.
    Parents can attend parenting classes, as well as join associations and self-help groups to ensure their concerns and opinions are heard.

National Advice Service Factsheets

The information on this page is taken from the NAS factsheet, which you can download in pdf format and print for individual use.