Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly studied and diagnosed childhood-onset psychiatric disorder, affecting between 3 to 5 per cent of children and adolescents in the UK. Around 50 to 60 per cent of those diagnosed in childhood will continue to have symptoms into adulthood. Symptoms generally become apparent between the ages of 3 and 7, and ADHD is diagnosed 2 to 4 times more frequently in boys than in girls. However, because symptoms vary from person to person, it can sometimes be difficult to reach a conclusive diagnosis. Occasionally ADHD goes undiagnosed until adulthood. ADHD is sometimes misconstrued as 'bad behaviour', but there is increasing evidence that genes play a large role, and the condition often runs in families. Brain scans have shown a variety of different problems in ADHD, but in general an imbalance in brain chemicals - such as noradrenaline and dopamine - is often found which affects normal brain functioning, including information processing and decision making. So what does this mean?

ADHD is characterised by inattention, hyperactivity and impulsiveness. Inattentiveness may mean the sufferer does not seem to pay attention when spoken to directly, may fail to follow instructions, and be forgetful in daily activities because they are easily distracted. Hyperactivity may be apparent in that the individual often talks excessively, runs about when it is not appropriate, and squirms and fidgets rather than sitting still. Impulsiveness may manifest in the person frequently interrupting others, having trouble waiting their turn, or engaging in dangerous activities without considering the consequences. Individual sufferers may vary considerably in their behaviours, and whilst some may be primarily inattentive, others may be of the hyperactive-impulsive type, or a combination of all characteristics may be present. However, generally there will be difficulties in planning ahead, problem solving, and impulse control; maintaining attention without being distracted is often problematic. Whilst for some sufferers, intelligence levels may be normal or advanced, more than half of children with ADHD have learning difficulties such as dyslexia or problems expressing themselves in words; this can lead to underachievement and low self esteem. Anxiety and depression are common among children with this condition. Adults with ADHD may similarly suffer, and additionally experience problems at work, or in maintaining satisfactory relationships, for example.

For the majority of sufferers, ADHD is a lifelong condition for which there is currently no 'cure', but symptoms can and often do improve over time. With the right treatment (please see Interventions section) most individuals can become successful in school, and achieve a good quality of life. Research is ongoing to try to better understand ADHD and to develop more effective ways to treat, and even prevent the condition. Early diagnosis, and the right kind of help and support for parents of sufferers, can make a big difference to the wellbeing of the developing child. Hyperactivity tends to decrease with age, and adolescents and adults with ADHD often develop improved skills so that they learn to compensate and find better ways to concentrate, and to control their impulses. Furthermore, a combination of medications, behaviour and lifestyle changes, and counselling - tailored to the individual and their specific needs - can help most sufferers to ultimately lead happy and productive lives.

Symptoms

ADHD is characterised by inattention, hyperactivity and impulsivity, and these symptoms may present in different ways from one person to another. A child may be predominantly inattentive, predominantly hyperactive-impulsive, or may have a combination of all three characteristics. The following is a guide to some of the more commonly occurring symptoms.

Inattention

  • have difficulty in focusing on one task, and shift from one incomplete activity to another
  • be easily distracted, forgetful, and prone to daydreaming
  • have difficulty learning something new, or taking in new information
  • appear not to listen when talked to, and fail to follow instructions

Hyperactivity

  • talk incessantly, often failing to listen to others, or take turns
  • run around inappropriately, rather than sitting down and focusing on an activity
  • fidget and squirm in their seats, such as during lessons or at mealtimes
  • difficulty with playing or working quietly

Impulsivity

  • engage in dangerous activities without considering the consequences
  • have difficulty waiting their turn, or in waiting for things they want
  • interrupt others inappropriately, often showing unrestrained emotions

Assessment & Diagnosis

ADHD can sometimes be hard to diagnose, because of the difficulty in determining whether inattention, hyperactivity and impulsivity are normal childhood behaviours, or whether they are severe enough to be of clinical significance. For a diagnosis to be reached, several of the above symptoms must be present, and for a duration of at least 6 months. Significant impairment must be evident in two or more settings, such as the classroom, the playground, the community or the home. Parents and teachers are usually the first to notice that a child is behaving differently to their peers, most frequently between the ages of 3 and 7. A GP who suspects that further investigation is warranted may refer your child to a paediatrician, or a mental health specialist with experience in childhood disorders such as ADHD. Information will be gathered from school and medical records, as well as from the parents themselves, to determine whether the child's behaviours are excessive, long-term, and affecting several areas of their life. It will then be determined whether your child meets the criteria for a diagnosis of ADHD. Your child may additionally be assessed for learning difficulties.

Interventions

As noted earlier, there is no known 'cure' for ADHD, yet the quality of life of the sufferer can be greatly improved. Early diagnosis and the right intervention, including appropriate help at home, can lead to better outcomes for sufferers and their families. Methods of treatment often involve a combination of behaviour therapy, life-style changes, counselling and medication, and these will need to be tailored to the individual and their particular needs. These interventions focus on reducing the symptoms of ADHD and on improving general functioning.

Medication

Stimulants are the most frequently prescribed medicines for ADHD, the most common being Ritalin. However there are a wide range of different medications available, and what works for one person may not work for another. Different medications and dosages may be tried in order to arrive at the most effective means of treatment for a given child, and they will be closely monitored during this process. Stimulants tend to have a calming effect on children with ADHD, and act to reduce hyperactivity and impulsivity, as well as to improve focus. Anti-depressants such as venlafaxine, are sometimes used to treat adults with ADHD, and this has been found to be beneficial in some cases. Medications will usually be used in conjunction with psychological therapies (please see below).

Psychological Therapies

Behaviour and stress management strategies, as well as educational support, can be highly effective in improving the quality of life of the sufferer, and it will be important to involve the family as they have a significant part to play in improving outcomes for their child. Parents are best placed for understanding the strengths and weaknesses of their child. It is recommended that parents receive support and training themselves to enable them to cope with and manage their child's behaviour, and thus help them to reach their full potential. Your child may qualify for special educational services which will require an evaluation by a team of professionals who will look at all areas related to your child's disability. If eligible, your child should gain access to an individualised education programme.

A combination of behaviour therapy, stress management techniques, social skills training and practical support can help the sufferer and their family adjust to, and cope with, everyday problems. Behaviour therapy may involve helping the child to organise their tasks and school work, as well as to cope better with any emotional difficulties. A system of rewards for desired behaviours, such as curbing impulses, controlling anger, and following rules, can reinforce positive changes, and the child can be taught to self-monitor their own behaviour. Clear rules and structured routines will also be important, with immediate praise given by teachers and parents when set goals are achieved. Social skills training can help the child in their interactions with others, such as learning to take turns in conversations, and how to read others, which in turn can improve self-confidence in social situations. Cognitive behaviour therapy can be very effective with adult sufferers of ADHD, and learning how to think before acting, how to avoid taking unnecessary risks, and how to better organise one's life, can do much to enhance confidence and self-esteem so that a fulfilling life can be achieved.