Attention deficit hyperactivity disorder (ADHD)
What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) or Hyperkinetic Disorder is a complex condition that is mainly diagnosed in childhood, but it can persist into adolescence and adulthood. Hyperkinetic Disorder is the official term used by health professionals in the UK, but ADHD is the official term used in the USA, and is the term that most people recognise. Behaviours associated with the condition are hyperactivity, impulsivity and inattention.
Symptoms of ADHD
Hyperactivity can include being unable to sit still, or finding it difficult to participate in activities quietly. Sometimes, people with ADHD can appear to be ‘on the go’ all of the time, or act as if ‘driven by a motor’. Impulsivity might include interrupting or intruding, (e.g., butting into conversations or games); having trouble waiting one’s turn or talking excessively. Inattention related symptoms might include finding it difficult to pay attention to details (making careless mistakes), being unable to remain focused on a specific task or having problems following instructions and organising activities.
While all of these behaviours can be seen as part of normal behaviour, (we can all be impatient, over-enthusiastic, lose our concentration or find it difficult to focus), for a health professional to make a diagnosis of ADHD, these symptoms have to be severe and cause problems for the individual across their home, school/work and social life.
ADHD symptoms start in childhood, but are not always recognised and treated at this age. For some, symptoms reduce or are less obvious by adolescence, but for others symptoms and impairment continue into adulthood.
ADHD is a complex disorder and can affect individuals in different ways – while most children with ADHD will have difficulties in hyperactivity, impulsivity and inattention, some may have problems only with attention.
The disorder affects some children more severely than others, and other problems can occur alongside ADHD such as Autistic Spectrum Disorders (ASDs), conduct problems, tics and learning difficulties such as Dyslexia. Some people with ADHD may also have emotional problems such as anxiety or depression.
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If parents become concerned about a child, their GP will be able to offer advice and can refer the child to a specialist. Schools may also raise concerns and may be able to refer to a specialist or suggest visiting the GP.
Getting a diagnosis of ADHD requires a full and detailed assessment usually by either a specialist paediatrician or child and adolescent Psychiatrist – unfortunately there is no quick and easy test for ADHD. Assessments often gather information from a number of different sources and may include observations and reports of the child’s behaviour at home and school.
There are a number of different approaches to helping people with ADHD, which can be effective in managing the condition.
Following an ADHD diagnosis, UK guidelines (from NICE – the National Institute for Clinical Excellence) suggest that families or carers are given information about ADHD.
Environmental changes to minimise the impact of ADHD on day to day life are also recommended. These could include social skills training, or small changes at school, such as moving children with ADHD to the front of the class to eliminate distractions and help them to focus.
At home, parents can adopt different ways of dealing with behaviours associated with ADHD, such as introducing reward charts.
If symptoms are still causing significant difficulties after these changes have been made then medication may be offered.
Medication has also been shown to alleviate the symptoms of ADHD, enabling children to concentrate and focus more effectively and reducing hyperactivity. Common medications used to treat the condition include Methylphenidate (Ritalin®, Equasym®, Concerta®), Atomoxetine (Strattera®) and Guanfacine (Intuniv®).
These medications generally start to work shortly after each dose, and do not have a long lasting effect. They can be very effective, but as with all medication, there is a chance of side effects.
Not all children with ADHD will need medication, whilst those taking medication will also need educational or psychological treatment.