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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Getting help

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.

Treatments

There are a number of different approaches to helping people with ADHD, which can be effective in managing the condition.

UK guidelines recommend that the first line of treatment for milder cases of ADHD should focus on changing behaviours. This 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.

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.

Tips and advice

Tips for parents and carers
  • Remember that your child isn’t being wilful or deliberately difficult – try to keep in mind that ADHD is a disorder and these behaviours are part of it.
  • Praise your child for good behaviour and look for their strengths – it will boost their self confidence and also make you feel better.
  • Get support – many parents and young people find joining support groups where you can discuss issues with others are very helpful.
  • Use rewards and discipline – reward charts for positive behaviour and effective, consistent discipline for misbehaviour can help address behaviour.
  • Keep instructions simple and consistent – children with ADHD find it difficult to process many things at the same time. Try to break up long strings of instructions.
  • Write things down – stress the importance of writing down homework tasks – and bringing homework books home too. It will make it much easier to keep on top of tasks and what’s required.
  • Try to be organised yourself – if everything (school things, clothing etc) has its place and your child is encouraged to use that place, it will be easier for them to remember where things are and hopefully encourage organisation in them.
Homework tips for young people with ADHD

Tasks that need a lot of concentration, like homework, can be especially difficult for young people with ADHD. Here a few ideas that can help:

  • Keep a homework diary and write down everything you need to do. It might help to ask your teacher to check your diary to make sure you have all the information you need. Take your homework diary home with you!
  • Find a quiet place to do your homework with few distractions.
  • Get everything you need ready before you start. It might help to keep all your stationery and books in one specific place.
  • Take time to read instructions carefully so you know what to do. Check the instructions again as you start to make sure you know exactly what to do.
  • Break long tasks into smaller sections. n Take short breaks every 20 minutes or so to give your brain a rest.

Resources

Separating facts from fiction

Professor Anita Thapar discusses some of the myths and misunderstandings around the condition, focusing on what has been learnt from science, and how this might help clinical and educational practice.

 

Professor Anita Thapar answers questions on ADHD

Claire has a daughter with extreme ADHD and puts her questions to Professor Anita Thapar, one of the principal investigators at NCMH and a clinical professor at Cardiff University. This video was produced as part of the Challenge Cardiff series.

 

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