Attention Deficit Hyperactivity Disorder, or ADHD, is the term used to describe three main kinds of behavioural problem in children:
- overactive behaviour (hyperactivity)
- impulsive behaviour
- difficulty in paying attention.
All young children have lots of energy and like to be active. Young children also tend to have a short attention span - they soon get tired of an activity and want to move on to something new. So how can you know whether your child has ADHD or is just restless or bored?
Children with ADHD are not just very active; they also have a wide range of other problem behaviours that can make them very difficult to care for, manage and teach.
Because they are overactive and impulsive, children with ADHD often find it difficult to fit in at school. They may also have problems getting on with other children. These difficulties can continue as they grow up, particularly if children and families do not get the help they need. Some children have significant problems with concentration and attention, but are not overactive or impulsive. These children are sometimes described as having Attention Deficit Disorder (ADD), rather than ADHD. ADD can easily be missed because the child may be quiet and dreamy rather than disruptive.
ADHD and ADD are not related to intelligence. Children with all levels of ability can have them.
What Causes ADHD?
Although the exact cause of ADHD remains unknown, it is believed to be caused by poor transmission of messages in the brain, and in particular by low levels of the neurotransmitters dopamine and norepinephrine, which carry messages from one neuron to another. These neurotransmitters are particularly associated with attention, organisation and managing emotions.
Some research has shown that it tends to run in families and, in most cases, it is thought inheriting the condition is the most likely cause. Both parents and siblings of a child with ADHD are four to five times more likely to have ADHD themselves.
Other potential risk factors include:
- being male
- smoking, alcohol or drug abuse during pregnancy
- being born prematurely (before week 37 of the pregnancy)
- having a low birthweight
- brain damage either in the womb or in the first few years of life
Types of ADHD
A person with ADHD usually has symptoms characteristic of one of the three subtypes of the condition. The subtypes are:
- ADHD mainly inattentive
- ADHD mainly hyperactive-impulsive
- ADHD combined
If your child has symptoms of all three behavioural problems – inattentiveness, hyperactivity and impulsiveness – they may have ADHD combined, which is the most common subtype of ADHD.
Alternatively, if your child has symptoms of inattentiveness but not hyperactivity or impulsiveness, they may have ADHD mainly inattentive. This form of ADHD is also known as attention deficit disorder (ADD).
ADHD is normally diagnosed between the ages of three to seven, although in some cases it may not be until much later. It is more commonly diagnosed in boys, but this may be because disruptive behaviour, which the diagnosis may be partly based on, tends to be more common in boys than girls.
There is no simple test to determine whether your child has attention deficit hyperactivity disorder (ADHD). If you think that your child may have ADHD, it is adviseable to see your GP.
Diagnosing ADHD in children depends on a set of strict criteria. To be diagnosed with ADHD, your child must have six or more symptoms of inattentiveness, or six or more symptoms of hyperactivity and impulsiveness.
The type of ADHD your child will be diagnosed with will depend on the number of symptoms they have from each group. For example, if they have eight symptoms of hyperactivity and impulsiveness and only three symptoms of inattentiveness, they will be diagnosed with ADHD mainly hyperactive-impulsive.
To be diagnosed with ADHD, your child must also have:
- been displaying symptoms continuously for at least six months
- started to show symptoms before the age of seven – although in some cases a diagnosis can still be made if symptoms do not start until after this age
- been showing symptoms in at least two different settings – for example, at home and at school, to rule out the possibility that the behaviour is just a reaction to certain teachers or parental control
- symptoms that make their lives considerably more difficult, on a social, academic or occupational level
- symptoms that are not just part of a developmental disorder or difficult phase, and are not better accounted for by another condition
Symptoms in Children
The symptoms of ADHD in children are well defined. The main symptoms of each behavioural problem are detailed below.
- a short attention span
- being easily distracted
- making careless mistakes, for example in schoolwork
- appearing forgetful or losing things
- being unable to stick at tasks that are tedious or time consuming
- being unable to listen to or carry out instructions
- being unable to concentrate
- constantly changing activity or task
- having difficulty organising tasks
- being unable to sit still, especially in calm or quiet surroundings
- constantly fidgeting
- being unable to settle to tasks
- excessive physical movement
- excessive talking
- being unable to wait for a turn
- acting without thinking
- interrupting conversations
- little or no sense of danger
Related Conditions in Children
Although not always the case, your child may also have other problems or conditions alongside ADHD. These are explained below.
Anxiety disorder - Some children with ADHD may have an anxiety disorder that causes them to worry and be nervous most of the time. Your child may also have physical symptoms, such as a rapid heartbeat, sweating and dizziness.
Oppositional defiant disorder (ODD) – This is common among children with ADHD. It is defined by negative and disruptive behaviour, particularly towards authority figures such as parents and teachers.
Conduct disorder - Children with this disorder may have a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism, harming people, or harming animals. If your child is behaving in this way, book an appointment with your doctor as soon as possible.
Depression - It is possible for children with ADHD to become depressed as a result of their condition.
Sleep problems - Children with ADHD can be hyperactive and find it difficult to sleep at night. They may experience irregular sleeping patterns.
Epilepsy - A condition of the brain that causes seizures (fits).
Tourette's syndrome - A condition of the nervous system (the nerves, brain and spinal cord) that causes involuntary movements and sounds.
Learning difficulties - It is thought that around a third of children with ADHD also have learning difficulties, such as dyslexia (difficulty reading and spelling words).
Do children grow out of ADHD?
Some children grow out of ADHD; others have problems that continue into adolescence and beyond. Approximately two out of five children with ADHD continue to have difficulties at age 18. The main symptoms of ADHD, such as attention difficulties, may improve as children get older, but behavioural problems such as disobedience or aggression may become worse if a child does not receive help. In particular, boys who are hyperactive and aggressive tend to become unpopular with other children. It is therefore very important for children to receive help as early as possible, to prevent them from getting socially isolated and from developing other emotional and behaviour problems that can persist into adult life.
There is no cure for ADHD, but treatment, using medication or therapy (or a combination of both), can alleviate the symptoms and make the condition much less of a problem in day-to-day life.
ADHD is often treated with stimulant medication, which can produce short-term benefits, the theory being that it reduces the uptake or increases the production of the neurotransmitters, so increasing the levels in the brain.
Medication does not cure ADHD – it can only reduce a child’s difficulties. The aim is to give children some relief from the symptoms, so they calm down, are better able to make friends and manage their emotions, learn more easily and are more responsive to other people. Children may become less aggressive as well as less hyperactive, and their performance at school may improve significantly. Once they are having fewer problems in their family, school and social lives, the hope is they can learn to manage their own behaviour better without the help of drugs.
As well as taking medication, different therapies can be useful in treating ADHD in children, such as psychotherapy, behaviour therapy, cognitive behaviour therapy, parent training and education programmes, and social skills training.
There are other ways of treating ADHD that some people with the condition find helpful, such as cutting out certain foods and taking supplements, however, there is no medical evidence these methods work, and they should not be attempted without medical advice.
Living with a child with ADHD can be challenging but it is important to remember that they cannot help their behaviour. As a parent, you can learn ways of talking, playing and working with your child that can improve their attention and behaviour.
There are many ways in which teachers can organise the classroom, lessons and behaviour to help children with ADHD. Minimising distractions can help – seating children with ADHD away from windows, and avoiding putting groups of pupils together round one large table. It is important to include a variety of activities during each lesson, and to alternate physical and sitting-down activities. Teachers are encouraged to set short, achievable targets and give immediate rewards when the child completes the task.
Concerns about Medication
There are concerns that the drugs administered to people with ADHD may be used too quickly to deal with behaviours that are not due to ADHD/ADD at all; the child may be simply over-boisterous or unruly or difficult to manage for other reasons to do with their family and environment. Also, they are very powerful drugs – some are classed as amphetamines – and can carry other health risks:
- the long-term effects of stimulants on young, developing brains are still not fully known
- children and adults with existing heart conditions are at risk of heart attacks if they take stimulant medications
- stimulants can trigger or exacerbate hostility, aggression, anxiety, depression and paranoia – anyone with a personal or family history of suicide, depression or bi-polar disorder is at very high risk and should be closely monitored
The reported side effects of stimulant medication for ADHD/ADD include some of the problems for which they are prescribed. They include: restlessness, difficulty sleeping, irritability and mood swings, depression, loss of appetite, headaches, upset stomach, dizziness, racing heartbeat and tics.
For these reasons, stimulant medication should only be prescribed to children who have been professionally assessed and diagnosed by an expert, and should be reviewed regularly.
Non-medical ways of managing ADHD include exercise, healthy diet, sleep management and behavioural therapies.