Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder (a problem related to brain development) that causes hyperactivity, impulsive behaviour, and attention problems. It interferes with a person’s ability to exercise age-appropriate control of their behaviour and/or their cognition.
Children at school with ADHD may be seen as disruptive, they may tend to call out in class and appear not to listen to their teacher, they may also have difficulties keeping up with their peers academically. At home and in social situations they may do ‘silly’, irresponsible or inappropriate things and they may seem to not respond to attempts to discipline them.
The child with ADHD is not wilfully naughty and their inability to be a good student or behave appropriately can be extremely distressing for them. Adults can have ADHD too and in their working life they may be seen as careless, inefficient employees.
ADHD is the most common problem encountered in outpatient child and adolescent mental health settings and is 10 times more common in boys than in girls. Three types of ADHD are now recognised: predominantly inattentive type, predominantly hyperactive-impulsive type and combined type.
Symptoms of inattention include:
- failing to complete activities or being slow to complete them
- not following through on instructions
- making ‘careless’ mistakes
- having trouble organising activities
- frequently switching between activities
- being easily distracted and forgetful.
Symptoms of hyperactivity include:
- excessively active behaviour
- inappropriately running and climbing,
- frequently leaving their seat,
- fidgeting and squirming in their seat,
- excessive talking,
- being unable to play or work quietly,
- even just subjective feelings of restlessness.
Symptoms of impulsivity include:
- difficulty awaiting their turn,
- interrupting conversations and calling out,
- generally acting without thinking.
Specific symptoms will vary from person to person but a significant number must be present for behaviour to be seen as abnormal. Children or adults with predominantly inattentive type ADHD tend to be less obvious, they are often quiet, underachieving students who don’t necessarily attract a lot of attention. Those who have symptoms of impulsivity and hyperactivity are much harder to overlook. Other important factors that define ADHD are that the symptoms occur in two or more settings (eg. school and home), that symptoms were present before the age of 7 years, and that symptoms cause significant impairment in everyday functioning.
Studies suggest that the prevalence of ADHD has more than doubled in the last 10 years. This is partly because of an increased awareness and recognition of the disorder, but to some extent it is also because of misdiagnosis and the diagnostic criteria for ADHD not always being applied as rigorously as they should be. In addition to the ADHD characteristics listed above, many people with ADHD also show symptoms of other behavioural/psychiatric conditions that complicate the clinical picture, such as learning disabilities, anxiety and disruptive behaviour disorders.
A comprehensive assessment of the child is necessary when considering a possible diagnosis of ADHD. This is because some the symptoms can occur as a result of a number of conditions or situations and because of the high rate of associated or ‘comorbid’ conditions.
Accurate assessment is vital for effective treatment. A comprehensive assessment should involve meeting, with both the parents and the child, and taking a detailed birth, developmental, medical, social and school history. In addition, behavioural checklists from home and school can be extremely helpful. Assessment and diagnosis is most commonly performed by a paediatrician or psychiatrist. Psychologists can also assess and diagnose ADHD. Since a large percentage of children with ADHD have learning or cognitive difficulties, psychological and neuropsychological testing can often be helpful in assessing academic and cognitive skills, such as intelligence, attention and ‘executive functioning’.
Stimulant medications such as methylphenidate, dexamphetamine and pemoline are commonly used to treat ADHD with very good effect. However, most experts agree that treatment for
ADHD should address multiple aspects of the individual’s functioning and should not be limited to the use of medications alone. Ideally, treatment should also include structured behaviour management programs that are consistently applied both at school and home, modification of curriculum and teaching methods, and parent education and support. Currently, more than 200 studies have demonstrated the effectiveness of both pharmacological (involving medication) and psychosocial treatments.
There is no doubt that ADHD can cause significant emotional, social, and educational problems. Although some children appear to grow out of their ADHD as they reach their adolescent years, for others the disorder remains a lifelong problem. With the help of timely and targeted interventions, most children with ADHD learn how to cope with their disorder effectively as they get older. When ADHD is diagnosed and treated early, the condition can be effectively managed, so that children with ADHD will grow to have productive, successful and fulfilling lives.
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Reviewed by Sara Coombes, Neuropsychologist, Royal Prince Alfred Hospital
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