ADHD

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.

ADHD can occur in people of any intellectual ability but people with ADHD tend to have other learning difficulties too although this isn't always the case.

Causes of ADHD 

The exact cause of ADHD is not fully understood, but a combination of factors is thought to be responsible.

Genetics

ADHD tends to run in families. In most cases, it is thought the genes you inherit from your parents are a significant factor in developing the condition.

Brain Function and Structure

Research has identified a number of possible differences in the brains of people with ADHD compared to those who don't have the condition.

Some studies have suggested that people with ADHD could have an imbalance in the level of chemicals in the brain. These chemicals are called neurotransmitters, or that these chemicals may not work properly.

Other Possible Causes

Various other causes have also been suggested as having a role in the development of ADHD, including:

Being born prematurely (before the 37th week of pregnancy)

Having a low birthweight

Brain damage either in the womb or in the first few years of life

Drinking alcohol, smoking or misusing drugs while pregnant

Exposure to high levels of toxic lead at a young age

However, the evidence for many of these factors is inconclusive, and more research is needed to determine if they do actually contribute to ADHD.

Symptoms of ADHD 

The symptoms of ADHD can be categorised into two sets of behavioural problems These categories are inattentiveness & hyperactivity and impulsiveness.

The majority of people with ADHD have problems that fall into both these categories, but not always.

For example, some people with the condition may have problems with inattentiveness, but not with hyperactivity or impulsiveness. This form of ADHD is also known as attention deficit disorder (ADD), and it can sometimes go unnoticed because the symptoms may be less obvious.

Symptoms Of ADHD in Children and Teenagers

The symptoms of ADHD in children and teenagers are well outlined, and they are usually noticeable before the age of six & will be displayed at home & at school. Main symptoms include...

Inattentiveness

Short attention span & easily distracted

Making careless mistakes in things such as school work

Appearing forgetful or losing things

Being unable to stick at tasks

Appearing to be unable to listen to or carry out instructions

Constantly changing activity or task

Having difficulty organising tasks

Hyperactivity and Impulsivenes

Being unable to sit still  in calm or quiet surroundings

Constant fidgeting

Being unable to concentrate on tasks

Excessive physical movement

Excessive talking

Being unable to wait their turn

Acting without thinking

Interrupting conversations

Little or no sense of danger

Although not always, some children may also have signs of other problems or conditions alongside ADHD. These include...

Anxiety disorder. This causes your child to worry and be nervous much of the time. It may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness

Oppositional Defiant Disorder (ODD) This is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers

Conduct Disorder. This often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals

depression

Sleep Problems. Finding it difficult to get to sleep at night, and having irregular sleeping patterns

ASD This affects social interaction, communication, interests and behaviour

Epilepsy.  A condition that affects the brain and causes repeated fits or seizures

Tourette’s Syndrome. A condition of the nervous system, characterised by a combination of involuntary noises and movements called tics

In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD.

ADHD is a developmental disorder. It is believed that it cannot develop in adults without it first appearing during childhood. However, it is known that symptoms of ADHD are often present from childhood into a person's teenage years, and then adulthood. 

An estimated 15% of people diagnosed with ADHD as children will at 25 years old still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives.

The symptoms in children and teenagers, which are listed above, is sometimes also applied to adults with possible ADHD

Possible Symptoms Of ADHD in Adults

Carelessness and lack of attention to detail

Continually starting new tasks before finishing old ones

Poor organisational skills

Inability to focus or prioritise

Continually losing or misplacing things

Forgetfulness

Restlessness and edginess

Difficulty keeping quiet and speaking out of turn

Blurting out responses and often interrupting others

Mood swings, irritability and a quick temper

Inability to deal with stress

Extreme impatience

Taking risks in activities, with little or no regard for personal safety or the safety of others

One of the most common conditions that can occur alongside ADHD is depression. Other conditions that adults may have alongside ADHD include:

Personality disorders

Bipolar disorders

OCD

Diagnosing ADHD 

If you think you or your child may have ADHD you should speak to your GP.

If it's your child you are worried about, it may help to speak to their teachers before seeing your GP, to find out if they have any concerns about your child's behaviour.

Your GP can't diagnose ADHD but they can discuss your concerns with you and refer you for a specialist assessment, if necessary.

When you visit your GP they may ask you questions similar to these to help. The questions could include...

Explaining your symptoms or those of your child

When these symptoms started

Where the symptoms occur eg. at home or in school

If the symptoms affect your or your child’s day to day life

If there have been any recent significant events in your or your child's life

I there is a family history of ADHD

About any other problems or symptoms of different health conditions you or your child may have.

If your GP thinks your child may have ADHD, they may first suggest a period of "watchful waiting" lasting around 10 weeks. This is to see if you or your child's symptoms improve, stay the same or get worse.

If the behaviour doesn't improve, and both you and your GP thinks it is seriously affecting day-to-day life, you should be referred to a specialist for a formal assessment.

Assessment

There are a number of specialists you or your child may be referred to for a formal assessment, including:

A Psychiatrist

A Paediatrician

A learning disability specialist, social worker or occupational therapist with expertise in ADHD

Who you are referred to will depend on your age and what is available in your local area.

There is no simple test to determine whether you or your child have ADHD, but your specialist can make an accurate diagnosis after a detailed assessment.

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.

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 12

Been showing symptoms in at least two different settings eg. at home and at school

Displayed 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

Diagnosis in Adults

Diagnosing ADHD in adults is more difficult because there is some disagreement about whether the list of symptoms used to diagnose children and teenagers applies to adults.

In some cases, an adult may be diagnosed with ADHD if they have five or more symptoms of inattentiveness, or five or more symptoms of hyperactivity and impulsiveness, that are listed in the criteria for children with ADHD.

As part of your assessment, the specialist will ask about your present symptoms although, under current diagnostic guidelines, a diagnosis of ADHD in adults cannot be confirmed unless your symptoms have been present from childhood.

If you find it difficult to remember whether you had problems as a child, or you were not diagnosed with ADHD when you were younger, your specialist may wish to see your old school records or talk to your parents, teachers or anyone else who knew you well when you were a child.

For an adult to be diagnosed with ADHD, their symptoms should also have a moderate impact on different areas of their life, such as:

Underachieving at work or in education

Difficultly making or keeping friends

Difficulty in relationships with partners

If your problems are recent and did not occur regularly in the past, you are not considered as having ADHD. This is because it is currently not thought that ADHD can develop for the first time in adults.

Treating ADHD 

There is no cure for ADHD, but treatment can help relieve the symptoms and make the condition much less of a problem day to day.

ADHD can be treated using medication or therapy, but a combination of both is often the best way to treat it.

Treatments include...

Medication

There are four types of medication licensed for the treatment of ADHD. These medications are not a permanent cure for ADHD, but they can help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.

Some medications need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended, to assess whether the medication is still needed.

If you or your child is prescribed one of these medications, you will probably be given small doses at first, which may then be gradually increased. You or your child will need to see your GP for regular check-ups, to ensure the treatment is working effectively and to check for signs of any side effects or problems.

If either you or your child begin to feel depressed or suicidal while taking this medication, speak to your doctor.

Therapy

As well as taking medication, different therapies can be used n treating ADHD in children, teenagers and adults. Therapy is also effective in treating additional problems, such as conduct or anxiety disorders, that may appear with ADHD.

These therapies include...

Psychoeducation

Psychoeducation means you or your child will be encouraged to discuss ADHD and how it affects you. It can help children, teenagers and adults make sense of being diagnosed with ADHD, and can help you to cope and live with the condition.

Behaviour Therapy

Behaviour therapy provides support for carers of children with ADHD, and may involve teachers as well as parents. Behaviour therapy usually involves behaviour management, which uses a system of rewards to encourage your child to try to control their ADHD.

If your child has ADHD, you can identify types of behaviour you want to encourage, such as sitting at the table to eat. Your child is then given some sort of small reward for good behaviour, and removal of a privilege for poor behaviour. For teachers, behaviour management involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.

Parent Training and Education Programmes

If your child has ADHD, specially tailored parent training and education programmes can help you learn specific ways of talking to your child, and playing and working with them to improve their attention and behaviour. You may also be offered parent training before your child is formally diagnosed with ADHD.

These programmes are usually arranged in groups and can last several weeks. They aim to teach parents and carers about behaviour management while increasing your confidence in your ability to help your child, as well as improving your relationship. 

Social Skills Training

Social skills training involves your child taking part in role play situations, and aims to teach them how to behave in social situations by learning how their behaviour affects others.

Cognitive Behavioural Therapy (CBT)

CBT is a talking therapy that can help you manage your problems by changing the way you think and behave. A CBT therapist would try and change how your child feels about a situation, which would in turn potentially change their behaviour.

CBT can be carried out with a therapist individually or in a group.

Living with ADHD 

Caring for a child with attention deficit hyperactivity disorder (ADHD) can be draining.

The behaviours typical of ADHD can make normal everyday activities exhausting and stressful.

Ways to cope...

Although it can be difficult sometimes, it's important to remember a child with ADHD cannot help their behaviour. People with ADHD find it difficult to suppress impulses, which means they do not stop to consider a situation or the consequences before they act.

If you are looking after a child with ADHD, you may find this advice helpful.

Plan the Day

Plan the day so your child knows what to expect. Set routines can make a difference to how a child with ADHD copes with everyday life. 

Set Clear Boundaries

Make sure everyone knows what behaviour is expected, and reinforce positive behaviour with immediate praise or rewards. Be clear, Explaining if the boundaries are crossed there are consequences eg a privilege is ttaken away & and follow these through consistently.

Be Positive

Give specific praise. Instead of saying a general, "Thanks for doing that," you could say, "You washed the dishes really well. Thank you." This will make it clear to your child that you are pleased, and why.

Giving Instructions

If you are asking your child to do something, give brief instructions and be specific. Instead of asking, "Can you tidy your bedroom?" say, "Please put your toys into the box, and put the books back onto the shelf." This makes it clearer what your child needs to do and creates opportunities for praise when they get it right.

Incentive Scheme

Set up your own incentive scheme using a reward chart, so good behaviour can earn a privilege. For example behaving well on a shopping trip will earn your child time on the computer or some sort of game. Involve your child in it and allow them to help decide what the privileges will be.

These charts need regular changes or they become boring. 

Intervene Early

Watch for warning signs. If your child looks like they are becoming frustrated, overstimulated and about to lose self-control, intervene. Distract your child if possible, by taking them away from the situation, which may calm them down.

Social Situations

Keep social situations short and sweet. Invite friends to play, but keep playtimes short so your child does not lose self control. Do not aim to do this when your child is feeling tired or hungry, such as after a day at school.

Exercise

Make sure your child gets lots of physical activity during the day. Walking, skipping and playing sport can help your child wear themselves out and improve their quality of sleep. Make sure they are not doing anything too strenuous or exciting near to bedtime.

Bedtime

Stick to a routine. Make sure your child goes to bed at the same time each night and gets up at the same time in the morning. Avoid overstimulating activities in the hours before bedtime, such as computer games or watching TV.

Night Time

Sleep problems and ADHD can be a vicious circle. ADHD can lead to sleep problems, which in turn can make symptoms worse. Many children with ADHD will repeatedly get up after being put to bed and have interrupted sleep patterns. Trying a sleep-friendly routine can help your child and make bedtime less of a battleground.

Help at School

Children with ADHD often have problems with their behaviour at school, and the condition can have a negative impact on a child's academic progress.

Speak to your child's teachers or their school's special educational needs co-ordinator (SENCO) about any extra support your child may need

Adults with ADHD

If you are an adult living with ADHD, you may find the following advice useful.

Make lists

Keep diaries

Stick up reminders and set aside some time to plan what you need to do if you find it hard to stay organised

Let off steam by exercising regularly

Find ways to help you relax, such as listening to music or learning relaxation techniques

If you have a job, speak to your employer about your condition, and discuss anything they can do to help you work better

Talk to your doctor about your suitability to drive, as you will need to tell the Driver and Vehicle Licensing Agency (DVLA) if your ADHD affects your driving

Contact or join a local or national support group. These organisations can put you in touch with other people in a similar situation, and they can be a good source of support, information and advice.