Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a neuro-developmental disorder which affects a child’s behaviour. 

Children with ADHD show symptoms of: 

• inattention 
• hyperactivity 
• impulsivity.

These symptoms: 

• are seen in more than one setting, for example school and home 
• persist for at least six months and are more severe than normal for children of the same age 
• start from an early age – usually before the age of seven and cannot be explained by other causes 
• are severe enough to impair functioning in various settings, such as home or school.

1. Inattentive (also known as attention deficit disorder – ADD). Children find it hard to concentrate. They make careless mistakes, are forgetful, and are easily distracted. They have difficulties in organising themselves, even for daily essential activities.
2. Hyperactive-impulsive – main symptoms include excessive fidgeting, difficulties in remaining seated and running inappropriately. Children find it hard waiting their turn, often interrupt and talk excessively.
3. Combined type – features of both inattention and hyperactivity are present.

The exact cause of ADHD is still unclear.

No single factor decides the expression of ADHD; ADHD may be the result of a variety of complex brain developmental processes.

Genetics – there is a strong genetic predisposition. ADHD tends to run in families. No single gene has been identified. It is likely that multiple genes are involved.

Environmental factors – extreme prematurity, very low birth weight, maternal substance misuse and traumatic brain injury have been identified as factors associated with increased risk of ADHD. Psychological family stresses can also contribute or exacerbate the symptoms of ADHD.

Disturbance in the dopamine systems (chemicals in the brain) may be related to the onset of ADHD.

Sometimes parents feel blamed for not having controlled their child, but there is no evidence that poor parenting directly causes ADHD. However, it is important to note that parents can play a crucial role in helping and managing a child with ADHD.

It is fairly common. About 3-5 children in every 100 are affected. ADHD is more common in boys than girls. Adults are also affected.

Children with ADHD are more likely to have: 

• difficulties with learning 
• sleep difficulties 
• coordination difficulties 
• anxiety 
• oppositional defiant disorder 
• conduct disorder 
• autism 
• tic disorder.

Please ask your doctor if you need more information on any of these.

There is no simple test to diagnose ADHD. Diagnosis is usually made by a community paediatrician or a child and adolescent psychiatrist following a referral made by the school or GP.

Diagnostic assessment for ADHD includes: 

• discussion with parent and child 
• detailed history including development 
• a physical examination 
• review of reports from school 
• review of ADHD screening questionnaires completed by a teacher and parents 
• clinical assessments/observations

Treatment depends on the severity of symptoms and age.

Management of ADHD in pre-school child (under five years) For mild to moderate ADHD, behavioural support programmes, such as parent training and education programmes are first-line treatment, which advise on strategies for managing challenging behaviours.

Medication is only rarely used in severe cases alongside behavioral support, and sometimes obtaining specialist opinion from a tertiary centre. ADHD medications are not licensed below six years of age.

Management of ADHD in school-age child (five years and above) Mild – Moderate ADHD is usually managed with parent training and education programmes as in the pre-school child. Medication can be added in cases which do not respond to behavioural support. Medication is offered as a first-line treatment in severe cases.

Behavioural support through an appropriate parent training or education programme is recommended alongside medication.

In addition, at school a child with ADHD is likely to need extra help and support to achieve his or her full potential.

Medications used to treat ADHD are broadly divided in two groups: 

• stimulants like methylphenidate and dexamphetamine 
• non-stimulants like Atomoxetine and Guanfacine.

Stimulants have the effect of making people feel more alert, energetic, and awake. In a person suffering ADHD, they can improve attention and reduce hyperactivity. The stimulants used in the treatment of ADHD include methylphenidate and dexamphetamine.

Methylphenidate is available as different forms. Immediate release methylphenidate is short-acting. It is used for its flexibility in dosing and can be used to determine the correct level of dose during dose changes. Slow or modified-release methylphenidate work for 8-12 hours and can be given once a day. They are more convenient and, as the child or young person need not take a dose in school, reduces stigma attached to this disorder.

Non-stimulant medications by nature do not make people alert or active. However, in ADHD, they can improve symptoms of inattention and hyperactivity. These include medications like Atomoxetine and Guanfacine.

Medications act on certain chemicals in the brain called ‘noradrenaline’. They seem to affect the parts of the brain that control attention and organise our behaviour.

They do not cure ADHD. They help to control the symptoms of poor attention, over activity or impulsivity.

Side effects are unusual but where they do occur, the most common include: 

• loss of appetite 
• mild sleep disturbances 
• weight loss 
• tummy upset, tics, irritability.

Side effects are always monitored closely. Also your child’s height, weight and blood pressure needs to be monitored periodically.

Most children and young people need the medication at least until they finish their education or schooling. A few might need to take it even when they grow up. Some children need medications only at specific times, like for example while attending school, and do not have to take it on weekends or on school holidays.

Your doctor or ADHD nurse will regularly check, at least once a year, if they need to continue the medicine.

Taking these medications can affect driving, and even certain careers like joining the army. It is important that the child is aware of this and will need to discuss it with their doctor as they grow up.

Young people may need explanations and support as they grow up about taking their medication. Stopping medication can cause symptoms to return, and some young people can put themselves at risk in terms of their education, their work, and socially by being impulsive and taking alcohol or drugs.

Remember: if you have any further questions regarding this medication, do not hesitate to contact your doctor. ADHD nurse or pharmacist.

The Ministry of Parenting Suite 6, Wellington House, 90-92 Butt Road, Colchester CO3 3DA Tel: 01206 562626 Email: [email protected] 

Extra – Support for Families Jaywick Community Resource Centre, Brooklands Gardens, Jaywick, Essex CO15 2JP Tel: 01255 475001 Text: 07794 991987 Email: [email protected] 

Triple P online parenting programme Give your name, your child’s name, age and your email address to your child’s nurse or doctor and they can arrange for you to be registered onto the online programme.

ADDISS (Attention Deficit Disorder Information and Support Service) Tel: 020 8952 2800 Web: www.addiss.co.uk Young Minds Parents’ helpline: 0800 018 2138 for any adult concerned about the emotions and behaviours of a child or young person.

Further reading For parents ADD/ADHD behaviour change resource Kit – ready-to-use strategies and activities for helping children with attention deficit disorder.

Grad A Flick.

ADHD Handbook – for parents and professionals Dr Alison Munden and Dr Jon Arcelis The Incredible Years – a trouble-shooting guide for parents of children aged 3-8.

Webster-Stratton Taking charge of ADHD – the complete, authoritative guide for parents. Barkley RA 1-2-3 Magic – effective discipline for children aged 2-12.

4th edition. Phelan T The explosive child – a new approach for understanding and parenting easily frustrated, chronically inflexible children.

Green R.

For children Everything a child needs to know about ADHD (2006) Dr C R Yemula