Everything you need to know about…

ADHD

ADHD is a behavioural disorder that affects attention.

It can impact a child’s focus, organisation and self-control. ADHD affects approximately 11% of school-aged children and may run in families.

There are three “types” of ADHD.

The American Psychiatric Association has defined three types of ADHD, according to what behaviours are demonstrated: inattentive; hyperactive-impulsive; and a combine presentation.

It may be a lifelong condition, but early intervention can help.

Many children will continue to show symptoms well into adulthood, but early diagnosis and management can help them lead happy and productive lives.

Executive Function

Before diving into what ADHD is, it’s helpful to understand a little bit about how our brains are wired.

When we plan, organise and complete tasks, our executive function (EF) – a set of skills or mental processes – is responsible. Children with ADHD typically have issues with some of these processes and find it hard to self-regulate or pay attention for long periods of time.

On the right, we review some of the processes that are affected in ADHD.

Working memory

Working memory provides the ability to grasp information and then use it. For school-aged children with ADHD, an issue with working memory means they may struggle to read information, retain it and recall it when completing tests, exams or homework.

Flexible thinking

Also called cognitive flexibility, this mental process allows us to think about or interpret something in more than one way. For children with ADHD, issues with this can make spotting patterns, solving problems, and forming correlations difficult.

Self-control

Self-control or self-regulation allows us to resist temptation and ignore distractions. For children with ADHD, this may make regulating emotions and refraining from acting on impulse challenging – both in the classroom and on the playground.

Defining ADHD

ADHD – or Attention Deficit Hyperactivity Disorder – is a behavioural condition that can affect how a child focuses and behaves.

Typically, ADHD makes an initial appearance in children younger than 7 years old. However, it’s not always easy to distinguish whether symptoms are a normal part of childhood, or perhaps something more. Learning what ADHD looks like means that you have the insight to understand their behaviours.

Children may find it difficult to:

  • Perform well in school
  • Control spontaneous responses or urges
  • Build relationships and form bonds
  • Develop a sense of self-esteem

Most children will show some signs of the condition. If your child is presenting symptoms regularly and across all areas of their life, it may be worth investigating. While most children may daydream in class or not sit still at the dinner table, constant inattention, hyperactivity and impulsivity could be signs of ADHD.

There are many myths surrounding ADHD, so what is and isn’t true?

Myth: Children with ADHD are boisterous or undisciplined troublemakers.

Fact: A child with ADHD is not a bad child. They aren’t lazy either. Often, they are trying as hard as they can to sustain willpower or keep focus, but they find it truly difficult to comply.

Myth: All children with ADHD are hyperactive.

Fact: A lot are, but some can be inattentive without being overly active or impulsive in their actions. Instead, they may appear lethargic, unmotivated and a bit “spaced out.”

A child with ADHD can also be hyperactive but able to pay attention, while others will display all three components of the condition: inattention, hyperactivity and impulsivity. Their symptoms will depend on which characteristics are more dominant and will vary from child to child.

Symptoms

Does your child often say or act, seemingly without thinking about the consequences? Do they have trouble managing time, remembering things and paying attention? Perhaps you’ve noticed that they frequently shift focus from one thing to another or don’t seem to be able to get started on a task.

In some cases, these may be symptoms of ADHD, which can surface at any time or school grade – from preschool to high school. It’s critical to bear in mind that the way ADHD presents in a child depends on age and other factors.

Preschool children

In your preschool child, you might notice that he/she:

  • Takes things without permission
  • Gets easily frustrated
  • Ignores directions
  • Must be reminded frequently to stop and listen
  • Walks around, fidgets or talks when asked not to

School-aged children

In your school-age child, you might notice that he/she:

  • Constantly seem restless
  • Consistently forgets to turn into assignments
  • Is slow to complete tasks
  • Seems distracted or dreamy
  • Often and easily loses focus
  • Doesn’t think about the consequences of their actions

Teens and adults

In your teen or adult child, you might notice that he/she:

  • Has trouble meeting deadlines
  • Often rushes to complete work and makes mistakes
  • Talks too much or fidgets
  • Has difficulty explaining things to others
  • Needs directions repeated or has to re-read information
  • Has a tendency to act on impulse
  • Has trouble prioritising and organising things

Causes

Much is yet to be discovered about the underlying and root causes of this disorder. Research, however, does note a strong genetic component, which shows ADHD can be inherited.

Environmental factors may also increase the likelihood of having the condition. These include: exposure to pesticides and toxins in early childhood; brain injury; and low birth weight or premature birth. 

Genetics

If ADHD runs in the family, the risk of inheriting it increases. Research shows that parents and siblings of a child with ADHD are more likely to have ADHD themselves.

Environment

Low birth weight, exposure to toxins in early childhood and prematurity at birth could all play a part in whether a child later develops ADHD.

Brain Development

Since ADHD is a behavioural condition, having a brain injury could impair the executive function. It is thought that this could be a cause of ADHD in some people. 

Risk Factors

Risk factors for ADHD include traumatic experiences and family stress. Managing ADHD in children can be overwhelming for parents, but it is worth knowing that family stress or pressure can sometimes make the process of coming to terms with the disorder more challenging.

Even if the ADHD symptoms themselves are the cause for family arguments or tension, a calm and supportive home life will really help your child manage their emotions. However, please note that family stress in itself will not cause the disorder.

Complications

ADHD can affect all suffers differently depending on the severity of their case.

Unfortunately, the disorder can engender a number of complications, from poor performance in school to difficult or challenging personal relationships.

Academic failures. As the name suggests, ADHD can interfere with attention. In addition, impulsive behaviour and the consequent lack of productivity when studying, may cause feelings of resentment to arise in some children.

Social interaction. Children with ADHD often find conversations difficult and others may struggle to understand them if they talk fast, interrupt or don’t keep up with a storyline. ADHD can produce erratic behaviour which can make building and keeping relationships with parents, siblings and others difficult to sustain.

Difficulty coping. Life for ADHD sufferers can be tough as they lag behind in school and struggle to be somewhere on time. This can be overwhelming, frustrating and confusing to children with ADHD and may lead to low self-esteem and even suicidal or depressive tendencies.

Comorbidities

Around two-thirds of ADHD sufferers may have at least one other coexisting condition. In fact, more obvious ADHD symptoms can mask more subtle underlying disorders. While any disorder can coexist with ADHD, there are a few that seem to appear with more frequency than others.

Mood Disorders

This is characterised by rapid and extreme changes in mood. All children have mood swings, but the frequency and severity of such mood swings could hint at an underlying issue. If your child is in a bad mood often, cries daily or gets easily irritated by others for no reason, be sure to talk to a doctor as they might be developing depression or bipolar disorder alongside their ADHD.

Sleep Disorders

While sleep problems can be a symptom of ADHD, many children will struggle to fall asleep and stay asleep – to the extent that sleep deprivation can become a separate entity that will require its own individual treatment.

Oppositional Defiant Disorder (ODD)

Nearly 40% of individuals with ADHD may have Oppositional Defiant Disorder. If your child or teenager struggles to control their temper, has a history of being argumentative, constantly refuses to follow rules or comes across as spiteful or vindictive, it could be time to speak to a medical professional.

Anxiety

ADHD can put children under a lot of stress and drastically lower self-esteem. They might worry far too excessively or be easily put on edge, which can result in anxiety and panic attacks. How ADHD is managed may have a positive or negative contribution to their mental health, so it’s important to ensure your child doesn’t feel isolated or excluded.

Tics or Tourette’s Syndrome

Did you know that between 60 to 80% of people with Tourette’s may have ADHD? This condition is typified by involuntary, rapid and recurrent vocalisations or movements. In extreme cases that could mean barking, swearing excessively, flinching and repetitive blinking.

Diagnosis

If you suspect that your child may have ADHD, consult your pediatrician.

It might also be good to talk with your child’s teacher to gain a deeper insight into their school life. However, a formal diagnosis means meeting with a clinician so they can rule out other conditions or potential external contributors. It won’t always be straightforward. Diagnosing ADHD is complex and there is no lab test for it. It is vital that you are open and honest, and work closely with your clinician to narrow down the exact cause of their symptoms.

The first step in diagnosing ADHD involves gathering information through extensive interviews, third-party observations, obtaining patient history, filling out checklists and evaluating behaviour. Your child will also get a full medical examination, which may include both seeing and hearing tests.

If the physician identifies signs of ADHD, they will often refer the child over to psychologist or someone who has specialist experience in diagnosing ADHD. These professionals will know whether a child’s behaviour meets the criteria for the condition when considering age. Please note that teachers and coaches cannot diagnose ADHD.

Treatment

There is no known cure for ADHD but with the right treatment, symptoms can improve over time. If parents and teachers work effectively together, children can learn how to manage their behaviour, attention and emotions. As they enter adulthood, they will need these skills to build a happy and independent life for themselves. Treatment options for ADHD tend to include medication, parent coaching, behaviour therapy, education support and psychotherapy.

Schools are often equipped to provide specialized instruction for children with ADHD. Consult your child’s teacher for more information. Other professionals who can help include: child psychologists, child neuropsychologists and special education teachers.

In the United States, schools have a legal obligation to help children with disabilities. These children are entitled to a 504 plan, or a menu of special accommodations to assist them.

Psychological testing and on-going evaluation can help parents and teachers develop a highly-targeted approach for each child. Counseling can help a child manage the emotional difficulties they may face when struggling academically or managing social anxieties as a result of challenging interactions with their peers.

If you are a parent or caregiver to a child with ADHD, coaching will help you find better ways to manage the condition so you learn how to respond to difficult behaviours and low focus. You will learn how to reward positive behaviour as well as how to teach your child all about the consequences of their actions. They will typically advise you to give your child immediate feedback when they present positive behaviour, while redirecting the types of behaviour you want to discourage. Teachers can also join in to help them enjoy school more.

Stimulants are the most common type of medication used to treat symptoms of ADHD as they help to increase dopamine and norepinephrine (brain chemicals), which are essential in activating the brain’s ability to pay attention and use more self-control. They are considered safe for children to take depending on the dosage and other existing medical problems, with some side effects:

  • Decreased appetite
  • Stomach aches
  • Personality changes
  • Increased irritability
  • Anxiety
  • Sleep problems

If you notice any of these side effects, book your child in with a physician straight away.

Non-stimulants can also be used but they tend to take longer to work. These can help improve focus, impulsivity and attention. Often, these are prescribed as an alternative option if your child is struggling with the side effects of stimulants.

Behavioural therapy helps improve emotional and social skills by aiming to change behaviour and outlook. Psychotherapists will also assist children with practical tasks like completing schoolwork, stress management and coping with emotionally difficult events. This is all done in a positive and supportive way to help them combat self-esteem issues.

Support Your Child

If ADHD is not treated, it can make it hard for children to succeed. Constant failure will impact on their self-esteem and could them lead down a path of depression and risk-taking or oppositional behaviour.

  • Get involved by learning everything you need to know about ADHD
  • Be sure to keep therapy appointments and attend sessions with your child
  • Work with teachers to find out how your child is doing and if there’s anything they would like you to enforce at home – and vice versa
  • Always strive to parent with warmth, affection and support
  • Focus on your child’s strengths – talk openly with them about ADHD and encourage them to view their condition in a positive way
  • Ask for help because it can be hard on parents too
  • Administer medicines safely by following the doctor’s instructions regarding dosage and recommended time of day