Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is condition that makes it hard for children to control their behaviour and concentration. It is estimated that around 2-3% of children have ADHD. At present the condition is more common in boys, however this may just be that it is less diagnosed in girls.

There are three main characteristics of ADHD, they are inattention, hyperactivity and impulsiveness, and in general these symptoms appear early on in a child’s life. The process of accurately diagnosing a child with ADHD is very complex, as many children naturally display ADHD-like behaviour. Just because a child appears not to be able to pay attention, or to not concentrate, doesn’t lead to an automatic diagnosis of ADHD. There are three types of ADHD recognised by professionals; the predominantly hyperactive-impulsive type, the predominantly inattentive type and the combined type (who show both inattentive and hyperactive-impulsive behaviour).

Hyperactivity-Impulsivity.

Those children showing hyperactive behaviour traits are constantly active and on the go, they may talk non stop and have difficulty sitting down calming for any length of time. Impulsive children are unable to control their immediate reactions; they fail to think before they act, this may be seen with spontaneous comments or an inability to wait patiently for anything.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) states the following as signs of hyperactivity-impulsivity:

• Feeling restless and fidgeting with hands and feet.
• Being unable to sit quietly when expected.
• Shouting out answers before questions are finished.
• Difficulty in waiting their turn.

Inattention.

Children showing signs of inattention tend to become easily bored and lack commitment to any particular task. They struggle to focus on learning new skills and become easily bored. Inattentive children often have difficulty at school and find homework particularly hard.

The DSM-IV-TR gives the following as signs of inattention:

• Becoming easily distracted by small noises and movements.
• Moving from one activity to another without ever finishing them.
• Not paying attention to details and making lots of basic, simple mistakes.
• Not following instructions and often losing things.

Children that are diagnosed with the predominantly inattentive type of ADHD are rarely impulsive or hyperactive. However they do have difficulty paying attention and often appear to be day dreaming. They may not act mischievously and be a disruption to the class, yet these children struggle to fully understand instructions and can appear distant. As their symptoms are less obvious and disruptive than those displayed by hyperactive-impulsive types, their problems can be easily overlooked.

Many children act impulsively at times, many children fail to pay attention at times, and many children appear hyperactive at times, yet not every child acting in this way has ADHD. To be diagnosed with ADHD a child must display these behaviours to such a degree that is not normal for their age. These behaviours must also appear early in life, before 7 years old and be present for at least 6 months. On top of this, the behaviours must cause disruption in at least 2 areas of their lives, such as in class, in the playground, at home or in social situations. Therefore a child, who displays symptoms of ADHD, without them disrupting their school life, friendships or home life, would not be diagnosed with ADHD.

  It is important to find someone that has been specifically trained to diagnose ADHD, as it can be a complex assessment. Specialists will usually look at whether there are any other situations in the child’s life that may have led to these types of behaviour. Typically these may include a death of a parent, a divorce, middle ear infections causing hearing problems, a learning disability, or anxiety and depression. The specialist will then look at the nature of the child’s school life, to see if it is overly stressful, and the way in which parents and teachers respond to the child’s symptoms. Teachers will often be asked to assess the child’s behaviour and to evaluate it using behaviour rating scales. This way, subjective judgements can be made as to the degree of each behaviour. The child will also be directly assessed by the specialist, who may also interview other adults who come into contact with the child, such as a baby sitter, football coach or other family members. Once all the information has been gathered, the specialist will piece together an overall profile of the child. This will then be compared to the official ADHD-like behaviours listed by the DSM-IV-TR. Criteria then need to be met, such as; which symptoms does the child display? How often? For how long? At what age did these symptoms begin? To what degree do these behaviours affect aspects of the child’s life?

 A correct diagnosis can help the child and their family move forward and have a better understanding of the problems, rather than simply being labelled a ‘naughty’ child. Parents and teachers are likely to be able to deal with the behavioural problems in a more educated way. There is lots of information available for families, to help them be more informed about ADHD sufferers, and to learn what can be done to help the child.