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Attention Deficit Hyperactivity Disorder (ADHD)

Posted On: February 01, 2020

Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is common in both children and adults. Children particularly can be difficult. Bouts of inattentiveness and hyperactivity are commonplace in young children and should not be a cause for concern. However, if you are noticing troubling patterns of decreased concentration and organisation in your child it may be worth having them checked for ADHD (Attention Deficit Hyperactivity Disorder)

ADHD is a behavioural disorder that is complicated and often hard to diagnose. While in most cases the symptoms are noticed at an early age, symptoms may worsen during a change to the child’s circumstances (i.e. moving house or starting school) It occurs in children and most cases are diagnosed before the child’s teenage years. However, symptoms can persist into adulthood.

ADHD is characterized by a lack of attentiveness and hyperactive and impulsive behaviours. ADHD can be detrimental to a child’s development if left untreated.

While there is no permanent cure for ADHD, there are a range of treatments to facilitate living with the condition.

WHAT CAUSES ADHD?

Unfortunately, the cause of ADHD is not yet properly understood, although it has been shown to run in families.

Research into the area is ongoing. Some research shows that individuals with ADHD have differences in areas of the brain. Particularly those regulating emotion and reward processing. Their role in ADHD is, however, still not fully understood.

Other factors that may cause ADHD include:

Individuals with brain damage and epilepsy are also at greater risk of ADHD.

SYMPTOMS OF ADHD

The symptoms of ADHD are divided into two categories:

  1. Inattentiveness
  2. Hyperactivity and impulsiveness

The majority of individuals with ADHD will likely experience symptoms from both categories. In some cases, people may suffer from lack of attentiveness but have no issues with impulsivity and hyperactivity. This is known as ADD (Attention Deficit Disorder) and is often harder to diagnose due to the subtler symptoms.

CHILDREN AND TEENAGERS

Symptoms are usually noticeable before the age of 6. To be classified as ADHD they must occur in more than one situation (i.e. home and school)

INATTENTIVENESS SYMPTOMS

  • short attention span, easily distracted
  • making simple mistakes
  • forgetfulness and regularly losing things
  • inability to stick to long and/or tedious tasks
  • difficulty following instructions
  • constantly switching between tasks
  • difficulty organizing tasks

HYPERACTIVITY AND IMPULSIVENESS SYMPTOMS

  • constantly fidgeting and unable to sit still
  • losing focus
  • talking and moving excessively or more than average
  • inability to wait for their turn
  • interrupting other people’s conversations
  • acting thoughtlessly
  • diminished or non-existent sense of danger

Without support and treatment these symptoms can greatly impact your child’s academic and social development. If you notice your child regularly exhibiting these behaviours it is advisable to consult with your GP.

DIAGNOSING ADHD

If you suspect your child may have ADHD, your GP should be your first port of call. However, they cannot provide a formal ADHD diagnosis as this must be done through a specialized assessment by a psychiatrist, paediatrician, or another individual with expertise in ADHD such as a learning disabilities specialist, social worker or occupational therapist. Your GP can refer you for assessment after a consultation.

During your meeting with your GP they may ask you some questions about your child’s symptoms such as when they started, where they occur, and how severely they affect your child’s day-to-day life.

They may also ask you if there is a history of the condition in your family, if there have been any recent events that may have triggered these behaviours or if there are any other symptoms or conditions.

If it appears likely that your child has ADHD, your GP will likely advise a 10-week supervisory period to monitor the development of your child’s symptoms for worsening or improvement. If their behaviour has not improved after this time and it is having a negative impact on their day-to-day life, then you should be referred for a specialist assessment.

TESTING FOR ADHD

While there is no simple procedure to verify whether or not an individual has ADHD, a specialized assessment can provide an accurate diagnosis.

The assessment will include a series of interviews with your child as well as with other important people such as parents or teachers. They will also take a physical examination to ensure that the symptoms cannot be explained by another cause.

DIAGNOSTIC CRITERIA

For your child to be diagnosed with ADHD they must display 6 or more symptoms from either category (inattentiveness & hyperactivity and impulsiveness).

A diagnosis will depend on how long your child has been displaying their symptoms. Children with ADHD will have displayed six or more symptoms from before the age of 12 and will have been exhibiting these behaviours for at least six months.

They must also have symptoms in more than one setting. This is to eliminate the possibility that they are just reacting to certain other factors such as a teacher they don’t like.

Finally, the diagnosis must show that their behaviour is having a negative impact on their life, making social or academic progress more difficult, and that it cannot be best explained by other causes such as a developmental disorder or simply a difficult time in their life.

ADHD IN ADULTS

Diagnosing ADHD in adults is more difficult than diagnosing it in children. Adults with undiagnosed ADHD may have found ways to cover up their symptoms and be completely unaware of their condition, believing instead that they simply find day-to-day tasks more taxing.

ADHD symptoms will manifest themselves differently in adults than children. For example an adult with ADHD may find themselves struggling to keep a job or a relationship, having difficulties in managing their money and engaging in risky behaviours such as reckless driving. This can lead to feelings of guilt, distress, anxiety, and shame.

When diagnosing an adult with ADHD, a diagnosis cannot be given unless the symptoms were present in childhood. It is not currently thought that ADHD can develop in adulthood.

If you were not diagnosed with ADHD as a child, the specialist may need to interview past teachers, parents, or others who knew you well as a child.

Similar to diagnoses in children, adults with ADHD must show a negative impact on their quality of life from the symptoms.

LIVING WITH ADHD

There are a variety of treatment options available for adults and children with ADHD to help them cope with the condition and improve their professional, academic and social lives.

Individuals with ADHD will usually be prescribed medication. Therapy and counselling is also available and can be used in conjunction with medications for a comprehensive approach. For children younger than 6, therapy is prescribed as a first line of treatment as the side effects of medication can be more severe in younger children.

The most common form of medication prescribed for ADHD is stimulants. These drugs work by boosting levels of dopamine in the brain. Dopamine is a neurotransmitter which plays a key part in motivating us through our reward center. For people with ADHD, stimulants can increase their focus, countering symptoms of inattentiveness.

Stimulants come in a variety of forms including pills, capsules, liquids, and skin patch. They are also available in immediate release and extended release forms. The most common stimulants used for ADHD are:

  • Amphetamine (Adderall)
  • Methylphenidate (Ritalin, Concerta, Metadate, Methylin. Also available in patch form as Daytrana)
  • Dexmethylphenidate (Focalin)
  • Dextroamphetamine (Dexedrine, Dexostat)
  • Lisdexamfetamine dimesylate (Vyvanse)

Side effects of these drugs include

  • Depression
  • Insomnia
  • Irritability and Restlessness
  • Appetite reduction
  • Increased heart rate
  • Stomach pain
  • Dizziness
  • Headaches

Stimulants are especially dangerous and even fatal for individuals with heart conditions. As such it is recommended that anyone beginning a course of stimulant medication have a cardiac evaluation beforehand.

Stimulants for ADHD are also mildly addictive with a potential for abuse. Young people especially may use them to stay awake and focus while studying or for weight loss. Consequently, stimulant medications are not recommended for people with a history of drug abuse.

People with personal or family history of psychiatric disorders such as depression or bipolar disorder are at risk of experiencing aggravated symptoms when taking stimulants.

There are also non-stimulant medications available for treating ADHD which may have a gentler side effect profile if stimulants do not work for you. The most common are atomoxetine and guanfacine. These may also be taken alongside stimulants. It should also be noted that atomoxetine may cause suicidal ideation in young people. However, atomoxetine does have some antidepressant properties, making it especially useful for people with comorbid depression or anxiety.

Always consult with your GP when starting a course of medication. It is important to remember that treatment takes time and is often a process of trial and error. You might not find the perfect medicine and dosage that works for you immediately. Be sure to monitor the effects, both positive and negative, and inform your doctor if you think you need to change prescription.

THERAPY

As well as medications there are a variety of therapy options to assist you and/or your child with living with ADHD.

Parenting skills

Parenting a child with ADHD can be challenging, it may be helpful for you to learn special parenting skills and tactics to better support your child. These focus on ways to simplify and organise your child’s life as well as managing and minimizing difficult symptoms in healthy and supportive ways.

Support groups can also be immensely useful for those living with ADHD. They allow parents of children with ADHD to connect, encourage and share with each other

Psychotherapy

This is an excellent tool to help individuals recognize and manage behaviours associated with ADHD such as impulsivity and procrastination. Psychotherapy can educate a person about their disorder, helping them recognize when symptoms are manifesting and implement strategies to overcome these symptoms. Most experts recommend a combination of medication and therapy as the most effective treatment of ADHD.

Social skills training

Because symptoms of ADHD can seriously affect a child’s social development and interaction, it may sometimes be necessary to provide them with training to manage in social settings. Social skills training teaches the child more appropriate behaviours for interacting with others.

Lifestyle changes

In addition to medication and therapy, making changes at home can have a beneficial effect on those with ADHD. For children it is important to cultivate a well organised household with minimal clutter and distractions (such as TV) as well as a regular routine for meals and bedtime etc. As a parent being supportive is essential: frequent affection and support will be helpful in maintaining your child’s self-esteem as well as an understanding of situations which will be triggering for your child. It is important to be patient with your child, consider enacting a “time out” discipline system where they can be removed from situations and distractions and allowed to calm down before you can both discuss their behaviour. If you are finding parenting overwhelming, consider a support group or counselling.

COMORBID CONDITIONS

Sometimes children with ADHD may exhibit symptoms of other conditions, such as:

  • anxiety disorder, characterized by excessive worrying which can manifest itself in physical symptoms
  • depression
  • Autistic Spectrum Disorder (ASD)
  • Oppositional Defiant Disorder (ODD), where the child is especially disruptive and rebellious towards authority figures
  • Conduct Disorder, a tendency towards general antisocial behaviour such as violence or vandalism
  • Epilepsy, a brain condition which causes fits or seizures
  • Tourette’s, a nervous condition which causes physical and verbal tics
  • sleeping problems, these may be caused or exacerbated by stimulant medications
  • other learning difficulties

 

 

OTHER RESOURCES

ADDA (Attention Deficit Disorder Association) – an international, non-profit organisation focusing on adults with ADHD/ADD

Child Mind Institute

Impact ADHD provides resources for parents of children with ADHD

ADHD Institute

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