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ADHD (attention deficit hyperactivity disorder)
Written by Dr Helen Likierman, and Valerie Muter, chartered clinical psychologists
What other difficulties can occur alongside ADHD?
ADHD often occurs alongside other difficulties and is not the sole cause of problem behaviour. Children may exhibit temper tantrums, sleep disorders, and be clumsy. Other behavioural problems that occur with ADHD include:
What causes ADHD?
Environmental factors
How is ADHD diagnosed?
It will often be appropriate for other professionals such as psychologists, speech therapists, teachers and health visitors to contribute their observations to the assessment of a child with possible ADHD. There is no single diagnostic test for ADHD so different sorts of information needs to be gathered, such as the following:
Medical history
Several medical conditions are known to be associated with ADHD. These include fragile-X syndrome, fetal alcohol syndrome, G6PD deficiency, phenylketonuria and generalised resistance to thyroid hormone.
Accidents, operations and chronic medical conditions such as epilepsy, asthma and heart, liver and kidney disorders all need to be taken in to account. Also of possible relevance is any medication the child is taking, as well as any adverse reactions they have had to medication in the past.
Past psychiatric history
Educational history
Evaluation of the child's temperament and personality
Family history
Social assessment
What treatment is available for ADHD?
It is not easy to live or cope with a child with ADHD. Both parents and teachers can follow general guidelines to manage a child's problematic behaviour but they may need specialist support and advice, e.g. from a psychologist.
Medication
Ritalin reduces hyperactivity and impulsiveness and helps to focus a child's attention. They become less aggressive, seem to comply with requests, and become less forgetful. Many parents say their child's behaviour has vastly improved as a result of Ritalin.
However, there is growing concern about the use of Ritalin to treat ADHD. Like amphetamines, Ritalin is classified as a class A drug. Many parents and professionals are worried about alleged side effects, including damage to the cardiovascular and nervous systems. Ritalin's manufacturers recommend that it is only used to treat children aged six years and over. If symptoms don't improve after a month's trial it should be discontinued. The manufacturers also recommend that even if Ritalin is effective it should discontinued periodically to assess the child's condition. You should discuss any concerns with your child's doctors, and they may alter the dose prescribed.
Psychological treatments
Educational management
Diet
What is the likely outcome?
ADHD requires a medical diagnosis by a doctor, usually a child or adolescent psychiatrist, a paediatrician or paediatric neurologist or a GP.
Risk factors that could predispose the child to ADHD include difficulties and risks in pregnancy and during birth, for example if the mother was in poor health, very young or drank alcohol or smoked or had an extended or complicated labour.
Enquiring about any mental health problems the child has had can help rule out depression or anxiety being behind the symptoms.
This means the level of their ability and what specific difficulties they have, how they function within their peer group and get on with teachers, and any behaviour difficulties such as suspensions or exclusions. A more detailed evaluation of the child's learning by a psychologist may be necessary.
The child's temperament and personality, those of other family members and the nature of relationships within the family may need to be assessed. This will include discussion of the methods used by the parents to manage the child's behaviour and how successful they have been. Although this seems intrusive, the assessor will remain neutral and parents should not feel the disorder is 'their fault'.
The mental and physical health of the child's parents and other family members can be relevant, particularly regarding the incidence of ADHD or depression.
The family's social circumstances, such as housing, poverty, and social support may all have an impact on the child's behaviour.
Treatment depends on a child's exact diagnosis. It should take into account any specific difficulties and those strengths that may aid their improvement.
Behavioural management techniques such as those above are always important, and for mild attention deficit problems they are the treatment of choice. US research suggests that medication is the best treatment for true ADHD. The most common and effective medications are amphetamine-like stimulants, mainly methylphenidate and dexamfetamine. If there are coexisting conditions then these may also require medication.
In addition to the management techniques described, other forms of psychological treatment might include anxiety management, cognitive therapy, individual psychotherapy and social skills training.
This includes individual, or group, learning support for coexisting learning difficulties and educational underachievement.
Research suggests that diet is not a significant factor in ADHD for most children. Some children have particular food allergies that need investigation. Dietary changes need to be supervised by a doctor and nutritionist. In this approach all foods suspected of causing behavioural problems are removed from the diet then gradually reintroduced while the child's behaviour is monitored by the psychologist.
Many children simply outgrow ADHD. About half of those affected appear to function normally by young adulthood, but a significant number will have problems that persist into adult life. These may take the form of depression, irritability, antisocial behaviour and attention problems.
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