ADHD/ADD

Attention Deficit Hyperactivity Disorder

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What is Attention Deficit Hyperactivity Disorder?

ADHD is a common behavioral disorder that affects an estimated 8% to 10% of school-age children. There are three main types of ADHD:

(1) Attention Deficit/Hyperactivity Disorder- Predominantly Inattentive Type. These are the children who are dreamy and unfocused in the classroom who generally do not have conduct issues or get into trouble. This subtype can be easily missed diagnostically by teachers. This is sometimes referred to as ADD, however in the 2000 diagnostic criteria (DSM-IV) this was changed.

(2) Attention Deficit/Hyperactivity Disorder- Predominantly Hyperactivity Type. This is a little known subtype of ADHD where the chlidren have high excess motor energy, are always on the go and fidgeting, but generally do not have attention issues and can concentrate.

(3) Attention Deficit/Hyperactivity Disorder- Combined Type. Children with this subtype are generally inattentive and hyperactive/impulsive. These are the kids that you tend to see on the news as they often get themselves into trouble at school for misbehaving and can be very misunderstood by teachers and parents.

It is important to understand that attention skills, like all other skills, are on a continuum. A child can have an attention weakness without it being classified as a disorder, and only children with clinically significant impairments to their daily functioning are considered to have this disorder. It is important that this is assessed very carefully by a specialist with experience in this condition, and that attention and behaviour ratings are obtained from a variety of carers and settings before diagnosis is confirmed. Medication should only be considered if a diagnosis is confirmed and functional impairments are significant. Medication is often the last resort in treatment once other more cognitive means are trialled.

What are the main symptoms?

There are two main criteria used to make a diagnosis: attention symptoms and hyperactivity/impulsivity symptoms.

The key features associated with symptoms of inattention include:

• failing to give close attention to details and difficulty sustaining attention in tasks or play
• not listening when spoken to
• not following through on instructions and failure to finish tasks
• difficulty organising tasks and activities
• avoiding, disliking or being reluctant to engage in tasks that require sustained mental effort
• losing things necessary for tasks or activities
• easily distracted

The key features associated with symptoms of hyperactivity (sometimes known as hyperactivity-impulsivity) include:

• fidgeting with hands or feet, squirming in seat
• leaving seat when remaining sitting is expected
• running about or climbing excessively
• difficulty playing or engaging in leisure activities and often ‘on the go’
• talking excessively and blurting out answers before a question is completed
• interrupting others

To fulfil a diagnosis of ADHD, symptoms must persist for six months or more and have been present before the age of 7 years. Impairment needs to be noted in two or more settings to confirm diagnosis. Issues in a single setting but not others is typically not indicative of ADHD.

While ADHD is recognised as a disorder that is distinct from other childhood disorders, it frequently overlaps with other conditions such as Conduct Disorder, Oppositional Defiant Disorder and learning disabilities. This can make diagnosis difficult and a child should be assessed wholistically to make a proper diagnosis. Also, many of the symptoms of ADHD are shared by other disorders.

What Causes ADHD?

There is no single cause underlying ADHD, and many different mechanisms can create the same behavioural symptoms. Genetic factors, brain chemistry, toxins in the environment, problems in pregnancy, or anything that affects brain development may have a role in the presence of ADHD. Studies show that certain areas of the brain of people who suffer from ADHD have less activity and blood flow and that particular structures of the brain are smaller. These areas are the ones that help restrain behaviour, uphold attention, and control mood such as prefrontal cortex, the basal ganglia, and the cerebellum. Much research is still being conducted.

How is ADHD diagnosed?

Usually a medical professional such as a paediatrician, child psychiatrist or psychologist conducts the initial assessment or diagnosis of ADHD. Psychologists usually focus mainly on how the disorder affects behaviour, learning, emotional functioning and social skills, and put together therapy programs to improve these areas. Paediatricians usually manage ADHD through medication. Psychiatrists can offer both medication and some counselling.

There are various ways to measure ADHD. Psychologists use rating scales, questionnaires and other tests for collecting information from the children themselves, their parents/caregivers and their teachers. Usually as a minimum an IQ test, academic achievement testing, attention testing and tests of executive functioning are conducted, along with screening for behavioural, social and emotional problems. If learning has been impacted it is important to examine whether there are real learning disabilities or whether a child is learning but cannot express their knowledge in the classroom. This is assessed though the IQ and academic achievement testing, which is then analysed for the presence of specific learning disabilities like reading disorders (dyslexia) , writing disorders (dysgraphia) and mathematical disorders (dyscalculia). Only a qualified and registrered psychologist is able to do this type of testing, and usually only more specialised educational, developmental or neuropsychologists have the specialised tests available.

How is ADHD treated?

Treatments can include medication, training for parents/caregivers/teachers, and tailored behaviour management programs for children. Medication is generally used in more severe cases to help focus the child’s attention. Psychological treatments generally aim to develop skills for successful behaviour and learning at school and home, strong emotional functioning, and good social skills.

Medication

Typically, the most commonly prescribed medication is a stimulant such as dexamphetamine, concerta (long acting) and methylphenidate (Ritalin- both long acting and short). More recently non-stimulant medication such as Strattera has been started to be more frequently used as it does not appear to exacerbate anxiety and depression in the same way stimulant medications can.

Psychological treatment

Psychologists commonly provide the following treatments:

• parent/caregiver education about the nature of the disorder and training in behaviour management techniques
• teacher education about the nature of the disorder as well as training in behaviour management techniques and appropriate learning interventions
• therapy and psychological treatment of the child, including education and advice, and skills training to improve concentration. Addressing issues of self-esteem, anxiety and peer relationships is also a crucial element of therapeutic intervention.

In general, medication alone should generally not be regarded as the best treatment of ADHD. Even children with severe ADHD should have access to long-term behavioural programs, as should their families and school. Close collaboration and consultation between professionals involved with children with ADHD can ensure medical and psychological interventions are coordinated, to maximise the benefits and outcomes for each child.

What is adult ADHD and how do I get help?

Attention deficit disorder is not just a problem in children. If you were diagnosed with childhood ADD/ADHD, chances are, you’ve carried at least some of the symptoms into adulthood. But even if you were never diagnosed with ADD/ADHD as a child, that doesn’t mean you can’t be affected by it as an adult. For ADHD to be properly diagnosed there have to have been symptoms of inattention or hyperactivity in childhood. You cannot develop ADHD in adulthood, and if you have had sudden onset of symptoms it is recommended that you immediately see a doctor. Adults with ADD/ADHD often have difficulty staying focused and attending to daily, mundane tasks. When you have adult ADD/ADHD, life often seems chaotic and out of control. Staying organized and on top of things can be extremely challenging—as is sorting out what information is relevant for the task at hand, prioritising the things you need to do, keeping track of tasks and responsibilities, and managing your time. If the symptoms of ADD/ADHD are still getting in the way of your life, despite self-help efforts to manage them, it may be time to seek outside support. Adults with ADD/ADHD can benefit from both psychological treatment and even medication.