ADHD is a developmental disorder that leads to severe challenges around attention, hyperactivity and impulsivity. In the UK, it is thought that around 1 child in every 20 has ADHD.
To be diagnosed, your child must show signs of ADHD before age 12 in more than one setting (eg at home and school). The characteristics of ADHD should also persist for at least six months and affect their ability to function.
Here, we will explore the signs and risk factors of ADHD, as well as how it is diagnosed and managed, and other conditions that commonly occur alongside ADHD.
Characteristics of ADHD
Someone with ADHD may present with characteristics associated with inattention or those associated with hyperactivity and impulsivity, or both.
Inattention
Difficulties with inattention present as:
- An inability to focus and concentrate
- An inability to pay attention to details
- Being easily distracted
- Being forgetful
- Frequent loss or misplacement of belongings
- Having problems with organisation
Children may not be able to pay attention in class, daydream or zone out in conversation, not be able to remember instructions and need several prompts. They may also find it difficult to organise themselves, find all the right equipment for an activity or have a sense of the passage of time.
They may start tasks and hobbies that they do not finish and start to avoid tasks that they find difficult or those that require sustained attention eg homework or reading books.
Hyperactivity
Hyperactivity implies a constant need for movement, that is, an inability to be still. Hyperactivity can present in different ways, including:
- Fidgeting and squirming even while seated
- Inner feelings of restlessness when asked to be still
- Running and climbing excessively
- Talking a lot and often loudly
Sometimes signs of hyperactivity may be more subtle, like twirling a lock of hair or biting nails.
Impulsivity
Impulsivity may present with blurting out answers or interrupting conversations, acting without thinking and, therefore, not thinking of the consequences of actions, and being impatient and finding it difficult to wait.
In addition, a child may have difficulties with emotional regulation. They may become frustrated, overwhelmed and angry more easily.
Risk factors for ADHD
The cause of ADHD is unknown, but it is thought to be an interplay of genetics and environmental factors.
There is a strong genetic component, and ADHD tends to run in families. There are some conditions that increase the risk of developing ADHD, including prematurity (birth before 37 weeks of pregnancy), having epilepsy, brain injury or having autism.
Conditions that often occur with ADHD
More than two-thirds of children and young people with ADHD will have at least one coexisting condition. Common co-occurring disorders include:
- Anxiety disorders
- Autism
- Learning difficulties eg dyslexia, dyscalculia, dysgraphia and dyspraxia
- Oppositional defiant disorder
- Sleep disorders
- Tics and tourette syndrome
Diagnosing ADHD in children
The exact pathway for the diagnosis of ADHD varies across the UK. However, in general, parents can either approach their GP or a special educational needs coordinator at their child’s school.
This kickstarts a referral pathway to the local service, which may reside in Developmental or Community Paediatrics and Neuro-disability and/or Children and Adolescent Mental Health Services.
Typically, there will be a screening process (eg a screening questionnaire) that will determine whether your child needs a full assessment. This will be completed by the parent and the school.
The full assessment varies across the UK. In most cases, it involves an interview with the parent and child, and may also include observations at school. Your child’s school will be contacted for feedback on their behaviour.
A child or young person may need to complete a QbTest. This is a computer-based test to check for characteristics of ADHD, such as activity levels, measures of attention, and impulsivity.
Your doctor may also use the Conners Scale to assess your child. This involves a series of detailed questionnaires: one for parents, one for teachers and one for the child if they are aged 8 or over.
Taken together, all this information will allow your doctor to determine whether or not your child has ADHD.
Managing ADHD
The first step in managing ADHD is to understand that ADHD is not about bad behaviour. It is about difficulty with attention, concentration, levels of activity and impulsivity.
A key part of managing ADHD is a parenting programme. This is because the usual parenting approaches are often not helpful for supporting a child with ADHD eg a child with ADHD will struggle to remember an instruction that involves several sequential tasks and will need to be instructed to do each task one at a time using succinct language.
Similarly, consistent routines, appropriate behaviour management and positive parent–child interaction are important.
Your child’s carers at school and extracurricular clubs will also need to make adaptations to better support your child. Crucially, when your child receives a diagnosis of ADHD, it is important for them to understand how their condition affects them to help reduce their anxiety levels and learn to advocate for themselves.
When is medication for ADHD appropriate?
The first line of management for ADHD should be education for the parents, carers and child. However, when strategies focused on support are not enough to help your child, your doctor may recommend medication.
Several medicines are available to manage ADHD. They broadly come under the headings of stimulant and non-stimulant medication. The usual first-line medication is methylphenidate, which is effective at controlling core symptoms of ADHD and is well-tolerated.
Methylphenidate can be prescribed in different preparations that are released into the bloodstream at different rates eg immediately, over 2–4 hours, over 6–8 hours and over 8–12 hours. Treatment can, therefore, be tailored to the needs of the child.
Other medications are dexamfetamine and lis-dexamfetamine. Stimulant medications have a similar profile of side effects, which includes appetite suppression, and an increased rate and force of contraction of the heart that may lead to a slight rise in blood pressure — this rise is not clinically significant in the majority of individuals.
Due to these side effects, a careful history of heart problems is taken for the child and family before any medication is prescribed. Also, weight, height and blood pressure are monitored at regular intervals as per guidance.
Non-stimulant medications like atomoxetine and guanfacine are also used. It is advisable to read the product leaflet to familiarise yourself with the effects and side effects of medication.
Outcomes for children with ADHD
ADHD is a lifelong condition. However, in most cases, when a child with ADHD receives appropriate support, they will continue to develop coping strategies and the skills they need to thrive as an adult. In some cases, they may be able to come off their ADHD medication.
How to support your child with ADHD
Supporting your child with ADHD can feel overwhelming at times. It can help to focus on these key approaches:
- Being proactive and seeking help for yourself and your child — you will not always know what to do, so identify people with expertise in the areas that you or your child need help with
- Building your child’s self-esteem — try to avoid labelling behaviours caused by their ADHD as ‘naughty’ or ‘bad behaviour’
- Educating yourself about ADHD and learning how best to support your child
What support is available for children with ADHD?
Support for children with ADHD varies considerably across the UK. To find out what is available in your local area, refer to your local council’s SEND (Special Educational Needs and Disabilities) Local Offer. This provides information on the support services available locally for children with SEND.
Your local area may also have:
- Charities that offer support and advice for living with ADHD
- Clubs and extracurricular activities to support children with ADHD
- Support groups for parents and carers of those with ADHD
In addition to the information supplied by the NHS, other reliable sources of information, advice and support about ADHD include the following national charities and organisations: ADHD Foundation, ADDISS, ADHD UK and ADHD Embrace.