Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a common condition diagnosed in children who display symptoms of hyperactivity, inattention and/or impulsivity. Although its causes are not fully understood, factors including genetics and antenatal problems are thought to play a role.

Treatment for the condition will generally involve a team of professionals experienced in child development and ADHD specifically. It may encompass parent-training and the setting of stricter boundaries at home, as well as behavioral therapy and medication. With adequate support, children with ADHD can learn to manage their symptoms effectively.

The symptoms of ADHD may first be recognised by a parent, teacher or caregiver. They can in some cases be difficult to distinguish from age-appropriate energeticness and/or misbehavior.

The core symptoms are persistent hyperactivity, inattention and/or impulsivity. These behaviors should be displayed in more than one setting – for example, at home and at school – and during more than one activity – for example, when doing schoolwork and when going to bed.

To be classed as ADHD, the symptoms must:

• First appear before the age of 12
• Occur in more than one setting
• Occur for at least six months
• Interfere with social, academic and/or occupational activities
• Be unrelated to any other condition or disorder that the child may have

The symptoms of ADHD tend to vary from child to child. There are, however, three key subtypes that most cases will fit into.

• Hyperactive-impulsive subtype: Hyperactivity and impulsivity commonly occur together in young children with ADHD. This may mean that a child feels the need to move around constantly, talk a lot and may struggle with controlling their impulses.
• Inattention subtype: The main features of this subtype are difficulty paying attention and reduced cognitive ability. This may mean that a child is easily distracted, struggles to take in and follow instructions, and is forgetful. The symptoms of inattention will typically not become apparent until a child is eight or nine years old.
• Combined subtype: Children with this subtype will display features of both the hyperactive and inattention subtypes.

Hyperactivity in children with ADHD tends to fade after the age of eight or nine and may be difficult to detect to outside observers from then on. Adolescents, however, may still experience restlessness or find it difficult to settle down. Symptoms of impulsivity and inattention tend to persist throughout a person's life, although inattention may not be detectable until the age of eight or nine. People or parents of children experiencing symptoms that may be linked to ADHD can check their symptoms using the free Ada app.

The exact cause of ADHD is not fully understood by medical professionals, though a number of factors are believed to play a role.

Factors that are thought to contribute to ADHD include:

• Brain function and structure: Research suggests that there are small differences in the brains of people with ADHD compared with the brains of people without the condition. The significance of this is not yet clear.
• Genetics: Research suggests that a child is more likely to develop ADHD if a close family member, such as a parent or sibling, also has the condition.
• Learning issues: While learning issues do not cause ADHD, children with conditions such as dyslexia, dyscalculia and dysgraphia are more likely to also experience ADHD.
• Antenatal problems: If a mother smokes, drinks alcohol or takes drugs during pregnancy, this may increase the likelihood of the child having ADHD.
• Birth problems: If a child is born with a low birth weight, is deprived of oxygen during birth or experiences any other kind of issue during birth, this may increase their chance of developing ADHD.

One or more of these factors may apply to a child with ADHD. Conversely, none of these factors may apply and there may be no clear cause of the condition.

The diagnosis is usually made by a specialist pediatric doctor with experience in child development. There is no special test for ADHD; instead, a diagnosis will be based on the symptoms displayed and through an observation of the child’s interactions with their parents, siblings and, if possible, teachers and classmates.

Seeking a formal diagnosis is important because it enables families and teachers to coordinate plans for managing behavior and education. People or parents of children experiencing symptoms that may be linked to ADHD can also check their symptoms using the free Ada app.

The way in which a child with ADHD is treated will depend on the severity of the condition as well as the age of the child. Treatment should be coordinated by a team of professionals, including pediatricians, ADHD specialists and behavioral therapists.

The condition cannot be cured, but it can be effectively managed. The first stage of treatment will usually involve referral to a parent-training programme. The aim of this kind of training is to teach parents ways to manage behavioral problems, to understand the condition more thoroughly and to communicate more effectively with their child. These methods may also need to be taught to teachers and other caregivers, so activities can be tailored to suit the child’s attention span.

Other treatments include cognitive behavioral therapy (CBT), a method of psychological training that can help a child to understand why they act as they do and to come up with strategies to help manage their condition.

All children, including those with ADHD, are recommended to get at least 60 minutes of moderate to vigorous intensity activity per day. Regular physical activity is associated with improved cardiovascular health, mental wellbeing and cognitive performance.

Medication can also be prescribed to help treat ADHD in children over the age of six. Methylphenidate is the most commonly prescribed medication. It works by increasing the amount of dopamine released into the parts of the brain responsible for attention and self-control. A child may need to take medication for a number of years.

Medication is generally prescribed in severe cases of ADHD or in milder cases when other treatment options have not been effective. When used in children, ADHD medications are not thought to have an addictive potential. They can, however, cause side-effects.

Possible side-effects of methylphenidate include:

• A slight increase in blood pressure and heart rate
• Loss of appetite
• Sleeping problems
• Headaches
• Stomach aches
• Mood swings

According to studies, an estimated 40 to 60 percent of children with ADHD will continue to experience the condition into adulthood. As a development disorder, however, it is thought that people cannot develop the condition for the first time as adults, though it may only be recognised and/or diagnosed for the first time once a person has reached adulthood. Indeed, the rate of adults being diagnosed with ADHD is thought to be increasing significantly.

The symptoms and behaviors associated with ADHD in adults typically differ from those present in childhood. For adults, hyperactivity may manifest as persistent restlessness, and inattention as an inability to focus and carry out daily tasks. Adults with ADHD may find that the condition affects their ability to maintain employment and take care of their responsibilities; it may also result in financial and interpersonal difficulties.

Similarly to children, adults with ADHD are likely to be treated for the condition using a combination of medications and psychotherapy. Commonly prescribed medications include methylphenidate and amphetamine, while psychotherapy will usually focus on cognitive behavioral therapy.

• ADHD
• Attention deficit hyperactivity disorder in children
• Hyperkinetic disorder

Q: Are ADHD and autism related?
A: There does seem to be a link between ADHD and autism spectrum disorder (ASD), or autism. Although they are separate conditions with differing symptoms, many people are diagnosed with both simultaneously. The reason for this is not entirely clear, but genetics are thought to play a role.

Q: Are ADHD and ADD the same?
A: ADD, or attention deficit disorder, is a type of ADHD. It is characterized primarily by the symptom of inattentiveness and does not include hyperactivity or impulsivity.

Q: Are ADHD and bipolar disorder related?
A: ADHD and bipolar disorder are separate conditions. They do, however, have some overlapping symptoms, and many people are diagnosed with both simultaneously. Shared symptoms include hyperactivity, irritability, restlessness and impulsivity. The key difference between the two is that ADHD primarily affects behavior, whereas bipolar also affects a person’s mood. It is important for people with both conditions to be diagnosed accurately, as co-occurrence can affect the appropriateness of management techniques. Concerned that you, or a loved one, may be showing signs of bipolar disorder? Get a free symptom assessment with the Ada app.

Are ADHD drugs stimulants, and are they addictive?
A: Some drugs used to treat ADHD are classed as stimulants and can be addictive. This includes methylphenidate, the most widely prescribed ADHD medication. For many doctors, however, the positive effects of the medication outweigh the potential for abuse.

Nonetheless, it is important for doctors, parents and the affected person themselves to be educated on the potential for abuse and for the negative consequences, including the possible legal repercussions and the various psychiatric symptoms that may result, to be frankly discussed.