Expert: ADHD And How To Recognise The Signs
ADHD is a behavioural disorder which often becomes obvious in early childhood. Known as ADD (Attention Deficit Disorder), ADHD (Attention-Deficit Hyperactivity Disorder), or HKD (HyperKinetic Disorder); it is a condition in which the brain’s neurotransmitter chemicals (which regulate how the brain controls behaviour) don’t work properly.
This largely affects children, who are diagnosed as being hyperactive, impulsive, and who have sustained difficulty concentrating. Many children (especially under-fives) can sometimes be restless, and of course this doesn’t necessarily mean they're all suffering from ADHD: Instead, the disorder presents an exaggerated and persistent inattention and/or hyperactivity; which affects the child in their school, social and family life.
How common is it?
Up to 5% of school-age children can suffer from ADHD; and the condition is four times more frequent in boys than in girls. This may be partly because boys with ADHD tend to be more hyperactive and disruptive, while girls may be predominantly inattentive and can often appear to be in a world of their own. Their symptoms may not be noticed because they don’t disrupt the class; however, the condition may lead to problems academically, and socially.
ADHD can also co-exist to some degree, with disorders such as Dyslexia, Autism, Dyspraxia, Speech & Language Issues, Conduct Disorder, Oppositional Defiance Disorder, or Mood Disorder.
How Does ADHD Present Itself?
ADHD is usually described as being made up of three core behaviours:
- Predominantly inattentive type - problems of attention, short-term memory & learning.
- Predominantly hyperactive type - impulsive, poorly self-monitored behaviour.
- Combined type - most children with ADHD fall into this category.
- Easily distracted
- Difficulty following through on instructions
- Flit from task to task
- Slow to complete school work and forget instructions
- Difficulty remembering things.
- Often loses things necessary for tasks or activities at school
Inattentiveness can be confusing because of its selectivity. The child who is extremely inattentive while doing schoolwork may be fully focused when playing video games, carrying out practical procedures or when being tested by a psychologist.
- ‘Shooting from the hip’ both verbally and physically.
- Talking over others, and interrupting others’ conversations
- Tend to be accident-prone and have very short fuses
- Difficult awaiting their turn, and tendency to intrude into others’ games
- Blurt out answers before the question has been completed.
- Act without forethought, which leads to problems in the playground
- Do not learn from the consequences of their behaviour
The volatility of these children makes them prone to escalate out of control when their behaviour is handled insensitively. Often teachers and parents cannot understand why someone so intelligent can act so inappropriately.
In primary school, ADHD sufferers are often restless, and fidgety.
- Difficulty remaining seated
- Fidgeting with hands and feet
- Shifting from one uncompleted task to another
- Find it hard to stop talking, and looking around at classmates
- Difficulty playing quietly
- Restless sleeper
In secondary school; many will be able to remain seated for the 40-minute class and generally, their hyperactivity seems to have lessened. However, they are generally still noisier and more talkative than their peers. The fiddling, scribbling and touching everything can remain at quite a high level; and some retain high levels of physical activity.
“I do things I don’t mean to do… and it makes me stick out.” Jacob, 9
- Low self-esteem
- Poor social skills/relationship problems
- Poor Coordination
- Poor time management
- Specific learning difficulties
- Motivation difficulties
- Engaging in activities without thinking about the consequences
- High pain threshold
- Can be immature/clumsy
Is it definitely ADHD?
It’s easy to confuse ADHD with normal child development and other conditions. However, if you answered yes to at least eight characteristics listed above over a period of six months; you should contact your GP to discuss your concerns, and seek a referral. Your doctor will usually refer you to a child psychiatrist, psychologist or paediatrician for assessment. See The A to Zee of ADHD for lists of those who diagnose ADHD.
As there isn’t a biological test for the condition; diagnosing ADHD (and any coexisting difficulties) is much like putting together a puzzle. An accurate diagnosis requires an assessment by a well-trained and experienced professional. Each specialist differs in their approach, but there are strict diagnostic criteria, which draw the line of demarcation between ADHD and other conditions. As ADHD affects everyone differently, assessments must be flexible and adapt to the specific individual.
How Is ADHD Treated?
The good news is that ADHD is extremely treatable. With the right kinds of education, intervention, and support; the individual can go on to reach their potential. Effective treatment generally requires a multi-modal approach, which includes the following components:
- Early assessment/diagnosis and formulation of a management strategy
- Behaviour Management training
- Special educational support at school
- Medication when appropriate
- Speech and Language Therapy (SLT)
- Occupational Therapy (OT)
- Cognitive Behavioural Therapy (CBT) or Psychotherapy
- Support for families
Getting support is critically important. Joining a support group, reading books, and working together with others (e.g. teaching staff and carers) are all part of making life easier for the individual and the family living with the effects of ADHD.
ADHD and School
If your child has been diagnosed with ADHD they will most likely have problems at school. If you are concerned; you should discuss this with the class teacher, and School Principal. They should support you in identifying if your child would benefit from an Educational Assessment and Individual Education Plan (IEP).
The assessment report includes an evaluation of services the child needs to fully participate in school; and should be processed by the local SENO (Special Education Needs Organiser.) Schools should support children with special educational needs through existing mechanisms, or the school may apply to the NCSE (The National Council for Special Education) for additional resources. Unfortunately, services are mandated by legislation only insofar as resources exist. This means that they may not always be common practice.
How Long Does ADHD Last?
Until recently it was thought sufferers "outgrew" the condition with the onset of puberty. However, recent studies show that of those diagnosed with ADHD in childhood, 60% will continue with a modified form of the condition into adulthood.
It is a disorder that, without proper identification, treatment and management, can have serious and long-lasting consequences; but it is important to note that ADHD is a very treatable condition. If diagnosed and properly treated, people with ADHD can lead happy and successful lives. After all, Justin Timberlake, Olympic Champion Michael Phelps, Sir Richard Branson, and impressionist Rory Bremner all have ADHD.
The key is:
- Early diagnosis by a professional with expertise and experience in the area of ADHD.
- Treatment Programmes including Health and Education to cover all aspects of the condition.
- Continuous Support for the entire family.
For plenty more information, head to hadd.ie and incadds.ie. HADD.ie provides support and advice through phone and emails; as well as producing publications; organising information sessions; running courses for young people, and parents; and working to raise awareness of the condition.
This article is part of a new series looking at different conditions which affect children and families; getting expert advice on how to spot the signs, and manage symptoms. There'll be plenty more in the coming weeks in our child health section; but for now check out Expert: Asperger Syndrome, And How To Recognise The Signs.