Attention deficit hyperactivity disorder (ADHD) is a common condition that mainly affects behavior. It is usually diagnosed in children but can affect adults. Symptoms include persistent restlessness, impulsiveness and/or inattention. The diagnosis is made after a detailed assessment. Treatment includes parent training programs and sometimes medication. Diet may be a factor and may be worth considering.
Attention deficit hyperactivity disorder (ADHD) is also known as attention deficit disorder (ADD) and hyperkinetic disorder. There may also be problems with the child's intellectual, social and psychological development as a result of the behavior.
How will a child be if he has ADHD
Children with ADHD show persistent restlessness, impulsiveness and/or inattention. These features are seen in more than one setting (For example, at school and at home).They are also seen in more than one activity (For example, in schoolwork and in relationships). They occur at a level greater than expected for their age and cause significant disruption to the child's daily life.
There are three subtypes of ADHD:
- Hyperactive-impulsive. Some features of this type of ADHD are that a child may fidget a lot, run around in inappropriate situations, have difficulty playing quietly and may talk excessively. They may interrupt others and have trouble waiting their turn in games, in conversations and also in queues.
- Inattention. In this subtype, a child may have trouble concentrating and paying attention, may make careless mistakes, may not listen or follow through on instructions and may be easily distracted. They may also be forgetful in daily activities, lose essential items such as school books or toys, and have trouble organizing activities.
- Combined. If a child has this subtype, they have features of both of the other subtypes.
Children with ADHD are also more likely than average to have other problems such as anxiety and depression, conduct disorders and co-ordination difficulties. Some children with ADHD also have reading difficulties and dyslexia (difficulty in properly articulating).
Many children, especially those under the age of five, are inattentive and restless. This does not necessarily mean that they have ADHD.
What causes attention deficit hyperactivity disorder?
The cause of ADHD is not known. It is thought that there may be subtle changes in parts of the brain which control impulses and concentration.
Although the main cause of ADHD is not known, various factors are thought to increase the risk of a child developing ADHD. These include:
- Genetics. Genes are passed on to a child from each parent. Our genes determine how our body functions, what we look like and sometimes what diseases we will get. Some studies have shown that certain genes are related to ADHD. A child may therefore be more likely to have ADHD if there is another family member such as mother, father, brother or sister with ADHD.
- Antenatal problems. If a mother drinks alcohol, smokes while she is pregnant, this may increase the risk of her child developing ADHD.
- Obstetric problems. This means problems that occur when a baby is born, such as a difficult labor causing lack of oxygen to the brain. Babies with very low birth weight have an increased risk of developing ADHD.
- Severe deprivation. If a child is severely neglected early in life, this may increase their risk of developing ADHD.
Factors in a child's upbringing such as poor parenting, watching a lot of TV or DVDs, family stress, etc., do not cause ADHD. However, such factors may make the behavior of a child with ADHD worse. Diet may be a factor (discussed further later).
How is attention deficit hyperactivity disorder diagnosed?
There is no simple test to diagnose ADHD. If your child's teacher or doctor suspect that your child may have ADHD, it is likely that your child will be referred to a specialist who will be able to confirm the diagnosis by doing an assessment, and start any treatment. This specialist may be a specialist pediatrician (children's doctor), a child psychiatrist, or an adult psychiatrist. The type of specialist depends on the age of your child and also the availability of services in your local area.
The assessment may involve a discussion with you and your child as well as a physical examination. The specialist may ask for a report from the school and may even want to observe your child doing certain tasks. You and your child may also see a nurse or other healthcare professionals for further testing and assessment.
There are a few aims of this assessment. These include:
- To confirm whether your child definitely has ADHD.
- To make sure that there are no other reasons that explains your child's behavior. For example, a hearing difficulty, epilepsy or thyroid problem.
- To identify any other problems your child may have. For example, anxiety, low self-esteem or a learning difficulty.
What are the treatment options?
The treatments recommended depend on how severe the condition is as well as the age of your child. Ideally, treatment should involve a team of professionals, experienced and trained in ADHD. The team may include a doctor, teacher, nurse, social worker, occupational therapist, mental healthcare professional or psychologist. Treatments include drug and nondrug treatments.
Nondrug treatments for attention deficit hyperactivity disorder
Generally, for preschool children or for older children with mild-to-moderate ADHD, the first step is usually for you (parent or guardian) to be referred to a parent training program. Sometimes your child will also be referred for a group treatment program aimed at improving behavior. The parent program may include such things as:
- Learning skills to manage and reduce problem behavior.
- Learning more effective ways to communicate with your child.
- Helping you to understand your child's emotions and behaviors.
Your child's schoolteacher may be invited to be involved in the treatment process. They may be able to use certain techniques in the classroom to help your child learn and function better. Family therapy may also be helpful. In more severe ADHD, or where the above treatments have not succeeded, medication is usually recommended.
What about diet?
Dietary changes for the treatment of ADHD have been widely used for many years. They take the form of:
- Supplements with substances thought to be lacking. For example, supplements of fatty acids such as omega 3 and omega 6, and/or:
- Cutting out foods thought to be harmful. For example, cutting out foods containing artificial coloring and other additives.
Is there anything else available for older children or adults?
In older children, there may be some benefit gained from psychological treatment such as cognitive behavioral therapy (CBT) or social skills' training. These techniques aim to teach your child more about why they act and react the way that they do. They also give them strategies to use to help them to improve their behavior and daily functioning.
In adults, medication is recommended as part of a comprehensive treatment program. This should also include psychological treatment, advice on behavioral management and assistance with education and employment.
What is the prognosis (outlook)?
Up to 8 in 10 children with ADHD will continue to experience symptoms into their teenage years. This decreases to about 5 in 10 who continue to have some symptoms into adulthood. With age, the symptoms may alter. For example, a child who was always restless may feel a lot of inner tension as an adult. It is also likely that the symptoms will reduce in severity and cause less disruption over time. As mentioned, treatment can often improve symptoms.
Children with ADHD are more likely than average to have other problems as adults, such as unemployment, relationship difficulties, substance misuse and crime. However, treatment aimed at improving behavior at an early age aims to reduce the long-term impact of the condition.