What is ADHD?
Attention Deficit Hyperactivity disorder is a neurodevelopmental disorder characterised by inattention, hyperactivity and impulsivity. Neurodevelopmental disorders are a group of conditions that refer to a pattern of behaviour displayed in most situations that cannot be explained by other reasons.
ADHD is one of the most common childhood neurodevelopmental disorders and occurs in about 5% of the population worldwide. So whilst it is common in medical terms, it is worth remembering that it is also common for children to be active, restless and struggle with concentration (especially when they are young) - and 95% of children don’t have ADHD.
Neurodevelopmental disorders are pervasive – this means that they are persistent in all settings – so whilst we know that children behave differently at home and school, if they are only showing features in one setting then they do not have ADHD. Some children however have borderline features and can just about manage in one setting, especially if there are firmer boundaries in that setting, and when they get to a more relaxed setting their symptoms become more apparent.
Symptoms of ADHD
Inattention and hyperactivity are the behaviours that we see and are often what brings a child to the attention of professionals. These behaviours can make looking after them, keeping them safe and helping them learn a challenge. The important question is – why is my child showing these behaviours?
A healthy lifestyle is important for all children and young people. Poor sleep, high sugar diet and poor exercise can all mimic the features of ADHD - so before you think about a medical cause for your child’s behaviours, it is always important to review these lifestyle areas.
Worry or excitement can cause inattention, restlessness and fidgety behaviours – so it is important to think about what else is going on in your child’s life. Could this explain why your child is inattentive and impulsive?
Might my child have ADHD?
ADHD often presents as children start school and move to more formal education as they progress through key stage 1 ( Reception to Year 2), where they are required to sit for longer and engage in more formal work. It is important to remember that all children mature at different rates and that there is a big age range in a school year. So it is important to think – is my child young for their year, or perhaps progressing at the lower end of the normal developmental range? If so, they may just need time to learn these skills. It is for this reason that we do not consider a diagnosis of ADHD in children less than 6 years old. If things seem to be improving – that is a really positive sign.
One hard area to think about is your parenting style – no child comes with a manual, it is hard to bring up children and we all get lost from time to time. Children with impulsivity and hyperactivity need clear, firm boundaries to help them manage their behaviours and to have the best opportunities to develop into successful adults.
Sometimes when we are busy we forget to give our children attention when they are behaving in a calm, quiet way and we react when they display behaviours that we find more challenging.
Given that the first line in management for ADHD is with behaviour strategies, I would strongly encourage all parents to engage in a parenting course. There is a misconception that these courses are full of bad parents with naughty children – but it is of course quite the opposite – it is the best parents who want the best for their children who take the time to learn these important skills and use them effectively to help their child and family.
The second D in ADHD is for disorder – and this is really important – the so what question. There are many people who are really inattentive and impulsive but they are not disordered by it – they are keeping up with school work, friendships and are not getting into trouble – indeed they use these skills to be creative, or perhaps more daring on the sports field, or more productive when excited by something that they are doing – so it is important to remember there are lots of positives to ADHD too. That said – children with these behaviours can be exhausting to parent – so it is important to think about who these behaviours really are a problem for.
Still worried about ADHD?
Quick Check:-
Is your child showing difficulties of inattention, hyperactivity and impulsivity?
Have you excluded any other causes for these behaviours?
Are the behaviours present in most settings at most times and have they been present for over 6 months?
Is your child over 6 years old?
Are the difficulties getting worse?
Have you optimised lifestyle factors such as sleep diet and exercise?
Are these behaviours having an adverse affect on your child?
Then an assessment by a paediatrician may well be useful.
Diagnosis of ADHD
There is no formal test for ADHD but there are formal diagnostic criteria which are set out by ICD10 and DSM5. There is NICE guidance as to how this should be done by skilled professionals such as neurodevelopmental paediatricians, psychiatrists or psychologists.
Within Doctor Kate, a diagnosis is made by gathering information from you and school via a detailed questionnaire which you can download from the website if you want to get started. You will then have a face to face appointment with Doctor Kate where a full history and medical examination will take place. It is important that Doctor Kate meets with your child and hears your child's voice.
Sometimes the information that parents want to share is not appropriate or productive for your child to hear, so you may choose to bring a second adult who can take your child for a walk during some of this time. Alternatively you can arrange a second appointment which could be on the phone or by video link if not face to face.
It is important that other neurodevelopmental conditions that can mimic or co-exist with ADHD are also considered and there is a team of professionals including Speech and Language Therapists, Occupational Therapists and Educational Psychologists working with Doctor Kate who may also need to see and assess your child.
If it seems likely that your child has ADHD then Connors forms will be used to gather specific information from you and your child’s school.
Doctor Kate will then be able to make or exclude a diagnosis of ADHD. If a diagnosis is made it will be robust and evidence based. If other conditions such as Autism, language disorder, Dyspraxia need to be considered this can happen too.