ADHD
WHAT IS ADHD?
Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness.
Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child's circumstances change, such as when they start school.
Most cases are diagnosed when children are 6 to 12 years old.
The symptoms of ADHD usually improve with age, but many adults who were diagnosed with the condition at a young age continue to experience problems.
People with ADHD may also have additional problems, such as sleep and anxiety disorders.
Getting help
Many children go through phases where they're restless or inattentive. This is often completely normal and does not necessarily mean they have ADHD.
But you should consider raising your concerns with your child's teacher, their school's special educational needs co-ordinator (SENCO) or a GP if you think their behaviour may be different from most children their age.
It's also a good idea to speak to a GP if you're an adult and think you may have ADHD, but were not diagnosed with the condition as a child.
What causes attention deficit hyperactivity disorder (ADHD)?
The exact cause of ADHD is unknown, but the condition has been shown to run in families.
Research has also identified a number of possible differences in the brains of people with ADHD when compared with those without the condition.
Other factors suggested as potentially having a role in ADHD include:
- being born prematurely (before the 37th week of pregnancy)
- having a low birth weight
- smoking or alcohol or drug abuse during pregnancy
ADHD can occur in people of any intellectual ability, although it's more common in people with learning difficulties.
How attention deficit hyperactivity disorder (ADHD) is treated
Although there's no cure for ADHD, it can be managed with appropriate educational support, advice and support for parents and affected children, alongside medication, if necessary.
Medicine is often the first treatment offered to adults with ADHD, although psychological therapies such as cognitive behavioural therapy (CBT) may also help.
Living with attention deficit hyperactivity disorder (ADHD)
Looking after a child with ADHD can be challenging, but it's important to remember that they cannot help their behaviour.
Some issues that may arise in day-to-day life include:
- getting your child to sleep at night
- getting ready for school on time
- listening to and carrying out instructions
- being organised
- social occasions
- shopping
Adults with ADHD may also find they have similar problems, and some may have issues with relationships or social interaction.
SYMPTOMS OF ADHD
The symptoms of attention deficit hyperactivity disorder (ADHD) can be categorised into 2 types of behavioural problems: inattentiveness, and hyperactivity and impulsiveness.
Most people with ADHD have problems that fall into both these categories, but this is not always the case.
For example, some people with the condition may have problems with inattentiveness, but not with hyperactivity or impulsiveness.
This form of ADHD is also known as attention deficit disorder (ADD). ADD can sometimes go unnoticed because the symptoms may be less obvious.
Symptoms in children and teenagers
The symptoms of ADHD in children and teenagers are well defined, and they're usually noticeable before the age of 6. They occur in more than 1 situation, such as at home and at school.
Inattentiveness
The main signs of inattentiveness are:
- having a short attention span and being easily distracted
- making careless mistakes – for example, in schoolwork
- appearing forgetful or losing things
- being unable to stick to tasks that are tedious or time-consuming
- appearing to be unable to listen to or carry out instructions
- constantly changing activity or task
- having difficulty organising tasks
Hyperactivity and impulsiveness
The main signs of hyperactivity and impulsiveness are:
- being unable to sit still, especially in calm or quiet surroundings
- constantly fidgeting
- being unable to concentrate on tasks
- excessive physical movement
- excessive talking
- being unable to wait their turn
- acting without thinking
- interrupting conversations
- little or no sense of danger
These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.
Related conditions in children and teenagers with ADHD
Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as:
- anxiety disorder – which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness
- oppositional defiant disorder (ODD) – this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers
- conduct disorder – this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals
- depression
- sleep problems – finding it difficult to get to sleep at night, and having irregular sleeping patterns
- autistic spectrum disorder (ASD) – this affects social interaction, communication, interests and behaviour
- epilepsy – a condition that affects the brain and causes repeated fits or seizures
- Tourette's syndrome – a condition of the nervous system, characterised by a combination of involuntary noises and movements (tics)
- learning difficulties – such as dyslexia
Symptoms in adults
In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD.
As ADHD is a developmental disorder, it's believed it cannot develop in adults without it first appearing during childhood.
But it's known that symptoms of ADHD often persist from childhood into a person's teenage years and then adulthood.
Any additional problems or conditions experienced by children with ADHD, such as depression or dyslexia, may also continue into adulthood.
By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives.
The symptoms in children and teenagers are sometimes also applied to adults with possible ADHD.
But some specialists say the way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children.
For example, hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressures of adult life increase.
Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms.
Some specialists have suggested the following as a list of symptoms associated with ADHD in adults:
- carelessness and lack of attention to detail
- continually starting new tasks before finishing old ones
- poor organisational skills
- inability to focus or prioritise
- continually losing or misplacing things
- forgetfulness
- restlessness and edginess
- difficulty keeping quiet, and speaking out of turn
- blurting out responses and often interrupting others
- mood swings, irritability and a quick temper
- inability to deal with stress
- extreme impatience
- taking risks in activities, often with little or no regard for personal safety or the safety of others – for example, driving dangerously
Related conditions in adults with ADHD
As with ADHD in children and teenagers, ADHD in adults can occur alongside several related problems or conditions.
One of the most common is depression. Other conditions that adults may have alongside ADHD include:
- personality disorders – conditions in which an individual differs significantly from the average person in terms of how they think, perceive, feel or relate to others
- bipolar disorder – a condition affecting your mood, which can swing from 1 extreme to another
- obsessive compulsive disorder (OCD) – a condition that causes obsessive thoughts and compulsive behaviour
The behavioural problems associated with ADHD can also cause problems such as difficulties with relationships and social interaction.
DIAGNOSIS OF ADHD
If you think you or your child may have attention deficit hyperactivity disorder (ADHD), you might want to consider speaking to your GP about it.
If you're worried about your child, it may help to speak to their teachers, before seeing your GP, to find out if they have any concerns about your child's behaviour.
Your GP cannot formally diagnose ADHD, but they can discuss your concerns with you and refer you for a specialist assessment, if necessary.
When you see your GP, they may ask you:
- about your symptoms or those of your child
- when these symptoms started
- where the symptoms occur – for example, at home or in school
- whether the symptoms affect your or your child's day-to-day life – for example, if they make socialising difficult
- if there have been any recent significant events in your or your child's life, such as a death or divorce in the family
- if there's a family history of ADHD
- about any other problems or symptoms of different health conditions you or your child may have
Next steps
If your GP thinks your child may have ADHD, they may first suggest a period of "watchful waiting" – lasting around 10 weeks – to see if your child's symptoms improve, stay the same or get worse.
They may also suggest starting a group-based, ADHD-focused parent training or education programme. Being offered a parent training and education programme does not mean you have been a bad parent – it aims to teach you ways of helping yourself and your child.
If your child's behaviour does not improve, and both you and your GP believe it's affecting their day-to-day life, your GP should refer you and your child to a specialist for a formal assessment.
For adults with possible ADHD, your GP will assess your symptoms and may refer you for an assessment if:
- you were not diagnosed with ADHD as a child, but your symptoms began during childhood and have been ongoing since
- your symptoms cannot be explained by a mental health condition
- your symptoms significantly affect your day-to-day life – for example, if you're underachieving at work or find intimate relationships difficult
You may also be referred to a specialist if you had ADHD as a child or young person and your symptoms are now causing moderate or severe functional impairment.
Assessment
There are a number of different specialists you or your child may be referred to for a formal assessment, including:
- a child or adult psychiatrist
- a paediatrician – a specialist in children's health
- a learning disability specialist, social worker or occupational therapist with expertise in ADHD
Who you're referred to depends on your age and what's available in your local area.
There's no simple test to determine whether you or your child has ADHD, but your specialist can make an accurate diagnosis after a detailed assessment. The assessment may include:
- a physical examination, which can help rule out other possible causes for the symptoms
- a series of interviews with you or your child
- interviews or reports from other significant people, such as partners, parents and teachers
The criteria for making a diagnosis of ADHD in children, teenagers and adults are outlined below.
Diagnosis in children and teenagers
Diagnosing ADHD in children depends on a set of strict criteria. To be diagnosed with ADHD, your child must have 6 or more symptoms of inattentiveness, or 6 or more symptoms of hyperactivity and impulsiveness.
To be diagnosed with ADHD, your child must also have:
- been displaying symptoms continuously for at least 6 months
- started to show symptoms before the age of 12
- been showing symptoms in at least 2 different settings – for example, at home and at school, to rule out the possibility that the behaviour is just a reaction to certain teachers or to parental control
- symptoms that make their lives considerably more difficult on a social, academic or occupational level
- symptoms that are not just part of a developmental disorder or difficult phase, and are not better accounted for by another condition
Diagnosis in adults
Diagnosing ADHD in adults is more difficult because there's some disagreement about whether the list of symptoms used to diagnose children and teenagers also applies to adults.
In some cases, an adult may be diagnosed with ADHD if they have 5 or more of the symptoms of inattentiveness, or 5 or more of hyperactivity and impulsiveness, listed in diagnostic criteria for children with ADHD.
As part of your assessment, the specialist will ask about your present symptoms. However, under current diagnostic guidelines, a diagnosis of ADHD in adults cannot be confirmed unless your symptoms have been present from childhood.
If you find it difficult to remember whether you had problems as a child, or you were not diagnosed with ADHD when you were younger, your specialist may wish to see your old school records, or talk to your parents, teachers or anyone else who knew you well when you were a child.
For an adult to be diagnosed with ADHD, their symptoms should also have a moderate effect on different areas of their life, such as:
- underachieving at work or in education
- driving dangerously
- difficulty making or keeping friends
- difficulty in relationships with partners
If your problems are recent and did not occur regularly in the past, you're not considered to have ADHD. This is because it's currently thought that ADHD cannot develop for the first time in adults.
LIVING WITH ADHD
Caring for a child with attention deficit hyperactivity disorder (ADHD) can be draining.
The impulsive, fearless and chaotic behaviours typical of ADHD can make everyday activities exhausting and stressful.
Ways to cope
Although it can be difficult at times, it's important to remember that a child with ADHD cannot help their behaviour. People with ADHD find it difficult to suppress impulses, which means they do not stop to consider a situation, or the consequences, before they act.
If you're looking after a child with ADHD, you may find the below advice helpful.
Plan the day
Plan the day so your child knows what to expect. Set routines can make a difference to how a child with ADHD copes with everyday life.
For example, if your child has to get ready for school, break it down into structured steps, so they know exactly what they need to do.
Set clear boundaries
Make sure everyone knows what behaviour is expected, and reinforce positive behaviour with immediate praise or rewards. Be clear, using enforceable consequences, such as taking away a privilege, if boundaries are overstepped and follow these through consistently.
Be positive
Give specific praise. Instead of saying a general: "Thanks for doing that," you could say: "You washed the dishes really well. Thank you."
This will make it clear to your child that you're pleased and why.
Giving instructions
If you're asking your child to do something, give brief instructions and be specific. Instead of asking: "Can you tidy your bedroom?" say: "Please put your toys into the box and put the books back onto the shelf."
This makes it clearer what your child needs to do and creates opportunities for praise when they get it right.
Incentive scheme
Set up your own incentive scheme using a points or star chart, so good behaviour can earn a privilege. For example, behaving well on a shopping trip will earn your child time on the computer or some sort of game.
Involve your child in it and allow them to help decide what the privileges will be.
These charts need regular changes or they become boring. Targets should be:
- immediate – for example, daily
- intermediate – for example, weekly
- long-term – for example, three-monthly
Try to focus on just one or two behaviours at a time.
Intervene early
Watch for warning signs. If your child looks like they're becoming frustrated, overstimulated and about to lose self-control, intervene.
Distract your child, if possible, by taking them away from the situation. This may calm them down.
Social situations
Keep social situations short and sweet. Invite friends to play, but keep playtimes short so your child doesn't lose self-control. Don't aim to do this when your child is feeling tired or hungry, such as after a day at school.
Exercise
Make sure your child gets lots of physical activity during the day. Walking, skipping and playing sport can help your child wear themselves out and improve their quality of sleep.
Make sure they're not doing anything too strenuous or exciting near to bedtime.
Read my fitness page, which includes information on getting active.
Eating
Keep an eye on what your child eats. If your child is hyperactive after eating certain foods, which may contain additives or caffeine, keep a diary of these and discuss them with your GP.
Bedtime
Stick to a routine. Make sure your child goes to bed at the same time each night and gets up at the same time in the morning.
Avoid overstimulating activities in the hours before bedtime, such as computer games or watching TV.
Night time
Sleep problems and ADHD can be a vicious circle. ADHD can lead to sleep problems, which in turn can make symptoms worse.
Many children with ADHD will repeatedly get up after being put to bed and have interrupted sleep patterns. Trying a sleep-friendly routine can help your child and make bedtime less of a battleground.
Help at school
Children with ADHD often have problems with their behaviour at school, and the condition can negatively affect a child's academic progress.
Speak to your child's teachers or their school's special educational needs co-ordinator (SENCO) about any extra support your child may need.
Adults with ADHD
If you're an adult living with ADHD, you may find the following advice useful:
- if you find it hard to stay organised, then make lists, keep diaries, stick up reminders and set aside some time to plan what you need to do
- let off steam by exercising regularly
- find ways to help you relax, such as listening to music or learning relaxation techniques
- if you have a job, speak to your employer about your condition, and discuss anything they can do to help you work better
- talk to your doctor about your suitability to drive, as you'll need to tell the Driver and Vehicle Licensing Agency (DVLA) if your ADHD affects your driving
- contact or join a local or national support group – these organisations can put you in touch with other people in a similar situation, and can be a good source of support, information and advice
A
TREATMENT OF ADHD
Treatment for attention deficit hyperactivity disorder (ADHD) can help relieve the symptoms and make the condition much less of a problem in day-to-day life.
ADHD can be treated using medication or therapy, but a combination of both is often best.
Treatment is usually arranged by a specialist, such as a paediatrician or psychiatrist, although the condition may be monitored by your GP.
Medication
There are 5 types of medication licensed for the treatment of ADHD:
- methylphenidate
- dexamfetamine
- lisdexamfetamine
- atomoxetine
- guanfacine
These medications are not a permanent cure for ADHD but may help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.
Some medications need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended to assess whether the medication is still needed.
If you were not diagnosed with ADHD until adulthood, your GP and specialist can discuss which medications and therapies are suitable for you.
If you or your child is prescribed one of these medications, you'll probably be given small doses at first, which may then be gradually increased. You or your child will need to see your GP for regular check-ups to ensure the treatment is working effectively and check for signs of any side effects or problems.
It's important to let your GP know about any side effects and talk to them if you feel you need to stop or change treatment.
Your specialist will discuss how long you should take your treatment but, in many cases, treatment is continued for as long as it is helping.
Methylphenidate
Methylphenidate is the most commonly used medication for ADHD. It belongs to a group of medicines called stimulants, which work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour.
Methylphenidate may be offered to adults, teenagers and children over the age of 5 with ADHD.
The medication can be taken as either immediate-release tablets (small doses taken 2 to 3 times a day) or as modified-release tablets (taken once a day in the morning, with the dose released throughout the day).
Common side effects of methylphenidate include:
- a small increase in blood pressure and heart rate
- loss of appetite, which can lead to weight loss or poor weight gain
- trouble sleeping
- headaches
- stomach aches
- mood swings
Lisdexamfetamine
Lisdexamfetamine is a similar medication to dexamfetamine and works in the same way.
It may be offered to teenagers and children over the age of 5 with ADHD if at least 6 weeks of treatment with methylphenidate has not helped. Adults may be offered lisdexamfetamine as the first-choice medication instead of methylphenidate.
Lisdexamfetamine comes in capsule form, taken once a day.
Common side effects of lisdexamfetamine include:
- decreased appetite, which can lead to weight loss or poor weight gain
- aggression
- drowsiness
- dizziness
- headaches
- diarrhoea
- nausea and vomiting
Dexamfetamine
Dexamfetamine is similar to lisdexamfetamine and works in the same way. It may be offered to adults, teenagers and children over the age of 5 with ADHD.
Dexamfetamine is usually taken as a tablet once or twice a day, although an oral solution is also available.
Common side effects of dexamfetamine include:
- decreased appetite
- mood swings
- agitation and aggression
- dizziness
- headaches
- diarrhoea
- nausea and vomiting
Atomoxetine
Atomoxetine works differently from other ADHD medications.
It's a selective noradrenaline reuptake inhibitor (SNRI), which means it increases the amount of a chemical in the brain called noradrenaline.
This chemical passes messages between brain cells, and increasing it can aid concentration and help control impulses.
Atomoxetine may be offered to adults, teenagers and children over the age of 5 if it's not possible to use methylphenidate or lisdexamfetamine. It's also licensed for use in adults if symptoms of ADHD are confirmed.
Atomoxetine comes in capsule form, usually taken once or twice a day.
Common side effects of atomoxetine include:
- a small increase in blood pressure and heart rate
- nausea and vomiting
- stomach aches
- trouble sleeping
- dizziness
- headaches
- irritability
Atomoxetine has also been linked to some more serious side effects that are important to look out for, including suicidal thoughts and liver damage.
If either you or your child begin to feel depressed or suicidal while taking this medication, speak to your doctor.
Guanfacine
Guanfacine acts on part of the brain to improve attention, and it also reduces blood pressure.
It may be offered to teenagers and children over the age of 5 if it's not possible to use methylphenidate or lisdexamfetamine. Guanfacine should not be offered to adults with ADHD.
Guanfacine is usually taken as a tablet once a day, in the morning or evening.
Common side effects include:
- tiredness or fatigue
- headache
- abdominal pain
- dry mouth
Therapy
As well as taking medication, different therapies can be useful in treating ADHD in children, teenagers and adults. Therapy is also effective in treating additional problems, such as conduct or anxiety disorders, that may appear with ADHD.
Some of the therapies that may be used are outlined below.
Psychoeducation
Psychoeducation means you or your child will be encouraged to discuss ADHD and its effects. It can help children, teenagers and adults make sense of being diagnosed with ADHD, and can help you to cope and live with the condition.
Behaviour therapy
Behaviour therapy provides support for carers of children with ADHD and may involve teachers as well as parents. Behaviour therapy usually involves behaviour management, which uses a system of rewards to encourage your child to try to control their ADHD.
If your child has ADHD, you can identify types of behaviour you want to encourage, such as sitting at the table to eat. Your child is then given some sort of small reward for good behaviour and has a privilege removed for poor behaviour.
For teachers, behaviour management involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.
Parent training and education programmes
If your child has ADHD, specially tailored parent training and education programmes can help you learn specific ways of talking to your child, and playing and working with them to improve their attention and behaviour.
You may also be offered parent training before your child is formally diagnosed with ADHD.
These programmes are usually arranged in groups of around 10 to 12 parents. A programme usually consists of 10 to 16 meetings, lasting up to 2 hours each.
Being offered a parent training and education programme does not mean you have been a bad parent – it aims to teach parents and carers about behaviour management, while increasing confidence in your ability to help your child and improve your relationship.
Social skills training
Social skills training involves your child taking part in role-play situations and aims to teach them how to behave in social situations by learning how their behaviour affects others.
Cognitive behavioural therapy (CBT)
CBT is a talking therapy that can help you manage your problems by changing the way you think and behave. A therapist would try to change how your child feels about a situation, which would in turn potentially change their behaviour.
CBT can be carried out with a therapist individually or in a group.
Other possible treatments
There are other ways of treating ADHD that some people with the condition find helpful, such as cutting out certain foods and taking supplements. However, there's no strong evidence these work, and they should not be attempted without medical advice.
Diet
People with ADHD should eat a healthy, balanced diet. Do not cut out foods before seeking medical advice.
Some people may notice a link between types of food and worsening ADHD symptoms. If this is the case, keep a diary of what you eat and drink, and what behaviour follows. Discuss this with your GP, who may refer you to a dietitian (a healthcare professional who specialises in nutrition).
Supplements
Some studies have suggested that supplements of omega-3 and omega-6 fatty acids may be beneficial for people with ADHD, although the evidence supporting this is very limited.
It's advisable to talk to your GP before using any supplements, because some can react unpredictably with medication or make it less effective.
You should also remember that some supplements should not be taken long term, as they can reach dangerous levels in your body.
Tips for parents
If you're the parent of a child with ADHD:
- be sure your GP or specialist helps you understand the difference between ADHD and any other problems your child may have
- think about who else needs to know about your child's ADHD, such as their school or nursery
- find out the side effects of any medication your child takes and what you need to look out for
- getting to know people at local support groups can stop you feeling isolated and unable to cope
