What is Attention Deficit Hyperactivity Disorder (ADHD)?  

ADHD is a developmental disorder, most commonly identified in early childhood. The symptoms of ADHD are divided into two types of behaviours: inattention and hyperactivity/ impulsivity. These symptoms are usually evident by the time a child starts school, although a formal diagnosis may not be made until later in childhood. For a diagnosis to be made these behaviours must be present in multiple environments and information gathered from a number of different sources (e.g., school and home).

ADHD is commonly associated with academic failure or underachievement, poor social skills and behavioural problems. Therefore it is worth identifying its presence so that steps can be taken to manage it and limit the secondary problems.

 ADHD Symptoms

Diagnosis of ADHD

ADHD is the most commonly diagnosed childhood behavioural disorder occurring in 3 to 5% of school aged children. Boys are more commonly diagnosed than girls. The cause of ADHD is not known, although the current consensus is that it has a biological origin, i.e., is related to under-functioning in certain parts of the brain. ADHD does tend to run in families, suggesting a genetic predisposition.

Diagnosis of ADHD should involve multiple informants from multiple different settings.  There is no single attentional test that is diagnostic for ADHD and symptoms may not be obvious in a doctor's office. It is, therefore, important to gather information from parents, teachers and other carers, as well as observing the child's behaviour in their normal environment.  

The use of an electroencephalogram (EEG) does not make the assessment any more accurate or reliable.

Treatment of ADHD

Treatment focuses on identifying the child's problems in daily life and then developing interventions to modify them. Options for treatment include:

l       Behaviour modification

l       Pharmacotherapy with stimulants (e.g. Ritalin)

l       Combination of behaviour therapy and pharmacotherapy

l       Cognitive behaviour therapy

Behaviour Modification

Behaviour therapy involves outlining contingencies and providing consequences for the child and is implemented by both parents and teachers. Strategies may include:

·         Giving praise for positive behaviours

·         Ignoring minor inappropriate behaviours

·         Clear, consistent consequences for negative behaviours

·         Tangible rewards and privileges that can be provided or removed

·         Time-out

Pharmacotherapy (medication)

l       Central nervous system (CNS) stimulants (e.g., Ritalin and Concerta) are the most commonly prescribed medications for ADHD.

l       Ritalin is the most studied medication, and has been shown to improve classroom behaviour and academic performance, decrease classroom disruptive behaviour, improve compliance with adult requests and improve peer relationships.

l       Antidepressant medications have sometimes been used to treat hyperactivity, particularly in children who do not respond to CNS stimulants. These are less effective and have more side-effects.

Cognitive–Behaviour Therapy (CBT)

CBT can be a useful option for adults living with ADHD. CBT aims to improve a person's ability to live with the symptoms of ADHD by teaching skills to manage and minimise the effect of those symptoms. Click here to learn more about CBT.

Strategies may include:

l       Problem-solving

l       Managing urges and impulsivity

l       Relaxation

l       Challenging unhelpful beliefs about the disorder (e.g., “I have no control over my behaviour because of my ADHD”).

l       Managing emotions

Controversy about ADHD treatments

l       The decision to prescribe or maintain a child on CNS stimulants is often made in a subjective and unsystematic way.

l       Side-effects of medication can include weight loss, appetite loss, sleeping difficulties and reduced growth.

l       A medication approach should only be used if behaviour therapy has been tried and proven to be insufficient.

l       Neither behavioural therapy nor medication is effective for all children.

l       Often a combination of both is the most beneficial approach. 

l       Prescribing medications to children is often reported in an emotional way in the media. It is a serious issue but when done carefully (following the guidelines above) it can be safe and the advantages of treatment generally outweigh any disadvantages.

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