ADHD in children

Also known as attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder is a common behavioral disorder. Children with ADHD are easily distracted, act without thinking and very active.

They may understand what's expected of them but have trouble doing it because they can't sit still, pay attention or attend to details. They may also have other serious behavioural, emotional and learning problems, which can get them into an awful lot of trouble if ADHD is not recognised and treated.

Of course, all kids (especially younger ones) act in a busy, distracted and energetic way at times, particularly when they're anxious or excited. But the difference with ADHD is that symptoms are present over a longer period of time and occur most of the time. They affect the child's ability to function socially, at school, and at home.

Nowdays we refer to the condition as ADHD not ADD (attention deficit disorder).There is a difference, children with ADD (now called inattentive ADHD) still have extreme attention problems, they are just not hyperactive. They are the more dreamy types who seem often to be away with the fairies. In a classroom these children are in danger of being overlooked because the children who have the 'H' in ADHD cannot fail to get noticed!

Children with ADHD often have poor self-esteem as a result of being constantly criticised by their family/whānau and teachers who have not recognised their behaviour as a health concern.

It’s heartbreaking to hear these children talk about themselves as being dumb, stupid or naughty.

They are none of these things. With proper treatment, kids with ADHD can learn to successfully live with and manage their symptoms.

Who gets ADHD?

Boys are about three times more likely than girls to be diagnosed with ADHD, though it's not yet understood why. ADHD often occurs with other child mental health problems. These may exist alongside or develop as a result of ADHD. For example, some children with ADHD will have conduct disorder or experience anxiety or depression.

Learning difficulties that are not recognised or taken notice of also present a risk for serious mental health problems, as they affect progress at school and self-esteem.

For teenagers, ADHD and its associated problems are serious if untreated because they can put young people at risk for accidents, drug or alcohol abuse problems, or suicide.

What causes it?

Even though a lot of research into ADHD has gone on around the world, the exact cause is still unknown. What is known is that ADHD is not caused by poor parenting, too much sugar or vaccines. Studies of brain scans show that children with ADHD seem to have brain circuits that are wired a little differently from other people. This means that their brain has trouble processing messages.

There is thought to be a genetic element to most ADHD, that is, it runs in families. Studies have shown that brothers or sisters of children with ADHD have two to three times the risk of having it as well.

Signs to look for (symptoms)

A child with ADHD will have some or all of the following difficulties.

As babies and infants:

• They may be colicky, restless, and hard to cuddle babies and be poor sleepers.
• They may have crawled or walked earlier than other children.
• They have lots of energy and are constantly on the go. They seem unable to sit still even if they are enjoying doing something.
• They have a short attention span and often don't follow through what they set out to do.

At school:

• They may tune out or appear to be daydreaming, especially when being given instructions.
• They talk a lot, interrupt others and can't seem to wait their turn.
• At school they have trouble with the work and often give the impression they have not heard the teacher's instructions.
• They may frequently call out in class or a group and may be known as the class clown.
• They do dangerous and impulsive things, like jumping from heights or running out onto the road without looking out for traffic.
• They act before they think.
• They are often easily upset.
• They get angry and “explode” quite easily.
• They find it hard to make and keep friends, usually because they seem quite bossy.

How the doctor determines if your child has ADHD (diagnosis)

There is no test to determine if a child has ADHD. The diagnosis needs to be made by expert doctors or specialists, such as child psychiatrists or pediatricians (doctors who specialise in child health) who have experience in treating ADHD.

A diagnosis is made, based on whether your child has some or all of the typical symptoms, and the length of time they have had them. They also look at whether the behavior has occurred in a variety of situations, like at home and at school.

For a diagnosis of ADHD, some of the typical symptoms must have been present for at least the last six months. For this reason it’s important that your doctor or mental health professional spends time with you and your child to get a full understanding of their symptoms.

Treatment options

There is no magic pill to make ADHD disappear and it is now known that ADHD can progress into adulthood. For that reason, it’s really important that children with ADHD get help early in life so they can learn to manage their ADHD and develop the skills and confidence they will need to lead a successful adult life.

It’s a complicated condition, generally best managed by a mixed treatment programme, which may include the following components:

Medication

Stimulants are the main kind of medication used in the treatment of ADHD. These are designed to help your child concentrate better, be less impulsive, feel calmer and be able to learn and practise new skills. In fact, the same medications are used for both children and adults. It’s important that the progress of a child on medication for ADHD is checked and the treatment reviewed regularly with your doctor.

If your child is prescribed medication you are entitled to know:

• the names of the medicines
•  what symptoms they are supposed to treat
• how long it will be before they take effect
• how long the child will have to take them for and what their side effects are (short and long term).

Talking therapies and counselling

These are talk-based therapies which look at the child or young person's thinking, behaviour, relationships and environment. For ADHD, these treatments include behaviour management and social skills training to help support your child at home and at school. It’s important that children are encouraged to develop and learn coping behaviours and skills, and parents play a key role to help them learn and practise these new skills.

Family counselling can also play an important part in helping everyone in the family understand the condition and support the child, providing the counsellor has good knowledge of ADHD. Check this with the counsellor before starting.

Any therapy/counselling should be provided to children, adolescents and their families/whānau in a manner that is respectful of them, and with which they feel comfortable and free to ask questions. It should be consistent with and incorporate their cultural beliefs and practices.

Complementary therapies

Health and healing practices are varied and differ according to how people view illness. Any health-related practice that increases your child’s sense of wellbeing or wellness is likely to be of benefit.

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and which may be used to complement and support it. 

Complementary therapies can include using a number of herbal and other medicinal preparations to treat particular conditions. When considering taking any supplement, herbal or medicinal preparation consult a doctor to make sure it is safe, and will not react with other medication. 

Important things for a child with ADHD

For family/whānau of someone with ADHD, the following strategies are useful:

• Make sure there are everyday routines in the home. Most children respond to predictability and structure and it’ll be easier to handle your child with ADHD if he/she knows what the rules are around getting up, showering, meal times, homework, going to bed and playing.
  
  
• Your child may need a reminder list for some things. It’s important to give instructions clearly and one at a time so your child knows exactly what’s expected. It will be less time-consuming in the long run to look your child in the eye when you ask them to do something (you may need to catch them for this!) and ask them to repeat what you've said. Instructions such as "please put these toys in your room" (a specific request) will work better than "tidy your room" (a general and, to the child, confusing request).
  
  
• Discipline needs to be firm consistent and fair. Focus on the child's behaviour. He/she needs to know when they've behaved well or badly. Parents need to decide which battles to fight and which to ignore. Use small rewards (not bribes) for goals achieved (small achievable goals) and time out or withdrawal of privileges for unacceptable behaviour. Above all, discipline without anger.
  
  
• Encourage your child to talk about their life – the good things and the not so good. You may be able to help them with a problem, and it’s really important to keep the communication going.
  
  
• Build on your child's strengths. Find something the child is good at. It is vitally important for them to experience success. This may mean the whole family/whānau takes up rollerblading! Physical activities that can be done in short bursts may work out better than organised sports for the child with ADHD. Be positive about any successes, even if they can't complete a task. It is better for a child's self-esteem if you say that you noticed how hard they tried to do something, rather than to comment on how they didn't do it properly or finish it.
  
  
• Take care of other relationships. Often a child with ADHD demands so much time and attention, brothers and sisters can feel resentful or left out. Try and make sure that their needs are met and use all the help you can get from extended family/whānau and community for babysitting, time-out, or having fun. Marriages can be put under a lot of stress, so it may be helpful to consult a counsellor or family therapist to work out the best ways of living with a child with ADHD, keeping your partnership healthy and the rest of the family/whānau happy.

At school

It’s best to keep up with your child's school programme and inform the teacher of any changes in behaviour or treatment. A home-to-school notebook is a good idea. Some teachers know quite a lot about ADHD − others don't believe it exists, so as a parent you may have to help with the teacher's education! Talk to the school about getting assistance from the Ministry of Education’s Special Education Service for help with your child's classroom behaviour and learning needs.

In general, children with ADHD need a structured learning environment with as little distraction as possible. Having them sit beside a busy window or at the back of the classroom is not a good idea. Children with ADHD do well with lists, reminders and predictable schedules. And don't forget physical exercise. They generally need more motivation than others. Don't forget, too, that the children themselves are often able to tell adults what is most helpful to them.

You are your child’s best advocate at school and in dealing with health professionals because you know your child best. Help teachers and health professionals understand your child, so the best solution can be worked out for them.

Thanks to Janet Peters, registered psychologist, and Lisa Ducat, Like Minds, Like Mine mental health promoter, for reviewing this content. Date last reviewed: September, 2014