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Attention deficit hyperactivity disorder (ADHD)

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Attention deficit hyperactivity disorder (ADHD)


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Central nervous system
Attention deficit hyperactivity disorder (ADHD) is a neurological condition which is estimated to affect approximately 5% of children and approximately 2-4% of adults in the UK. The first behavioural signs are often found in early childhood, most children start to become recognised as having ADHD between the ages of 5 and 9 years. Three times as many boys are affected than girls. Boys more commonly display symptoms of hyperactivity; girls more commonly display symptoms of inattention. The condition continues throughout the school years and it is thought that 60 % of children will carry some symptoms through to adulthood.
The exact cause of ADHD is not known, but it is thought that ADHD may be due to a hereditary or genetic cause, or from damage to the developing baby's brain during pregnancy or to the child's brain at or shortly after birth. There is evidence to suggest that parts of the brain that control impulsive behaviour and the ability to concentrate respond more slowly in children with ADHD than they do in children without ADHD. As a result, a child with ADHD is not able to process information in the same way as other children, so they fidget, they can not concentrate and they quickly become bored.
Symptoms in children
A child suffering from ADHD will display some, if not all of the following symptoms:

Inattention - The child is easily distracted, with a tendency to flit from one thing to another, forgetting instructions. The child will often look distant or as if day-dreaming.

Impulsiveness - The child may speak or act without thinking, sometimes inappropriately, and may have a 'short fuse', leading to temper tantrums.

Over-activity - The child can be restless and fidgety, constantly tapping its feet or fiddling with its fingers.

Insatiability - Never satisfied, the child appears to go on and on about a certain subject. It can seem as though the child is interrogating and generally trying to intrude or take over other people's conversations. This can cause enormous tension.

Social clumsiness - The child never seems to quite 'fit' in with other children and can be silly when in a group. The child can be overpowering and bossy, wanting to be the centre of attention, whatever the cost.

Poor co-ordination - The child may be clumsy and appear awkward in its movements. The child may have difficulty doing two actions at the same time and will probably produce untidy written work.

Disorganisation - The child can have problems structuring school work and can find homework and projects difficult to start because of being disorganised and unaware of mess.

Variability - The child can have severe mood swings and be very volatile. The child may have good and bad days with no explanation as to what triggers either mood.

Specific learning disabilities - Although most children appear to have average intelligence, most will have learning difficulties due to their poor attention span. Many however do appear to have a combination of ADHD and a more specific learning difficulty, for example, dyslexia or a language problem.
Symptoms in adults
In adults, symptoms of ADHD include at least twelve of the following:
  • Childhood history of ADHD
  • Family history of ADHD, or manic-depressive illness, or depression, or substance abuse, or other disorders of impulse control or mood
  • A sense of underachievement, of not meeting goals, regardless of how much has already been accomplished
  • Difficulty in getting organised
  • Chronic procrastination or trouble getting started
  • Many projects going simultaneously; trouble with follow through
  • A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark
  • A frequent search for high stimulation
  • An intolerance of boredom
  • Easily distracted, trouble focusing attention, tendency to tune out or drift away in the middle of a conversation or a page when reading, but often coupled with an ability to hyper-focus at times
  • Often creative, intuitive, highly intelligent
  • Trouble in going through established channels, following "proper" procedure
  • Impatient; low tolerance of frustration
  • Impulsive, either verbally or in action, as in impulsive of spending money, changing plans, enacting new schemes or career plans, and the like; hot-tempered
  • A tendency to worry needlessly, endlessly; a tendency to scan the horizon looking for something to worry about, alternating with in-attention to or disregard for actual dangers
  • A sense of insecurity
  • Mood swings, mood lability, especially when disengaged from a person or a project
  • Physical or cognitive restlessness
  • A tendency toward addictive behaviour
  • Chronic problems with self-esteem
  • Inaccurate self-observation

A child with ADHD faces many challenges. It is a chronic condition that continues into adulthood in approximately 60% of children who are affected and, if left untreated, it is likely to interfere with social and working lives.

Treatment is aimed at helping the child learn, control behaviour and increase her/his self-esteem. A combination of methods is usually recommended to help the child learn, to increase her/his ability to deal with the emotional cruelty of other children and to increase self-confidence. Special behavioural programmes tailored to suit the child's needs can be effective in helping the child learn.

There is no medical cure for ADHD. However there are some medicines that may help with the symptoms. The most commonly used drug is methylphenidate. This drug is known as a central nervous system (CNS) stimulant. While this may appear strange giving a stimulant to a person who is already hyperactive, it appears that methylphenidate probably stimulates those parts of the brain that control compulsive behaviour and concentration that are otherwise slow to respond. Dexamfetamine is another CNS stimulant that may be tried if there is no response to methylphenidate. If neither medicine works, atomoxetine may be used. Unlike the other two, atomoxetine is not a CNS stimulant. Instead it improves the way messages are relayed in the brain, helping concentration and controlling compulsive behaviour.
When to consult your pharmacist
There are no medicines that a pharmacist is able to recommend without a prescription for the treatment of ADHD. However, if you are buying other medicines to treat another illness, it is important that you tell your pharmacist if you or your child has ADHD and let him or her know which medicine has been prescribed. Also say whether you or your child is taking any other medicines or food supplements that have been prescribed or bought over the counter from pharmacies and health food stores. The medicines used to treat ADHD should not be used if you have certain other illnesses such as heart problems and glaucoma, and they may interact with other prescription and OTC medicines and supplements.

If you or your child is feeling down, tell your pharmacist. A small number of people who take atomoxetine have thoughts about suicide. Your pharmacist may advise that you see your doctor for treatment to be reviewed.
When to consult your doctor
It is important to seek treatment if you think you or your child has ADHD. There is no simple test to confirm that it is ADHD but your doctor will arrange for you or your child to see a specialist. The specialist, usually a psychologist or paediatrician, can make an accurate diagnosis after a detailed assessment. The assessment will involve a series of interviews and reports from other people such as teachers.
Management of ADHD will involve a combination of behavioural programmes and medicines that will be agreed with you by the specialist and your doctor.
Living with ADHD
As the parent or carer of a child diagnosed with ADHD it will help you and your child if you get a better understanding of ADHD and how it is managed. By working together with your child, your child's doctor, behavioural specialists and teachers you will give your child the best opportunity to make the most of her/his life, and it will help you and your family cope with your child's condition.

When your child is first diagnosed with ADHD, you may experience feelings of guilt, blaming yourself or other members of your family for your child's condition. You may feel overwhelmed by the situation, wondering what to do and what comes next. You will have many questions. It is important that you remain positive. Your child's condition is not your or anybody else's fault. Take things one step at a time, there are lots of people available to give you support and advice, and to answer any questions or concerns that you may have.

Your child's treatment will depend on your child's age and the severity of symptoms, but generally it will be a combination of behavioural treatments and medication. The doctors and therapists providing this treatment will explain what they are doing and why they are doing it. Behavioural therapy applies as much to you and other members of your family as it does to your child. You will be given training on how to manage your child's behaviour, to focus on your child's strengths, to praise rather than criticise, and to avoid confrontation that will all help boost your child's self esteem and ability to relate with others.

Although there is no cure for ADHD, medicines can greatly improve your child's symptoms. It is important that you understand what the medicines can and can not do, how to give the medicines correctly and how to recognise any side effects. As your child gets older, or if symptoms change, your child's treatment may also change. Always raise any questions or concerns with your doctor, nurse or pharmacist. Your child will spend much of her/his day at school. Your child's teachers are your allies. Working together as a partnership with your child's teachers and your child's school will ensure that your child's behavioural therapy is continued during her/his crucial developmental years. It will help your child learn and gain an education that will help later in life. Importantly, it will also develop your child's social skills, enabling play and interaction with other children and adults.

As your child gets older and starts to become more and more independent, you will need to adapt. Work with your child, allow her/him to be involved in treatment decisions, provide support when changing schools, going to university or taking on new challenges. Encouragement and positive reinforcement of the things that your child does will help her/his transition into adulthood and increase the opportunities of having a full and independent life.
Useful Tips
  • Look to your doctor, nurse, pharmacist and behavioural therapists for support and advice
  • Learn as much about ADHD and its management as you can
  • Develop techniques that positively reinforce your child's good behaviour
  • Avoid confrontation by telling your child what she/he can do rather than what not to do
  • Work in partnership with your child's teachers and school
Further information
Further information can be obtained from ADDers, an organisation whose objective it is to promote awareness of ADHD and to provide information and as much free practical help as it can to adults, families and children affected by the condition.

Reviewed on 24 May 2010