Understanding Attention Deficit Hyperactivity Disorder (ADHD)
What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders, usually diagnosed in childhood and often lasting into adulthood. ADHD is thought to affect up to approximately 7% of school age children, with boys up to three times more likely to be diagnosed with ADHD than girls. Girls have been found to be more likely to have symptoms of inattentiveness only, and are less likely to show disruptive behaviour that makes ADHD symptoms more obvious which means that girls who have ADHD may not always be diagnosed. Until recently it was believed that children outgrew ADHD in adolescence, but it is now recognised that for about a third of children with ADHD the symptoms will continue into adulthood.
RocketEd ADHD assessments are conducted by Dr Kristy Fenton, Consultant Child and Adolescent Psychiatrist.
What causes ADHD?
In spite of being one of the most researched areas of child and adolescent mental health, causes of ADHD are still unclear and research highlights a range of possible explanations. Some researchers have found that ADHD appears to be genetic, with up to half of parents with ADHD having a child with the condition. There is also evidence indicating that the metabolism of children with ADHD is slower in the areas of the brain that control attention, social judgement and movement. Retrospective research has indicated that children with a low birth weight, those who were premature or whose mothers had challenging pregnancies may be at a higher risk of developing ADHD. The same is true for children with frontal lobe brain injuries as this is the area that controls impulses and emotions.
Symptoms of ADHD
ADHD is a neuro-biological condition affecting parts of the brain which control attention, impulses and concentration. The three main symptoms recognised as the markers of ADHD are inattention, impulsivity and hyperactivity. These symptoms usually occur together; however, one may occur without the others. Symptoms of hyperactivity, when present, are almost always apparent by the age of 7 while impulsivity or inattention may not be evident until later on.
The difficulties children and young people with ADHD experience cannot be explained by any other psychiatric condition and are not in keeping with those of the same-aged students with similar abilities and development.
Types of ADHD
There are three main types of ADHD. They are:
ADHD, combined type. This is the most common type of ADHD. It is characterised by impulsive and hyperactive behaviour as well as inattention and distractibility;
ADHD, inattentive and distractible type. This type of ADHD is characterised predominately by inattention and distractibility without hyperactivity. This type is sometimes referred to as Attention Deficit Disorder (ADD) and can sometimes go unnoticed because symptoms are less obvious.
ADHD, impulsive/hyperactive type. This is the least common type of ADHD. It is characterised by impulsive and hyperactive behaviour without inattention and distractibility.
How and by whom is ADHD diagnosed?
ADHD is a complex condition with a range of potential symptoms. Some symptoms can present as a result of other conditions or difficulties, which can make the process of assessing ADHD challenging. It is a medical condition and diagnosis therefore needs to be made by a medical professional such as a Child and Adolescent Psychiatrist.
In order for a child or young person to be diagnosed with ADHD, they must exhibit 6 or more symptoms of inattention, or 6 or more symptoms of hyperactivity and impulsivity. Such symptoms, outlined by the NHS, are below.
Inattention
Having a short attention span and being easily distracted
Making careless mistakes, for example in school work
Appearing to be forgetful or losing things easily and often
Being unable to maintain motivation for tasks that are perceived as tedious or time-consuming
Constantly changing activity or task
Having difficulty organising tasks and themselves
Hyperactivity and Impulsivity
Being unable to sit still, especially in quiet or calm surroundings
Constantly fidgeting
Being unable to concentrate on tasks
Excessive physical movement
Excessive talking
Being unable to wait their turn
Acting without prior thought
Interrupting conversations
Little or no sense of danger
As well as these, in order to be diagnosed with ADHD, the child or young person must also have all of the following:
Symptoms that have shown continuously for at least 6 months
Symptoms that have shown before the age of 12
Symptoms that present in at least two different settings, for example, home and school, to exclude the possibility that difficulties are a reaction to certain teachers or 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 a difficult phase, and are not better accounted for by another condition such as a mood, anxiety, psychotic or personality disorder.
Below are 5 strategies commonly suggested by Educational Psychologists to support children and young people with ADHD at school:
Consider their seating. Place the child with ADHD away from the windows and doors and position them in front of the teacher’s desk, unless that would be more distracting for them. Children and young people with ADHD find it easier to concentrate when sitting in rows facing the teacher than seated at tables facing their peers.
Giving instructions and information. Give the child with ADHD one instruction at a time and repeating them when needed. When possible, plan for more complex learning to take place early in the day. Offer visual learning materials alongside verbal instructions and information.
Independent work. Don’t overwhelm with lengthy projects or tests, but break them down into sections or shorter quizzes. Make clear what the expectations are for each part of a task.
Organisation. Help the child with ADHD to organise their work and possessions by working with them to develop personalised systems dependent on their individual needs and strengths. Regular and supportive communication between home and school is important to ensure that strategies are consistent in both settings.
Positive behaviour management. Encouraging positive behaviour in the classroom and as far as possible ‘catch them being good’ while ignoring low level disruption can be helpful in discouraging outbursts which may be in the child’s control.
