ADHD (Attention Deficit Hyperactivity Disorder)

What is Attention Deficit Hyperactivity Disorder?

Attention Deficit Hyperactivity Disorder (ADHD) is a treatable neurobiological condition, resulting in difficulties with impulsiveness, attention span and often, but not always, hyperactivity. It is estimated to affect between 3 and 5% of children.

While many children have lots of energy and can find it hard to concentrate, a child with ADHD will display this behaviour constantly and the problem is much more extreme. As a result they may find it difficult to fit in at school. The problem may continue into adulthood if a child with ADHD does not get the help they need.

Is ADHD a learning disability?

No. ADHD is not a learning disability. However, children with the condition may be more likely to have specific learning disabilities as well such as dyslexia.

What are the symptoms of ADHD?

The following behaviours are characteristic of ADHD and usually occur before the age of seven:

  • Fidgeting/restlessness
  • Difficulty remaining seated when asked to do so
  • Easily distracted
  • Difficulty awaiting turn in games or group situations
  • Often blurts out answers to questions
  • Difficulty following instructions
  • Difficulty sustaining attention
  • Often shifts from one incomplete activity to another
  • Difficulty playing quietly
  • Often talks excessively
  • Often interrupts or intrudes on others
  • Often does not seem to listen
  • Often loses things
  • Often engages in physically dangerous activities without considering the consequences.

Onset of ADHD may be from as young as 18 months; however the condition is often not noticeable until around age 5, when the child starts primary school.

What causes ADHD?

While the cause of ADHD is not certain, research has shown that certain areas of the brain work more slowly in children with ADHD. Genetic factors are thought to be involved as ADHD tends to run in families. Head trauma or complications at birth resulting in injury to the brain have also been implicated in the development of ADHD; however these are only thought to be factors in a few cases. Cigarette smoke and alcohol abuse during pregnancy may also be linked to development of ADHD in the child. Food allergies, excess sugar, poor home life and watching too much TV are not thought to be factors in the development of ADHD.

How is ADHD diagnosed?

A diagnosis of ADHD may be considered if your child exhibits a number of the symptoms listed above before the age of seven and for more than six months. Children do not have to be hyperactive to have ADHD many children with ADHD are not hyperactive but still find it difficult to focus. If the child displays significant problems with concentrating or paying attention, but is not hyperactive, it may be referred to as Attention Deficit Disorder (ADD) rather than ADHD.

Early diagnosis and treatment has a major psychological, social and educational impact - it can help to spare your child the distress of inappropriate social skills and deflated confidence.

If your first port of call is a GP, your child may be referred on to a child psychiatrist who can then diagnose the condition. However often, a primary school teacher will be the first to raise concerns with parents. With the parents' consent, the National Educational Psychological Service (NEPS) will be contacted. As part of this service, a psychologist will be sent to the school to assess the child and determine what they need.

There are waiting lists for this service however and it is not available to secondary schools.

How is ADHD treated?

There is no single, simple treatment. Instead, treatment comprises a combination of medication (mainly psychostimulants and antidepressants), parent training, child and parent counselling and a special education environment. Some alternative and controversial treatments have been suggested - for example, dietary intervention, vitamin supplementation and optometric vision training - but there is no scientific evidence to support these theories.

Some parents worry that medication may sedate their children or make them feel 'dopey'. However when used correctly, this should not happen. In fact, it will often make children more focused and alert. Medication may not help in a small number of cases.

If your child does experience negative side effects, this may be because the medication itself does not suit them, the dosage is wrong or the interval between doses is wrong.

Drug-free interventions that have been shown to be effective include educational interventions, behaviour modification, parent training and anger management.

What is the long-term outlook for children with ADHD?

A lot can be done for people affected by ADHD, however this can depend on how early they are diagnosed. If a young person slips through the net and fails to be diagnosed, they are at risk of leaving school early and suffering problems such as low self-esteem and depression.

Adults with ADHD may have good attention spans but remain restless/fidgety and have to keep busy. Significant progress has been made in treatment, although much remains uncertain or ill-defined.

What can I do?

  • Accept that your child may always be intrinsically active and energetic. You may never eliminate your child's hyperactivity but you can bring it under reasonable control.
  • Provide an outlet, such as sport, for your child's excess energy. In bad weather try to provide a room where he/she can play with minimal restrictions and supervision. Encourage your child to play with one toy at a time. Try not to encourage hyperactive behaviour, for example, chasing games or other noisy play.
  • Organise your home. Household routines help hyperactive children to accept order. Maintain regular times for wake-up, meals, snacks, naps and bed.
  • Try not to let your child become exhausted, as this will affect their self-control and the hyperactivity may become worse.
  • Initially you may want to avoid places where hyperactivity would be inappropriate and embarrassing (such as churches or restaurants). Your child can gradually be introduced to these situations when they develop their self-control.
  • Be firm. Children with ADHD are difficult to manage. Enforce a few clear, consistent, important rules and add other rules at your child's pace. Aggressive behaviour should not be accepted, but avoid unattainable rules, for example, don't expect your child to keep his/her hands and feet still.
  • Don't use physical punishment, as this will suggest to your child that physically aggressive behaviour is acceptable. Instead try to use a neutral tone of voice and isolate them in a chair or time-out room if a show of disapproval doesn't work. The time-out should last about one minute per year of your child's age.
  • Consistently encourage and praise attentive behaviour at home. Try to set aside several brief periods each day to teach your child listening skills by reading to them. Teach your child to play with building blocks and progress to puzzles and card or dice games. Matching pictures is an excellent way to build your child's memory and concentration span. When your child becomes restless, stop and return for another session later.
  • Be your child's advocate. Ensure that relatives, teachers and peers understand the disorder and don't label your child as 'bad'. Promote the attitude that your child is a good child with excess energy. If your child always feels loved and accepted within the family, their self-esteem will survive.
  • Medication can be helpful. Some stimulant drugs can improve a child's ability to concentrate, but you must discuss the use of drugs with your doctor. Medication without special education and home management programmes will have no long-term benefit.
  • Make some time for yourself. Periodic breaks and evenings out can provide much-needed breaks and help you to tolerate hyperactive behaviour.

Are there any ADHD support groups in Ireland?

The Hyperactivity and Attention Deficit Disorder (HADD) family support group can be contacted at (01) 874 83 49 or hadd@eircom.net

Reviewed: November 30, 2006