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Attention deficit hyperactivity disorder (ADHD) in childrenThis factsheet is written for parents of children with ADHD, or for people who want to know more about it. Attention deficit hyperactivity disorder (ADHD) is a term used to describe certain behaviour problems in children. Children with ADHD have an unusually short attention span and become easily distracted (attention deficit). They are also overactive and restless (hyperactive). Progress at school and development of social skills are often slowed down by ADHD. It can be treated with a combination of behaviour management and medicines. About ADHDMany young children are naturally restless and full of energy. ADHD - which is also known as hyperkinetic disorder - defines a type of behaviour at the extreme end of the normal range of behaviour. Children with ADHD demonstrate problem levels of:
Although estimates vary depending on the exact criteria used, ADHD is thought to affect about two to five percent of school-age children in England. It is at least four times more common in boys than girls. With specialist treatment (see Treatment), your child's behaviour can greatly improve, though some problems with attention and lack of control may continue into adolescence and later life. Aggressive or disobedient behaviour can get worse if ADHD is left untreated, so early diagnosis and management is important. Types of ADHDThere are three main types of ADHD:
Symptoms of ADHDSymptoms depend on what type of ADHD your child has. Behaviour problems are usually first noticed in toddlers. They are present in more than one setting. For example, if symptoms were present at home, there would also need to be problems in school and/or in social situations for a diagnosis of ADHD to be made. You may notice that your child is constantly restless, irritable and emotionally immature. Aggressiveness and poor discipline are common. Your child may show no sense of danger, for example, climbing fearlessly and ignoring repeated warnings. Sometimes children with ADHD are also clumsy. Starting school usually highlights the problem or makes it worse. Learning is often slowed down by the lack of attention and concentration, and boys who are hyperactive and aggressive tend to become unpopular with other children. ADD, however, can often go unnoticed because the child is dreamy and inattentive, but not disruptive. ADHD can affect social skill development, and problems with language and speech development are also common. As your child grows older, he or she may engage in antisocial behaviour and be unaware of the consequences. But ADHD is not related to intelligence - children of all levels of ability can be affected. CausesThe exact cause of ADHD isn't known, but there are likely to be a number of factors involved. Research suggests that people with ADHD may have differences in the parts of the brain which deal with controlling impulses and focusing attention. There is a strong genetic element; many children with ADHD have another family member with the same problem. In addition, children are more likely to have ADHD if they were born prematurely, or if their mother smoked or misused alcohol or drugs when pregnant. These factors can interact with other mental problems such as an anxiety disorder and a stressful family environment. This can make the behavioural and emotional symptoms of ADHD worse. DiagnosisIt is quite normal for children, especially under fives, to be inattentive and restless. A diagnosis of ADHD needs to be made by a trained professional. If you are concerned about your child, visit your GP. If ADHD is suspected, the doctor will refer your child to a child psychiatrist (doctor specialising in children's mental health) or paediatrician (doctor that specialises in children's illnesses) with expertise in this area. There are no specific tests for ADHD. The specialist will usually make the diagnosis on the basis of observing the child and reports of the child's behaviour. Parents or carers and teachers may be asked to fill in a questionnaire about the child's behaviour. TreatmentA combination of approaches are often used to treat ADHD. Managing behaviour at homeYou can help your child by providing a structured environment with clear rules of acceptable behaviour. The specialist seeing your child can help you learn how to manage his or her behaviour. SchoolMake sure that your child's teacher knows about the condition. A structured and orderly classroom without too many distractions is helpful. Often, small-group or individual teaching helps. An educational psychologist can help to check on your child's progress. Special help should focus on particular problem areas, such as difficulties with reading, spelling, maths and organisation. Speech therapy, physical education therapy and counselling may also be available for your child at school. MedicinesMedication can be prescribed as part of a treatment programme for children with ADHD. A specialist in ADHD, such as a child psychiatrist, will first prescribe these. Stimulant medication (also known as psychostimulants) is approved for children over the age of six, and can offer short-term improvements in behaviour after each dose. Children become less hyperactive and aggressive, so they can relate better to parents and teachers. This gives a short period for parents and health professionals to help the child learn to manage their own behaviour. The first type of stimulant that a doctor is likely to prescribe is methylphenidate (eg Ritalin). This can reduce hyperactivity and impulsiveness and increase the attention span, helping children to concentrate at school. Other stimulant medications such as dexamphetamine may be recommended for children who do not improve with methylphenidate. Atomoxetine is a non-stimulant that is sometimes prescribed for children who do not improve with stimulant medication. Like all drugs, these medicines can sometimes have side-effects, including insomnia, headaches and irritability. Managing behaviour at homeYou can help your child by providing a structured environment with clear rules of acceptable behaviour. The specialist seeing your child can help you learn how to manage his or her behaviour. TherapyPsychological and behavioural therapy can also help children with ADHD, and it is used in combination with drugs. The therapy is designed to help your child learn to cope with the condition and reduce impulsive behaviour. Some therapy can be offered to your child or your whole family. Talk to your GP or child's psychiatrist about what is best for you and your child. DietThe role of diet in ADHD is controversial. Many people believe that some types of food additives, such as artificial colourings or refined sugars, can make their child's behaviour worse. In fact, there is little evidence to support this. If you do decide to make any changes to your child's diet, you should speak to a paediatric dietician first, because permanently eliminating certain foods may be harmful. Some experts think that certain vitamin, mineral, or omega-3 fatty supplements can help to treat ADHD. Again, the evidence is not conclusive, but the safety of high doses of supplements is unproven so care must be taken. Nevertheless, eating a varied and balanced diet, including oily fish (eg mackerel, herring, trout), which is high in omega-3 fatty acids, certainly helps to promote healthy development in children. Coping with ADHDIt can be difficult caring for a child with ADHD and the effects on family life can be dramatic. National support groups are available for the families of children with ADHD, and your GP may be able to put you in touch with a local support group. Through one of these, you can meet other families in the same situation and get support and advice on behaviour management for your child. (See Further information.) Further information
Sources
Published by BUPA's health information team, healthinfo@bupa.com, December 2006.
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