Attention Deficit Hyperactivity Disorder (ADHD) or hyperkinetic disorder is used to describe children who have three main kinds of problems:
Young children have lots of energy and like to be active. Young children also tend to have a short attention span - they soon get tired of an activity and want to move on to something new. But if your child is very active and has behavioural problems most of the time, they may have ADHD. Children with ADHD often find it difficult to fit in at school because they are overactive and impulsive. These difficulties can continue as they grow up, particularly if they and their families do not get the help they need. Research has shown that a significant number of children diagnosed with ADHD will continue to have symptoms of the disorder that significantly interfere with their social and working lives as an adult. Many adults may remain unidentified and untreated. Research suggests that ADHD occurs in approximately 5% of school-age children and approximately 2-4% of adults. More children are now being diagnosed with ADHD as more people get to know about it. Boys are more often affected than girls. Girls more commonly display symptoms of inattention while boys more commonly display symptoms of hyperactivity.
ADHD defines a type of behaviour that is at the extreme end of the normal range. All of these symptoms can be normal human characteristics. ADHD is diagnosed if the degree of a number of these characteristics is above the normal level.
The main characteristics are:
A child with ADHD is not able to process information in the same way as other children. They may continually fidget and because they cant concentrate, they become bored quickly. This behaviour is usually first noticed at approximately five years old, with the behaviour occurring at home, at school and in other settings.
Some children have significant problems concentrating and paying attention but are not necessarily overactive or impulsive. These children are sometimes described as having Attention Deficit Disorder (ADD) rather than ADHD. ADD can easily be missed because the child is quiet and dreamy rather than disruptive. It is important to seek treatment for your child. Around 70% of children with ADHD still have symptoms when they are adolescents and about 70% of those will have symptoms as adults.
The main symptoms of ADHD, such as attention difficulties, may improve as the child gets older, but behavioural problems such as disobedience or aggression may become worse if the child does not receive help. Adolescents may find it difficult to make friends and keep them, do poorly at school, may behave aggressively and are more likely to get depressed. Again if left untreated many will continue to have symptoms of the disorder that significantly interfere with their social and working lives as an adult.
The cause of ADHD is not certain. Genetic factors play a significant part. It tends to run in families and boys are affected more than girls. Research suggests that part of the brain works more slowly in children with ADHD, with changes in the parts of the brain that control impulses and concentration (frontal lobes).
Children with ADHD may have an imbalance in the neurotransmitters (brain chemical) and possibly a lack of dopamine in the front part of the brain. Poor parenting, family stress, excessive watching of TV, too much sugar etc. is not seen as a cause. Families with a child with ADHD may be stressed or disorganised, but this may be to do with the problems of coping with a child with ADHD.
In a small number of cases, the cause it is thought to be due to injury to the brain during development e.g. premature birth (low birth weight) smoking during pregnancy, having an accident or surgery during the first month of life.
There is no simple test to determine whether you or your child has ADHD. Both your GP and school can arrange for you and your child to see a specialist. A specialist, usually a psychiatrist (an expert in mental and emotional health) or paediatrician (childrens doctor) can make an accurate diagnosis after a detailed assessment.
This assessment should include a physical examination, which will rule out other possible causes for the symptoms. The assessment will also involve a series of interviews with you or your child and interviews or reports from other significant people such as parents and teachers.
To be diagnosed with ADHD:
Currently, these guidelines are only accepted for evaluating children and adolescents with ADHD; there are no different guidelines for diagnosing ADHD in adults. If you are an adult and think you may have ADHD you should consult your GP who can refer you to a specialist.
The two main treatments for ADHD are stimulant medicines and a talking treatment called behaviour therapy. Treatment of ADHD with medicines works best when combined with behaviour therapies and advice and support for parents and teachers. Medicines produce a short-lived improvement after each dose but are not a permanent cure. They create a short period when your child can concentrate better and be less impulsive, feel calmer and learn and practice new skills.
Methylphenidate is the main medicine used for the treatment of ADHD. Dexamfetamine may be used as an alternative, usually, if your child does not respond to methylphenidate treatment. These medicines are controlled drugs, which means their availability and use is more closely controlled than other prescription medicines. They are central nervous system stimulants. It is not completely clear how they work in ADHD but it is thought that they stimulate a part of the childs brain that changes mental and behavioural reactions. These two stimulants seem to affect parts of the brain, which allow us to control how we pay attention to what is going on around us. Both these stimulants are effective in the treatment of ADHD.
Methylphenidate and dexamfetamine are used in children and adolescents as part of a treatment programme, which would also include psychological, educational and social support. A specialist may also treat adults with these medicines as part of a treatment programme. When your child has shown an improvement and the condition appears stable, the specialist may recommend a break from treatment, for example, over a weekend or during school holidays. These medicine holidays help to assess how your child can manage without the medicine.
The length of treatment depends on how your child responds to the medicine. Some children will be able to stop completely as teenagers, and some may be able to stop sooner. Others may have to continue as adults. It would normally be stopped after one month if there was no sign of improvement and another treatment tried. To start treatment, methylphenidate is usually given as 2.5mg or 5mg tablets twice a day, normally at breakfast and lunchtime.
When a suitable dose has been found and the condition is stable, these are slow release versions can work for up to 12 hours, so there's no need for a dose at school. Methylphenidate is sometimes provided as 10 mg tablets which may need to be halved, or even quartered. You can buy a pill cutter from your pharmacist. Dexamfetamine is usually started at 5mg twice a day, normally at breakfast and lunchtime. Talk to your childs teacher to make arrangements for them to receive their lunchtime dose.
It is best to give these medicines after a meal or snack to prevent any nausea or loss of appetite. Doses are given at breakfast and lunchtime to provide an opportunity during this daytime period to help your child learn how to be more in control of their behaviour. A night time dose is sometimes given if the specialist decides that this would help any rebound hyperactivity in the evening. If your child experiences deterioration in concentration or behaviour in the late afternoon or evening, the specialist may suggest changing the times that the tablets are taken.
The specialist may suggest a gradual increase of the dose over a few weeks until they see a satisfactory response and to keep side effects to a minimum. Adolescents and adults should avoid drinking alcohol during treatment because this can increase the risk of side effects.
The effect of some anti-epileptic medicines and tricyclic antidepressants may be changed if taken at the same time as methylphenidate or dexamfetamine, so caution is required in the prescribing of methylphenidate for children and young people with epilepsy, psychotic disorders, or a history of drug or alcohol dependence. It is best to avoid getting pregnant whilst taking methylphenidate and dexamfetamine as they may cause abnormalities in the unborn child. If you think you may be pregnant or would like to start a family, discuss this as soon as possible your specialist or GP. Always tell your specialist about all of the medicines being taken. Side effects- Two common side effects are nausea and loss of appetite, particularly at the beginning of treatment. These can be helped and avoided by taking the medicines with a meal or snack.
Sleeplessness can occur often at the beginning of treatment and the specialist may suggest that you alter the afternoon dose or add in an evening dose. In the case of children, your specialist will monitor the growth of your child during treatment if they consider it necessary. The long-term safety of these medicines is not completely known. The specialist will include occasional blood tests and blood pressure monitoring. The risk of dependency i.e. addiction or need for a higher dose to get the same effect is often a concern for carers of children with ADHD.
To keep this risk to an absolute minimum the specialist will use the lowest possible dose and may recommend occasional breaks in treatment. It is therefore very important that you do not alter the dose that your child has been prescribed.
Atomoxetine may be prescribed as an alternative to methylphenidate or dexamfetamine if those medicines do not work. Also, atomoxetine may be prescribed if the specialist is worried that the stimulant medicines could be misused. Unlike methylphenidate or dexamfetamine, atomoxetine isn't a stimulant.
It works in a different way to stimulants and it affects a smaller part of the brain. It increases the amount of a chemical in the brain called noradrenaline. This chemical helps to pass messages between brain cells and is thought to help us concentrate and to control our impulses.
Atomoxetine comes as capsules that your child takes once or twice a day. The capsules are long-acting, so your child will not need to take them at school. Your child will start on a low dose which may then need to be increased.
Side effects can include loss of appetite, nausea or vomiting, feeling tired, indigestion, itching and being more prone to infections.
Your childs doctor should also check for any signs of liver damage, but liver damage due to atomoxetine is very rare.
Recent studies have shown that a small number of children and young people who take atomoxetine are more likely to think about suicide. Therefore the advice is that if a child or young person is doing well on atomexetine they should keep taking it but if they show signs of depression or suicidal thoughts they may need to switch to a different treatment.
Clonidine is not normally used as a treatment for ADHD in the UK. But a specialist may try this medicine if your child's behaviour does not improve with other treatments. Clonidine comes as tablets for your child to swallow. Some antidepressants have been tried as a treatment for children with ADHD, but again are not usually used in the UK for the treatment of ADHD. Antidepressants may however be used if a child has anxiety or depression as well as ADHD. The only antidepressant that is recommended in the UK to treat depression in children is fluoxetine.
can provide support for parents, teachers and children with ADHD. A trained therapist may counsel and support your child and their whole family. They may also to teach skills to manage the behaviour that goes with ADHD. The term behaviour therapy covers a wide range of treatments. Some approaches involve working with a therapist one to one. Other approaches involve group activities with other children or parents. Your child's teacher may also be involved in the therapy.
Parenting skills training - As a parent you can learn some specific ways of talking, playing and working with your child, which have been shown to improve children's attention and behaviour. They will explore issues such as discipline, rules, playing with their child and rewarding for good behaviour. There are a number of programmes run by professional therapists to help parents.
Most of these programmes focus on behaviour management. This involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress. Programmes can also be run for teachers. Behaviour management often involves a system of rewards and penalties (positive reinforcement). Parents identify a few types of behaviour they want to encourage, such as sitting at the table to eat. This is explained to your child and then he/she is given some sort of small reward for good behaviour and a small penalty for poor behaviour.
Dietary supplements, which have been used in the treatment of ADHD, include zinc supplements and polyunsaturated fatty acids. There is still little evidence to prove how these supplements work or how safe or effective they are. No single approach to treatment is appropriate for everyone. In adults, diagnosis is very important to help understand past difficulties. Also a combination of methylphenidate or dexamfetamine and supportive counselling, together with an antidepressant, in cases of mood disorder and anxiety, has shown to be effective.
The information shown here is Crown copyright and has been reproduced with the permission of NHS Direct. Last updated June 2007.