What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder thought to affect 2-5% of all school-age children. ADHD is characterized by developmentally inappropriate levels of inattention, impulsivity and hyperactivity.

ADHD is more commonly diagnosed in boys than girls. However, it is thought that girls may be under-represented in referrals to ADHD services and therefore, ADHD can go unrecognised in girls. There are several possible reasons for why this might be. One theory is that girls tend to present with more inattentive symptoms than hyperactivity (although not always the case) and therefore are not noticed or seen as a problem. The impact of ADHD on girls however, particularly if ADHD is missed, can be significant.

Although ADHD can occur in people of any intellectual ability, it is more common in people with learning difficulties.

What are the causes of ADHD?

The exact cause of ADHD is not really known, but the condition has been shown to run in families. (Research shows that both parents and siblings of a child with ADHD are four to five times more likely to have ADHD themselves). Research has also identified a number of possible differences in the brains of people with ADHD compared to those who do not have the condition.

Other factors that have been suggested as potentially having a role in ADHD include:
• being born prematurely (before the 37th week of pregnancy)
• having a low birth weight
• brain damage either in the womb or in the first few years of life
• drinking alcohol, smoking or misusing drugs while pregnant
• exposure to high levels of toxic lead at a young age

The following factors are NOT known causes, but can make ADHD symptoms worse for some children:
• watching too much television
• eating sugar
• family stress (poverty, family conflict)
• traumatic experiences

Why do you need an assessment?

Individuals with ADHD can be very successful in life. However, without identification and proper treatment, ADHD may have serious consequences, including school failure, family stress and disruption, depression, problems with relationships, substance abuse, delinquency, accidental injuries and job failure.
Early identification and treatment are extremely important.

What are the symptoms of ADHD? (Does your child show majority of these symptoms?)

Typically, ADHD symptoms arise in early childhood. According to the DSM-5 (Diagnostic and Statistical Manual of Mental Health -5), several symptoms are required to be present before the age of 12.

The main signs of inattentiveness are:
• having a short attention span and being easily distracted
• making careless mistakes – for example, in schoolwork
• appearing forgetful or losing things
• being unable to stick at tasks that are tedious or time-consuming
• appearing to be unable to listen to or carry out instructions
• constantly changing activity or task
• having difficulty organising tasks

Hyperactivity and impulsiveness
The main signs of hyperactivity and impulsiveness are:
• being unable to sit still, especially in calm or quiet surroundings
• constantly fidgeting
• being unable to concentrate on tasks
• excessive physical movement
• excessive talking
• being unable to wait their turn
• acting without thinking
• interrupting conversations
• little or no sense of danger

These symptoms can cause significant problems in a child’s life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.

Related conditions in children and teenagers

Approximately 60 to 80 per cent of children with ADHD will have at least one other condition; in particular, other developmental conditions such as:

• Oppositional defiant disorder (ODD) – negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers
• Conduct disorder – a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals
• Autistic spectrum disorder (ASD) – affects social interaction, communication, interests and behaviour
• sleep problems – finding it difficult to get to sleep at night, and having irregular sleeping patterns
• Depression
• Anxiety disorder
• Epilepsy – a condition that affects the brain and causes repeated fits or seizures
• Tourette’s syndrome – a condition of the nervous system, characterised by a combination of involuntary noises and movements called tics
• learning difficulties – such as Dyslexia and Dyspraxia

Diagnosis and management

There is no single test, screening tool or ADHD assessment for identifying the condition. We will undertake a full ADHD assessment including information about your child’s physical health, family history, description and impact of symptoms and any previous ADHD diagnosis or treatment approaches.

We use evaluation tools and rating scales to aid ADHD assessment but is unlikely to rely on one tool alone. Consideration is given to any co-existing difficulties so that support can be best targeted to the individual needs.
Following the ADHD Assessment and diagnosis, an individual treatment plan is recommended. Although ADHD cannot be ‘cured’, with support it is possible to lessen the impact of many of the associated symptoms.

Possible treatment routes include Strategies and behavioural management advice for ADHD symptoms, medication management and necessary referral to relevant teams including mental health team, Psychologist and ADHD specialist nurse.

Diagnosing ADHD in children depends on a set of strict criteria. To be diagnosed with ADHD, your child must:
• been displaying symptoms continuously for at least six months
• started to show symptoms before the age of 12
• been showing symptoms in at least two different settings – for example, at home and at school, to rule out the possibility that the behaviour is just 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 aren’t just part of a developmental disorder or difficult phase, and aren’t better accounted for by another condition

ADHD Treatment:

Psychostimulants such as Methylphenidate and Dexamphetamines (first line of choice) are the most widely used class of medication for the management of ADHD related symptoms. Approximately, 70 to 80 percent of children with ADHD respond positively to psychostimulant medications.

Non-stimulant medications (Atomoxetine and Guanfacine) also have similar effects as the stimulants but take longer to build up the dose and vary in effectivity in controlling ADHD symptoms.

ADHD Brain – Neurochemical Dysfunction?

ADHD is characterized by a dysfunction, in particular, neurotransmitter systems (e.g. dopamine, noradrenaline) which are essential to normal brain function. The transmission of information in the nervous system appears to be impaired – as if the “go” and “stop” signals are delayed. Studies of brain function in people with ADHD reveal impairment in regions responsible for regulating certain behaviours, including initiating tasks, inhibiting unwanted behaviour, predicting consequences, retaining information and planning for the future. Appropriate treatment can diminish these symptoms and improve function.

C/o Private GP Clinic, Sunningdale, Ascot SL5 0DP

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