ADHD
ADHD (or Attention Deficit Hyperactivity Disorder) is a disorder in which people have problems with impulsiveness, poor attention span, distractibility, restlessness and overactivity. The problems typically start in early childhood and improve during the late teenage years, but it may persist into adulthood.
It is normal for young children to be overactive and easily distracted, but a child with real ADHD will have major problems at school and at home, will find it very difficult to do any kind of schoolwork, and will find it very hard to make friends and maintain friendships. These children may be very aware of their problems and very frustrated that they can't do the things that other children can do.
ADHD or ADD?
ADD is 'Attention Deficit Disorder' and this refers to people who have problems with attention and concentration, but are not very hyperactive or impulsive. Girls are more likely to have ADD (without hyperactivity) than ADHD. When people with ADHD grow older, as adults they are less hyperactive and their ADHD can turn into ADD. ADD and ADHD are really part of the same disorder and the treatments are mostly the same.
Causes
ADHD does not have a single cause. It can run in families and in some cases the cause is genetic. In some cases it can be due to developmental immaturity, and the child can grow out of it to a large extent in the late teenage years. Children who have developmental disorders like Autism can be more likely to have ADHD problems. In some cases psychological stress in early childhood can also be a causative factor. In some cases it could be due to dietary deficiencies or to sensitivity to certain food additives.
It is normal for young children to be overactive and easily distracted, but a child with real ADHD will have major problems at school and at home, will find it very difficult to do any kind of schoolwork, and will find it very hard to make friends and maintain friendships. These children may be very aware of their problems and very frustrated that they can't do the things that other children can do.
ADHD or ADD?
ADD is 'Attention Deficit Disorder' and this refers to people who have problems with attention and concentration, but are not very hyperactive or impulsive. Girls are more likely to have ADD (without hyperactivity) than ADHD. When people with ADHD grow older, as adults they are less hyperactive and their ADHD can turn into ADD. ADD and ADHD are really part of the same disorder and the treatments are mostly the same.
Causes
ADHD does not have a single cause. It can run in families and in some cases the cause is genetic. In some cases it can be due to developmental immaturity, and the child can grow out of it to a large extent in the late teenage years. Children who have developmental disorders like Autism can be more likely to have ADHD problems. In some cases psychological stress in early childhood can also be a causative factor. In some cases it could be due to dietary deficiencies or to sensitivity to certain food additives.
Assessment
To make a diagnosis of ADHD we need to establish that there has been a long term pattern of ADHD symptoms from an early age, in a range of different situations. We also need to be sure that there is no other explanation for these symptoms - such as for example hearing problems, speech and language problems, intellectual impairment, specific learning disabilities, or mood problems such as anxiety or depression. We can often make a diagnosis on the basis of detailed information from parents and teachers. Sometimes we might also need specialised testing such as psychological testing, or speech and language assessment.
Treatment
Diet
Diet is not as important as most people think, but some children do seem to have a problem with some food colourings. There is no scientific evidence that sugar causes hyperactivity (birthday parties can cause hyperactivity, but that is another matter). On the other hand if a child misses breakfast then he/she is likely to be distracted and not pay attention at school, because of low blood sugar. There is some scientific evidence that fish oil supplements can be helpful. There is also some research evidence that miconutrient supplements such as 'EMPower Plus' (a combination of vitamins and minerals) can be useful.
The best advice is to provide a balanced diet, home made with fresh ingredients and the absolute minimum of processed foods, and with a good amount of fish and other sources of Essential Fatty Acids. More on diet here.
Parenting and teaching
The basic rules of communicating with a child with ADHD: Keep it simple. Use short sentences. Give one instruction at a time. Make sure your child is looking at you when you speak. Follow up to check that they have taken it in. Yelling doesn't help.
Consistent and simple daily routines can be helpful for some children. Lists can be useful.
Reward and punishment: Children with ADHD can be very annoying but if you slip into a pattern of continuous lecturing and punishment, the child (and parent) will get demoralised, stressed and anxious, and the behaviour can get worse. It is more useful to encourage and reward the kind of behaviours you want to see - and remember, a 'reward' can be as simple as a smile and a 'well done!' Try to remember the 'five to one rule': children should have at least five positive statements for each criticism, otherwise they only hear the criticisms and not the praise. Children with ADHD need frequent rewards and positive feedback.
The video on this page by Dr Russell Barkley has a lot of great ideas on how to help a child with ADHD.
Mindfulness training
Mindfulness training can be a very helpful way for older adolescents and adults to cope with ADHD. You might want to have look at my mindfulness page.
Medication
Most ADHD medications work by increasing the amount of the neurotransmitter dopamine in parts of the brain's frontal lobe. Dopamine is the chemical responsible for alertness and for finding things rewarding and pleasurable. The frontal lobe is the part of the brain responsible for planning, decision making, social behaviour and self control.
Ritalin (methylphenidate) is the medication used most commonly for ADHD. It comes in three forms: regular Ritalin, Ritalin LA (long acting ritalin) and Concerta (another kind of long acting methylphenidate).
Dexamphetamine is often used as an alternative to Ritalin, if Ritalin is not working or is causing side effects. Vyvanse (lisdexamphetamine) is a long acting form of dexamphetamine.
Ritalin and dexamphetamine are called 'stimulant' medications because they work by stimulating the brain, increasing alertness, focus, concentration and motivation. If people appear calmer it is because they are more alert and focused, not because they are sedated or tranquillised.
Atomoxetine (Strattera) is another medication that is sometimes used as an alternative to ritalin and dexamphetamine if these are causing problematic side effects. Strattera is not a stimulant (although it has some similar effects to stimulants). It is similar to some antidepressant medications and for this reason it is useful for people who have mood swings or are anxious or depressed as well as having ADHD problems.
Clonidine (Catapres) is sometimes used as an alternative, or in combination with thee stimulant medications. Clonidine is also a gentle sedative and calming medication and can be useful for the problems of irritability and impulsiveness that some children have with ADHD. It can also be useful to help children with ADHD settle down to sleep.
Guanfacine (Intuniv) is another non-stimulant ADHD treatment which has recently become available in Australia. Guanfacine can be used on its own or in combination with a stimulant medication.
You can find more information on all these medications here.
Personal experience
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Here is my nephew Dan's experience of ADHD
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Links
CHADD - which stands for 'Children and Adults with ADD' is a good source of information
ADDitude - a great website with resources for adults with ADD/ADHD, and for parents of children with ADD/ADHD
USA National Institute of Mental Health (NIMH)
ADDRC - Tips for parents
A scientific review of non-medication treatments of ADHD - American Journal of Psychiatry
ADDitude - a great website with resources for adults with ADD/ADHD, and for parents of children with ADD/ADHD
USA National Institute of Mental Health (NIMH)
ADDRC - Tips for parents
A scientific review of non-medication treatments of ADHD - American Journal of Psychiatry
Books
ADD Success Stories - by Thom Hartmann (no relation) - practical tips for adults and children
Focused: ADHD & ADD Parenting Strategies for Children with Attention Deficit Disorder
Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach
ADD-Friendly Ways to Organise Your Life, by Judith Kohlberg and Kathleen Nadeau - a very useful book for adults and older teenagers
Focused: ADHD & ADD Parenting Strategies for Children with Attention Deficit Disorder
Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach
ADD-Friendly Ways to Organise Your Life, by Judith Kohlberg and Kathleen Nadeau - a very useful book for adults and older teenagers
Videos
Dr Russell Barkley - Essential Ideas for Parents Dr Russell Barkley - non-medication treatment of ADHD
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ADHD explained |
How to get stuff done when you have ADHD |
How to deal with ADHD meltdowns How to prioritise when you have ADHD
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Exercise and ADHD ADHD coping skills
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