What is Attention Deficit Hyperactivity Disorder?

• Attention Deficit Hyperactivity Disorder, or ADHD, is a chronic medical condition that affects the part of the brain that deals with attention, impulses and concentration1
• It is a neurobiological condition thought to be caused by an imbalance of chemicals affecting specific parts of the brain and is known to have a strong genetic basis1
• A child with ADHD may display some or all of the behaviours listed below; however, they are more frequent and more complex than in children of a similar age (who do not have ADHD) and impact on the child’s social, family and school life:
  • Hyperactivity, inattention, impulsive behaviour, disorganisation, mood swings, social clumsiness, poor coordination, restlessness2

Is ADHD ‘real’?

• It is now widely accepted that ADHD is not, as some people suggest, a new health condition, resulting from modern lifestyles and food
• The condition was, in fact, first described in detail in 1902 in a series of lectures at the Royal Society of Medicine by the Paediatrician, Dr George Still – and a paper written as early as 1798 by Dr Alexander Crichton identified all of the essential features of ‘innattentive’ ADHD5
• Since 1987 this complex condition has been widely known as ADHD. However, it is also referred to as Attention Deficit Disorder (ADD) or Hyperkinetic Disorder

Who suffers from ADHD?

• It is estimated that between 3% and 7% of school age children in the UK have ADHD. The UK’s National Institute for Health and Clinical Excellence (NICE), suggests that it affects 5% of the school-aged population3
• It was thought that children ‘grew out’ of the condition by the time they reached adolescence; however, it is now suggested that for up to half of children with ADHD, symptoms continue into adulthood1
• Some evidence shows that the condition is more common in boys than in girls –estimates suggest that boys are three times more likely to develop the condition than girls2

Why is early diagnosis and treatment so important?

• Early identification of ADHD is critical to ensuring that appropriate interventions can be put in place to adequately support the child through their developing years and help them maximise their potential
• Being aware of the condition and why the child exhibits such behaviour can make a significant difference to how the child is treated at home, at school and in social situations. This in turn can affect their self-esteem, social and emotional development and ability to fulfil their true potential

How is ADHD diagnosed?

• There is no one test for ADHD, rather a specialist, a Paediatrician or Child and Adolescent Psychiatrist, will study the child’s behaviour using a set of defined criteria and questionnaires to analyse a child’s behaviour at home, at school and in a social setting. Symptoms need to be apparent in more than one setting for a diagnosis to be made
• The two key guidelines used for diagnosing ADHD are the American Psychiatric Association DSM-IV (Diagnostic and Statistical Manual of Mental Disorders)2 and the World Health Organisation ICD-10 (International Statistical Classification of Diseases and Related Health Problems)6

What treatments are available for ADHD?

• Children can develop mild, moderate or severe forms of ADHD
• The severity of the condition and the impact on the child’s quality of life determines what management strategies are put in place
• Most specialists recommend a combination of therapies to ensure the best outcome for the child. Treatment will usually comprise the following:
  • Psychological support from both Psychiatrists and Psychologists • Behaviour therapies such as individual therapy for the child looking at ways they could alter their behaviour or family therapy looking at how best to manage the condition
  • Medical therapies (stimulant and non-stimulant) aimed at improving concentration and reducing hyperactivity. NICE published new National Guidance on ADHD Treatments early this year.3 The guidance is available to read or download via www.nice.org.uk
  • Educational support including the use of classroom and teaching techniques, Statement of Educational Needs and additional teaching support where appropriate
  • Fish oils have been known to improve some aspects of ADHD symptoms in some children
  • Diet and exercise can play a role and people may chose to limit the intake of caffeine (in chocolate and some fizzy drinks)/artificial colourings or introduce dietary supplements/vitamins5,6

What are the problems associated with diagnosing and treating ADHD?

• The behaviours associated with ADHD may be overlooked and mistakenly interpreted as a sign of a misbehaving child or of poor parenting
• Awareness levels of ADHD among people working with children and in General Practice are often low and there is regularly a lack of training and experience in recognising ADHD behaviour
• Undiagnosed or untreated ADHD can have significant long-term impact on a child. Without adequate support and interventions ADHD can result in:
  • Under-performance at school and reduced educational achievement
  • Mental health problems
  • Difficulties in making and sustaining relationships (with peers, teachers and family)
  • Difficulties finding and keeping a job
  • Criminal behaviour,5,6

References:

1. Green C and Chee K. Understanding ADHD – A Parent’s Guide to Attention Deficit Hyperactivity Disorder in Children. Vermillion Publishing 1997. ISBN 0 009 181700
2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
3. Palmer ED and Finger S 2001. An Early Description of ADHD (Inattentive Subtype): Dr Alexander Crichton and 'Mental Restlessness' (1798). Child and Adolescent Mental Health;6:66
4. World Health Organisation 2006.International Statistical Classification of Diseases and Related Health Problems, ICD-10
5. Centers for Disease Control and Prevention, Department of Health and Human Services. Attention Deficit Hyperactivity Disorder (ADHD). Available from www.cdc.gov/ncbddd/adhd/what.htm. Last accessed September 2006
6. National Institute of Mental Health, National Institutes of Health. Attention Deficit Hyperactivity Disorder. NIH Publication No. 3572. Available from www.nimh.nih.gov/publicat/adhd.cfm#intro. Last accessed September 2006

For further information for parents and professionals please download Information for Parents and Professionals (PDF 340Kb)
by Dr Nikos Myttas, Consultant in Child and Adolescent Psychiatry, St Leonard's Hospital, Hackney.