Mental Health and Growing Up
Factsheet
Attention-deficit hyperactivity disorder (ADHD):
Information for parents, carers and anyone working with young
people
About this factsheet
This is one in a series of factsheets for
parents, teachers and young people entitled Mental Health and
Growing Up. The aims of these factsheets are to provide
practical, up-to-date information about mental health problems
(emotional, behavioural and psychiatric disorders) that can affect
children and young people. This factsheet helps to understand what
attention-deficit hyperactivity disorder (ADHD) is and also offers
some advice about what is helpful and where to get help.
Introduction
‘Attention deficit (ADD)’, ‘attention-deficit
hyperactivity disorder (ADHD)', ‘hyperkinetic disorder' and
‘hyperactivity' are various terms used by people and professionals.
These differences in terminology can sometimes cause confusion. All
the above terms describe the problems of children who are
hyperactive and have difficulty concentrating.
What is ADHD (attention-deficit hyperactivity
disorder)?
ADHD is a behavioural disorder which often
becomes obvious in early childhood. The behaviours are due to
underlying problems of poor attention, hyperactivity and
impulsivity.
Many children, especially under-fives, are
inattentive and restless. This does not necessarily mean they are
suffering from ADHD. The inattention or hyperactivity becomes a
problem when they are exaggerated, compared with other children of
the same age, and when they affect the child, their school, social
and family life.
How common is it?
About 2 to 5% of school age children can
suffer from ADHD. Boys are more commonly affected than girls.
What causes ADHD?
We do not know exactly what causes these
disorders. ADHD can run in families. It is more likely in children
who have significant traumatic experiences as a child. Sometimes
parents feel blamed for not having controlled their child, but
there is no evidence that poor parenting directly causes ADHD.
However, it is important to note that parents can play a crucial
role in helping and managing a child with ADHD.
What are the symptoms?
ADHD can present with different behaviours
depending on the age, setting (i.e. school, home, playground) and
even motivation (e.g. when doing an activity or something a child
likes).
Not all children have all the symptoms. This
means some can just have problems with poor attention, while others
are mainly hyperactive.
Children with problems of attention can appear
forgetful, distracted, not seeming to listen, disorganised, take
ages to start doing things and then when they do they rarely finish
it.
Children with hyperactivity seem restless,
fidgety, full of energy ‘always on the go’. They may seem loud,
noisy with a continuous chatter.
Children with symptoms of impulsivity do
things without thinking. They have difficulty waiting for their
turn in games or in a queue, and interrupt people in
conversation.
What other problems can a person with ADHD
have?
Children with ADHD can have other problems
such as learning difficulties, autism, conduct disorder, anxiety
and depression. Neurological problems like tics, tourette’s, and
epilepsy can also be present. Children with ADHD can have problems
with coordination, social skills and seem to be disorganised.
How long will they have ADHD?
About 1 in 3 children with diagnosis of ADHD
can grow out of their condition and not require any treatment when
they are adults. The majority who receive specialist treatment
tailored to their needs may benefit considerably. They will have
been able to catch up with their learning, improve their school
performance and make friends.
Some are able to cope and manage by adapting
their careers and home life. However, some can have major problems,
even as adults, requiring treatment. They may also struggle with
difficulties in relationships, at work, in their mood and using
drugs or alcohol.
How is it diagnosed?
There is no single, simple, definite test for
ADHD. Making a diagnosis requires a specialist assessment, usually
done by a child psychiatrist or specialist paediatrician. The
diagnosis is made by recognising patterns of behaviour, observing
the child, obtaining reports of their behaviour at home and at
school. Sometimes a computerised test may be done to aid the
diagnosis. Some children also need specialised tests by clinical or
educational psychologist.
How is it treated?
A child suffering from ADHD needs treatment
across all situations where the difficulties occur. This means
support and help at home, school, with friends and community.
Firstly it is very important for the family,
teachers, professionals to understand the child’s condition and how
it affects them As they grow up the young person themselves need to
be aware of their condition and how to manage it.
Teachers and parents may need to use
behavioural management strategies like reward charts.
Parents/family may find parent training programmes helpful,
especially in managing the defiant behaviours which may arise from
their hyperactivity.
At school, children may need specific
educational support and plans to help with their daily work in
classroom and also homework. They may also need help to build their
confidence, develop their social skills. It is important that there
is good communication between home, school and the professionals
treating the child to ensure that the ADHD symptoms are treated as
well as possible, and that the child achieves their best
potential.
Medications can play an important role in
managing moderate to severe ADHD. Medications can help to reduce
hyperactivity and improve concentration. The improved concentration
gives the child the opportunity and time to learn and practise new
skills.
Children often say that medication helps them
to get on with people, to think more clearly, to understand things
better and to feel more in control of themselves. Not all children
with ADHD will need medication.
What can I do?
A child with ADHD can present with very
difficult behaviours at home, school or outside. However, they
still need to be boundaries and discipline. Having ADHD does not
mean they can disobey you or behave inappropriately (e.g. swearing
or being violent). A healthy lifestyle with balanced diet and
activity can help.
Children with ADHD can become easily
frustrated because of their poor attention span and high energy
levels. Some of the following can help manage these
difficulties:
- Give simple instructions.
Stand near them, look at them and tell them slowly and calmly what
you want them to do, rather than shouting across the room.
- Praise your child when they
have done what is required, however small it is.
- If needed, write a list of
things to do and put it somewhere where it can be seen clearly
(e.g. door of their room, bathroom).
- Break any task, like doing
homework or sitting on dining table, to smaller time spans such as
15-20 minutes.
- Give them time and
activities to spend their energy like basketball, swimming.
- Change their diet and avoid
additives. There is some evidence about the effect of diet on some
children. They may be sensitive to certain food additives and
colourings. If parents notice that certain foods worsen
hyperactivity, these may be avoided. It is best to discuss this
with your doctor or specialist dietician.
Many parents find it helpful to attend
parenting programmes, irrespective of whether child is being
treated for ADHD. Some areas offer parenting programmes and support
groups specifically for parents of children with ADHD.
How do I get help?
Your GP, teacher or school nurse can refer you
to a specialist to complete an ‘assessment’ and offer treatment.
They may refer you to a paediatrician (Child doctor) or to a child
and adolescent mental health service (CAMHS).
Additional information on medications for
ADHD
- What are the
medications used in treatment of ADHD?
Medications used to treat ADHD are broadly
divided in two groups:
- Stimulants like
methylphenidate and dexamphetamine
- Non stimulants like
atomoxetine.
Stimulants have the effect of
making people feel more alert, energetic, and awake. In a person
suffering ADHD, they can improve attention and reduce
hyperactivity. The stimulants used in the treatment of ADHD include
methylphenidate (previously commonly known by the name ‘ritalin’)
and dexamphetamine.
Methylphenidate is available as different
forms. Immediate release methylphenidate is short-acting. It is
used for its flexibility in dosing and can be used to determine the
correct level of dose during dose changes. Slow or modified release
methylphenidate work for 8 – 12 hours and can be given once a day.
They are more convenient, and as the child or young person need not
take a dose in school, reduces stigma attached to this
disorder.
Non stimulant medications by nature do not
make people alert or active. However, in ADHD, they can improve
symptoms of inattention and hyperactivity. These include
medications like atomoxetine.
Sometimes other medications may be used to
help with problems with sleep and challenging behaviours that are
associated with ADHD.
Medications act on certain chemicals in the
brain called ‘noradrenaline’. They seem to affect the parts of the
brain that control attention and organise our behaviour.
They do not cure ADHD. They help to control
the symptoms of poor attention, overactivity or impulsivity.
- Which
medication will be used for my child?
Stimulant medication methylphenidate is
usually prescribed first. The type of stimulant prescribed will
depend on a number of things like the symptoms your child has, your
choice of treatment, the ease of giving the medication and even
availability/cost of the medication.
If methylphenidate causes unpleasant
side-effects or does not work, other stimulant (dexamphetamine) or
non stimulant medications may be prescribed. Sometimes a child may
respond to a different form of methylphenidate.
- How do I know
it is working?
You will find that:
- your child’s concentration is
better
- their feelings of restlessness or
over-activity are less
- they control themselves better.
Sometimes school or teachers notice the
improvement before you do.
- What are the
side-effects?
As with most medications, there may be some
unwanted effects. However, not everyone gets side effects and most
side effects are mild and disappear with continued use. Side
effects are less likely if the dose is increased gradually when the
tablets are started. Some parents worry about addiction, but there
is no good evidence to suggest that this is a problem.
Some of the common side effects of
methylphenidate include:
- loss of appetite
- difficulty falling
asleep
- light headedness
Less common side effects to look out for
include:
- being ‘over-focused’, quiet and staring- this
may be a sign that the dose is too high
- anxiety, nervousness, irritability or
tearfulness
- tummy pains or feeling sick
- headache, dizziness or drowsiness
- tics or twitches.
In the long term, sometimes growth slows down
when children are on methylphenidate. Research shows that the total
adult height may be reduced by 2.5 cm when on methylphenidate.
This list of side-effects is not exhaustive.
If you notice anything unusual,
it is important to contact your
doctor immediately.
- Is there
anything I need to know before giving the medication?
Before you give any medication do tell your
doctor about:
- allergies your child might
have
- any other medicines they
take, including vitamins or supplements
- for older girls if they are
likely to become pregnant
- if you or anyone in your
family suffers from physical health problems, especially high blood
pressure, heart problems and repeated movements (called tics).
- Are there any
special tests before or while taking the medications?
Before taking the medication, your child
should be physically checked up especially for their heart rate,
blood pressure, growth and any other medical problems.
Sometimes they may need blood test or heart
tracing test to measure the electrical activity of the heart called
an electrocardiogram (ECG).
While taking the medication, your doctor will
monitor your child’s heart rate, blood pressure, weight and height
on a regular basis along with checking for any side effects.
- What do I need to know about
giving the medication?
Some helpful things to know:
DO's
- Give the medication at the
times you were told by your doctor or pharmacist
- Keep appointments for
regular review of medication
- Store the medication
safely
- Ensure your child swallows
the medication, not chew or crush it
- Make sure your child
drinks enough, especially in hot weather and while exercising.
DON’T 's
- Double the dose if they miss
a dose of medication
- Stop giving the medication
without discussing with the doctor
- Give the medication to
anyone else, even if you feel their difficulties are similar to
your child’s.
- How long do
they need to be on the medication?
Most children and young people need the
medication at least until they finish their education or schooling.
A few might need to take it even when they grow up.
Some children need medications only at
specific times, like for example while attending school, and do not
have to take it on weekends or on school holidays.
Your doctor would regularly check, at least
once a year, if they need to continue the
medicine.
Taking these medications can affect driving,
and even certain careers like joining the army. It is important
that the child is aware this and will need to discuss it with their
doctor as they grow up.
Young people may need explanations and support
as they grow up about taking their medication. Stopping medication
can cause symptoms to return, and some young people can put
themselves at risk in terms of their education, their work, and
socially by being impulsive and taking alcohol or drugs.
Remember: if you have any further
questions regarding this medication, do not hesitate to contact
your doctor or pharmacist.
Further information
ADD Information and Support
Services (ADDISS)
Provides information and resources about ADHD
to anyone who needs assistance.
Young Minds
Parents’ helpline: 0800 018 2138: for any
adult concerned about the emotions and behaviour of a child or
young person.
ADD
Resources
Website offers free and carefully chosen
articles helpful to adults with ADD/ADHD and to parents of children
with ADD/ADHD, links to other ADHD-related websites, and more.
Electronic Medicines Compendium
(eMC)
Contains information about UK licensed
medicines.
Further reading
- For
parents/professionals
ADD/ADHD Behaviour change resource Kit:
Ready-to-Use Strategies & Activities for Helping Children with
Attention Deficit Disorder, Grad A Flick, Paperback, 1998,Jossey
Bass Publishers, Wiley Print.
ADHD Handbook - For Parents and Professionals.
Dr Alison Munden and Dr Jon Arcelis. Jessica Kingsley
Publishers.1999
Everything a child needs to know about ADHD
(2006), Dr C R Yemula, ADDISS publications, 2007, second edition.
For children aged 6-12 years
Putting on the Brakes: Young People’s Guide to
Understanding Attention Deficit Hyperactivity Disorder.
For ages 8
– 12 . Author: Patricia O. Quinn, Judith M. Stern.
References
National Institute for Health and
Clinical Excellence: Attention deficit hyperactivity disorder
(ADHD). Clinical Guideline (September 2008); Attention deficit
hyperactivity disorder: Diagnosis and management of ADHD in
children, young people and adults.
National Institute for Health and
Clinical Excellence: Methylphenidate, atomoxetine and dexamfetamine
for attention deficit hyperactivity disorder (ADHD) in children and
adolescents: Technology Appraisal 98, 2009.
Pelsser LM, Frankena K, Toorman J, et al; Effects of a
restricted elimination diet on the behaviour of children with
Lancet. 2011 Feb 5;377(9764):494-503
Rutter, M. & Taylor, E. (eds) (2008)
'Child and Adolescent Psychiatry' (5th edn). London:
Blackwell.
British National Formulary; 62th
Edition (September 2011) British Medical Association and Royal
Pharmaceutical Society of Great Britain, London.
- Revised by the Royal College of
Psychiatrists’ Child and Family Public Education Editorial
Board.
- Series Editor: Dr Vasu Balaguru
This leaflet reflects the best available
evidence at the time of writing.
© March 2012. Due for review March 2014. Royal
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