The Doctor's notebook | Action Medical Research

Touching Lives - November 2007

The Doctor's notebook

What is ADHD?

Attention deficit disorder (ADD), also known as attention deficit hyperactivity disorder (ADHD), is one of the most common childhood-onset behavioural disorders. Often referred to as ‘hyperactivity’, ADHD refers to a range of problem behaviours relating to poor attention span, which often prevent children from learning or socialising well. ADHD shouldn’t, however, be confused with normal boisterous or exuberant childhood behaviour.

What are the symptoms?

Children with ADHD consistently and involuntarily have difficulty in areas such as staying seated when required, playing quietly, following instructions and waiting their turn. Other common symptoms include interrupting others, talking excessively, failing to pay close attention to detail and having difficulty following activities through to their conclusion. The symptoms can be very disruptive both for the individual and for family life. Children with ADHD may have normal or advanced intelligence, yet many suffer learning problems such as dyslexia, and many underachieve at school and have poor self-esteem. Hyperactive behaviour may improve with the onset of puberty, but many sufferers see some impact on their behaviour in adulthood.

How common is it?

It’s estimated that around five per cent of children and adolescents have ADHD to some degree, though some are more seriously affected than others. Boys are about three times more likely than girls to suffer from ADHD, and the condition can run in families.

What else could it be?

Other conditions can have similar symptoms. For example, epileptic seizures can make a child drowsy, impairing their attention. Hearing problems could make it hard for children to follow instructions, while reading difficulties can make it hard to complete tasks or follow instructions. If a child is not getting enough sleep they may well have difficulty concentrating during the day. Autism and Asperger’s syndrome often result in difficulties in understanding and using language, and Tourette’s syndrome involves involuntary movements of the body and sudden outbursts of noise or swearing. It is also important, though, to remember that many children have difficulty concentrating or keeping still, and can be easily distracted. Relatively mild displays of such behaviour are usually perfectly normal.

What causes ADHD?

Doctors don’t know exactly why some children develop the condition. It is thought that an inherited imbalance of neurotransmitters, the chemicals that transmit nerve signals in the brain, may be in part to blame. Studies of twins show that genetic factors are important — if one twin has it there is a strong chance that the other does too. Usually a parent or close relative has the condition, and studies show that several genes are likely to be involved. Brain injuries at birth or pre-birth problems have also been implicated. Parts of the brain that are thought to be linked to the development of ADHD may be damaged by inadequate oxygen supply before or during birth. Other factors such as the child’s own natural temperament may also play a part.

How is it diagnosed?

There is currently no cure for ADHD, but early diagnosis and intervention can make a big difference. Diagnosis is made by a doctor, usually an adolescent or educational psychologist, after formal testing for attention difficulties, hyperactivity and impulsivity.

What treatments are available?

Treatment depends on the exact diagnosis. Management techniques for parents which focus on creating a daily routine for the child, setting clear boundaries, making clear and reasonable requests, and the use of sanctions and rewards, can be very effective. Such techniques are the first treatment of choice, but medication can also be used to help children with ADHD concentrate and be less disruptive to those around them. One of the most common medications is Ritalin, which can reduce hyperactivity and impulsiveness and help to focus a child’s attention. In addition, other forms of therapy such as anxiety management or cognitive therapy, and educational learning support in the school environment, often have a positive effect. TL

For information and advice on a wide range of health topics, visit Dr Steele’s website www.thefamilygp.com

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