What is it?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurological developmental condition and no two people with ADHD are alike. ADHD is associated with an inconsistent attention span, being easily distracted, restlessness and impulsivity. It is a complex condition involving a developmental impairment of Executive Functioning which is the self-management system of the brain.
A person’s ADHD symptoms may vary considerably from one situation to another depending on the situation, the task and the incentives involved.
ADHD is a real condition with complicated neurochemistry. The brain’s chemical messengers involved with attention, reward, pleasure and motivation work differently in someone with ADHD compared to those who don’t have the condition, and it is also believed that there are some differences in brain structure.
The ADHD diagnosis is further broken down into one of three subtypes:
- Predominantly Inattentive Presentation: predominant symptoms of inattention, but not hyperactivity-impulsivity
- Predominantly Hyperactive-Impulsive Presentation: predominant symptoms of hyperactivity-impulsivity but not inattention
- Combined Presentation: symptoms of both criteria, inattention and hyperactivity-impulsivity
What are the characteristics of ADHD?
The following symptoms are characteristic of someone with ADHD (not every symptom will necessarily apply and this should not be used as a diagnostic tool):
- Becomes easily distracted and finds it hard to take notice of details, particularly with things they find boring.
- Finds it hard to listen to other people and may interrupt them.
- Finds it hard to follow instructions.
- Finds it hard to organise themselves and start a lot of things without ever finishing them, or have tremendous difficulties in starting things that hold little interest or are not urgent.
- Finds it hard to wait or when there’s nothing much going on – fidgets and can’t sit still.
- Is forgetful, tends to lose or misplace things and is often late.
- Becomes easily irritated, impatient or frustrated and loses their temper readily.
- Is impulsive, tends to do things on the spur of the moment, without thinking, which can get them into trouble.
- Feels restless or edgy, has difficulty turning their thoughts off, and finds stress hard to handle.
- Symptoms can appear to be inconsistent as they can hyper focus on an activity they are highly interested in.
It is not uncommon for any of us to put off doing tasks we really don’t want to do and don’t do them until they become really urgent, walk into a room and can’t remember why we entered it, lose our concentration and don’t listen to what is being said from time to time. For someone with ADHD they will have much more difficulty in these areas than their same age peers, to the extent that it negatively impacts on their lives and possibly the lives of those around them.
On the surface it may appear that the child, adolescent and even adult is inattentive or hyperactive and impulsive. For some, they will be, unfortunately, labelled as just a day dreamer, naughty or badly behaved. However, there is much more going on due to something called Executive Functioning.
Some myths surrounding ADHD:
“You have to be hyperactive to have ADHD” – No you don’t. For some people with ADHD it’s their minds that are hyperactive, or they may talk non-stop or they are constantly fidgeting. You don’t need to be climbing over the furniture and pinging off the walls to have ADHD.
“Girls don’t have ADHD”– Yes they do but it is often less visible than in boys. They are more likely (but not always) to have what is known as the Predominantly Inattentive Presentation of ADHD and, therefore, show less outward hyperactivity and impulsivity.
“ADHD is down to bad parenting and poor social demographics” – No it isn’t. ADHD can affect any child from any family, regardless of where they live, although there is a strong genetic link.
What causes ADHD?
ADHD can affect both sexes, all levels of ability and all families wherever they live. Although there is now overwhelming evidence for a strong hereditary link, there is unlikely to be one single genetic cause of ADHD. There are certain other conditions and circumstances (such as autism, low birth weight and very premature births) which are associated with a higher incidence of ADHD.
Role of medication in ADHD
ADHD medication is sometimes a controversial and misunderstood topic. Often a combined approach of structure, rewards, behaviour management in children (such as 1-2-3 Magic programme) or lifestyle changes in adults together with appropriate medication can be the most effective option. Medication may be recommended and can certainly help with some of the symptoms in those people whose ADHD is considered to be severe. Before trialling medication in children whose ADHD is mild to moderate, NICE guidance recommends lifestyle changes and behavioural management.
ADHD medication is a personal decision that you should only consider for your child or yourself in consultation with someone who is medically qualified and experienced to do so. Whilst ADHD medication is considered to be very effective, it doesn’t work for everyone.
What is Executive Functioning?
ADHD in essence is a developmental impairment of the brain’s self-management system, called ‘Executive Functioning’ (EF).
Someone with ADHD usually has chronic difficulties in organising and prioritising, getting started on necessary tasks (procrastination), and staying motivated to finish what needs to be done (sustaining effort, focus and attention). They often find dealing with interruptions and shifting their focus back to the job in hand difficult. They may have problems with their memory and learning from the consequence of their actions (or lack of). They often have a low frustration tolerance and may lose their temper easily.
On the surface these impairments in the Executive Functions look like problems with attention, hyperactivity and impulsivity.
How many people have ADHD?
ADHD is believed to affect up to 5-7% of the population, although there is an under-diagnosis in females in the UK. Hyperkinetic Disorder is a term sometimes used to describe severe ADHD which affects 1% of the population.
How can I get a diagnosis for my child?
If you think your child has ADHD, in the first instance you should speak with your GP, Health Visitor or School Nurse. Your school’s SENDCo (Special Educational Needs and Disabilities Coordinator) should also be able to help with a referral. They will ask you a variety of questions and then make a referral to a specialist paediatrician or child psychiatrist depending on the presenting problems. In Bedfordshire it is common practice to be referred to a specialist team either at the Child Development Centre in Kempston or the Edwin Lobo Centre in Luton. Your child may also be seen at an affiliated practice.
How does an adult get a diagnosis?
Adults suspecting they may have ADHD need to speak with their GP. You are entitled to ask for an assessment by a psychiatrist or clinical psychologist. Although NICE guidance stipulates each Clinical Commissioning Group must appoint an Adult ADHD Specialist, at the present time there is no ADHD Adult Specialist in Bedfordshire.
There isn’t one standard way for an assessment to be carried out. However, there are guidelines that professionals should be following such as those issued by the National Institute for Health and Clinical Excellence (NICE). You can read the NICE guidelines on their website.
How my child cope as an adult?
This varies widely and really depends on the support given as a child and during adolescence, the individual’s level of difficulty and the impact of any other associated conditions. Some will need ongoing support in a some areas of their life and careful management of medication, and there are those that understand and manage their condition so effectively they are independent and successful.
How can I get help for my child in school?
In the first instance speak with your school’s SENDCo (Special Educational Needs and Disabilities Co-ordinator). Support and Information is also available from Outside-iN. Those attending schools in Central Bedfordshire can contact Central Bedfordshire SEND Parent and Young Person Partnership Service Those living in Bedford Borough can contact Bedford Borough SEND Advice Advice is also available from IPSEA and Network 81
Where else can I go to for support and advice?
Your GP or Health Visitor is often your first port of call. They may refer you for an assessment. Other agencies that can help give support and information include Outside-iN, The National Attention Deficit Disorder Information and Support Service (ADDISS)
Co-morbidity (associated conditions)
ADHD can affect individuals of all ability. Dyspraxia, Dyslexia and Dyscalculia are common learning difficulties co-morbid with ADHD. Autistic Spectrum Conditions or ‘traits of’ ASC often go hand in hand (although it is more usual for someone with an ASC to also have an additional diagnosis of ADHD than someone with ADHD to also have an ASC). There are sometimes difficulties with sensory processing. Self-esteem is a particular concern, especially in older children and adults, which, if not managed correctly, can lead to mental health disorders and risk taking behaviours including self-medication.
What can you do to help yourself or your child?
ADHD is a complex condition and living with the frustration of unmanaged ADHD can lead to risky behaviours, difficulties with relationships, underachievement and problems at school, college and in the workplace. Below are some tips for managing ADHD in children and in adults:
- Find out more about ADHD. There are lots of things to read about ADHD in books and on the internet, and also support groups where you can find out more and meet other parents/carers of children with ADHD.
- Outside-iN has two parent/carer support groups a month and regularly runs Breaking Down Barriers Training courses for parents/carers of children with autism and/or ADHD. Outside-iN also has an adult support group for adults with ADHD and/or Asperger’s Syndrome/High Functioning Autism formally or self-diagnosed.
- Think about the things and situations that seem to help – or to make ADHD symptoms worse.
- For adolescents and adults, find out how the people that know you well perceive your problems and if they have noticed things which make things better or worse for you. Ask for feedback. How does what you do affect others?
- Structure to the day and reminders are essential. Implementation of a routine can also really help. The following are some suggestions:
- Give simple instructions one at a time until you know they can handle more.
- Break down any task, like doing homework or sitting at the dining table, to smaller time spans.
- Where required, write a list of things to do or use pictures to explain what they need to do and put it somewhere where it can be seen clearly (e.g. door of their room, bathroom, front door).
- Praise and use rewards for your child when they have done what is required.
For adults and adolescents:
Adults may find it hard to organise things so that you don’t get things done that they really need to. Set aside some time to plan what needs to be done.
- Use diaries either electronic or paper to structure day.
- Make to-do lists on phone or paper.
- Put reminders into phone and/or stick post-it notes somewhere relevant and where they are likely to be seen and taken notice of.
- Use colour coding for diary and lists/reminders.
- Write down any plans or use a voice recording app on your phone.
- Break down big goals into smaller, manageable tasks.
- Keep a basket by the front door for house and car keys.
- Use the same pockets in your handbag or backpack for your wallet, keys, pens etc.
- To facilitate concentration, a quiet distraction free environment is beneficial. Background music works well for some, noise cancelling headphones for others. Playing with a fiddle toy, a stress ball, therapeutic putty or even a piece of blue tack may be useful. Some children find wobble cushions helpful.
- Find plenty of opportunities to exercise regularly to let off steam.
- Good sleep hygiene and healthy eating can also help. Some people find certain foods and additives exacerbate their symptoms, aim to avoid these foods. Speak with a GP or dietician first.
- Build in some down-time to the everyday routine if possible including finding ways to relax in the run up to bedtime – perhaps music or relaxation techniques such as breathing exercises, mindfulness, meditation or visualisation.
- Be realistic, some situations will be difficult. It is important to remind the person with ADHD about their strengths and all the things they can do well.
- For challenging behaviour in children and adolescents, implement a structured behaviour management programme with a strong focus on rewards. 1-2-3 Magic has shown to be very successful for ADHD.
- Ask for help at school, further education or at work. ADHD can be very disabling and reasonable accommodations should be made.
- Understanding the condition, the perspective of the person with ADHD, accommodating their needs, focusing on and celebrating their strengths are essential.
- Some of the suggestions to support someone with autism may also helpful.