Attention deficit hyperactivity disorder (ADHD) is a particular condition that affects a young child’s behaviour or development (learning). Many children with ADHD say they do not understand why they sometimes feel out of control or very lonely. ADHD is not the child’s fault. We do not know exactly what causes ADHD.
ADHD is a behavioural disorder
ADHD is a behavioural disorder, not an illness or a sign of low intelligence. With understanding, care and medical treatment, a child who has ADHD can lead a normal life.
Children with ADHD have three main problems, being:
- Inattention – having difficulty concentrating, forgetting instructions, moving from one task to another without completing anything
- Impulsivity – talking over the top of others, having a ‘short fuse’, being accident prone
- Overactivity – constant restlessness and fidgeting.
All young children have a limited attention span and sometimes do things without thinking. But only a few of these children have ADHD.
Diagnosis of ADHD
The number of behavioural and developmental disorders that cause symptoms of ADHD in young children is growing. This means it is important to properly assess the causes of their symptoms.
A paediatrician, child psychologist or child psychiatrist can make the assessment or arrange a referral. They can diagnose ADHD only after making a complex assessment – there is no single test. They need to collect a range of information, especially from parents. The symptoms of ADHD must be obvious in most areas of the child’s life.
Assessments must include a developmental history of the child’s past behaviours. Assessment will also consider any problems with the child’s early attachment to a parent or caregiver, which may contribute to the behaviour. Doctors and psychologists use a variety of internationally recognised scales and criteria when diagnosing ADHD.
Inattention criteria for diagnosing ADHD
The following criteria are often used to diagnose the inattention part of ADHD. A child should have six or more of these symptoms of inattention for at least six months to a degree that is a problem and inconsistent with the normal developmental level.
A child with symptoms of inattention will, on a regular basis:
- Fail to give close attention to details, or make careless mistakes, in school work or other activities
- Have difficulty sustaining attention in tasks or play activities
- Not seem to listen when spoken to directly
- Not follow through on instructions
- Fail to finish school work, chores or other duties (but not because they are being wilful or do not understand instructions)
- Have difficulty organising tasks and activities
- Avoid, dislike or be unwilling to do tasks that need continuing mental effort (such as school work or homework)
- Lose things needed for tasks or activities (such as toys, school assignments, pencils, books or tools)
- Be easily distracted
- Be forgetful in daily activities.
Hyperactivity-impulsivity criteria for diagnosing ADHD
Doctors often use the following criteria to diagnose the hyperactivity-impulsivity of ADHD. The child must have six or more of these symptoms for at least six months, to a degree that is a problem and inconsistent with the child’s developmental level.
A child with symptoms of hyperactivity will often:
- Fidget with their hands or feet or squirm in their seat
- Leave their seat in the classroom or in other situations in which remaining seated is expected
- Run about or climb excessively in inappropriate situations
- Have difficulty playing or taking part in leisure activities quietly
- Be ‘on the go’ or act as if ‘driven by a motor’
- Talk too much.
Impulsivity criteria for diagnosing ADHD
A child with symptoms of impulsivity will often:
- Blurt out answers before questions have been completed
- Have difficulty waiting in turn
- Interrupt or intrude on others (for example, they will butt into conversations or games).
Other criteria for diagnosing ADHD
Other criteria may include:
- Some hyperactive-impulsive or inattentive symptoms that caused impairment before the child reached the age of seven years
- Some impairment from the symptoms in two or more settings, such as at school and at home
- Clear evidence of clinically significant impairment in how the child functions in social, school or work situations
- Symptoms that do not occur only during the course of a developmental disorder, a mental illness like schizophrenia or other psychotic disorder, and cannot be explained by another disorder (such as mood disorder, anxiety disorder, dissociative disorder or a personality disorder).
Types of ADHD
Using the above criteria, the health professional can determine the type of ADHD a child has, including:
- ADHD combined type – if the child meets the criteria for both inattention and hyperactivity-impulsivity for the past six months
- ADHD predominantly inattentive type – if the child meets the criteria for inattention, but not the criteria for hyperactivity-impulsivity, for the past six months
- ADHD predominantly hyperactive-impulsive type – if the child meets the criteria for hyperactivity-impulsivity, but not the criteria for inattention, in the past six months.
Causes of ADHD
We do not know the exact cause of ADHD, but researchers suspect that contributing factors may include:
- Neurophysiology – which includes differences in brain anatomy, electrical activity and metabolism
- Genetics – some research suggests possible gene mutations may be present
- Drugs – the child’s mother used nicotine or cocaine during pregnancy
- Lead – chronic exposure to low levels of the metal lead may influence behaviour and brain chemistry
- Lack of early attachment – if a baby does not bond with their parent or caregiver, or has traumatic experiences related to the attachment, this can contribute to their inattention and hyperactivity
- Childhood post-traumatic stress disorder – a child with this disorder may have symptoms similar to ADHD, but will need different treatment.
Caring for a child with ADHD
A child with ADHD can stretch the patience of all members of the family. Parents need to try a range of different ways to help their child learn and develop, and reduce stress in the family.
It is important for parents to be consistent and work as a team to support each other. Try to have breaks often, as it is valuable to get some respite from the demands of caring for a child with ADHD.
It will help if you:
- Develop consistent routines at home and at school.
- Keep rules clear and simple, and give reminders calmly.
- Get physically close to the child and make sure you have the child’s full attention when you talk.
- Give your child only one or two instructions at a time.
- Praise your child and notice when they do something good.
- Supervise closely – your child may put themself in dangerous situations.
- Try to ignore minor irritating behaviours.
- Be clear about discipline for behaviour you find unacceptable. For example, use ‘time out’ (between the ages of 18 months and six years) or logical consequences (for older children).
Remember – a child with ADHD does not intend to be difficult.
Other helpful techniques to manage ADHD
There are a number of techniques to help your child develop concentration and social skills. Counselling for your child and other family members may also be helpful. Some children may need medication so they can use their natural abilities and other learning strategies.
Where to get help
- Your doctor
- Kids Health Info, The Royal Children’s Hospital Melbourne Tel. (03) 9345 5522
- Specialist Services for Children and Families, Department of Human Services Victoria Tel. (03) 9096 0000 or 1300 650 172
- The Child Health and Safety Resource Centre (CHAS) Tel. (03) 9345 6429
- Attention Deficit Disorder Victoria (ADDVic) Tel. (03) 9890 2144 or 1800 233 842
- Hyperactive Children’s Association of Victoria (ACTIVE) Tel. (03) 9650 2570
Things to remember
- A child with ADHD has three main problems, being inattention, impulsivity and overactivity.
- Not all children who are inattentive, impulsive and overactive have ADHD.
- No single test can diagnose ADHD. Assessment by a doctor or psychologist involves putting together lots of pieces of information to make a diagnosis.
- A child with ADHD needs support and understanding from their family and teachers.
- Medication, positive parenting strategies, school support and counselling can help most children with ADHD and their families.
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