ADHD: A Help Guide
Attention deficit hyperactivity disorder (ADHD, also called ADD) is a pattern of consistent behaviours certain people have that centre around difficulties in concentrating.
While many children are diagnosed with attention deficit disorder, ADHD is also very much something that adults can struggle with.
Up to nine per cent of school aged children in the UK are thought to have ADHD.
Almost five per cent of adults are also thought to have ADHD (although this could be far higher, as many never seek help and receive a diagnosis).
“Only children suffer from ADHD”. Again, adults can very much suffer from ADHD.
“ADHD is a sign of inferior intelligence”. Not at all. ADHD can affect someone of any intellectual capacity, and many people with ADHD are in fact on the high end of the intelligence spectrum.
“If I had ADHD, I would be bouncing off the walls”. You don't have to be hyperactive to have ADHD. There are other symptoms (see below), and it's possible to have ADHD and just suffer from things like lack of attention and impulsivity.
"I can't have ADHD because every now and then I can focus so much I forget everything else". This is actually a sign of ADHD in adults called hyperfocus. It entails focussing so intensely on one thing that other things can slide. Sadly, the choice of the focus is often the wrong thing, such as organising your emails instead of finishing the work you are on a deadline for.
Like most psychological disorders, ADHD can't be pinned down to one thing, but tends to be caused by a combination of things that include genetic, biological, and environmental factors, and causes will vary by individual.
It is thought that a defect in a certain gene that affects the brain could be a contributing factor of some cases of ADHD, although the research proving this was done only on mice. This theory seems to be supported by studies that show ADHD does run in families, with around one third of ADHD sufferers also having a parent with symptoms of the condition.
Other biological reasons that research has suggested include certain areas of the brain being different sizes compared to the brains of people who don't have ADHD, or that levels of neurostransmmitters are different.
Experiences in early childhood are very often a contributing factor to an individual developing ADHD. This can begin at the very start of a child's life – complications before and during birth are thought to be related, including low birth weight, a mother experiencing high stress while pregnant, and medications, or drugs and alcohol, taken during pregnancy.
Childhood trauma is increasingly connected to ADHD. Trauma has now been proven to affect the growth of the brain, and many children and adults who manifest ADHD come from an unstable upbringing that involved difficult events. Of course this is not always true, but statistics do show that children with ADHD have a higher chance of coming from an upbringing where they are exposed to poverty, violence, abuse, and/or parents who are divorced or who abuse substances. There is great debate over whether some diagnosed children have ADHD at all, or are just suffering from trauma and post-traumatic stress disorder (PTSD), which can cause similar looking symptoms.
ADHD in children has three main symptom groups – hyperactivity, impulsivity, and inattention.
To be diagnosed with ADHD a child does not have to have all three symptoms. Some children with attention deficit disorder only manifest two symptoms, or even one. This means that quiet children who always seem lost in their thoughts can have ADHD just as much as the hyperactive child who runs heedlessly into the street or breaks all their toys before they realise what they are doing.
Hyperactivity is always being active. This would see a child:
- always on the move
- fidgeting non stop if asked to sit still
- seeming to have a battery that never runs out
- finding relaxing difficult, no 'off' switch
- having illogic and quick changes in mood.
Impulsivity is acting without thinking of consequences and speaking without filters. This sees a child:
- saying whatever they think
- blurting out mean comments to others
- taking toys that don't belong to them
- interrupting others
- not understanding the concept of personal space
- breaking and smashing things
- doing thoughtless things like touching a hot stove
- being overreactive or volatile
- upsetting or scaring other children.
Inattention is difficulties maintaining attention. This would see a child:
- sitting at her desk at school staring out the window
- being seen as a 'daydreamer'
- not listening well when spoken to
- having difficulty following directions
- unable to finish things
- often forgetting their homework
- losing their possessions
- upsetting other children due to an inability to grasp rules or protocol.
All children, by their very nature, will at some point manifest signs of ADHD – they will struggle to pay attention if there is something more exciting to do, they will impulsively grab a toy off another child, or will forget instructions you told them only five minutes ago.
So it's important not to jump to conclusions that your child has ADHD or make a diagnosis by yourself. The only way to be sure is to consult a paediatrician or psychiatrist who specialises in ADHD and has the right experience.
As for self-diagnosing as an adult, it's better to seek the help of a mental health professional who is an expert. It is possible that you are actually suffering from something else instead, such as severe stress, alcohol or drug abuse, depression, or anxiety disorder.
You can't just apply childhood symptoms to grownups. Adult ADHD tends to be more subtle, with many adults not suffering from hyperactivity so much as concentration and attention difficulties.
The symptoms of Adult ADHD are most likely to be noticeable when you are going through a period of change where your typical structures are not as strong. This might be something like starting a new job or moving house.
Adult ADHD is divided into five general categories: disorganisation, hyper focus, impulsivity, hyperactivity, and emotional difficulty.
Disorganisation- It's harder for adults with ADHD to think in a linear fashion, which results in things like forgetting important tasks or meetings, losing things constantly, and struggling to ever keep up with paperwork and finances.
Hyper focus – it's not true that adults with ADHD can't focus. It's just that when they do focus, they tend to hyperfocus – meaning they are so focussed they let other important things slide. It's also common for adults with ADHD to choose the wrong thing to focus on, meaning that at work, if there is something important with a deadline that is soon but another more enjoyable task that is due later, they might hyperfocus on the latter. Or that when you are supposed to be doing your taxes you suddenly spend hours finally sorting out your kitchen cupboards.
Impulsivity – Acting without thinking in adults looks like compulsive shopping, rushing out to meet a friend when they call even though you have work to do, jumping into relationships before getting to know someone properly, or saying the wrong things before you can stop yourself.
Hyperactivity - This might not look like jumping off the walls like a hyperactive child might, but rather like restlessness, fidgeting, troubles sleeping, talking too fast and too much, not being able to sit thorugh seminars, and having troubles relaxing.
Emotional Difficulty- Adults with ADHD often find life more stressful than others due to their disorganisation and the results of their impulsivity. This can result in moodiness, a short temper, or bouts of depression and low self-esteem.
ADHD in children is diagnosed by a paediatrician or child psychologist with training and expertise in this area. They will first rule out other medical conditions which can cause similar symptoms, like a learning diffiulty, conduct disorder, or thyroid issue. Then your child and you will be asked specific questions that look at the way both your child and your family functions.
ADHD rarely exists by itself, but rather coexists with other issues (see our section below on related mental health conditions). Your doctor will will carefully look at what these other issues might be for your child.
The recommended way forward will then be discussed with both you and your child - it is important that your child is included and understands in their own way what they are experiencing and how they can now be helped.
In the UK part of child diagnosis also involves offering you, the parent, support. Having a child with ADHD can place different demands on a parent. As well as letting you know about parent-training programmes, your mental health care professional will discuss with you how your own mental, emotional and social needs are being met.
The doctor you work with will not just use their own judgement but will adhere to professional guidelines, which in the UK is the advice of the National Institiute for Health and Care Excellence (NICE). You can read about their recommendations for diagnosis here.
Mental health care professionals in the UK might also refer to the American mental health guide, the Diagnostic and Statistical Classification of Mental Health Disorders (DSM), or the international guide put out by the World Health Organisation (WHO) which is called the International Classifciation of Mental and Behavioural Disorders (ICD).
As for diagnosis of ADHD in adults, it can actually be harder to diagnose Adult ADHD. This is because by the time one is an adult other commonly co-occuring psychological condtions tend to be more fully defined, such as personality disorders and depression. These can mask the ADHD so it is overlooked.
Again, it's important to be diagnosed by a proper expert. In the UK, adult attention deficit hyperactivity disorder is diagnosed by psychiatrists who speicalise in the condition. They will ask you to fill out several questionnaires then very thoroughly ask you about your life history before making a diagnosis.
In children, co-existing mental health issues tend to be:
- mood disorders
- conduct disorders
- anxiety disorders
- learning difficulties
- sleep problems
- communication difficulties
- motor difficulties
In adults, mental health issues that can occur in tandem might also include:
- personality disorders
- bipoloar disorder
- obsessive compulsive disorder
- substance abuse
You can't, unfortunately, 'get over' ADHD, as it's a diagnosis that refers to the way your brain works. You can, however, find support and learn to manage your ADHD to the extent it has much less power over you and your behaviour.
Recommended treatment in the UK for attention deficit hyperactivity disorder varies according to age group.
For those of pre-school age, parent-training and education programs will be offered to you as a parent or carer. You will also be given materials like videos and manuals. If you consent to it, it's likely that the health care professional you are working with will then also contact your child's school or nursery to make sure your child's needs are understood. If this combined approach is not sufficient in managing your young child's behaviour then you will be recommended to other healthcare professionals for futher help.
Treatment for children who are school-aged or a young adolescent will again involve parent-training for you. Your child will then be offered a psychological treatment, such as social skills training or cognitive behavioural therapy (CBT). This will be carried out in a group or one-on-one, depending on your child's age, his or her needs, and whether you are seeking help through the NHS or privately. Again, only with your consent, your child's teacher will be contacted to discuss educational needs.
Not all children are offered medication in the UK – this is a myth. Medication is a suggested treatment only if your child has a severe case of ADHD that really affects their functioning, or if your child doesn't respond to the other support offered. Drug treatment should not be undertaken without a comprehensive treatment plan that includes psychological and educational interventions.
For adults with ADHD, drug treatment is the first-line treatment in the UK unless you prefer and ask for just a psychological approach. Medication should only be started under the advice of a psychiatrist or clinical prescriber who is trained in diagnosing attention deficit disorder, and after a full assessment. As for talk therapies and ADHD, cognitive behavioural therapy (CBT) is again the most recommended psychotherapy.
Another part of recommended treatment in the UK is to look at the self-care regime of the person with ADHD. Your healthcare provider will discuss with you things like the best diet for your child, as well the positive effects of regular exercise. You might be asked to keep a food diary to see if specific foods or drinks are having an influence, and in some cases you might be referred on to a dietician.
Not treating ADHD in children can leave your child really struggling at school, meaning they don't do as well as they could if they had the proper support. A child can also really struggle socially, where they might have troubles making or maintaining frienships, or where they sense how different they are but do not understand why. The resulting alienation and frustration can lead to behavioural problems, moodiness, and low self-esteem.
Not treating ADHD in adults can result in many life complications, including unstable relationships, financial difficulties, problems at work or redundancy, and mental health issues like depression and anxiety.
Young Minds UK Charity Resources for young people with ADHD.
Living With ADHD UK For parents, carers, and teachers, as well as for child and adolescent sufferers themeselves.
ADD Up UK Practical support for parents and families in the Havering, Barking and Dagenham areas.
Adders Help for both children and adults with ADHD, as well as their families.
ADDISS UK The National Attention Deficit Disorder Information and Support Service, providing information, support, and training for parents, those who have ADHD themselves, as well as professionals dealing with ADHD.
ADHD Voices A research project funded by the UK's Wellcome trust that works to bring the perspectives of children themselves to the debates around ADHD including the use of drugs in treatment for children.
The ADHD foundation The ADHD Foundation works to improve understanding and management of ADHD for both individuals and their familes as well as with doctors and teachers.