Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD)

Children and young people with ADHD may have poor concentration, poor control of impulses and can be overactive. This interferes with their ability to learn and socialise and can affect family functioning. Children with ADHD need support and understanding from family/whānau, teachers and the community.

All young children have a limited attention span and sometimes do things without thinking. But when these behaviours are severe enough to interfere with their learning and social relationships, in more than one setting, it can be a sign of ADHD.

Key points to remember

  • attention deficit hyperactivity disorder (ADHD) is a developmental problem
  • children with ADHD may have poor concentration, poor control of impulses and can be overactive
  • children with ADHD need support and understanding from family/whānau, teachers and the community
  • 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
  • medication, positive parenting strategies, school support and counselling can help most children with ADHD and their families

What is attention deficit hyperactivity disorder?

Attention deficit hyperactivity disorder (ADHD) is a developmental problem. Children and young people with ADHD may have poor concentration, poor control of impulses and can be overactive. This interferes with their ability to learn and socialise and can affect family functioning.

People often think that children with ADHD are 'being naughty' or 'misbehaving' but this is not necessarily the case. Children with ADHD need support and understanding from family/whānau, teachers and the community.

How common is it?

At least 5 of every 100 children have ADHD. It is more common in boys than girls. Sometimes girls with ADHD show more signs of inattention and cause less disruption so may be less likely to be diagnosed, or may be diagnosed later.

It might seem like there are more children with ADHD now than in the past. This is probably because of better recognition of ADHD. For many years, doctors have recognised that some children have difficulty with concentration and/or increased levels of activity. In more recent decades the term 'ADHD' has been used to describe these children.

ADHD occurs in children and adults.  ADHD symptoms usually improve with age. However, a significant proportion of children with ADHD will continue to experience some symptoms in adulthood and may need ongoing help.

What causes it?

We don't know the exact cause of ADHD but it is likely to be a combination of factors. These include genetics – children with ADHD are more likely to have a family member with ADHD. ADHD can also be associated with:

  • alcohol, smoking or drug exposure in pregnancy
  • being born prematurely or having a low birth weight

There is no good evidence that ADHD is caused by children eating too much sugar or food additives, although this is a commonly held view.

What are the signs and symptoms?

Children with ADHD have 3 types of main difficulties:

  • inattention - difficulty concentrating or focusing
  • being overly active (hyperactive)
  • acting impulsively

Children with ADHD may struggle with one of these areas of difficulty or with all three. As children get older, the symptoms can change.

Common signs and symptoms

Inattention

Has short attention span, is easily distracted, forgets instructions, moves from one task to another without completing anything, doesn't listen when directly spoken to, makes careless mistakes, has difficulty organising tasks and activities, daydreams a lot, appears forgetful or loses things a lot.

Impulsivity

Talks over people, 'butts in', loses control of emotions easily, is accident prone, has difficulty waiting for their turn, acts without thinking, has little or no sense of danger.

Overactivity/hyperactivity

Is unable to sit still and constantly fidgets, leaves their seat in situations where remaining seated is expected, is unable to play quietly, behaves 'as though driven by a motor', talks too much.

How is it diagnosed?

In New Zealand, a trained and experienced health professional makes a diagnosis of ADHD. The health professional could be a paediatrician, child and adolescent psychiatrist, or a psychologist. To accurately identify whether or not your child has ADHD, the health professional will usually:

  • meet with you and your child in order to explore symptoms of ADHD and associated conditions, identify any family history of ADHD, and to understand the impact of symptoms on your child and family
  • communicate with your child's preschool or school in order to understand how your child's symptoms may be affecting their learning
  • ask you and your child's teacher (and your child, if they are old enough) to complete some questionnaires that help to confirm the diagnosis
  • undertake other tests as required

There is no single test to diagnose ADHD. The diagnosis is best made after the health professional has collected a range of information and this process may take more than one appointment.

For ADHD to be diagnosed, the symptoms are usually present in more than one setting of a child's life (for example, home and school or day care). It is the extent and impact the symptoms are having on day to day functioning that is important. It will be important to make sure that the symptoms are not caused by other problems such as hearing difficulties, sleep problems, learning difficulties or some other issue.

Disorders that are sometimes found with attention deficit hyperactivity disorder

Children with ADHD are more likely to also have:

  • learning difficulties
  • anxiety
  • depression
  • disruptive behaviour

You should discuss any other concerns at your specialist appointment.

What should I do if I think my child might have attention deficit hyperactivity disorder?

If you are concerned about your child, talk to your family doctor and teacher. Sometimes teachers may be the first to raise concerns and suggest that you and your child see your family doctor.

Your family doctor may arrange a referral to a paediatrician, child psychiatrist or psychologist to make an assessment.

What treatment(s) are available?

There is no cure for ADHD, but in most cases, symptoms can be managed.

In preschool children diagnosed with ADHD, behavioural and parenting strategies are usually effective.

In school aged children, behavioural therapy works best in combination with medication. Your child may also be able to get extra support through their school and this is something to discuss with your child's teacher.

Behaviour strategies

There are well researched programmes that can help families of children with ADHD learn how to better support their child.

The following all help:

  • positive parenting
  • home and classroom strategies such as keeping structure
  • boosting self-esteem
  • building social skills
  • planning the physical and learning environment

Sometimes counselling for your child or your family is also needed.

While you are waiting for your child's assessment, there are some strategies your family could try - see Ways to help children with ADHD at the Royal Children's Hospital (Melbourne) website.

Medication

In school aged children, research shows that medications known as 'stimulants' are the single most effective treatment for the symptoms of ADHD. For some children, a combination of behaviour therapy and medication works even better.

Stimulant medication helps your child with ADHD to:

  • concentrate better
  • be less impulsive
  • feel calmer
  • learn and practice new skills

Parents and teachers often notice that children with ADHD have a significant improvement in their symptoms when they start taking medication.

While some parents may understandably feel cautious about starting their child on medication, it is important to know that stimulant medications do not affect your child's personality or brain, and are not addictive. These medications have been used safely for many years in children with ADHD.

The most common stimulant medication in New Zealand is methylphenidate. This has a number of different names such as Ritalin or Rubifen. Methylphenidate comes in different forms and it may take some time for your doctor and you to find the dose and timing that works best for your child.

Common side effects of methylphenidate may include loss of appetite, mild tummy discomfort and mild headache when first starting. These side effects can usually be reduced by starting on a low dose. If your child develops any side effects, discuss these with your doctor.

If stimulant medications do not work for your child there are other medications that can be used. Your doctor will discuss these with you.

For more information about methylphenidate, see the leaflet at the New Zealand Formulary for Children's website:

  1. UpToDate. Clinical decision support resource. ADHD.  [Accessed 27/07/2016] (Only available to subscribers)
  2. National Institute for Health and Care Excellence (NICE) guideline. U.K. 2008 (last updated 2016). Attention deficit hyperactivity disorder: Diagnosis and management.  [Accessed 27/07/2016]
  3. American Academy of Pediatrics. U.S. 2011. ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents  [Accessed 27/07/2016]
  4. Health Navigator. ADHD. New Zealand. 2016.  [Accessed 27/07/2016]
  5. The Royal Children's Hospital Melbourne. 2003 (last updated 2012). ADHD: An overview.  [Accessed 27/07/2016]

This page last reviewed 27 July 2016.
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