Our guide to ADHD

 

ADHD

We often hear from our clients that there is a huge amount of information out on ADHD but that it can be a real effort to trawl through all the different sites and blogs to find the answers they are looking for.  The aim of this blog is therefore to create a hub of information about ADHD that hopefully answers your questions. If you have more questions or would like to have a chat then please reach out to us in the usual ways ( via email or call ) and we will be happy to see how we can help. 


WHAT IS ADHD?

ADHD is a behavioural disorder that includes symptoms such as hyperactivity, impulsiveness and inattentiveness.

Concerns relating to ADHD are often noticed at an early age and may become more noticeable when a child or young person’s circumstances change, such as when they start school.  Children can be assessed from the age of 6 and we can also assess adults who feel that they may be experiencing ADHD and feel that their difficulties have been missed. They may be hoping for clarification either in adolescence or adulthood through a formal assessment.  


WHAT ARE THE MYTHS AROUND ADHD?

Myth – ADHD is caused by poor parenting  

Truth – This myth has often created negative feelings of self-blame in parents of children with ADHD. 

It is simply not true that poor parenting causes ADHD. What is true, however, is that positive parenting with clear and consistent expectations and consequences and a home environment with predictable routines can help manage symptoms of ADHD. Conversely, a home setting that is chaotic or parenting that is punitive and critical can worsen symptoms of ADHD.  

Myth – What are the actual causes of ADHD? 

Truth – By far the biggest cause of ADHD is genes. Research and studies on families, twins, and adopted children have been helpful in our understanding about the genetic factors of ADHD. 

However, if a parent has ADHD, it does not automatically mean his or her child will inherit ADHD. 

Eating too much sugar, allergic reactions, watching television, playing video games, poor parenting, or a lack of discipline does not cause ADHD. 

Myth – You can outgrow ADHD? 

Truth – Though the symptoms of ADHD must be present by age 7 ( in order to meet the criteria for diagnosis ) any individuals remain undiagnosed until adulthood. For some adults, a diagnosis is made after their own child is diagnosed. As the adult learns more and more about ADHD, he or she recognizes the ADHD traits in themselves. They may think back to their own childhood and recall the struggles in school and problems with attention that were never treated. It is often a huge relief to finally understand and put a name to the condition causing the problems. Thirty percent to 70 percent of children with ADHD continue to exhibit symptoms into adulthood. Often times, the hyperactive behaviours common with children decrease with age, but symptoms of restlessness, distractibility, and inattention continue. Left untreated adult ADHD can create chronic difficulties with work and in relationships and can result in secondary issues such as anxiety, depression and substance abuse. 

Symptoms of ADHD are typically seen early in a child’s life, often when he or she enters a school setting. Though plenty of children outgrow it, ADHD may continue into adolescence and adulthood, particularly the inattentive type.  

Many adults don’t realize they have ADHD because they weren’t diagnosed as children. By the time you reach adulthood, you have likely learned ways to cope better with your symptoms and you may even have outgrown some of them, especially hyperactive ones. Because of these factors, your symptoms won’t necessarily be as obvious a child’s, but if you think back to your childhood, you’ll probably recognize yourself since all adults with ADHD had it as children. 


WHAT ARE THE HALLMARK SYMPTOMS OF ADHD?

Inattention  

  • Children and adults have difficulty staying focused and attending to tasks that they perceive as mundane.  
  • They may procrastinate doing their homework or work since there is a great deal of mental energy needed to complete it.  
  • They are easily distracted by irrelevant sights and sounds, shift from one activity to another and seem to get bored easily.  
  • They may appear forgetful and even spacey or confused as if they’re in a fog or living in a different world in their own heads.  
  • They may not seem like they’re listening when they’re being spoken to.  
  • Organizing and completing tasks is often extremely difficult, as is sorting out what information is relevant versus what’s irrelevant. 
  • If you have inattentive symptoms, you may have great difficulty keeping up with school work or bills, frequently lose things, and live your life in a disorganized way.  
  • Following through on promises and commitments may be a struggle and time management is also often an issue. 
  • Inattentive behaviours are often overlooked because they’re harder to identify and less disruptive than hyperactive and impulsive symptoms, so kids with these symptoms may slip through the cracks.  
  • An individual with the predominantly inattentive presentation of ADHD may even appear sluggish, lethargic, and slow to respond and process information. 

Hyperactivity  

  • Hyperactivity is the symptom most people think of when they hear the term “ADHD.”  
  • Children and adults who are hyperactive have excessively high levels of activity, which may present as physical and/or verbal overactivity 
  • They may appear to be in constant motion and perpetually on the go as if driven by a motor. They have difficulty keeping their bodies still—moving about excessively, squirming, or fidgeting. 
  • People are often feel restless, especially if they’re adults or teens.  
  • They may talk excessively, interrupt others, and monopolize conversations, not letting others talk. It’s not unusual for an individual with hyperactive symptoms to engage in a running commentary on the activities going on around them.  
  • Their behaviours tend to be loud and disruptive. This difficulty regulating their own activity level often creates great problems in social, school, and work situations. 

Impulsivity  

  • Children and adults have trouble inhibiting their behaviours and responses.  
  • They often act and speak before thinking, reacting in a rapid way without considering consequences.  
  • They may interrupt others, blurt out responses, and rush through assignments or forms without carefully reading or listening to instructions.  
  • Waiting for their turn and being patient is extremely difficult for people who are impulsive. They prefer speed over accuracy and so they often complete tasks quickly but in a careless manner. They go full swing into situations and may even place themselves in potentially risky situations without thought. Their lack of impulse control can not only be dangerous but it can also create stress at school or work and in relationships with others.  
  • Delayed gratification or waiting for larger rewards is very hard for an impulsive person. 

Comorbid Conditions  

As many as one-third of children with ADHD have one or more coexisting, or comorbid, conditions.  

The most common of these are behavioural problems, anxiety, depression, and learning and language disabilities. Adults with ADHD show an even higher incidence of comorbid disorders. These adults may also suffer from depression, bipolar disorder, substance abuse disorders, anxiety disorders, or behavioural problems. 


HOW IS ADHD DIAGNOSED?  

People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development: 

1. InattentionADHD journey

A child (up to 16 years old) has 6+ symptoms or adolescents (over 17 years) to adults have 5+ symptoms of inattention that have been present for at least 6 months and they are inappropriate for developmental level:  

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities. 
  • Often has trouble holding attention on tasks or play activities. 
  • Often does not seem to listen when spoken to directly. 
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked). 
  • Often has trouble organizing tasks and activities. 
  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework). 
  • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). 
  • Is often easily distracted 
  • Is often forgetful in daily activities. 

2. Hyperactivity and Impulsivity

Children (up to 16 years old) 6+ symptoms of hyperactivity-impulsivity of 5+ symptoms for adolescents (17 years and older) and adults.  

Symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level. 

  • Often fidgets with or taps hands or feet, or squirms in seat. 
  • Often leaves seat in situations when remaining seated is expected. 
  • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless). 
  • Often unable to play or take part in leisure activities quietly. 
  • Is often “on the go” acting as if “driven by a motor”. 
  • Often talks excessively. 
  • Often blurts out an answer before a question has been completed. 
  • Often has trouble waiting his/her turn. 
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met

  • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years. 
  • Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities). 
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. 
  • The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder). 

PRESENTATIONS OF ADHD?

  • Combined Presentation: If enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
  • Predominantly Inattentive Presentation: If enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
     
  • Predominantly Hyperactive-Impulsive Presentation: If enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months. 

Because symptoms can change over time, the presentation may change over time as well. 

Diagnosing ADHD in children depends on a set of strict criteria. To be diagnosed with ADHD, your child must have 6 or more symptoms of inattentiveness, or 6 or more symptoms of hyperactivity and impulsiveness.  

Read more about the symptoms of ADHD. 

DIAGNOSIS IN CHILDREN

Children must also have

  • Been displaying symptoms continuously for at least 6 months  
  • Started to show symptoms before the age of 12  
  • Been showing symptoms in at least 2 different settings – for example, at home and at school, to rule out the possibility that the behaviour is just a reaction to certain teachers or to parental control  
  • Symptoms that make their lives considerably more difficult on a social, academic or occupational level  
  • Symptoms that are not just part of a developmental disorder or difficult phase, and are not better accounted for by another condition 

DIAGNOSIS IN ADULTS

Diagnosing ADHD in adults is more difficult because there’s some disagreement about whether the list of symptoms used to diagnose children and teenagers also applies to adults. 

In some cases, an adult may be diagnosed with ADHD if they have 5 or more of the symptoms of inattentiveness, or 5 or more of hyperactivity and impulsiveness, listed in diagnostic criteria for children with ADHD. 

As part of your assessment, the specialist will ask about your present symptoms. However, under current diagnostic guidelines, a diagnosis of ADHD in adults cannot be confirmed unless your symptoms have been present from childhood. 

If you find it difficult to remember whether you had problems as a child, or you were not diagnosed with ADHD when you were younger, your specialist may wish to see your old school records, or talk to your parents, teachers or anyone else who knew you well when you were a child.  

For an adult to be diagnosed with ADHD, their symptoms should also have a moderate effect on different areas of their life, such as: 

  • underachieving at work or in education  
  • driving dangerously  
  • difficulty making or keeping friends  
  • difficulty in relationships with partners 

If your problems are recent and did not occur regularly in the past, you’re not considered to have ADHD. This is because it’s currently thought that ADHD cannot develop for the first time in adults. 


MANAGING ADHD AT HOME

Positive parenting 

Clear and consistent expectations and consequences and a home environment with predictable routines can help manage symptoms of ADHD. Conversely, a home setting that is chaotic or parenting that is punitive and critical can worsen symptoms of ADHD.  

Communication 

With the teacher, football coach, activity leader, or whoever the activity supervisor may be about what works best for your child. You should also educate them about ADHD in general, as many may be unfamiliar with the basics that you know like the back of your hand. One good way to start is to let these adults know how ADHD affects behaviour in group settings. 

Reframe ADHD  

When a child grows up feeling less than, stupid, lazy and defective, life can feel pretty hopeless. It is our job as adults to help children understand that they are not these negative labels and that the future holds wonderful possibilities for them. 

Structure your child’s home life

Routines allow him to focus on the big picture instead of fretting over the mundane details of living. Establish mealtimes, a bedtime, and quiet times. You may want to write down his schedule to help both of you stick to it and draw a step-by-step chart for any task he has particular trouble with. Manage his activities so that he isn’t overstimulated or exhausted.

Teach your child to look before he leaps

Children with ADHD tend to be impulsive and unaware of how their behaviour may affect others. Help your child develop the habit of considering the consequences of his actions. Suppose he wants to play catch just outside the living room window. What might happen? Is there a better place to play?  

Develop your child’s empathy

Some children with ADHD need to learn how to care about other people. Talk about the importance of feelings. If your child is responsible enough, a pet is an excellent way for him to learn to care for another being — as well as carry out simple tasks like filling the animal’s water bowl every morning.  

(If your child doesn’t mind) go to school with him for a day

Watch him in class to see if his teacher could easily do something that would help him concentrate — move him to the front of the room, for example, or check that he’s written out his homework assignment. Not all teachers are trained to engage children with ADHD. In the classroom, your child needs clear goals and a reward system that reinforces desirable behaviour. And don’t forget that federal law requires public schools to provide special education services to eligible children; these might include modified instructions, assignments, and testing; assistance from a classroom aide or a special ed teacher; or assistive technology.  

Help with homework

Think of homework as a way to teach your child how to get organized and break down big problems into small ones. First, make sure that your child has a neat, quiet place to work. Sit down with him before he begins his assignments and discuss his plan. There’s a book report due Friday? You may have to sketch out what he needs to do every night of the week until it’s finished. Resist the temptation to do his work for him; rather, help him figure out the best way to go about it. If homework becomes a daily battle ending in lost tempers, get your child a tutor; talk to school administrators about setting this up.  

Reward your child

You may want to use tokens of appreciation as incentives; for example, if he does his homework every night for a week, he gets a trip to the hobby store to buy a new model-making kit. Also use nonmaterial rewards that allow you to spend time together, such as a walk to the park to play catch.  

Stay cool

Keeping your emotions under control can be tough as your growing child continues to act out or ignore what you say, but remember that children learn by example. Paediatrician William Sears, author of The ADD Book, suggests using “time-ins” for older kids as an alternative to time-outs: Instead of sending your child to his room, drop what you’re doing and ask him to sit down with you and be silent. The time-in should last as long as a time-out would, that is, one minute for each year of your child’s age. This calming period lets your child break his pattern of misbehaviour without getting angry about being sent away. After the time-in, talk with him about how he might mend his ways. If, however, this tactic seems to backfire — your presence merely riles your child — don’t push it; just spend the quiet time in separate rooms until you’re both ready to talk. 


MANAGING ADHD IN THE CLASSROOM

  • Classroom rules should be clear and concise and reviewed regularly with the student. It is helpful to have the child repeat back rules, expectations or other instructions to make sure they are understood. These rules should be posted prominently in the classroom. 
  • Because students with ADHD are susceptible to distractions, seat the student close to the teacher. Make sure he or she is seated away from easy distractions, such as doors, windows, cubby areas or pencil sharpeners.  
  • Give the student frequent and immediate feedback or consequences about behaviours. 
  • Catch the student being good and give him immediate praise. Ignore negative behaviours that are minimal and not disruptive. 
  • Use rewards and incentives before punishment to motivate the student and to help keep school feeling like a positive place. Change up the rewards frequently to help prevent the student from becoming bored. 
  • Allow student frequent physical breaks to move around (to hand out or collect materials, run errands to the office or other areas in the school building, erase the board, get a drink of water at the water fountain, etc.). 
  • Allow some restlessness at work area. Allow students to stand up at his desk if it helps him stay on task. 
  • Tape an index card to the student’s desk with written class rules. Help him keep track of the schedule by reviewing it with him at various times during the day and prepare him for each transition. 
  • Limit distractions, excessive noise, distracting visual stimuli, clutter, etc. (For some kids with ADHD listening to “white noise” or soft background music can help concentration and focus.) 
  • Reduce the student’s total workload. Break work down into smaller sections. 
  • Place a hand on the student’s shoulder, hand or arm while talking to him in order to help him stay focused on what is said. 
  • Allow the student to hold a small “koosh ball” or silly putty or something tactile for him to manipulate. This slight stimulation often helps keep an ADHD child focused. 
  • If the school allows it, some students benefit from chewing gum to release energy and keep concentration. 
  • Schedule the most difficult subjects in the morning time when the student (and the whole class) is fresher and less fatigued. 
  • Do not use loss of recess as a consequence, for negative behaviour. (ADHD kids benefit from the physical movement that occurs during recess and can usually focus better following this exercise). 
  • Use timers, taped time signals, or verbal cues to show how much time the student has remaining for an activity. 
  • Pair the student with a “study buddy”—a kind and mature classroom peer who can help give reminders or refocus the child when he gets off track. 

What to do if you have more questions or would like an assessment?  

We offer families with children, young adults and adults the initial screening and / or full assessments with full recommendations for support moving forward. 

The Assessment is undertaken by a Multi-disciplinary Team in line with the National Institute of Clinical Excellence (N.I.C.E) guidelines. This involves a full clinical and psychosocial assessment of the person; which includes discussion about behaviour and symptoms in the different domains and settings of the person’s everyday life as well as a full developmental and psychiatric history and observer reports and assessment of the person’s mental state (N.I.C.E, 2018 https://www.nice.org.uk/guidance/ng87). 

For school age children this will also include a school observation and questionnaires completed by school. Evolve Psychology Services also uses QbCheck, the only CE marked and FDA approved for use as an aid in the assessment and treatment evaluation of ADHD for individuals aged 6 to 60 years old. QbCheck enables the provision of objective, unbiased information to clinicians, giving them a better assessment of ADHD. 

If a diagnosis is made, the team will discuss appropriate recommendations to support the child, young person or adult. If this involves a consideration for medication we can arrange for you to see one of our Consultant Child and Adolescent Psychiatrists to discuss your options further.