As part of the World Mental Health Day we are hoping to support families all over Yorkshire who may be looking to understand more about ADHD, are already on a journey towards an assessment or are looking for post diagnostic support.
If you have become aware of your child or a family member displaying a new behaviour or seen that something, that was previously manageable, has now becoming unmanageable following a recent school transition, then please read on.
What is ADHD?
ADHD is a behavioural disorder that includes symptoms such as hyperactivity, impulsiveness and inattentiveness.
You will often notice the symptoms of ADHD at an early age and they 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 their difficulties have been missed.
What do we look for when we think about ADHD?
When we are thinking about assessing ADHD it is important to recognise that children and adults can present with a range of different traits and behaviours across the following three areas. They don’t necessarily present all behaviours and to receive a diagnosis relating to ADHD they may not have all of them to the same degree.
The first area is inattention where someone has difficulty staying focused and attending to a task that they see as mundane.
They may procrastinate doing their homework or work because it takes a great deal of mental energy to complete it. They are easily distracted by irrelevant sights and sounds, shifting from one activity to another and seem to get bored easily. Someone with ADHD may appear forgetful and even spacey or confused as if they are in a fog or living in a different world in their own heads. They may not seem like they are listening when they are being spoken to and find organising and completing tasks extremely difficult, as is sorting out what information is relevant versus irrelevant.
If you have inattentive symptoms, you may have great difficulty keeping up with schoolwork or bills, frequently lose things, and live your life in a disorganised 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 are 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.
Another area is hyperactivity, which is what 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 are adults or teens.
You may notice that they talk excessively, interrupt others, and monopolize conversations, not letting others talk. It is 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.
The third aspect is 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 extremely hard for an impulsive person.
What are the myths around ADHD?
Myth 1: ADHD is not a real disorder…
ADHD is recognized as a disorder/disability. Part of the misunderstanding about ADHD stems from the fact that no specific test can definitively identify ADHD.
A doctor can’t confirm the diagnosis through laboratory tests as they can other medical diseases such as diabetes.
Though there is not yet a specific medical test for diagnosing ADHD, clear and specific criteria must be met for a diagnosis to be made. Using these criteria and an in-depth history and detailed information about behaviours, a reliable diagnosis can be made.
An additional misconception may occur because symptoms of ADHD may not always seem clear-cut. We all experience problems with attention and focus to some degree.
For an individual with ADHD, however, these symptoms are so severe that they impair daily functioning. ADHD represents an extreme on a continuum of behaviours. Sometimes the behaviours are misunderstood.
Symptoms of ADHD can certainly appear similar to other conditions. That is why the health professional making the diagnosis must first rule out any other pre-existing conditions or causes for the symptoms.
Myth 2: ADHD is caused by poor parenting…
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.
So what are the causes of ADHD?
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 or a lack of discipline does not cause ADHD.
Myth 3: Only Children can have ADHD
Though the symptoms of ADHD must be present by age 7 in order to meet the criteria for diagnosis, many 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. 30% to 70% 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.
Can you grow out of ADHD?
Previously known as ADD, 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.
Can the presentation change over time?
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.
Diagnosis of ADHD in children
For a child to be diagnosed with ADHD they must
- 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 of ADHD 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.
How to manage ADHD at home?
Creating clear and consistent expectations and consequences with a home environment that has predictable routines can help manage symptoms of ADHD. Solutions can be found by identifying the aspects of life that your child may find difficult and creating strategies to help them manage these e.g. organisations skills.
Empowering the support team with knowledge
Whether it is a teacher, football coach or family member, it is important they know and understand about ADHD so that they can reinforce and stay consistent with your approach.
When a child grows up feeling less than, stupid, lazy or not as able as other people, life can feel 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. Traits of ADHD can be real strength for many people.
Structure your child’s home life
Routines allow him to focus on the big picture instead of worrying over the small details of living. Establish mealtimes, a bedtime, and quiet times. You may want to establish a schedule and draw a step-by-step chart for any task they have trouble with. You can also look at how to manage their activities so that they are not overstimulated or exhausted.
Teach your child to look before they leap
Children with ADHD can to be impulsive and unaware of how their behaviour may affect others. Help your child develop the habit of considering the consequences of their actions. Suppose they want to play catch just outside the living room window. What might happen? Is there a better place to play?
Help with homework
Think of homework as a way to teach your child how to get organised and break down big problems into small ones. First, think about the best time of day for doing their homework and what they need to be able to stay on task and avoid distractions. Secondly, make sure that your child has a neat, quiet place to work. It is useful to sit down with them before they begin and discuss the plan. They can write down what they need to do every night of the week until it is finished to create a structure. Resist the temptation to do the work for them and instead help them figure out the best way to go about it.
How to manage 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.
- Give concise one- or two-step directions. Avoid “overloading” with too much info.
- 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 should you do if you would like an ADHD assessment?
We offer families with children, young adults and adults the initial screening and / or full assessments with full recommendations for support moving forward.
What is the ADHD assessment process?
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.