Attention Deficit Hyperactivity Disorder, or ADHD, is the term used to describe three main kinds of behavioural problem in children:
- overactive behaviour (hyperactivity)
- difficulty in paying attention.
What is ADHD?
All young children have lots of energy and like to be active. Young children also tend to have a short attention span - they soon get tired of an activity and want to move on to something new. So how can you know whether your child has ADHD or is just restless or bored?
Children with ADHD are not just very active; they also have a wide range of other problem behaviours that can make them very difficult to care for, manage and teach.
Because they are overactive and impulsive, children with ADHD often find it difficult to fit in at school. They may also have problems getting on with other children. These difficulties can continue as they grow up, particularly if children and families do not get the help they need.
Some children have significant problems with concentration and attention, but are not overactive or impulsive. These children are sometimes described as having Attention Deficit Disorder (ADD), rather than ADHD. ADD can easily be missed because the child may be quiet and dreamy rather than disruptive.
ADHD and ADD are not related to intelligence. Children with all levels of ability can have them.
What causes ADHD?
The causes of ADHD are still not fully known. It is believed to be caused by poor transmission of messages in the brain, and in particular by low levels of the neurotransmitters dopamine and norepinephrine, which carry messages from one neuron to another. These neurotransmitters are particularly associated with attention, organisation and managing emotions.
Do children grow out of ADHD?
Some children grow out of ADHD; others have problems that continue into adolescence and beyond. Approximately two out of five children with ADHD continue to have difficulties at age 18. The main symptoms of ADHD, such as attention difficulties, may improve as children get older, but behavioural problems such as disobedience or aggression may become worse if a child does not receive help. In particular, boys who are hyperactive and aggressive tend to become unpopular with other children. It is therefore very important for children to receive help as early as possible, to prevent them from getting socially isolated and from developing other emotional and behaviour problems that can persist into adult life.
Does medication help?
ADHD is often treated with stimulant medication, which can produce short-term benefits for many children with ADHD. The theory is that medication can either reduce the uptake or increase the production of the neurotransmitters, so increasing the levels in the brain.
Medication does not cure ADHD – it can only reduce a child’s difficulties. The aim is to give children some relief from the symptoms, so they calm down, are better able to make friends and manage their emotions, learn more easily and are more responsive to other people. Children may become less aggressive as well as less hyperactive, and their performance at school may improve significantly. Once they are having fewer problems in their family, school and social lives, the hope is they can learn to manage their own behaviour better without the help of drugs.
However there are concerns that these drugs may be used too quickly to deal with behaviours that are not due to ADHD/ADD at all; the child may be simply over-boisterous or unruly or difficult to manage for other reasons to do with their family and environment. Also, they are very powerful drugs – some are classed as amphetamines – and can carry other health risks:
- the long-term effects of stimulants on young, developing brains are still not fully known
- children and adults with existing heart conditions are at risk of heart attacks if they take stimulant medications
- stimulants can trigger or exacerbate hostility, aggression, anxiety, depression and paranoia – anyone with a personal or family history of suicide, depression or bi-polar disorder is at very high risk and should be closely monitored
- stimulant abuse is an increasingly common problem among young people – young people use them to give them a boost when preparing for exams, and to help lose weight.
The reported side effects of stimulant medication for ADHD/ADD include some of the problems for which they are prescribed. They include: restlessness, difficulty sleeping, irritability and mood swings, depression, loss of appetite, headaches, upset stomach, dizziness, racing heartbeat and tics.
For these reasons, stimulant medication should only be prescribed to children who have been professionally assessed and diagnosed by an expert, and should be reviewed regularly.
Non-medical ways of managing ADHD include exercise, healthy diet, sleep management and behavioural therapies.
The first thing parents need to know is that ADHD is not your fault – you are not a ‘bad parent’. The second is that there are things you can do to help your child to manage their behaviour. There are now a number of behaviour management programmes run by professionals to help parents. You can learn ways of talking, playing and working with your child that can improve their attention and behaviour. These techniques can also be very helpful for other carers and friends, not just parents.
There are many ways in which teachers can organise the classroom, lessons and behaviour to help children with ADHD. Minimising distractions can help – seat children with ADHD away from windows, and don’t put groups of pupils together round one large table. Include a variety of activities during each lesson, and alternate physical and sitting-down activities. Set short, achievable targets and give immediate rewards when the child completes the task.
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