Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition. Its core features are persistent inattention and/or hyperactivity and impulsivity that are not appropriate for the child's age, occur in more than one setting and significantly interfere with education, relationships or everyday life.
How ADHD may present in a child
Inattention:
- difficulty sustaining attention and completing tasks;
- frequently losing items, forgetting instructions or being easily distracted;
- difficulty organising sequences of actions and managing time;
- avoiding prolonged tasks that require sustained concentration.
Hyperactivity and impulsivity:
- frequent movement or leaving a seat when remaining seated is expected;
- difficulty playing quietly, waiting for a turn or holding back an answer;
- excessive talking, interrupting or acting before considering the consequences;
- activity that appears excessive for the child's age and the situation.
Emotional outbursts, anxiety, marked mood changes or sleep problems are not core diagnostic symptoms of ADHD. They may coexist with ADHD, result from overload or indicate another condition that also needs assessment.
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Why ADHD develops
ADHD has a complex genetic and biological basis and cannot be explained by a simple “dopamine deficiency”. It is not caused by poor parenting, insufficient discipline or a lack of effort from the child. Stress, traumatic experiences, sleep problems and other mental or physical health conditions can intensify difficulties or produce a similar presentation.
Diagnostic assessment
Diagnosis is made by a psychiatrist, paediatrician or another appropriately qualified healthcare professional with training and expertise in ADHD assessment. A professional title on its own does not guarantee this specialist competence.
Assessment includes the child's developmental and health history, a detailed discussion with parents or legal representatives, the child's own views when appropriate for their age, and information about behaviour at home, at school and in other situations. The clinician considers not only symptom counts but also their effect on development, education, family and social life.
Parent and teacher questionnaires, Conners rating scales and computerised attention tests such as MOXO can support the assessment. They cannot establish or rule out an ADHD diagnosis on their own. The clinician also considers sleep disorders, anxiety, depression, autism spectrum conditions, learning difficulties, hearing or vision problems and other possible explanations.
Treatment and support depend on age
The care plan is developed individually with the child and family. It takes account of age, symptom severity, impairment, coexisting conditions and the family's goals.
- For younger children, parent support programmes, environmental modifications, a predictable routine and practical behaviour strategies are the first priorities. Medication is not a routine first step and requires advice from a specialist service.
- For school-age children and adolescents, psychoeducation, changes at home and in the classroom, collaboration with school, organisational support and behaviour strategies are important.
- Medication may be offered by a trained specialist when symptoms continue to cause significant impairment after environmental modifications have been implemented and reviewed. The decision is individual and follows assessment of potential benefits, risks and physical health.
When medication is used, effectiveness, side effects, sleep, appetite, height, weight, pulse and blood pressure are monitored according to age and clinical circumstances. Treatment should not be started, stopped or changed without medical advice.
The role of parents and school
Parent support does not imply that parents caused ADHD. Its purpose is to help the family respond to the child's additional needs, reduce conflict and support skills. With the family's consent, collaboration with school can provide clear instructions, fewer distractions, tasks divided into steps and other reasonable adjustments.