“My child is very active – but it’s normal, he’s still young.”
“My child always forgets his things – I’ve had to buy four scarves this year.”
“My child never listens when I tell him to do something.”
“My child often throws tantrums.”
“My child’s teacher is always complaining about him talking in class.”
Are these all normal? Well… the answer is – there is no way to know, really, unless you ask a professional. The criteria for ADHD are well-defined in the DSM-5- the bible of psychological conditions- (“a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development”), but a parent will find it hard to identify it.
ADHD can be a huge handicap for children, both in class and in social situations. These children are often misunderstood and judged for their behaviour. We are going to talk about ADHD, but there are actually three main forms of the condition:
- Inattentive (ADD)
- Hyperactive-impulsive
- A combination of both
When might you start to suspect ADHD?
The criteria are: concentration difficulties, impulsivity and agitation/hyperactivity lasting for more than six months, and not related to a traumatic event. By traumatic, I mean parents divorcing, birth of a new sibling, moving home or any other upheaval in their lives.
Children with ADHD show difficulties in concentration, impulsivity and restlessness for at least 6 months. These symptoms have a significant impact on daily life, especially if they are associated with other disorders (oppositional behaviour, anxiety, dyslexia, etc.) The symptoms last over time if left untreated, and can worsen.
Although behavioural problems in children are often spontaneously attributed to hyperactivity, not all agitated or turbulent children have ADHD. Moreover, the symptoms often present differently in boys and girls, with boys tending to be more hyperactive-impulsive and girls more inattentive.
Concentration:
My child does not concentrate and is not attentive.
S/he has difficulty, s/he moves very quickly from one activity to another, and lacks perseverance in situations requiring sustained attention. S/he is easily distracted by the slightest external stimulus or by his/her thoughts.
S/he does not follow instructions. S/he might not read the instructions at all and try to do the task without. S/he finds it hard to follow instructions with several steps.
S/he also tends to avoid repetitive or boring tasks (eg homework, housework). This includes reading, or even sometimes leisure activities that do not entail physical participation, like watching TV, or long family meals.
S/he often forgets things (e.g. writing down homework, bringing things to school. S/he loses toys, clothes, schoolbooks, gym clothes etc.
In the family or at school, people say: “S/he never listens”, “S/he is quickly distracted”, “S/he is a dreamer”, “S/he is unable to concentrate”.
Impulsivity
S/he responds too quickly to requests and acts before thinking, without waiting for all the instructions or evaluating the negative (even dangerous) consequences of his/her actions.
Similarly, s/he responds too quickly to questions, without waiting for the questions to be answered and by cutting off speech.
S/he talks a lot. You can’t interrupt him/her.
In a group, s/he does not know how to wait his/her turn and interrupts the activities of others. When s/he wants something, s/he has difficulty waiting.
Those around him describe him/her as “demanding”, “capricious” and “egocentric”.
Hyperactivity
S/he is always on the move, unable to stay in one place. S/he climbs all over the furniture, runs instead of walking.
At school, s/he squirms in his/her seat, cannot sit still, gets up without permission, fiddles with things, comments out loud, etc.
They are said to be always on the move, “springy”, and are often described as noisy, disruptive and even aggressive.
It’s often when the child starts school that the matter comes up, at around six years old. You cannot give a diagnosis much before that age. The condition can quickly become intrusive because even if the child is very bright, it may cause fluctuating results and learning delays.
Where does it come from and what is it exactly?
ADHD is a neurodevelopmental disorder. It runs in families. Anywhere from one-third to one-half of parents with ADHD will have a child with the disorder. There are genetic characteristics that seem to be passed down. If a parent has ADHD, a child has more than a 50% chance of having it. If an older sibling has it, a child has more than a 30% chance.
It can also be caused by problems during pregnancy. Children born with a low birth weight, born prematurely, or whose mothers had difficult pregnancies have a higher risk of having ADHD. Studies show that pregnant women who smoke or drink alcohol may have a higher risk of having a child with ADHD. Exposure to lead, PCBs, or pesticides may also have a role.
It cannot be caused by too much sugar or too much video-gaming. It is not a consequence of bad parenting.
How can I get a diagnosis?
The diagnosis is made by a doctor or a team of doctors, usually a children’s psychiatrist. They analyse the child’s past and present behaviour and use questionnaires – depending on the child’s age, for the parents, the teacher, and the child him or herself. They will also often use tests to evaluate the severity of the condition.
My child has been diagnosed with ADHD – what do we do now?
The main options are medication and cognitive remediation. These are usually implemented in parallel with a kind of cognitive therapy to help the child and the parents deal with the condition and its consequences.
The molecule used to counteract the effects of ADHD is methylphenidate, usually sold under the brand names Ritalin or Concerta. Methylphenidate is a central nervous system (CNS) stimulant. It works by stimulating the brain chemicals dopamine and norepinephrine, chemicals associated with control and attention. Dopamine also has strong associations with pleasure and reward. Norepinephrine mobilizes the brain and body to get ready for action and is involved in the fight or flight response. Paradoxically, although it is a stimulant, it helps the children to be calmer and more focused. It is a prescription-only drug, and has to be carefully monitored medically to avoid side-effects.
Many parents are reluctant to give a drug to their young child, and this is perfectly understandable. However, the specialists now know this molecule very well – it was created in 1954. It works quickly, and the child can stop the treatment during the weekends or holidays. Of course, it can be considered a pharmaceutical crutch, but it helps most children tremendously.
The other alternative is cognitive remediation, usually with a neuropsychologist. It aims at re-training brain functions such as memory, attention and executive functions. Cognitive remediation, however, is still a rather new technique, and the current success rate is about 30%.
Teachers have to be made aware of the child’s condition, so they can make arrangements, like sitting in the front row, allowing the child to get up more often, allowing “soothing” toys like Popups etc.
Sport can usually help when hyperactivity is the main concern.
What if we do nothing?
The child, and then the teenager, will have to make a huge effort that most likely won’t be rewarded. In effect, it will be like asking him or her to run a marathon with a broken leg. This will cause a drop in self-esteem and impede his or her relationships. Furthermore, young people with ADHD are at increased risk of academic failure, dropping out of school or college, teenage pregnancy, and criminal behaviour. Driving is also dangerous for them.
I’m an adult, but I think I have ADHD – surely it only exists in children?
It does not. Some forms of ADHD disappear in late adolescence, some do not. Moreover, ADHD was less frequently diagnosed until about ten years ago – misbehaviour or forgetfulness were just that, not signs of a neurological trouble. Therefore, it is completely possible for an adult to have ADHD. Once again, the diagnosis has to be made by a professional, and involves questionnaires, such as the DIVA (Diagnosis Interview for ADHD in Adults). As for children, the symptoms must have been present for a long time – since childhood – and not be a reaction to a traumatic life event. The symptoms need to be associated with significant clinical or psychosocial impairments that affect the individual in two or more life situations.
All this seems very bleak; are there any upsides?
There are! People with ADHD are sometimes said to have “superpowers”.
They are capable of intense bouts of concentration, especially if they are interested in their task.
They are often creative, all the more so when they are given a goal-oriented task. Since they have to manage their everyday life differently, they are also good at thinking “outside the box” and finding innovative solutions. They are also very detail-oriented.
They can be really spontaneous, and can enjoy life to the full without overthinking the future. They also have a lot of energy, and that serves them well in sports, and other environments where movement is necessary. Living with ADHD also presents many challenges, and overcoming them builds resilience and self-awareness.