ADD and ADHD - what are they?
attention; deficit; hyperactivity; disorder; behaviour; ADD; ADHD; sleep; apnoea; hyper; hypo; active; hyperactive;
Contents
Most parents are concerned about their child's behaviour at some time during childhood. However, for some parents their child's behaviour seems to be out of control, unpredictable, and very difficult to manage much of the time. The behaviour may be causing problems with school work and with making friends.
Our community is now more aware that some children who may have been called 'bad' or 'naughty' may have Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). ADD or ADHD are not the reasons for every type of difficult behaviour in children. It is important to have a proper assessment, so that the right kind of help can be given to your child.
While a teenager may have better control over his behaviour, many children do not 'grow out of' their ADD or ADHD, and they continue to have problems concentrating in high school. Have a look at the Teen Health topic 'ADHD - how it can affect teenagers'.
What is ADD or ADHD?
ADD and ADHD are a group of behaviour problems where children have more difficulty with concentrating on what they are doing (problems with attention) than other children of their age.
- Some, but not all, of these children will also have a much greater activity level (hyperactivity) than other children of their age (ie they have ADHD).
These difficulties occur due to the way that the child's brain works. They are not caused by brain damage, but specialised brain imaging tests can show differences in brain function compared to children without ADD or ADHD.
ADD and ADHD do exist, they are real, but there is a lot of disagreement about how many children have ADD or ADHD.
- Some studies suggest that about 2% of primary school aged children have ADD or ADHD, while others have suggested that almost 18% have ADD or ADHD. Most estimates are between 5% and 10%.
- Boys are at least 4 times more likely to be diagnosed with ADD or ADHD than girls.
Signs and symptoms
Your school age child may have ADHD if he or she is having difficulties both at school and at home and has had at least six of the behaviours listed below in either of the following groups. Remember that for younger children these are part of normal everyday behaviour. Children who are distressed or unhappy for other reasons, or who have other learning problems can also show these behaviours.
Inattention
The child often:
- misses details or makes careless mistakes in school-work or other activities
- has trouble organising tasks and activities
- loses things needed for tasks or activities, eg. toys, school assignments, pencils, books
- has trouble sticking to tasks or play activities
- does not seem to listen when spoken to directly
- doesn't follow through instructions that he is able to understand, and does not finish tasks (eg. at school or chores at home)
- tries to get out of doing things that require a lot of thinking and concentrating (these are hard work and tiring)
- is easily distracted
- is forgetful in daily activities.
Hyperactivity/Impulsivity
The child often:
- fidgets with hands or feet, or squirms in her seat
- leaves her seat in the classroom when she should be seated
- runs about or climbs excessively (more than most other children)
- has trouble playing quietly
- is continually 'on the go'
- talks 'all the time'
- blurts out answers before the questions have been completed
- has difficulty awaiting her turn
- butts into conversations or games
and
- the behaviour pattern is different from most other children of about the same age
- the behaviours happen in more than one place, for example at home and school
- the behaviour has lasted for more than 6 months
- the behaviour pattern started before age 7 years
- the child does not have other major health or development problems, and
- the behaviour is causing the child problems with school work, friends and daily living.
The last thing listed here is very important - the behaviour pattern must be interfering with the child's ability to get on with his life, to learn or to fit in with his world.
Adapted from the 'Diagnostic and Statistical Manual of Mental Disorders, DSM-IV'
What causes ADHD?
Despite at least 40 years of research worldwide, there is no clear explanation for why ADHD happens in some children.
- Specialised brain imaging has shown slight differences in the way that a child's brain works. These cause the child's brain to deal with some activities, information and feelings in a different way from other children.
- Family inheritance is part of the explanation of ADD. ADD tends to 'run in families'. Often other family members also have difficulties with their behaviour or with learning.
- For some children who have ADHD, some foods (such as sugar and food colourings) seem to trigger more 'out of control' behaviour, but food is not a trigger for many children with ADHD. Being at a party often triggers 'out of control' behaviour which might be due to foods, but the behaviour is more likely to be due to too much excitement.
- Sleep apnoea (blocking of the airway during sleep) is linked to problem behaviours in many children. Some research has shown that about 30% of children who have ADD or ADHD have some sleep apnoea. Signs of sleep apnoea including snoring (often loud snoring) and stopping breathing for a brief time during sleep. Not all children who snore have sleep apnoea, but if a child with ADHD also snores, this might be part of the problem.
There is not yet a full explanation for ADHD, which doesn't mean that it does not exist - we simply have to wait for some of the answers.
Other problems that can occur with ADD/ADHD
It is common for children with ADD/ADHD to have other problems.
- Many will not do well at school, and may have specific learning problems.
- Many children who are diagnosed with ADD/ADHD will have behaviour problems such as conduct disorders, anxiety disorders, mood disorders and motor coordination problems (be clumsy).
- In secondary school, a teenager needs to be better organised, and be able to concentrate for longer times compared to younger children. Although his behaviour may be better than when he was young, his problems with learning may be greater, and it can be worthwhile for him to continue taking medication if it has been useful when he was younger.
The importance of assessment
Without a full assessment of why a child may be having difficulties, there is a risk of overlooking very important aspects of the child's needs, and of using the wrong treatment for the problem. Insist on a thorough assessment for your child if you are worried about ADD/ADHD before you try any treatments.
The assessment should include:
- assessment of the child's development, behaviour, and how well she manages at school
- psychology assessments to work out how she manages different tasks, including learning
- thinking about what is happening for the child at home and how your discipline works for her
- assessment of the child's school and friendships
- a family assessment - ADD/ADHD runs in families, but stress within the family can trigger behaviour problems in children, so thinking about other people in the family is important
- checking that she can see clearly and has normal hearing
- checking to see if there are other reasons to explain your child's behaviour, such as sleep apnoea, illness or medicines.
Assessment should involve parents, teachers, psychologists, doctors and possibly others, depending on your child's needs.
- Brain scans and EEGs (Electro-encephalo-grams or brain wave tracings) are usually not needed. They are not helpful in working out whether a child has ADD/ADHD, but they might be useful for some children, seeing if there are some other problems such as epilepsy.
- It is also important that other problems which often come with ADD/ADHD, such as specific learning problems, and difficulties with movements (coordination) are fully checked and a plan is made to help your child manage them if they are present.
Note: Preschool age children do many of the things that would be called ADD/ADHD if they were older - yet ADD/ADHD does happen in this age group - extra care is needed in assessing young children's behaviour.
For information about what to do see the topic ADD and ADHD – how to manage them.
Reminders
- Make sure that your child's behaviour is not caused by something else. Have a proper medical assessment.
- ADD/ADHD is only one of many possible explanations for inattentive, distractible or hyperactive behaviour in children.
- The management of ADD/ADHD is not simple. It involves many people - it is important to share difficulties and successes, especially with teachers.
- To really help your child all the other areas such as behaviour and learning also need attention.
Resources
South Australia
- The Attention Disorders Association of SA (ADASA)
302 South Road, Hilton SA 5033
Telephone: 8152 0187
Fax: 8152 0447
Email: admin@adasa.com.au
http://adasa.com.au
- Disability Information & Resource Centre Inc.
(DIRC) in South Australia. Telephone 8223 7522, 1800 182 179 (country callers)
http://www.dircsa.org.au
General
Books
- Barkley RA. Taking charge of ADHD: the complete authoritative guide for parents (revised edition). London: Guilford Press; 2000.
- Cooper P, Ideus K. Attention deficit hyperactivity disorder: a practical guide for teachers. London: Fulton; 1996
- Green C, Chee K. Understanding ADHD: a parents guide to attention deficit hyperactivity disorder in children. Doubleday, Sydney 1998
- Hallowell EM, Ratey JJ. Driven to Distraction. Recognising and coping with Attention Deficit Disorder from Childhood through Adulthood. New York: Simon and Schuster; 1995.
- Ingersoll BD. Distant drums different drummers: a guide for young people with ADHD. London: Jonathon Cape; 1995.
- Ingersoll BD. Daredevils and daydreamers: new perspectives on attention deficit hyperactivity disorder. New York: Doubleday; 1998.
- Kurcinka, Mary Sheedy: Raising your spirited child: a guide for parents whose child is more intense, sensitive, perceptive, persistent, energetic US: HarperCollins, 1991.
- Parker RN. Making the grade: an adolescent's struggle with ADD. Plantation (Fl): Speciality Press; 1992.
References
American Psychiatric Association. 'Diagnostic and Statistical Manual of Mental Disorders, DSM-IV'
http://www.psych.org
Clinical Excellence Commission ‘Attention Deficit Hyperactivity Disorder in children and adolescents in New South Wales 2007’ http://www.cec.health.nsw.gov.au/pdf/specialreports/adhd_080211.pdf
Royal Australasian College of Physicians ADHD Statement June 2007
Click here
Royal Australasian College of Physicians 'Medication management of Attention Deficit Hyperactivity Disorder - a brief guide for parents and non health professionals' July 2006
Click here
SIGN 'Attention deficit and hyperkinetic disorders in children and young people'
http://www.sign.ac.uk/guidelines/fulltext/52/section1.html
Articles
McCann D, et al ‘Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial’ The Lancet. Published online September 6, 2007 DOI:10.1016/S0140-6736(07)61306-3
Robb AS, Surman CBH, 'Diagnosis and management of ADHD from adolescence through adulthood' Medscape, September 28, 2006
http://www.medscape.com/viewprogram/6034?src=mp
Wolraich ML, Wibbelsman CJ et al 'Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment and clinical implications' Pediatrics Vol 115, No 6 June 2005 pp1734-1746
Written in partnership
Child and Youth Health and Parenting SA
Related Parent Easy Guide (Parenting SA web site) - PDF format
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.