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Attention Deficit Hyperactivity Disorder (ADHD): what parent/s need to know?

This leaflet is produced by George Still Forum for children, adolescent, parent/s and carers.

ACKOWLEDGEMENTS: George Still Forum acknowledges the following members for producing this leaflet-

1.  Dr Somnath Banerjee, Community Paediatrician, East Kent Hospitals University NHS Foundation Trust

2.  Dr Hamilton Grantham, Higher Speciality Trainee, Community Paediatrics, Mersey

3.  Dr Geoff Kewley, Consultant Paediatrician, Learning Assessment centre, Horsham

4.  Dr Diana Leaver, Community Paediatrician, Borders NHS Trust, Scotland

5.  Dr Neel Kamal, Community Paediatrician, Hull and East Yorkshire Hospitals NHS Trust

6.  Dr S J Perera, Community Paediatrician, Southend University Hospital NHS Foundation Trust

7.  Dr Chinnaiah Yemula, Community Paediatrician, Bedfordshire Community Health Services

Version: 1

Date of production: 9 September 2011.

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INTRODUCTION

·  ADHD stands for Attention Deficit Hyperactivity Disorder.

·  In ADHD there is persistent inattention, hyperactivity, and/or impulsivity.

·  Boys are three to four times more affected than girls.

·  Approximately 60% of children with ADHD continue to have problems with the condition as adults.

·  Children with ADHD have trouble at home and in school.

·  They often have trouble with keeping friends.

·  As they grow older, children with untreated ADHD may experience drug abuse, antisocial behaviour, and are prone to accidental injuries of all kinds.

SYMPTOMS

·  Symptoms of ADHD can differ from person to person.

·  They often have over-activity, impulsivity and have poor attention.

·  The symptoms of hyperactivity and impulsiveness appear to diminish with age.

·  An inattentive child has difficulty in keeping his/her mind on one thing and may get bored with a task after only a few minutes. They can only engage themselves in brief activities, and change activities frequently. They may seem to drift away into their own thoughts or lose track of what was going on around them.

·  Children who are hyperactive always seem to be in motion. They do not sit still. Hard times for a hyperactive child are carpet times, car journeys, meal times, and in other places, which needs sitting calm.

·  Children who are impulsive seem to be unable to think before they act. As a result they may blurt out answers to questions or run into the street without looking. An impulsive child often interrupts others in their conversations.

·  Most healthy children exhibit many of these behaviours at times especially in the preschool years. For example, parents may worry that a 3-year old who cannot listen to a story from beginning to end or finish a drawing may have ADHD.

·  The same is true of hyperactivity. Young children are naturally energetic- they often wear their parents out long before they are worn out themselves. They may also become more active when they are tired, hungry, anxious or in a new environment.

·  Some children just naturally have higher activity level than others.

·  However; when children have ADHD, when stimulated, they can quickly get out of control and sometimes aggressive or even physically or verbally abusive.

·  Children with ADHD do not necessarily have all the symptoms of the disorder.

·  ADHD symptoms may be different in boys and girls. Boys are more likely to be hyperactive and impulsive and girls tend to be inattentive.

·  Girls who have trouble paying attention often day dream, so the diagnosis may be overlooked in them since they are not being disruptive in the classroom.

·  Inattentive boys are more likely to fiddle aimlessly. Boys also tend to be less compliant with teachers and other adults, so their behaviour is often more conspicuous.

·  Often ADHD coexists with other conditions such as depression, anxiety, conduct disorder, oppositional defiant disorder and autism spectrum disorder.

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Causes

·  The cause is unknown. There are a number of factors involved.

·  Some studies have shown that parts of the brain are not working, as they should.

·  ADHD tends to run in families. Children who have it usually have at least one close relative who also has ADHD and if one parent had problems with overactivity or inattention in childhood then the risk to an offspring is just over 50%.

·  Even more convincing of a possible genetic link is that when one twin of an identical twin pair has the disorder, the other twin has a 100% chance of having ADHD.

·  Children are more likely to have ADHD if they were born prematurely, or if their mother smoked or misused alcohol or drugs when pregnant.

Diagnosis

·  Because so many of the symptoms are related to child development, they can be normal at one age and not at another. In many cases, a child will show signs of the disorder in early childhood but go undiagnosed until they start school, when the demands of schoolwork make them more apparent.

·  Occasionally, ADHD is not recognized until in secondary school years or even in adulthood.

·  There is no specific test for ADHD.

·  A diagnosis of ADHD in childhood and adolescence is usually made after discussing symptoms at length with the child, parents and teachers. Information about any family history of similar problems is gathered as well. The doctor will consider other possibilities, including other medical or psychiatric conditions.

Treatments options

·  Effective interventions for children with ADHD fall into three broad categories: drug therapy, behaviour management, and educational modifications in school.

Drug therapy: Brain stimulants are the most commonly prescribed medications.

·  Parents often wonder why stimulants are given to children who are already over-stimulated.

·  Stimulants boost and balance the level of brain chemicals, which stimulate the inhibitory mechanism of brain. These chemicals also stimulate a part of the brain called reticular activity system, which maintains attention and arousal and helps to control impulsiveness.

·  Medications help to alleviate the symptoms of inattention, hyperactivity and impulsivity.

·  The most extensively used stimulant is methylphenidate (Ritalin, Medikinet). The other drug used is Dexamfetamine (Dexedrine). There are long-acting preparations of methylphenidate available in UK. Capsule Equasym XL (by Shire) and capsule Medikinet XL (by Flynn-Pharma) work up to 8 hours whereas tablet Concerta XL (by Janssen) works up to 12 hours. These sustained-release drugs avoid the need for a lunchtime dose.

Non-Stimulants: In the UK, capsule Strattera (atomoxetine) is the only licensed non-stimulant medication that appears to work as well as the stimulants in treating ADHD.

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Side effects: The common side effects of ADHD drugs include loss of appetite, difficulty getting off to sleep, headache, tummy pains, nervousness and tearfulness especially in the first few days after the start of medication. Parents also worry about the addiction risk. Drug dependence is not reported in children who take stimulants orally. This is because the drug level in the brain rises too slowly to produce a “high”.

Behaviour management: All children with ADHD often greatly benefit from behaviour modification programme, which may be provided by parents and teachers under the supervision of a psychologist or other mental health professional. In situations where such provisions are not available there are various websites from where parents can get information about behaviour modification programs.

Managing behaviour at home: Parents can help their child by providing a structured environment with clear rules of acceptable behaviour. Good behaviour should be reinforced with rewards and bad behaviour should be ignored. When punishment is necessary this should be time-limited.

School: A structured classroom without too many distractions is helpful. Often, small-group or individual teaching helps. Parents should make sure that the programs started at school should be continued at home as this will cause minimal confusion to the child.

Role of diet

·  Most of the dietary manipulations involve eliminating additives and foods incriminated to increase hyperactivity, such as sugar, chocolate, and caffeine or common food allergens such as wheat, milk, and eggs.

·  Current medical evidences suggest that diets are arduous to implement and some may be nutritionally deficient and a restriction of diet in children with ADHD is not advisable.

·  Some people believe supplements of certain vitamins; minerals or omega-3 fatty acids can help to treat ADHD. There is no firm scientific evidence for this.

·  Eating a balanced diet, including oily fish (e.g. mackerel, herring, trout), which is high in omega-3 fatty acids, certainly helps to promote healthy development in children.

Cure

·  There is no proven cure for ADHD.

· Good treatment options are available.

Further information and support

·  Explore the following web sites for support groups:

www.addiss.co.uk, www.adders.org, www.addcontact.org.uk

·  Because an ADHD child may process information in faulty ways, s/he tends to be bombarded with corrections, leaving her/him with a low opinion of self.

·  Praise and reward good behaviour promptly.

· Make sure everybody in the family follow the same methods.

·  Make instructions simple and specific (“Brush your teeth now, get dressed”), instead of general (“Get ready for school”).

·  Encourage child’s strengths, particularly in sports and out-of-school activities.

·  Have set routines for meals, sleep, play and TV.

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9 September 2011.

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