It’s common for all children to sometimes have trouble sitting still, paying attention and controlling their impulses and actions. When these troubles get in the way of everyday life, one possible cause might be attention deficit hyperactivity disorder or ADHD.
What is attention deficit hyperactivity disorder (ADHD)?
Attention deficit hyperactivity disorder (ADHD) is a medical condition where children have trouble focusing, can’t sit still a lot of the time, and act before they think.
Many children have trouble with some of these things. But in children with ADHD, this behaviour is extreme and has a big impact on their daily lives.
With ADHD, the different parts of the brain don’t ‘talk’ to each other in a typical way. Because of this, children might have trouble thinking, learning, expressing their feelings or controlling their behaviour as well as other children of the same age.
We don’t know the exact cause of ADHD. But we do know that ADHD isn’t caused by bad parents or parenting. That is, it’s not because of inconsistent parenting or a lack of limits on behaviour.
Types of ADHD
There are three types of attention deficit hyperactivity disorder (ADHD):
ADHD combined type: children with this type tend to have trouble concentrating, are fidgety or restless and are always on the go. They often act without thinking.
ADHD inattentive type or attention deficit disorder (ADD): children with this type tend to have trouble concentrating, remembering instructions, paying attention and finishing tasks.
ADHD hyperactive/impulsive type: children with this type are always on the go, have trouble slowing down and often act without thinking.
Symptoms of ADHD
The symptoms of attention deficit hyperactivity disorder (ADHD) fall into three groups.
This means that a child:
- doesn’t pay close attention to details and makes ‘careless’ mistakes
- has difficulty following instructions and finishing tasks like homework or chores
- has difficulty keeping attention on things and is easily distracted
- is often distracted by little things
- has trouble remembering everyday things
- avoids tasks that require a lot of mental effort like schoolwork or homework
- doesn’t seem to listen to when spoken to
- can’t get organised – for example, she has trouble getting things in order or doing things on time
- often loses things – for example, schoolwork, pencils, books, wallets, keys or mobile phones.
This means that a child:
- fidgets a lot and can’t sit still
- runs around and climbs on things in inappropriate situations
- is on the go all the time
- finds it hard to play or take part in activities quietly
- talks a lot
- has difficulty staying seated at school or the dinner table.
This means that a child:
- is impatient and doesn’t wait for a turn
- blurts out answers before questions are finished
- interrupts other people’s conversations or games or uses things without asking.
Even if your child has symptoms like the ones listed above, it doesn’t always mean your child has ADHD. There are other problems that could cause behaviour that looks like ADHD – for example, problems with health, emotions, sleep or school. This is why your child needs careful diagnosis.
Diagnosing ADHD: what professionals look at
When health professionals are working out whether a child has attention deficit hyperactivity disorder (ADHD), they use careful guidelines to check the child’s symptoms.
How old the child is
Children usually must be five years or older to get an ADHD diagnosis. That’s because there might be lots of other reasons for difficult behaviour in younger children.
The child’s symptoms must also begin before the age of 12 years.
How many symptoms the child has
A child might get a diagnosis of:
- combined ADHD if he has six or more hyperactive and impulsive symptoms and six or more inattentive symptoms
- inattentive ADHD if he has six or more inattentive symptoms
- hyperactive/impulsive ADHD if he has six or more hyperactive/impulsive symptoms.
How long the child has had the symptoms
The child must have had her symptoms for a long time – at least six months.
How bad the symptoms are
All children sometimes have trouble sitting still, paying attention and controlling their actions and impulses. But for a child to be diagnosed with ADHD, his symptoms must be worse than the behaviour of other children the same age.
Also, the symptoms must be present in, and interfere with, at least two areas of the child’s life – for example, school, home, child care and so on.
Diagnosing ADHD isn’t easy, because ADHD can overlap with many other medical and behaviour conditions. For example, you might say, ‘If she concentrated more, she would learn more at school’. But it might actually be the other way around – your child’s learning difficulties are causing concentration problems. But the right diagnosis means a child can get the right therapies and management plan for her condition.
Getting an ADHD diagnosis
If you’re concerned about your child’s behaviour, your GP is a good place to start. Your GP might refer your child to a paediatrician, a psychologist or a child psychiatrist for a diagnosis of attention deficit hyperactivity disorder (ADHD) or other condition.
The diagnosis process might include most, if not all, of the following:
- an interview with you and other primary carers of your child
- an interview with your child
- behaviour checklists that you and/or your child’s carers and teachers fill out
- discussions with your child’s teachers or carers
Your child might also have other tests, including:
- developmental, learning, educational or IQ checks
- language, speech and movement checks
- general health checks
- vision and hearing tests.
Everyday life for children with ADHD
Children with attention deficit hyperactivity disorder (ADHD) often have associated problems at school, including learning disabilities, language impairment and movement difficulties.
Sleep problems, like trouble falling asleep and staying asleep overnight, can often make school even more difficult.
Your child might have social difficulties – for example, he can’t concentrate or sit still long enough to enjoy a game with other children.
Other mental health difficulties might also develop, including oppositional defiant disorder and conduct disorder, anxiety in the younger years, anxiety in teenagers and/or depression in teenagers.
ADHD symptoms might put a strain on day-to-day family life, particularly if other family members also have ADHD or other learning difficulties.
That’s why it’s very important to diagnose and treat ADHD as early as possible. The earlier it’s diagnosed, the earlier you and your child’s health professionals can work on a plan to manage your child’s symptoms.
Children with ADHD can be highly creative and can spend a long time doing activities they love. Some children might enjoy using their energy on sport or dancing. They might also be more open to trying new things than other children. Finding positive ways for your child to use her energy can be good for her self-esteem and help protect her against mental health problems.
ADHD and teenagers
Sometimes children don’t get diagnosed with attention deficit hyperactivity disorder (ADHD) until they’re teenagers.
ADHD symptoms might not cause problems until later childhood or the teenage years, when children have more schoolwork and go through social and emotional changes.
On the other hand, as your child with ADHD gets older, his ADHD symptoms might change or tone down. For example, your child might still have trouble focusing, remembering things and thinking before he acts, but he might be less obviously hyperactive.
By the time she’s a teenager, your child might also have built up some strategies to manage her symptoms more effectively.
Some children with ADHD don’t have symptoms any more when they’re adults.
Factors affecting ADHD
A combination of genes and environmental factors might increase the risk for attention deficit hyperactivity disorder (ADHD).
Some environmental factors might include extreme prematurity or low birth weight, smoking and other substance use during pregnancy, mothers’ age at childbirth, mothers’ prenatal and postnatal mental health, as well as exposure to environmental toxins like lead.
There’s no evidence that food intolerances cause children to develop ADHD symptoms.
But some artificial food colourings might make children with ADHD more cranky, and their ADHD symptoms might seem worse. These colourings include tartrazine (lemon yellow) (102), quinoline yellow (104), sunset yellow FCD (110), carmoisine (red) (122), ponceau 4R (red) (124) and allura red AC (129).
There are some conditions that don’t necessarily cause ADHD but do cause behaviour that looks like ADHD or makes ADHD symptoms worse. These include various genetic syndromes, seizures and hydrocephalus. Conditions like intellectual disability and cerebral palsy also affect the way the different parts of the brain talk to each other.
If you’re worried that your child’s behaviour might be caused by other developmental problems, make an appointment to see your GP or paediatrician.