Attention deficit hyperactivity disorder (ADHD) is a condition characterised by three main behaviours: hyperactivity, inattention, and impulsivity. These behaviours are common in children but it is the extent and the impact they have on a child's day-to-day functioning that may suggest the presence of ADHD. It is generally agreed that ADHD can be broken down into three main subcategories:
ADHD – Combined type
ADHD – Predominantly inattentive
ADHD – Predominantly hyperactive or impulsive
The onset of symptoms generally occurs before seven years of age, and symptoms are most commonly noticeable at four to five years of age. It is estimated that between 2 - 5% of school aged children may be affected by the condition in New Zealand.
The causes of ADHD continue to be investigated. It is thought the underlying causes are neurological in nature rather than behavioural, and genetics may be a causal factor. The following may also play a role in the development of ADHD:
- Chemical disturbances in the brain
- Complications that occur around the time of birth eg: oxygen deprivation
- Exposure to toxins during pregnancy or infancy eg: medications, alcohol, drugs, cigarette smoke, environmental pollutants such as lead.
It is always important to check whether the behaviour might be caused by other problems such as anxiety, learning or hearing difficulties.
Signs and symptoms
The way ADHD presents in individuals varies considerably. Each person’s symptoms vary in type, number, frequency and severity. Many of the behaviours that occur in children with ADHD occur as part of normal childhood development. However, in a child with ADHD these behaviours are exaggerated.
Early signs that may occur in babies and toddlers include:
- Cot rocking
- Head banging
- Poor sleeping patterns
- Biting and hitting
- Demanding constant attention and entertaining
- Getting easily frustrated and having tantrums.
The baby or toddler may also cry a lot, be difficult to hold or cuddle, have fussy eating habits, and toddlers may have a tendency to run away. Toddlers with ADHD may also display unusual strength and a desire to climb. They may also be prone to ear infections and asthma and may have food intolerances or allergies.
Common behaviours in young children with ADHD include:
- Emotional instability
- Antisocial behaviour
- Coordination difficulties
- Inattention and impulsiveness.
As children with ADHD grow, they may have trouble sitting still, concentrating on one topic or task, waiting in turn for a toy or other object and remaining quiet. They may seem to be in constant motion. Physical symptoms such as digestive upsets, excessive thirst and perspiration, headaches, and food and drink cravings may also be present. Into the teen years and adulthood symptoms may include:
- Getting easily bored
- Being overexcited or hyper focused
- Intolerance of others
- Difficulty getting organised
- Mood swings
- Unfounded anxiety or oversensitivity
- Feel angry or appalled if misunderstood
- Difficulty following rules or regulations
- Difficulty retaining information.
It is estimated that for as many as 75% cases of ADHD, symptoms continue to be displayed into adolescence and adulthood, though hyperactivity may decrease with age.
Despite the array of symptoms that can be displayed with ADHD, it should be highlighted that people with ADHD are often creative, sensitive, energetic, intuitive and highly intelligent.
The onset of symptoms is likely to be early in childhood, before seven years of age. Symptoms are generally noticeable at 4-5 years and some research has indicated that ADHD may be recognisable as early as the age of three. The most common time for a formal diagnosis of ADHD to be made is when a child begins school.
There is no one medical or psychological test that can provide a conclusive diagnosis of ADHD. An accurate diagnosis will rely on a thorough diagnostic process and must rule out other factors that could be producing the symptoms eg: emotional disturbances or certain food allergies, or underlying medical conditions such as overactive thyroid or vision or sight disturbances.
If ADHD is suspected a referral to a paediatric specialist skilled in ADHD diagnosis is necessary before a formal diagnosis of ADHD can be made. Specialists able to undertake this diagnostic process include paediatricians, neurologists, psychiatrists and child psychologists. Initially a history of the child’s medical, social, behavioural, psychological and educational development will be taken. Factors considered will include:
- The age the symptoms began
- The nature of the child’s behaviour in different situations
- The relationship with the parents and other family members
- Medical history of the child and family
- Psychosocial factors such as family conflict, economic pressures, poverty and parental absence.
Successful treatment of ADHD usually involves input from a number of different people including family, GPs, medical specialists, counsellors, teachers, behaviour therapists and dietitians. Treatment may include:
Diet and Nutrition
Debate exists as to whether dietary management can influence ADHD. It is known that some foods negatively influence some behaviours. In children with ADHD it may be beneficial to assess what they are eating, avoid foods known to affect behaviour (eg, food colouring, high sugar foods, soft drinks – especially those containing caffeine), and focus on maintaining a healthy, balanced diet.
This may include parent training in behavioural management. Management of behaviour can include implementing behavioural contracts to define which behaviours are acceptable, reward and recognition systems, and clearly defined consequences and punishment for unacceptable behaviour.
Individual and family counselling
Counselling for the affected child may focus on aspects such as low self-esteem, compliance to treatment, relationship issues, and adaptation to issues created by having ADHD. Families may benefit from counselling to help them deal with any difficulties that may arise from having a family member with ADHD.
To assist with academic success a child may benefit from speech therapy focusing on language as well as speech, and occupational therapy to refine motor skills and coordination. While most children are able to function well in a class room setting, a certain percentage of children will require additional teaching assistance to improve skills such as handwriting, reading, spelling and maths. Assistance with social skills may also be required.
Medications from a class known as “psychostimulants” are the most commonly used medications in the treatment of ADHD. Commonly known stimulants in this class include Rubifen (or Ritalin), Dexamphetamine and Concerta. It is estimated that psychostimulants are effective in at least 70% of children and adults with ADHD. These medications are commonly prescribed to control hyperactive and impulsive behaviour, and to increase attention span. They work by stimulating the production of certain chemicals (called neurotransmitters) in the brain. Other medications that may be used to treat ADHD include some antidepressants. These may be used in children who do not respond to, or are unable to take psychostimulants.
The decision to use medication or not is often a difficult one. When ADHD symptoms are affecting educational or social development, then medications are usually considered. Medications must be carefully evaluated and monitored to ensure proper dosage and appropriateness.
In some cases alternative therapies have proved beneficial in addressing some aspects of ADHD. Such therapies include homeopathy, naturopathy, herbal therapy, hypnotherapy, biofeedback and nutritional therapies. With early identification and intervention, compliance to treatment, and supportive home and school environments, children and adults with ADHD can flourish both socially and academically.
Further information and supportThe ADHD Association
Postal Address: PO Box 9063, Newmarket 1149 Auckland
Phone: 09 625 1754
Every Day with ADHD New Zealand
Postal Address: P.O. Box 1322, Rotorua, 3040
Phone: 027 297 5164
ADHD Association (2014) What is ADHD. ADHD Association. Auckland. www.adhd.org.nz/what-is-adhd/diagnosis/
National Resource Center on ADHD (2008) What we know; the disorder called ADHD. CHADD. Maryland. www.help4adhd.org/documents/WWK1.pdf
Basile, M. (2005) Attention deficit hyperactivity disorder. The Gale Encyclopaedia of Genetic Disorders, Second Edition. Brigham Narins (Editor). Farmington Hills, MI. Thompson Gale.
Forde-Martin, P. A., Odle, T. G. (2006) Attention-deficit/Hyperactivity disorder (ADHD). The Gale Encyclopaedia of Medicine, Third Edition, Jacqueline L. Longe (Editor). Farmington Hills, MI. Thompson Gale.
Ministry of Health (2012) Attention deficit hyperactivity disorder. Ministry of Health. Wellington. www.health.govt.nz/your-health/conditions-and-treatments/disabilities/attention-deficit-hyperactivity-disorder