ADHD - your questions answered
How do you know if your child has ADHD - and what treatment is available? Here, Dr Sarah Jarvis, a GP and medical broadcaster, answers parents' most common questions.
This page contains affiliate links, which means we may earn a small amount of money if a reader clicks through and makes a purchase. All our articles and reviews are written independently by the Netmums editorial team.
Read on to find out more about ADHD in children, including the signs and symptoms of Attention Deficit Hyperactivity Disorder.
And take a look at the fascinating animation from researchers at Kings College, London taking a look inside the brain of people with the condition.
This Q&A has been funded by Shire Pharmaceuticals, but Dr Jarvis is an independent medical expert and the opinions expressed are independent and for general advice. Always get advice from your own GP.
What are the symptoms of ADHD and how do I know if my child has it?
ADHD is the abbreviation for Attention Deficit Hyperactivity Disorder. It’s a condition that mainly affects behaviour. There are three main groups of behaviour-related problems, known as ADHD subtypes. They are:
- hyperactive-impulsive subtype
- inattention subtype
- combined subtype
Children with hyperactive-impulsive ADHD tend to talk and fidget all the time and run around even when it’s not appropriate. They often find it impossible to wait, blurting out answers in class or getting frustrated if they’re asked to take turns playing with toys.
Children with inattention type ADHD have more trouble with forgetfulness and concentration.
They’re easily distracted and disorganised and constantly seem to be losing things. With schoolwork, even though they may be bright, they will make careless mistakes and have trouble following instructions because they get distracted part way through.
Children with combined ADHD have features of both hyperactive-impulsive and inattention type subtypes of ADHD. If there are insufficient symptoms for a combined diagnosis then predominantly inattentive and hyperactive diagnoses are available.
According to current NICE (the National Institute for Health and Care Excellence) guidelines, for a child to be diagnosed with ADHD, they must:
- Show at least six of the behaviours in a set list compiled in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.
- Have had these symptoms for at least six months.
- Have symptoms severe enough that they are ‘maladaptive’ – in other words, setting the child apart from other children of their age and development and causing problems in their lives.
- Have similar behaviour problems in at least two social settings (e.g. at home and at school).
If you think your child may be affected, keep a careful diary of their symptoms and compare them with the official list. Then make an appointment with your GP to discuss your concerns.
What’s the difference between ADHD in children and bad behaviour?
One of the things that parents of my patients with ADHD find most distressing is that other people assume their child is badly behaved or badly brought up. It can be really upsetting for affected children as well. In fact, there is no connection whatsoever between how good a parent you are and your child’s chances of suffering from ADHD.
Bad behaviour often comes and goes. A badly behaved child may actively plan to be disruptive at certain times for maximum effect. They can also behave well if it’s in their interest to do so. For instance, if a child is badly behaved and knows they’re going to be rewarded for behaving well, such as sitting still, staying quiet etc, they’ll usually manage it, at least in the short term.
However, a child with ADHD may desperately want to behave well but just can’t manage it, no matter how hard they try. They find it hard if not impossible to learn from their mistakes and they can’t plan or organise.
Is there a test for ADHD in children - how is it diagnosed?
For a child to have a diagnosis of ADHD made, they should be referred to a specialist psychiatrist or paediatrician with training and expertise in diagnosing the condition. There is no 'test' for ADHD, instead, NICE recommends that diagnosis should be based on:
- A full history of the child’s symptoms (including how long they have been present and how much impact they are having on the child’s life).
- All the different areas of a child’s life (home, school, nursery etc) to confirm that their symptoms are present in more than one setting.
- Possibly a behavioural assessment from the child’s school, school grades, report cards, samples of schoolwork etc.
- How long they have had the symptoms for (for a diagnosis to be made, symptoms should have Understanding ADHD started before the age of seven-years-old and have been present for at least six months).
- Whether the symptoms are having a significant (moderate or severe) impact on their education, or their social functioning or psychological wellbeing.
- The young person’s views of how much impact their symptoms are having.
- Their childhood development milestones and any psychiatric history.
NICE covers diagnosis in children from the age of three-years-old. However, it’s often difficult to make a diagnosis before your child starts school because by definition they need to have problems in several social settings. While pre-school children often go to nursery, they may not spend enough time there for the staff to get a really clear idea of the issues. What’s more, pre-school age children often show signs of hyperactive behaviour, which settles on its own. This is particularly common among boys.
What is the treatment for ADHD?
A formal diagnosis of ADHD should be made by a specialist hospital team led by a specialist paediatrician or psychiatrist. However, your GP may make a provisional diagnosis and one option if your child is not severely affected is for ‘watchful waiting’ – monitoring and regular follow up – for up to 10 weeks. During that time you and your child can be referred to an education programme.
Once your child has a diagnosis of ADHD, there will also be an assessment of how severely their symptoms are affecting their life. This will guide the treatments they are offered.
If your child’s condition is defined as ‘moderate’ (rather than mild or severe), NICE recommends that you should be referred to a parent training/education programme, either on its own or together with a group training programme for your child.
If your child's condition is defined as 'severe', NICE recommends that medication should be a first-line treatment for school age children or young people with ADHD. Medication should only be started by a specialist and should be closely monitored. Medication is not normally recommended for pre-school children, regardless of how severe the symptoms are.
Whatever other treatments they have, a balanced diet and regular exercise are important. Getting enough exercise may seem the last of your problems if your child had ADHD – so many parents describe children who are constantly on the go and never stop.
Ensuring that they get a balanced diet can be much harder, and if your child is a very fussy eater a dietician from the specialist team may be able to give useful tips.
Can changing diet or supplements help with ADHD?
There has been a huge amount of interest in both removing foods from the diet and giving food supplements for young people with ADHD, because individual parents have reported dramatic improvements. Studies have looked at removing a wide variety of food additives and colourants, including tartrazine. There have also been studies looking at excluding several foods, including cows’ milk, wheat flour, citrus fruit and eggs.
However, one of the problems with diets like this is that it’s difficult to design a ‘double blind’ study, where neither the patients nor the doctors know whether they’re in the elimination side or the ‘control’ diet side. Some studies have found a benefit, some haven’t found any.
The other big problem with looking at food elimination is that it’s impossible to predict which, if any, foods will have an impact on an individual child’s symptoms. Eliminating several foods at a time can make organising meals for the family a nightmare, and can make it very difficult to provide a balanced diet. This in turn brings the risk of nutritional deficiencies. That’s why elimination diets aren’t routinely recommended.
If you do think your child’s behaviour is affected by their diet, start by keeping a diary of your child’s behaviour and everything they eat and drink. If this suggests there might be a link, your doctor should refer you to a dietician who can work with you on a carefully planned elimination diet.
The most commonly studied supplements are different kinds of long chain fatty acids, called PUFAs. Again, the results haven’t been consistent.
How useful are non-drug therapies in managing ADHD?
The most important thing to remember is that being offered a ‘parent training /education programme’ does not for a second suggest you’re a bad parent.
Children with ADHD have very different needs to other children, so the normal rules don’t apply. If your child’s condition is defined as ‘moderate’ (rather than mild or severe), NICE recommends that you should be referred to a parent training/education programme, either on its own or together with a group training programme for your child
If your child's condition is defined as 'severe', NICE recommends that medication should be a first-line treatment for school age children or young people with ADHD. Medication should only be started by a specialist and should be closely monitored. Medication is not normally recommended for pre-school children, regardless of how severe the symptoms are.
Behavioural training can make an enormous difference to your child’s symptoms. However, it has to include everyone who has regular contact with your child, including their school.
All children benefit from routine and consistency, but any change of routine can have a negative impact on the behaviour of a child with ADHD. They need rules that are consistent.
Other children might understand that getting a little more leeway than usual at the end of term, or when you’re on a family holiday, doesn’t mean the overall rules have changed. A child with ADHD needs to know that the same consequences will always apply if they break a given rule.
Ideally, engaging your child’s school can help them to help your child. For instance, ask if they can help with:
- Sitting your child at the front of the class to reduce distraction from other pupils.
- Setting up a consistent timetable with the same classroom, the same teachers etc.
- Focusing on positive reinforcement of good behaviour.
Will my child have adult ADHD or will they grow out of it?
It’s estimated that about four out of five children with ADHD will continue to have some symptoms into their teenage years, and about half will still have symptoms into adulthood. However, the symptoms they have may change and often become less disruptive with time.
Inattention too may diminish in absolute terms, and attention span will usually increase with age. But it tends still to lag behind that of unaffected people, and behind the level that is expected and needed for everyday attainments.
Although ADHD symptoms persist in the majority of cases, it is important to remember that many young people with ADHD will make a good adjustment to adulthood and be free of mental health problems.
Management aimed at improving behaviour at an early stage, and sticking to a rigid routine to reinforce behaviour changes, can improve your child’s ability to cope with their symptoms right into adulthood.
What should I do if I think my child has ADHD? Where can I get more help?
Your first port of call, if you think your child has ADHD, should be your GP. Remember that many parents worry that their child is hyperactive, and that this often settles. For your doctor to make even a provisional diagnosis of ADHD, your child’s symptoms:
- Must have started before the age of seven-years-old.
- Be present in several different social settings.
- Have lasted for at least six months.
What causes ADHD?
Nobody knows exactly what causes ADHD.
There are clear biological aspects to the disorder since ADHD has been associated with atypical brain development and structure of the brain in patients with ADHD compared to those who do not have the condition.
The differences are demonstrated visually in this animation on ‘ADHD and the Brain’ based on currently available, peer-reviewed research.
The good news is, these days, doctors and the public know much more about ADHD, and a child who’s significantly affected has a much better chance of being diagnosed and treated. Only a generation ago, they were more likely to be labelled naughty and punished regularly.
Read more on Netmums about ADHD and find local support groups in your area
Published: September 2013 UK/CNPROM/NBU/13/0030a
