• Tashya De Silva

Attention-deficit hyperactivity disorder (ADHD)

Updated: Jan 18, 2021

Attention-deficit hyperactivity disorder (ADHD) is defined as a pattern of behaviors in which a child shows levels of inattention, impulsivity, or hyperactivity that are higher than other children the same age.


Common signs for diagnosis include (as per Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition):


Impulsivity:

  • blurts out answers before questions have been completed

  • has difficulty awaiting turn

  • interrupts or intrudes on others (e.g., butts into conversations or games)


Inattention:

  • fails to give close attention to details or makes careless mistakes

  • does not seem to listen when spoken to directly remaining seated is expected

  • has difficulty sustaining attention in tasks or play activities

  • does not follow through on instructions and fails to finish tasks (not due to oppositional behavior or failure to understand instructions)

  • has difficulties organizing tasks and activities

  • avoids or dislikes tasks that require sustained mental effort

  • loses things necessary for tasks or activities

  • is easily distracted

  • is forgetful in daily activities


Hyperactivity:

  • Fidgets with hands or feets or squirms in chair

  • leaves seat in classroom or in other situations in which remaining seated is expected

  • runs or climbs excessively when it is inappropriate(in adolescents, may be feelings of restlessness)

  • has difficulty playing or engaging in leisure activities quietly

  • is always "on the go" or acts as if "driven by a motor" (such as schoolwork or homework)

  • Often talks excessively


*not all symptoms need to be present nor do they need to be exhibited in all instances. For example, a child may be able to hold their attention during their favourite TV show.


Since the above mentioned behaviours are commonly displayed by children, it is important to note that ADHD requires the behaviours to be displayed to an Extreme Degree compared to other child of a similar age, resulting in Significant disruption to the child's daily life. Further, it should have been persistent for at least a period of 6 months, appearing before the age of 12 years.

People often have a misconception that ADHD is overdiagnosed or not a real problem. Yet, brain imaging studies have shown a difference in the brains of child with ADHD versus those without ADHD. Children with ADHD can face significant difficulties that can continue to impact their success into adulthood, such as their functioning, interpersonal, social, academic and professional skills. It can lead to significant issues at school and work, relationship problems, anxiety, depression, financial struggles and legal difficulties. Among adults with ADHD, there is lower educational achievement and career attainment, co-occurring psychiatric disorders and higher suicide rates. Children with ADHD have higher rates of retention in grade level, high school dropout, substance abuse, co-occurring psychiatric disorders, unintentional injuries and emergency department visits.



A diagnosis will involve standardised testing and interviews with parents and teachers to identify which of the listed behaviours is present. More importantly, the focus should be on the behaviours that impact the child's daily functioning and what can be done to improve these challenges rather than diagnosis.It is also important to review the family dynamics such as marital problems, alcoholism, stress and depression in one or both of the parents, this is a common factor in children with ADHD and will need to be addressed in the intervention plan.


Research has shown that the most effective intervention is behaviour therapy/modification implemented at home, school and by peers rather than a therapist. This includes tactics such as:

  • establishing specific daily goals for the child

  • establishing and consistently enforcing clear rules

  • giving clear and appropriate commands

  • praising children for desired behaviors and ignoring negative behaviors that can be ignored

  • using rewards (for example, privileges or special activities) to encourage good behaviors

  • using appropriate, nonphysical punishments (for example, time out) to discourage bad behaviors

  • using a Daily Report Card to motivate the child and facilitate communication between school and home

Medication may also be given in extreme cases, including a psycho-stimulant drug, such as methylphenidate (Ritalin, Concerta, Metadate-CD, Focalin) or amphetamine (Adderall, Adderall-XR, Vyvanse). However, medication alone does not decrease a child's risk for the poor outcomes of adolescence and adulthood. Therefore, medication should not be relied upon as the only treatment for a child with ADHD. Ideally, medication should be reviewed as a last option once all other options are deemed ineffective.



Disclaimer: The following information is not a suitable replacement for therapy or professional help. Mental health is very complex and there are various individual differences due to circumstances, genetics and life experience. All information published has been generalised and done in good faith. However, we will not be liable for any actions taken as a result of this website/post. If you are facing mental health concerns, it is important you reach out to a professional. You may also contact us at tashya1@gmail.com for further support.