ADHD symptoms and diagnosis

Attention deficit hyperactivity disorder (ADHD) is a chronic (long lasting) condition that can have a serious impact on the lives of affected children, parents and families. ADHD is more common in boys than girls, and it can persist into adulthood. Generally, the ability to control symptoms like impulsivity improves with time, but not everybody with ADHD will ‘grow out of it’.

Fortunately, there are treatments available that help improve symptoms, learning and social interactions, allowing children to fulfil their potential.

What’s the difference between ADHD and normal childhood behaviours?

ADHD is a somewhat controversial condition. Some people feel it is a label that ‘over medicalises’ ordinary or even bad behaviour. Others feel it is underdiagnosed, and that they have been punished for ‘bad behaviour’ when they should have been treated for a disorder.

It’s certainly true that from time to time, most children won’t pay attention or will seem ‘hyperactive’. This doesn’t mean they have ADHD. Likewise, many of us are impulsive at times. Because ADHD can overlap with normal behaviour, it’s important that the diagnosis is only made after a very thorough assessment by a medical specialist who is skilled in this area.

What causes ADHD?

ADHD is related to problems with brain development. Scientists believe that neurotransmitters (chemical messengers) in the brains of people with ADHD do not work properly. There also seem to be structural changes in the brain. Although the exact cause of ADHD remains a mystery, several factors seem to be involved.

Genetic factors are probably the most important — many children with ADHD have at least one close relative with the disorder. Several genes may be involved and, as always, how these are expressed is influenced by the presence of other factors, including:

  • exposure of the developing fetus to tobacco, alcohol or other drugs;
  • low birth weight;
  • history of a head injury; and
  • environmental agents — high levels of lead may be associated with a raised risk of ADHD, and research continues into whether other chemicals may contribute to the disorder.

So far, research into whether diet significantly affects ADHD symptoms has been inconclusive.

Symptoms of ADHD

Children with ADHD can have problems with inattention (being unable to concentrate), hyperactivity (always being ‘on the go’) and impulsivity (lack of self-control). ADHD symptoms often emerge gradually.

There is no ‘typical’ ADHD kid. Many parents and teachers tend to think of ADHD when a child has difficulty listening, tends to act out and is behind in their school work. But children with mostly inattentive symptoms, who are often quiet, are often not recognised as quickly.

When assessing ADHD, hyperactivity and impulsivity tend to be grouped together.

ADHD symptoms
Inattention symptomsHyperactivity / impulsivity symptoms
  • Finds it hard to concentrate
  • Makes careless mistakes
  • Does not seem to listen
  • Avoids difficult tasks
  • Becomes distracted easily
  • Is disorganised and forgetful
  • Does not follow through on instructions
  • Has difficulty finishing work
  • Frequently loses things
  • Has difficulty planning and being on time
  • Tends to fidget or squirm
  • Gets up during class when not supposed to
  • Runs about or climbs in inappropriate situations
  • Has difficulty playing quietly
  • Often interrupts others
  • Finds it hard to wait for a turn
  • Often ‘on the go’ or acts as if ‘driven by a motor’
  • Talks excessively
  • Blurts out answers before questions have been finished
  • Feels restless
  • Acts without thinking things through
  • Finds it hard to deal with boredom and frustration

 

Some children mostly have inattention symptoms, others primarily have hyperactivity and impulsivity symptoms. However, most children have a mixture of both types of symptoms.

Diagnosing ADHD

Sometimes a child’s teacher will be the one to notice that something is wrong. In other cases the situation concerns parents or caretakers before a child starts having problems at school.

If you are concerned about your child, your GP (general practitioner) is a good place to start. Your GP will ask about your concerns about your child’s behaviour and/or learning and briefly assess your child. They will ask about your family history and when your child reached various developmental milestones. Your doctor will also want to rule out other conditions that might be causing their symptoms.

Most children are referred to a paediatrician (specialist in children’s health), child psychiatrist or child psychologist for a thorough assessment. That’s because a diagnosis of ADHD should only be made by a professional with special training in this area. The specialist will probably ask for information from your child’s teachers to help with diagnosis.

For a diagnosis of ADHD, a child must have several symptoms that:

  • started before the age of 12 years;
  • have caused significant problems for at least 6 months;
  • occur in at least 2 settings (such as home and school); and
  • significantly affect social functioning and/or academic performance.

When assessing a child, doctors also take into account what’s appropriate for the child’s developmental level — for example, it’s normal for a preschooler to have a short attention span.

There is no single test for ADHD. As part of the diagnostic process, you will generally be asked to fill in questionnaires and specific rating scales concerning your child’s behaviour, and your child may be asked to do some neuropsychological tests — a series of written and spoken questions. These can be time-consuming but they help give a fuller picture of your child’s mental state and development.

A mixed picture

At the end of this process, your child may be diagnosed with ADHD. This resolves confusion about their behavioural problems, and it can pave the way to moving forward with ADHD treatments.

However, the picture may be more complex than a diagnosis of ADHD alone. Children with ADHD commonly also have other conditions, such as anxiety, learning difficulties or disruptive behaviour disorders. These may be detected during the ADHD assessments. If so, remember that treatment is available for these disorders, as it is for ADHD, and seeking assistance will give your child the best chance of reaching their full potential.

Support for families dealing with ADHD

If your child has ADHD, there is support available. Support groups can help you connect with other families in your area who have children with ADHD. This can provide not only emotional support, but you can also share practical advice. Ask your doctor or therapist, or search the internet for a group that suits your needs.

References

1. National Health and Medical Research Council (NHMRC). Clinical practice points on the diagnosis, assessment and management of attention deficit hyperactivity disorder in children and adolescents (published September 2012). http://www.nhmrc.gov.au/guidelines/publications/mh26 (accessed Aug 2018).
2. National Institute of Mental Health. Attention deficit hyperactivity disorder (updated March 2016). https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml (accessed Aug 2018).
3. American Academy of Pediatrics. ADHD: Clinical practice guideline for the diagnosis, evaluation and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011 Nov; 128(5): 1007-22. http://pediatrics.aappublications.org/content/128/5/1007 (accessed Aug 2018).
4. ADHD Australia. What is attention deficit hyperactivity disorder (ADHD)? https://www.adhdaustralia.org.au/about-adhd/what-is-attention-deficit-hyperactivity-disorder-adhd/ (accessed Aug 2018).
5. Tonge B. Principles for managing attention deficit hyperactivity disorder. Aust Prescr 2013;36:162-5. https://www.nps.org.au/australian-prescriber/articles/principles-for-managing-attention-deficit-hyperactivity-disorder (accessed Aug 2018).
6. Attention deficit hyperactivity disorder (published July 2013). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Jul. https://tgldcdp.tg.org.au/ (accessed Aug 2018).
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