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ADHD in Children - Attention Deficit Hyperactivity Disorder in Children
ADHD is common in children and teenagers and, with the right medication and support, can be successfully managed allowing your child to reach their full potential and enjoy their lives.
What is ADHD?
ADHD (Attention Deficit Hyperactivity Disorder) and ADD (Attention Deficit Disorder) are neurodevelopmental conditions affecting thousands of families in the UK. ADHD and ADD are psychiatric disorders characterised by impulsive, hyperactive or inattentive behaviour. The child may appear ‘naughty’, can struggle in school and home settings and be challenging to parent. With the right treatment and support, children and teenagers with ADHD and ADD are much more able to reach their full potential.
Causes of ADHD in children
ADHD in children is thought to result from many genetic and environmental factors interacting.
1. Genetic
Children with a family history of ADHD are much more likely to have the condition themselves. Many children with ADHD have been found to have slightly different gene structures. One study found a greater number of ‘copy number variants’ (a term used to refer to deletions and duplications of certain chromosomes) in children with ADHD.
2. Neurobiological
Brain imaging has shown a difference in the brain size of children with ADHD. Brain maturation is slower in children with ADHD; grey matter maturity is approximately 3 years behind that of children who do not have ADHD.
The levels of neurotransmitters, the chemicals that deliver messages in the brain are different in children with ADHD. Noradrenaline, linked to our ability to pay attention, and dopamine, linked to our ability to control impulses, have been found in lower levels in children with ADHD. Medication can be successfully used to adjust the levels of brain chemicals.
3. Environmental
Premature birth and low birth weights are linked to an increased chance of ADHD. Factors such as alcohol, drug and cigarette use during pregnancy have links to a greater likelihood of ADHD.
Symptoms of ADHD in Children and Teenagers
All children can be fidgety, impulsive and have short attention spans at times and it is perfectly normal. For children with ADHD however these behaviours are more pronounced, occur more frequently, have a bigger impact on their lives and will occur in a variety of settings.
The signs your child may have ADHD or ADD fall into three common areas:
- Hyperactivity
- Impulsivity
- Inattention
Children will experience these signs to the varying degree, and it is common for children and teenagers behaviour to be different or more pronounced in different settings. It is also common for children with ADHD / ADD to experience differing symptoms as they grow up, so as a parent you may notice a shift in the challenges they experience, and this is normal.
A diagnosis of ADHD / ADD requires an impact to be seen in a variety of settings, a thorough assessment should seek feedback from parents, schools and other environments your child spends time in to ascertain this. It is important that parents understand that there can be other reasons why a child might behave in a ‘bouncy’ way or find it really hard to concentrate. These may include ASC or anxiety or mood disorders.
Understanding the reasons behind your child’s behaviour is therefore crucial to getting the right treatment in place and a thorough assessment will look at whether there is another reason that would better explain your child’s behaviours.
Diagnosing ADHD in children
Diagnosing ADHD and ADD in children is often complicated as the symptoms can be indicative of another condition. Finding a clinician with experience of diagnosing ADHD is really important to ensuring your child has the right treatment plan in place.
Your GP or a mental health professional, such as a Psychiatrist is the best place to start for any parent unsure if their child has ADHD. An experienced child and adolescent Psychiatrist will be able to rule a diagnosis in, or out ADHD and make recommendations for further assessments and treatment.
Treatment for ADHD/ADD in Children
Most experts agree the most effective way to treat the core symptoms of ADHD and any associatedproblems is to use a combination of different approaches which normally include:
- Medication
- Behavioural therapy / psychotherapy
- Parenting support
Frequently Asked Questions
What does an ADHD assessment look like and what can you expect?
You will be asked to complete a few questionnaires on relevant issues which you will need to return at least 48 hours prior to the assessment.
The assessment consists of a semi-structured interview probing the main areas of functioning that are usually involved in ADHD; this is called the DIVA (the Diagnostic Interview for ADHD in Adults and Children and Adolescents). This interview yields scores for attention deficit and for hyperactivity and impulsivity and these scores are mapped against internationally agreed diagnostic thresholds, above which it is highly likely someone has ADHD and below which it is clear they do not. This information is merged with the information elicited in the general assessment with the specialist, during which relevant issues are explored which are having an impact on someone’s life. All assessments are currently conducted in video consultation format. Patients / Parents receive a Video Appointment Confirmation Email after a booking is made.
Ultimately the specialist establishes the diagnosis: he can overrule any scores from the DIVA if there are sound clinical grounds to do so.
All the findings will be summarised in a report, which is held securely in our practice system: the report will be sent by secure email, which will enable you to download the report in pdf format and save or print it. The report is your property: you can choose to share it with others (e.g. your GP), but you don’t have to. Before the final version is shared with you, you can ask for amendments if you think something important is forgotten or a detail is wrong.
The assessment concludes with deciding a treatment plan: ADHD is eminently treatable with medication, although there is sometimes also a role for other approaches, such as ADHD coaching or psychotherapeutic interventions.
The prescription is £ 75 if it is only prescription. The cost of medication is naturally not included and will need to be paid extra to the pharmacy. It concludes with a Shared Care Agreement.
We normally recommend using a pharmacy that delivers the medication to you, as it is more secure. They are called Pharmacierge, and we can arrange for the prescription to be sent to them directly: you will get a payment link from them on your mobile phone and once you have paid, they will deliver the medication to you: within 24hrs if you are within the London area and within 48hrs anywhere else in the UK.
Once a treatment plan is agreed, a so-called titration period starts. As it is largely unpredictable what medication and what dose is the right one for a particular individual, it is a matter of trial and error to establish it. The titration period involves regular, half-hour, reviews to monitor response and adjust the treatment accordingly.
The main medications are controlled drugs, which means prescribing is subject to legal restrictions, so prescriptions are for a maximum of 30 days.
It is unpredictable how many reviews are needed in an individual case before it is clear a sustained and optimal improvement has been achieved. When that happens, a shared care agreement is up together to invite the GP to take over prescribing on the NHS, after which we review the patient once every 6 months. These various components of the treatment plan follow the relevant NICE guidelines. Follow up appointments cost ££225, shared care proposals cost £100. Briarbridge Psychiatrists provides a direct communication service to all of its patients after their assessments. This is free of charge and patients are able to communicate with their doctors via email.