Attention Deficit and Hyperactivity Disorder
The symptoms of attention deficit hyperactivity disorder (ADHD) can be categorised into three types of behavioural problems:
- inattentiveness
- impulsiveness
- hyperactivity
Most people with ADHD have problems that fall into all 3 categories.
Some youngsters with the condition may have problems with inattentiveness, but not with hyperactivity or impulsiveness. This form of ADHD is also known as attention deficit disorder (ADD). ADD is more common in girls and can sometimes go unnoticed because the symptoms may be less obvious.
The symptoms of ADHD are usually noticeable before the age of six. They occur in more than one situation, such as at home and at school.
The main signs of each behavioural problem are detailed below.
Inattentiveness
The main signs of inattentiveness are:
- having a short attention span and being easily distracted
- making careless mistakes – for example, in schoolwork
- appearing forgetful or losing things
- being unable to stick at tasks that are tedious or time-consuming
- appearing to be unable to listen to or carry out instructions
- constantly changing activity or task
- having difficulty organising tasks
Hyperactivity and impulsiveness
The main signs of hyperactivity and impulsiveness are:
- being unable to sit still, especially in calm or quiet surroundings
- constantly fidgeting
- being unable to concentrate on tasks
- excessive physical movement
- excessive talking
- being unable to wait their turn
- acting without thinking
- interrupting conversations
- little or no sense of danger
These symptoms can cause significant problems in a child’s life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.
The main treatment is behavioural management and may or may not include medication. Specific behavioural management includes strategies and exercises to extend attention span and to reduce impulsivity and hyperactivity. Occasionally family approaches are useful.
Treatment with me consists of 4 to 6 sessions about a fortnight or a month apart. This can include titrating of medication to the lowest effective optimum dose in addition to behavioural and family approaches.
In cases where medication is required I also offer follow up longer term 3 or 6 monthly for physical monitoring and dose adjustment for as long as the patient remains on medication. These appointments can include “refreshers” and checking in with you on behavioural strategies. If all is straightforward these are usually 30 minute appointments.
Some General Practitioners work with me offering a shared care package where they prescribe and I offer physical monitoring and advise on dosage of medication and progress.
Talking treatments in ADHD
Different therapies can be useful in treating ADHD in children, teenagers and adults. Therapy is also effective in treating additional problems, such as conduct or anxiety disorders, that may appear with ADHD.
Some of the therapies that may be used are outlined below.
Psychoeducation
Psychoeducation means that you or your child will be encouraged to discuss ADHD and how it affects you. It can help children, teenagers and adults make sense of being diagnosed with ADHD, and can help you to cope and live with the condition.
Behaviour therapy
Behaviour therapy provides support for carers of children with ADHD, and may involve teachers as well as parents. Behaviour therapy usually involves behaviour management, which uses a system of rewards to encourage your child to try to control their ADHD.
If your child has ADHD, you can identify types of behaviour you want to encourage, such as sitting at the table to eat. Your child is then given some sort of small reward for good behaviour, and removal of a privilege for poor behaviour.
For teachers, behaviour management involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.
Parent training and education programmes
If your child has ADHD, specially tailored parent training and education programmes can help you learn specific ways of talking to your child, and playing and working with them to improve their attention and behaviour. Parent training can be helpful before your child is formally diagnosed with ADHD. Its aim is to teach parents and carers about behaviour management (see above), while increasing confidence in your ability to help your child and improve your relationship.
When there are sufficient numbers of interested parents I also offer 6 meetings in a Parent Group for parents of youngsters with ADHD. This is for an hour monthly between September and June.
Social skills training
Social skills training involves your child taking part in role play situations, and aims to teach them how to behave in social situations by learning how their behaviour affects others.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a talking therapy that can help your child manage their problems by changing the way they think and behave. A CBT therapy would try to change how your child feels about a situation, which would in turn potentially change their behaviour.
Other possible treatments
There are other ways of treating ADHD that some people with the condition find helpful, such as cutting out certain foods and taking supplements. However, there’s no strong evidence these work.
Medication for ADHD
There are four types of medication licensed for the treatment of ADHD:
- methylphenidate
- lisdexamfetamine
- atomoxetine
- guanfacine
These medications aren’t a permanent cure for ADHD, but may help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.
Some medications need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended, to assess whether the medication is still needed.
In the UK, all of these medications are licensed for use in children and teenagers. Atomoxetine is also licensed for use in adults who had symptoms of ADHD as children.
Methylphenidate
Methylphenidate is the most commonly used medication for ADHD. It belongs to a group of medicines called stimulants that work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour.
Methylphenidate can be used by teenagers and children with ADHD over the age of six. Although methylphenidate isn’t licensed for use in adults, it may be taken under close supervision from your GP and specialist.
The medication can be taken as either immediate-release tablets (small doses taken two to three times a day), or as modified-release tablets (taken once a day in the morning, and they release the dose throughout the day).
Common side effects of methylphenidate include:
- a small increase in blood pressure and heart rate
- loss of appetite, which can lead to weight loss or poor weight gain
- trouble sleeping
- headaches
- stomach aches
- mood swings
Lisdexamfetamine
Lisdexamfetamine is a similar medication to dexamfetamine, and works in the same way.
It can be used by children with ADHD over the age of six if treatment with methylphenidate hasn’t helped. You may continue to take it into adulthood if your doctor thinks you’re benefitting from treatment.
Lisdexamfetamine comes in capsule form, which you or your child usually take once a day.
Common side effects of lisdexamfetamine include:
- decreased appetite, which can lead to weight loss or poor weight gain
- aggression
- drowsiness
- dizziness
- headaches
- diarrhoea
- nausea and vomiting
Atomoxetine
Atomoxetine works differently to other ADHD medications.
It’s known as a selective noradrenaline reuptake inhibitor (SNRI), which means it increases the amount of a chemical in the brain called noradrenaline. This chemical passes messages between brain cells, and increasing the amount can aid concentration and help control impulses.
Atomoxetine can be used by teenagers and children over the age of six. It’s also licensed for use in adults if symptoms of ADHD are confirmed.
Atomoxetine comes in capsule form, which you or your child usually take once or twice a day.
Common side effects of atomoxetine include:
- a small increase in blood pressure and heart rate
- nausea and vomiting
- stomach aches
- trouble sleeping
- dizziness
- headaches
- irritability
Atomoxetine has also been linked to some more serious side effects that it’s important to look out for, including suicidal thoughts and liver damage.
If either you or your child begin to feel depressed or suicidal while taking this medication, speak to your doctor.
Guanfacine
Guanfacine acts on part of the brain to improve attention and it also reduces blood pressure.
It’s used for ADHD in teenagers and children if other medicines are unsuitable or ineffective.
Guanfacine is usually taken as a tablet once a day, in the morning or evening.
Common side effects include:
- tiredness or fatigue
- headache
- abdominal pain
- dry mouth
Diet
People with ADHD should eat a healthy, balanced diet. Don’t cut out foods before seeking medical advice.
Some people may notice a link between types of food and worsening ADHD symptoms. For example, sugar, food colourings and additives, and caffeine are often blamed for aggravating hyperactivity, and some people believe they have intolerances to wheat or dairy products, which may add to their symptoms.
If this is the case, keep a diary of what you eat and drink, and what behaviour this causes. Discuss this with your GP, who may refer you to a dietitian (a healthcare professional who specialises in nutrition).
Supplements
Some studies have suggested that supplements of omega-3 and omega-6 fatty acids may be beneficial in people with ADHD, although the evidence supporting this is very limited.