Attention Deficit Hyperactivity Disorder is a common behavioural disorder.

There are 3 subtypes:

• Inattention – difficulty concentrating especially if boring or repetitive, may sit quietly at their work but child is not paying attention, not listening to instructions, not finishing tasks, easily distracted
• Impulsivity – talking over the top of someone, accident prone, blurting out answers before question is asked, interrupting constantly
• Overactivity – constant fidgeting and restlessness, leaving seat when expected to stay sitting, running about, has a ‘short fuse’.

The most common form of ADHD is those with a combination of all 3 types.

Diagnosis

A detailed physical and mental assessment by a Paediatrician or Child Psychiatrist is made using questionnaires and recognised rating scales with information collected from the parent, child, GP and teacher etc. These criteria must be met for at least 6 months and the symptoms must be obvious in most areas of the child’s life.

Some medical conditions like thyroid disease or epilepsy, a traumatic life experience such as a death in the family or divorce or a psychological disorder like anxiety or depression can cause symptoms similar to ADHD.

Certain learning disabilities and behavioural disorders like conduct disorder are also similar to ADHD.

Cause

There is no known cause. There is continuing discussion over the role of genetic, environmental and social factors.

Treatment

ADHD is treated with psychotherapy, education and /or medication.

Many primary school children with ADHD respond well to a reward system with clear consequences for behaviors. Any underlying issues at home or school need to be addressed including bullying, poor diet, sleep problems, family dysfunction. Counseling, skills training and addressing issues of peer relationships, self esteem and anxiety are more useful to adolescents.

In Australia two stimulant medications are used – dexamphetamine and methylphenidate (Ritalin). Stimulants have a calming effect on someone with ADHD helping the person to focus, to concentrate and can improve social skills. Stimulants such as Ritalin are S8 controlled drugs so their supply, distribution and possession are restricted and parents need to be aware of this and monitor usage.

Not all children will require, or benefit from medication so clinical judgement is made on each individual case.

ADHD can persist into adulthood. Teens and adults may not be as hyperactive, but can be restless and inattention persists. They can be disorganised – talking on many things at once and prefer quick fixes as solutions rather than working through a correct procedure. At a time when they are expected to be more self-reliant and responsible you can see how these teen years can be difficult. Help them to stay organised and to get enough sleep. Make clear fair rules allowing for negotiation and compromise. Keep in good communication with school.

Sister Margaret Bates
School Nurse