In this blog, Dr Sabina Dosani, Child and Adolescent Psychiatrist and Clinical Partner London, looks at what ADHD is and what the causes are thought to be.
Attention deficit hyperactivity disorder (ADHD) is a behavioural syndrome characterised by core symptoms of hyperactivity, impulsivity and inattention. Some children diagnosed with ADHD are predominantly hyperactive and impulsive, while others are chiefly inattentive.
First suggestions of ADHD are typically educational underachievement, but can also be frequent accidents, minor criminality and serious yet not readily explicable disruptions to family life. For a child with ADHD, the outside world rushes in as a flood of noise and images and it is difficult or impossible to decide what is important.
ADHD is diagnosed more frequently in boys than in girls.
Children with ADHD are often found to have one or more other mental health disorders or learning disabilities. ADHD lacks physical characteristics so it recognised by behavioural characteristics. ADHD is generally accepted to be a robust clinical syndrome that satisfies particular diagnostic criteria.
The precise causes of ADHD are unknown. Research has indicated that ADHD runs in families, but the responsible genes have not been identified. ADHD is a medical condition affecting the brain that makes it difficult for children to control their behaviour. Poorly controlled ADHD can have a calamitous effect on the lives not only of children and young people, but also their families, siblings and friends.
Years of being told off or hectored for bad behaviour can contribute to educational underachievement and social disadvantage. The line between normal and abnormal behaviour is often blurred and subjective. Many children who have other emotional or behavioural disturbances also show signs of core ADHD symptoms.
Two diagnostic criteria are in current use: the International Classification of Mental and Behavioural Disorders 10th revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V). ICD-10 uses a narrower diagnostic category, which includes people with more severe symptoms and impairment. DSM-V has a broader, more inclusive definition, which includes a number of different ADHD subtypes.
Definitive diagnosis requires the presence of symptoms before child reaches seven years, and that symptoms continue for at least six months, occur in more than one setting (for instance at home, school, or with friends), cause significant functional impairment and cannot be better explained by another psychiatric childhood condition.
Diagnostic tools are used, such as questionnaires and psychometrics, which ask questions of the parents, school and even the child (depending on their age). A detailed history will be taken to understand the child’s development and challenges. The Psychiatrist or other health professional will also spend time with the child to observe their behaviours first hand.
ADHD differs from naughty or boisterous behaviour in that children with ADHD struggle with inattention, daydream, are disorganised and often lose things. Children with hyperactivity problems seem to be on the go all the time, are into everything and are often restless and talkative. Although many children show some disruptive behaviour as part of growing up, those with ADHD have behavioural problems so all-encompassing and unrelenting it disrupts their lives and the lives of those around them.
It has been suggested ADHD is overdiagnosed and overtreated and that many of these children are simply naughty or boisterous.
A key consideration in differentiating naughty or boisterous behaviour from core symptoms of ADHD, is the degree of functional impairment across multiple contexts, and the degree to which these deficits interfere with a child’s normal developmental trajectory, as perceived by multiple informants.
If you want to find out more about ADHD or talk about an assessment, please call the Clinical Partners triage team on 0203 761 7026.
Clinical Partners is the UK’s largest private mental health partnership, helping children, adults, families and organisations nationwide.