ADHD is the most common behavioural disorder occurring in children today.
It affects between 3% and 9% of school-aged children and young adults in Ireland. It is a Neuro-Developmental condition arising from problems within the developing brain and leading to a series of behavioural issues such as hyperactivity, inattentiveness and poor impulse control. Symptoms include extreme restlessness, marked distractibility and near constant fidgeting.
Its exact cause is unknown although the data suggest a strong genetic or familial basis. The impact of other environmental factors is less certain. Brain function in ADHD differs from that activity seen in healthy comparison children. The main abnormalities involve differences in the frontal lobes, areas that are responsible for executive control and task completion. Chemical messengers thought to play key roles include dopamine and nora-adrenaline.
ADHD symptoms are substantial, prolonged and significantly disabling for a young person. They also represent an enormous challenge for those caring for them. Many cases go undiagnosed for years or at least until they are identified on reaching school-going age.
ADHD problems differ from childhood mischievousness or the youthful high jinks typical in a healthy childhood. ADHD features are not episodic. They arise and persist throughout early childhood (most commonly diagnosed between the age of 3 and 7 years) and they are manifest in more than one area (e.g. home and school or nursery). At diagnosis symptoms have been present for at least six months with a significant and disabling effect on ordinary daily activity.
ADHD does exist in adulthood. By the age of 25 years it is estimated that at least 15% of patients diagnosed with ADHD in childhood have a persisting full blown ADHD condition. Up to 65% will have large number of symptoms. It is not clear whether ADHD can appear de novo in adulthood (i.e. with out any previous childhood symptoms). Treatment for adult ADHD is worthwhile and should be maintained. Without treatment in adulthood hyperactivity tends to decline but inattentiveness persists.
ADHD is recognised far more commonly in boys. It may be that boys present with more disruptive behaviour and so they are more likely to be recognised. Girls on the other hand may be equally inattentive and impulsive but less disruptive and so they tend not to be seen.
Children with ADHD are more likely to have related challenges that amplify and compound their difficulties. These might be referred to as “ADHD Plus”. Common coexisting problems include anxiety, depression, oppositional defiance, epilepsy, OCD and tourettes disorder. Additional psychological, educational and social help is essential in these young people with complex presentations.
ADHD is not a disorder of low IQ but learning difficulties do arise when ADHD is neglected and so the condition has been associated with poor educational performance.
There is no “cure” for ADHD but diagnosis leading to treatment is very worthwhile. The elements of treatment include medication with behavioural social and psychological support as required. Of all treatments for ADHD the most significant is medication. This fact alarms some parents at first but the substantial functional benefit experienced by many of those treated and witnessed by their families is both compelling and reassuring. Medication creates a period during which young patients can concentrate better, focus more effectively their efforts and thus become less distractible. The effect is maintained by repeating medication. These treatments come in thrice daily tablets or slow release once a day forms. They need prescription and regular monitoring.