This booklet has been written with three groups of people in
mind.
You may be a parent or carer of a child who has been diagnosed
with ADHD (Attention Deficit Hyperactivity Disorder). You may be
wondering whether your child has ADHD, because of difficulties
they are experiencing in settling down, paying attention or
controlling their behaviour. Or you may be someone with a
general interest in ADHD - a relative or friend, a teacher, GP,
or health visitor. Whatever the reason for your interest in
ADHD, this booklet will give you answers to some of the most
common questions about ADHD. It also points you in the direction
of more detailed publications, and gives you details of
organisations that can help.
Throughout the booklet we have included comments and statements
from parents of children diagnosed as having ADHD. Some of these
parents wrote about their experiences as part of the Mental
Health Foundation's Inquiry into the mental health of children
and young people. They have helped us all to understand more
about the impact of ADHD on children and their families. This
booklet concentrates mainly on young children with ADHD. If you
are concerned with older children, teenagers or adults with ADHD
you will find some relevant books listed at the end of this
booklet.
Finally, this is a booklet with an optimistic message. Children
with ADHD and their families have faced many difficulties in the
past, but we now know much more about how to help and support
them - at home, at school, and in their future lives.
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1. What is ADHD? ADHD stands for Attention Deficit Hyperactivity
Disorder. It is normally used to describe children who have
three main kinds of problems:
overactive behaviour ( hyperactivity) impulsive behaviour
difficulty in paying attention Because they are overactive and
impulsive, children with ADHD often find it difficult to fit in
at school. They may also have problems getting on with other
children. These difficulties can continue as they grow up,
particularly if children and families do not get the help they
need.
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Some children have significant problems in concentration and
attention, but are not necessarily overactive or impulsive.
These children are sometimes described as having Attention
Deficit Disorder (ADD) rather than ADHD. ADD can easily be
missed because the child is quiet and dreamy rather than
disruptive. ADHD is not related to intelligence. Children with
all levels of ability can have ADHD.
Overactive behaviour
One mother described the first years of her son's life as
follows:
'The day always began from the moment he was awake with his
exhausting and insatiable demands. No one was prepared to
babysit because he was so exhausting and a liability. It was
impossible to enjoy him and no fun to take him anywhere. His
energy levels were incredible. As parents we wondered where we
were going wrong.' (Alison Douglas, Young Minds 39)
If you have a child with less severe problems, overactive
behaviour may only cause major difficulties when she or he goes
to school. For example, a child who races around the classroom,
unable to sit still, interfering with other children's
activities, will probably not be very popular with other
children, and may be seen as naughty or unwilling to learn.
Impulsive behaviour Being impulsive means acting without
thinking about the consequences. Children with ADHD may be
impulsive in many ways, such as saying or doing the first thing
that occurs to them. They are also easily distracted by
irrelevant things. These children find it very hard to carry out
tasks which involve waiting, since they have great difficulty
stopping themselves from responding straightaway. They will find
it hard to do any activity which involves waiting to give an
answer, or in which they have to take turns.
Sometimes impulsive children find it easier to wait if they are
given a reward for waiting, or some other kind of motivation.
This does not mean that they have been deliberately impulsive.
It just means that they find this kind of task particularly hard
to handle and need extra encouragement to succeed.
Difficulty in paying attention Children with ADHD have a short
attention span. They find it hard to concentrate and therefore
hard to learn new skills, both academic and practical. Research
from the USA suggests that 90% children with ADHD underachieve
at school and 20% have reading difficulties. For example, a
mother of a child with ADHD described how
'Every parents' evening told stories of poor compliance, shoddy
and incomplete work, class clowning, no homework, incessant
talking and easy distraction both to himself and others.'
This explains why it is important to identify attention problems
as soon as possible, preferably before children go to school, so
that they can be given help. Children with ADHD may themselves
be quite distressed, because they do not mean to behave badly in
class but do not know how to change.
Social problems Children with severe ADHD may be rejected or
disliked by other children, because they disrupt their play or
damage their possessions. It is easy for a child with ADHD to
become labelled as troublesome, or for parents to think it is
their fault for not controlling their child. One mother noted
that her six year old son '... gets picked on by children and
adults because he is always being told off by people - other
children blame him for things he didn't do.'
Another parent commented: 'T has only recently been diagnosed.
Until then people thought all his problems were due to his
upbringing. So no help or care was offered until we kicked up
and demanded help.'
Part of the difficulty is that children with ADHD may not
realise how their behaviour affects other people. They may want
to make friends, but have no idea how to go about it, having
never picked up the basic rules of social behaviour which most
children learn naturally. Because the children are impulsive, it
is also easy for other children to 'set them up' to behave badly.
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2. When is a diagnosis of ADHD appropriate? We know that young
children have lots of energy and like to be active. Young
children also tend to have a short attention span - they soon
get tired of an activity and want to move on to something new.
So how can you tell whether your child has ADHD or is simply
restless or bored? To a certain extent it may be a matter of
degree - children with ADHD are not just very active but have a
wide range of problem behaviours which can make them very
difficult to care for and control. For example, one parent
described her eight-year-old son's behaviour as follows:
'(he)... fidgets with hands and feet continually... great
difficulty remaining seated... very easily distracted...
difficulty following instructions... very poor short-term
memory... difficulty sustaining attention on activities for more
than twenty minutes... shifts from one uncompleted task to
another... doesn't seem to listen to what is said... loses
things necessary for a task... engages in some physically
dangerous activities - he acts before he thinks... poor social
skills...'
It is important to remember that no label or diagnosis will give
a perfect description of an individual child. Children are all
different, and will express their problems in different ways.
Diagnosis Diagnosis of ADHD can be quite difficult because:
There is no test for ADHD; we cannot take a blood sample or an
X-ray to make a firm diagnosis. All children have some problems
with self-control and it can be hard to decide where to draw the
line and give a diagnosis of ADHD Other problems can result in
behaviour similar to ADHD, for example langauge or hearing
difficulties, dyslexia, major disruptions in a child's life.
Over half of the children with ADHD will have other areas of
difficulty, such as these, in addition to ADHD. Symptoms The
kinds of symptoms professionals look for in diagnosing ADHD
include
difficulty following instructions or completing tasks difficulty
'sticking to' an activity easily distracted and forgetful often
doesn't listen when spoken to fidgets, is restless, can't sit
still in class can't stop talking, interrupts others runs about
when it is not appropriate blurts out answers without waiting
for the question to finish difficulty in waiting or taking turns
In order to be diagnosed with ADHD some of these problems would
have been apparent before the age of six or seven years.
These behaviours must normally occur in more than one setting
(for example at home as well as at school) for ADHD to be
diagnosed.
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3. How common is ADHD? It is difficult to say exactly how many
children worldwide have ADHD because different countries have
used different ways of diagnosing it. In the UK, diagnosis is
based on quite a narrow set of symptoms, and about 0.5-1% of
children are thought to have attention or hyperactivity
problems. In comparison, until recently, professionals in the
USA used a much broader definition of the term ADHD. As a
result, up to 10% of children in the USA were described as
having ADHD. Current estimates suggest that ADHD is present
throughout the world in about 1-5% of the population.
About five times more boys than girls are diagnosed with ADHD.
This may be partly because of the particular ways they express
their difficulties. Boys and girls both have attention problems,
but boys are more likely to be overactive and difficult to
manage.
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