What is ADHD and ADD?
Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) have been recognised since Greek times. ADHD is one of the most common neurodevelopmental disorders and affects 7% of school age children. Three times as many boys are affected but it is not an age-related disorder. 35% of individuals affected also have oppositional defiant disorder. 25% affected also have a conduct disorder.

How do I know if my child has ADHD?
ADHD is not a disorder that can be identified by one test.
It depends on the frequency, severity and duration of the behaviour.

Before the diagnosis can be made, the symptoms have to have been present from a young age, and the child has to have the problems in more than one setting. That's why it's important for both the parent and the doctor to make sure that there is a clear picture of how the child behaves at school, as well as at home.
It's true that, in different circumstances, individuals can appear better or worse - trying to keep quiet in church is different from quietly watching a football game. It also depends what's expected from the individual child as children with ADHD can show variable patterns of behaviour which suggests a lack of control e.g. they may show over-attention and seem into everything in some areas, and they may seem to lack attention in others.

A child's behaviour can be misdiagnosed as ADHD when actually they are suffering because of other problems e.g. DCD, hearing problems, Tourettes syndrome, trauma including abuse, speech and language difficulties, dyslexia, Asperger's Syndrome. There is a correlation with increased school failure and ADHD, and long-term difficulties in the workplace as well as in other areas, such as showing negative behaviour like dependency on alcohol and nicotine.

The signs to look out for are:

• Hyperactivity
• Impulsivity
• Attention problems - the child has difficulty working on his own or with groups in a classroom, and finds it difficult to follow the teacher's commands at times.

Starting a task may be fine, but seeing it to an end may be very difficult for the child, who may break off and move on to something else. The child may not be able to plan and see the whole so does not have a vision of a completed task but rather sees a task in fragmented parts, not one section relating to any others.

• Disruption - The child's behaviour has an impact on their work and interrupts other children in the classroom. He/she may show this by making a noise or moving around and inviting others to join in his conversation.
• He/she may behave inappropriatiately in certain situations - not being able to adapt and be flexible, seeing and cognifying how to behave in one situation rather than another e.g. running around a field is fine, running around in a church is not!
• Often has difficulty playing and engaging in leisure activities quietly.The child may need verbal reinforcement to help him with the task.
• Often intrudes or interrupts others or has difficulty awaiting his turn.
• He/she may seem to concentrate well in a one-to-one situation when he/she can be brought back to the task in hand. It is when the child is placed in a real situation where he/she has to listen, attend and record, for example, in the classroom, that the child's distractibility appears to be at its worst.
• The inattentive child may miss parts of a conversation and so miss the meaning. This has a knock-on social impact for the child and how others see him/her.
• The child may not always seem to listen when spoken to.
• He/she may have difficulty organising activities or tasks.

How is ADHD diagnosed?

Usually using rating scales for home and school to compare behaviours and see consistencies and inconsistencies. The Connors scale is the best known method and is one of the most consistent. It compares the child in school and at home to show consistent patterns of behaviour in different settings.

How should ADHD be managed?
If your child is diagnosed with ADHD and prescribed drug treatment, it is necessary to consider ongoing monitoring.

At present the most common medical treatment is the use of Ritalin or similar compounds. Ritalin (methylphenidate) is started at a lower dose and gradually increased up to a twice daily dose. It's usually given after breakfast and after lunch, and its effects last about four hours. Some children need a further dose at four o'clock.
Some children may be sensitive to Ritalin, and find their appetite or sleep pattern is affected, but if the dose is adjusted this may be controlled. There are now long-acting versions of the drug that mean that only one dose need be given daily. This can increase efficacy and compliance.
Psychosocial treatments have been used. There's little evidence to show that combined treatments are more effective than single therapy with medication.
Combined treatments may have an effect on other symptoms such as anxiety, and social skills.

The symptoms of most children with ADHD will improve with age but a proportion of adults do continue to have symptoms into adulthood.

What to do at home

• Develop consistent routines at home, and school
• Keep rules clear and simple and give reminders calmly (remember - the child does not intend to be difficult)
• Try and redirect behaviour
• Talk to the child with their full attention and keep reinforcing this
• Check that the child's making eye contact before giving instructions and give instructions
• Supervise closely; the child's impulsivity may place them in dangerous situations
• Be positive about the child and continually look out for them 'being good' and praise them
• Try to ignore minor irritating behaviour
• Provide clear disciplinary consequences such as time-out

Working with the school

Co-operation between parents and teachers is essential. Blaming staff or blaming parents is counter-productive to addressing the child's needs at school and home.

Children with ADHD need to be supported with an educational programme designed for their specific needs. School is often where the child faces their greatest difficulties and a management plan needs to be developed in collaboration with teachers. Working with the school is essential.

Children with ADHD respond well to a highly organised and routine classroom structure, with a minimum of visual distraction and noise. They perform best if seated at the front of the room, as close to the teacher as possible. Frequent adult input throughout the day may be necessary to keep the child on task, interspersed with breaks to move around and burn off excess energy.

The child should be praised and rewarded for on-task behaviour. Clear consequences for unacceptable behaviour need to be specified. Underlying learning difficulties will require additional individual or small group remedial instruction. Other allied health professionals may be involved. For example, occupational therapists can offer specific programmes for handwriting or gross motor difficulties, as can a speech and language therapist for language difficulties.