ADHD in children

Also known as attention deficit hyperactivity disorder

ADHD is a developmental problem where distraction and impulsiveness can interfere with a person's ability to learn and socialise. All young children have a limited attention span and sometimes do things without thinking. When the level of distraction and impulsiveness becomes so severe that it interferes with your child’s ability to learn and/or develop healthy relationships, it can be a sign of ADHD.

This page is about ADHD in children. See also our page on ADHD in adults.

Key points

  1. ADHD is a developmental problem where distraction and impulsiveness interfere with a person's ability to learn and socialise.
  2. It affects about 5% of the population, normally beginning in childhood and usually continuing into adulthood.
  3. Not all people who are distractible, impulsive and overactive have ADHD. However, if your child does seem to be affected in this way, talk to your doctor.
  4. If your child is diagnosed with ADHD, there are treatments that can help them concentrate and learn. Stimulant medication is currently the most effective treatment for ADHD.
  5. Positive parenting strategies, school support and counselling can also help most children with ADHD and their families.


Which of the following people could have ADHD?

  • A 10-year-old boy with a high IQ who still cannot read or write.
  • A 12-year-old girl with the nickname 'motor mouth' who cannot stop talking.
  • A 4-year-old from a stable home who has been expelled from kindergarten for leading a mass escape.
  • A mother of two whose home is in chaos because no job ever gets finished.
  • A teenager who is a chronic TV channel surfer or X-box addict and a constant fidget.
  • A father of many kids by numerous partners who keeps moving on because he is bored.
  • A soldier who volunteered for bomb disposal and found a minefield in Cambodia to be the most fulfilling place of his life.

The answer may well be that all these people have ADHD.

What are the symptoms of ADHD?

Common signs and symptoms of ADHD are:

  • distraction – difficultly sustaining attention, forgetting instructions and not completing tasks
  • impulsivity – losing control of emotions easily and acting without thinking
  • overactivity – fidgeting and general restlessness. 

There is a wide spectrum in ADHD from the inattentive dreamer to the hyperactive impulsive extreme. The dreamers are much more likely to pass through school unnoticed.

What are the causes of ADHD?

The exact cause of ADHD is not known, but it is thought to be a combination of inherited and environmental factors. These include genes, alcohol or drug dependency during pregnancy, and being male as well as some other factors listed below.

Genes

ADHD tends to run in families. Someone with ADHD is 4 times as likely to have had a relative who had also been diagnosed with ADHD. Genetic research has found that:

  • People with ADHD seem to have lower levels of dopamine in the brain. This is thought to be genetically determined.
  • Certain variations of genes can cause brain tissue to be thinner in the areas of the brain associated with attention.
  • As children with this gene get older, the brain tissue thickens, and the symptoms of ADHD may disappear.

Alcohol or drug exposure during pregnancy

Women who drink alcohol when pregnant are more likely to have a child with ADHD. It is thought that smoking and drug abuse during pregnancy can also increase the risks of ADHD. But the truth is probably the reverse. ADHD greatly increases the risk of alcohol and drug abuse (in the mother). So mothers with ADHD are more likely to drink or abuse drugs. Therefore, the increased risk of ADHD may be due to genetic factors rather than to alcohol and drug abuse itself.

Being male

It's more common for boys to be diagnosed with childhood ADHD than girls. One possible reason for this is that girls who exhibit attention deficit disorder (ADD) are more likely to do so in the absence of the loud, disruptive (hyperactive) behaviour that is used to define ADHD.

Other factors

Other possible aggravating factors in ADHD include:

  • being born prematurely (before week 37 of the pregnancy)
  • having a low birthweight
  • brain damage either in the womb or in the first few years of life
  • excessive exposure to television in children under 3 years of age. 

Contrary to popular myth, ADHD is not a new condition, with one physician in Europe as far back as 1798 noting the core symptoms in some of his patients. Its modern title, ADHD, goes back to 1983, but the realisation that ADHD is not just a childhood disorder came not much more than 20 years ago. Even so, it has taken a long time for ADHD to be accepted as an important problem and it remains a controversial topic.

What is the impact of ADHD?

In children, the combination of distraction, impulsiveness and overactivity can cause learning difficulties and underachievement compared with your child's actual ability. Sometimes, this includes dyslexia, even to the point of illiteracy.

In adults, distraction will cause forgetfulness for names, phone numbers, appointments, car keys, cell phones and wallets. This is stressful, and stress often leads to conflict and depression. More than 25% of patients diagnosed with ADHD have also been diagnosed with depression.  The biggest factor is frustration from knowing you could achieve but repeatedly failing to do so.  This kind of depression or anxiety will often improve or disappear when ADHD is effectively treated.

Impulsiveness is the tendency to speak or act without thinking of the consequence. Most people have a thought and then hold a 'mental committee meeting' to consider the effect of the plan. Very often, the committee will abandon the idea for the sake of the individual or others. In ADHD, the committee is always 'out to lunch'. This leads to actions that cause damage to your relationships – with family, friends, teachers, employers, marriages.

Impulsiveness can take many forms, eg, opening your mouth and 'putting your foot in it', substance abuse, criminal behaviour, violence, suicide, gambling, dangerous driving. Many people with ADHD describe this tendency towards impulsivity as one of ‘ready, fire – aim!’

Overactivity combined with impulsiveness and distraction is a lethal combination. People with ADHD tend to be more accident-prone. Because of this, they are more likely to experience head injuries which can make the problem worse. 

How is ADHD diagnosed?

Not everyone who is inattentive, impulsive and overactive has ADHD. Factors considered when making a diagnosis of ADHD include:

  • how intense the behaviour is and how long it has been going on for – previously undiagnosed adults would have been showing some signs of ADHD in childhood or adolescence
  • whether the behaviour has been happening in a variety of situations, for example, at school as well as at home
  • the absence of any other explanation.

The diagnosis of ADHD is based on:

  • careful listening by the doctor to the patient's history – it can take up to an hour for a patient or a family to tell their story in their own words, with minimum prompting by the doctor
  • simple tests of concentration and of intelligence and sometimes a visit to an educational psychologist to obtain a more accurate measure of ability and specific learning difficulties
  • possibly questionnaires to help make sure all of the key areas are covered
  • corroboration of the story from parents, siblings, spouses and teachers, for example, school reports over a number of years are a great help because comments about concentration, distraction and having trouble completing work, crop up year by year
  • possibly the computer-based Test of Variable Attention (TOVA), which can measure concentration and impulsivity either visually or aurally. The test is 80% specific (if it is positive it is right 80% of the time) and 80% sensitive (it picks the problem up 80% of the time) for ADHD.

While ADHD can be a relatively straightforward diagnosis for a doctor to make, there are other possibilities to consider, which may co-exist with ADHD or be separate issues. At least half the children with ADHD also have oppositional defiant disorder (always taking the opposite point of view), conduct disorder (antisocial behaviour with no apparent conscience) or a specific learning disorder. Moving into the teens and beyond, alcohol and drug abuse is much more common.

Other conditions that can be confused with or present with ADHD

  • Asperger’s syndrome describes children who seem emotionally cut off from others while sharing many of the other features of ADHD.
  • Depression is common because of the frustration caused by ADHD.
  • Anxiety may accompany ADHD because past experience has shown that impulsive decisions frequently go wrong.
  • Obsessive-compulsive disorder occurs particularly in those with ADHD who are perfectionists, frustrated by their unreachable standards in the face of poor concentration.
  • Tourette’s syndrome is a rare and progressive neurological condition that starts off like ADHD.
  • Petit mal epilepsy can mimic the inattention of ADHD.
  • Intellectual handicap from birth or brain damage can appear as poor attention, but these people are achieving according to their limited ability.
  • In adolescent and adults, schizophrenia and bipolar disorder can occur on top of pre-existing ADHD.
  • Hypothyroidism will cause slow responses in those affected, but this condition should be abundantly evident for other reasons.

It is important to keep an open mind until this assessment is complete – there are many factors your doctor must take into consideration before making a diagnosis.

What is the treatment for ADHD?

Treatment for ADHD is a combination of medication and behaviour therapy. Behavioural strategies may include creating structure in the physical and learning environment, helping build social skills and praising appropriate behaviour. Parents and good friends who are firm, patient, consistent and – above all – loving are the best therapists. Find out more about ways to help children at school and home

If after trying these strategies your child’s symptoms are still having a big impact on their life, your doctor may recommend medication. Read more about medication for ADHD.

How can I care for my child who has ADHD?

Learning strategies and lifestyle management are crucial in dealing with ADHD. You can help your child to manage their ADHD by:

  • acknowledging and rewarding achievements and positive behaviour often
  • attending to learning difficulties as soon as possible
  • providing a quiet place without clutter for homework
  • talking with them about the consequences of their actions. 

See the resources in the sidebar and below for help with this.

Support

You may find the support groups below useful for:

  • sharing experiences
  • gaining informal support
  • increasing knowledge about available resources and referral processes
  • exchanging information on strategies that parents have found useful in managing their child’s ADHD symptoms. 

National support and information group ADHD Association, NZ
ADD Information Service NZ
Addventurers@runway.net.nz A support group based in Pukekohe, south of Auckland

You may also find family counselling or parenting courses helpful, and you may be entitled to financial or carer support. Find out more at www.workandincome.govt.nz and www.health.govt.nz/our-work/disability. Talk to your child’s principal about help that may be available at school.

Learn more

The following links provide further information about ADHD. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Ways to help children with ADHD The Royal Children's Hospital Melbourne, Australia, 2012
College resources for students with disabilities Affordable Colleges Online, USA
Research on ADHD ADHD Association, NZ
Attention deficit hyperactivity disorder (ADHD) Kidshealth, NZ, 2016
Children and Adults with Attention Deficit/Hyperactivity Disorder CHADD, US, 2018
ADHD resources, online courses and screening tools Open Forest, US, 2018
Attention deficit hyperactivity disorder Patient Info, UK, 2017

References

  1. Edward M. Hallowell & John J. Ratey. (2011). Driven to distraction - recognizing and coping with Attention Deficit Disorder. 
  2. Edward M. Hallowell & John J. Ratey. (2005). Delivered from distraction  getting the most out of life with Attention Deficit Disorder.

Reviewed by

Dr Tony Hanne is a GP at The Family Practice in Howick and has a special interest in ADHD. He was a member of the original government-appointed National Guidelines Group on ADHD Policy and has written many articles on the subject of childhood and adult ADHD. Tony trained at Guys Hospital in London before moving to New Zealand in 1964. He was based in a group practice in Panmure for 20 years before starting The Family Practice in 1987.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Tony Hanne Last reviewed: 26 Feb 2018