When does an energetic, lively child become a problem? When does
its chattering, fidgeting and easy distraction make it a candidate
for a diagnosis of hyperkinetic disorder, or attention deficit
hyperactivity disorder (ADHD)?
Most children are inclined not to pay attention from time to
time, to fidget, and to jump from one activity to another. But
children diagnosed with hyperkinetic/ADHD behave in this way to an
extent that is unusual for children of a similar age and level of
development. The diagnosis also means they have been behaving this
way for at least six months, started before the age of seven, and
are affected in at least two settings, for example at school and at
Without support, ADHD often prevents children from learning well
and disrupts their ability to form friendships.
More boys than girls
About 1.7 per cent of the UK population have ADHD. They are
mostly children, and of those affected, there are about six boys to
every girl. ADHD is a medical diagnosis, but there is no single
diagnostic test and professionals other than doctors – such as
teachers, psychologists and speech therapists – can often
contribute valuable information. This can be information about the
child’s family, or their educational, psychiatric and symptom
history to back up the diagnosis.
Back in control
Many children seem to grow out of ADHD, but research suggests
that in fact what is happening is that, with correct management,
they learn to control it. Around half have problems that may take
the form of depression, irritability, antisocial behaviour and
attention difficulties that are persisting symptoms of ADHD in
Behavioural management techniques are the treatment of choice
for mild ADHD. In the US – and increasingly in the UK – medication
is also used, most commonly stimulant drugs such as methylphenidate
(Ritalin is one well known brand name). The original stimulant
drugs were only effective for three or four hours and meant an
embarrassing trip to the school nurse for top-ups, but a new
slow-release formula is now available.
While stimulants tend to increase attention span and improve focus
there are concerns about their possibly serious side-effects. For
people who are worried about this, non-stimulant medication is
increasingly being used.
Medication will not cure ADHD and it is often combined with
behaviour therapy/modification, counselling and educational
intervention. The exact causes of ADHD are not yet known. Some
believe it is caused by diet and there is evidence that it is the
result of an imbalance of chemicals that affect the
neurotransmitters in the brain.
How you can help
Treatment depends on a child’s exact diagnosis and should take
account of specific difficulties and strengths. It might be
necessary to call on a psychologist for expert support.
General guidelines for managing a child with ADHD:
- Create well defined daily routines.
- Set clear boundaries on behaviour.
- Be consistent but flexible.
- Avoid unnecessary changes in schedules.
- Communicate on a one-to-one basis.
- Reward (eg, give stickers) consistently and often to reinforce
appropriate behaviour, but once a reward is given it should stay
given and not be taken away for bad behaviour.
- Use sanctions (eg loss of privileges, being sent out of the
group/to their room) for unacceptable behaviour or overstepping the
boundaries, but use sparingly as they can lead to low
- Find ways to encourage the child and understand their
particular strengths and weaknesses.
- Help them to be organised.
Signs and symptoms that a child has ADHD:
- Easily distracted, difficulty sustaining attention.
- Failure to listen.
- Restlessness and overactivity.
- Frequent interruption or intrusion on others.
- Impulsiveness and inability to wait their turn.
- Poor social skills and low self-esteem.
‘Harry was made to sit on his own’
From birth, his parents knew he was different from his older
brother and from any other babies they knew. Harry (not his real
name) cried constantly and slept very little. As a toddler he was
constantly into everything. He ran away in shops, wouldn’t stay in
his pushchair, ran into the road and seemed totally unaware of
At playgroup he didn’t interact with other children, was
aggressive, couldn’t wait his turn, wet himself almost daily and
had regular tantrums. His mother was regularly called to pick him
At infant school the problems became even more pronounced. He
was banned from PE and made to sit on his own at the front of the
class. The school psychologist was called in, but he said that
Harry was just a naughty child.
In the juniors there were major problems and emotional and
behavioural support services were involved. At this point his
parents contacted the local ADHD support group who advised that she
contact Harry’s GP to refer him to child and adolescent mental
After waiting seven months for an appointment, the psychiatrist
took a further six months of tests before diagnosing ADHD. The
tests included questionnaires for the family and schools, a
detailed history from birth onwards and a trial period of avoiding
artificial colouring and flavours in food.
As they had already tried the dietary treatment, the
psychiatrist prescribed a combined treatment of medication and
behavioural management. The medication was closely monitored and
increased until the correct dose was reached.
Although the family still have problems, Harry – now aged 10 –
is much calmer, his mother is no longer on anti-depressants and the
family as a whole get along much better. Harry has improved so much
at school that he is expected to do well in his SATs later this
With thanks to Lincoln ADHD support group