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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 home.

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 adult life.

Treatment

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 self-esteem.
• 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.
• Forgetfulness.

'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 danger.

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 up early.

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 health services.

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 year.

With thanks to Lincoln ADHD support group