ADHD – Attention Deficit / Hyperactivity Disorders

Firstly it is probably useful to say what we mean by the diagnostic terms:

Inattention (Attention Deficit).

Essentially here we are looking at difficulties in paying attention to detail, making careless mistakes in school work, struggling to sustain attention, or often not able to listen even when being spoken to directly.

There may be difficulty following through on instructions, completing work, or organising activity efficiently. The individual may have poor time management and struggle to meet deadlines. There may be reluctance to engage in tasks that require sustained attention, and the young person may frequently lose or misplace things they need such as school materials, keys, glasses etc. The individual may be easily distracted, and/or forgetful,

Hyperactivity and impulsivity.

This is likely to be a young person who constantly fidgets or is on the move. They may leave their seat in class frequently, run around, climb things, and be unable to engage in quiet play.

This young person is likely to struggle to sit still, always needing to be moving or doing something, possibly talking excessively, blurting out answers before the question is finished, interrupting others or struggling to take turns. They may have difficulty with boundaries around using other people’s things.

Diagnoses may be “combined”, or may be (1) or (2).

BUT: Differential diagnosis is extremely important.

It is really common for non-clinicians to incorrectly label a child as “ADHD”, to the extent that I have even seen one referral from a (nameless!) school which simply requested “ Please prescribe medication for this child with ADHD” (a child who had not yet even been assessed by a trained clinician, and in fact turned out to have had trauma). So here are a number of things which can look a lot like ADHD, but aren’t!

Attention Deficit can be caused by:

Anxiety,
social phobia,
depressed mood,
grief and loss,
sadness,
domestic violence,
child abuse and trauma.

Children who are emotionally overwhelmed often find it really hard to concentrate, hard to complete tasks, they become depressed, and this too can affect (weirdly) how great you feel and how motivated you might be to just get right on and finish that bit of school work.

Children who are exposed to family violence, or punitive, angry parents, can become hyper-vigilant – this can make it impossible to focus in class, as the child is constantly checking who is around them or behind them. I once raised my hand in a room to acknowledge a passing colleague, and a child in front of me flinched so hard he nearly fell off his chair. If parenting looks and feels like a reign of terror, it is probable that a parenting programme would be helpful. If there is family violence, tell someone – there is help or advice available from almost every agency in almost every town. There is also a shielded icon for Women’s Refuge on our main page.

Hyperactivity and impulsivity can often be caused by similar issues:

Anxiety,
social phobia,
child acting out due to domestic violence
family problems,
child abuse,
attachment issues,

But also…..

Children who struggle academically sometimes try to get put out of the classroom so they don’t have to be seen to “fail”.

Boys in particular often have a higher need for physical exercise to burn off energy, and sometimes are seen as “having ADHD”, when actually a good run once in a while is as effective as medication for some.

So the best advice is to first carefully consider whether what is happening may have a more run-of-the-mill explanation, rather than rushing to get a diagnosis and medication. By all means go and see someone, but don’t necessarily assume that a drug is the answer.

What if it really is ADHD? What is going on here?

Most people have a brain which has a certain level of brainwave activity:

But if they have ADHD there is less activity:

But by seeking constant stimulation from the environment, they can get enough external stimulus to

get the brain all fired up.

Then they feel OK J

(It’s just that now everyone else feels exhausted…..)

So in fact when we treat ADHD, we use a stimulant medication, so that the child does not need to work so hard to activate their environment to feel “normal” and get their brain properly online.

Why do we need a proper diagnostic work-up? Why don’t they just prescribe?

Because so many things can look like ADHD, but need to be excluded. It is always useful to carefully consider all the other issues that may be impacting on a child, before we start them on a stimulant drug.

All views expressed in this information sheet are those of the author, however based on broad research and clinical experience. Any feedback may be directed to the author: Steve Williams, Consultant Clinical Psychologist, Director: C&A Hub.