Attention-Deficit / Hyperactivity Disorder (ADHD) are known to be the most common neurodevelopmental disorder of children. ADHD is a neurobehavioral developmental disorder affecting children with inattention, hyperactivity, and impulsivity as its hallmark symptoms. Academic, social, and emotional functioning of children diagnosed with this disorder is negatively affected. Understanding ADHD can help parents, caregivers, and teachers effectively support children with this disorder.
What is ADHD?
ADHD is a long term condition that usually starts in childhood and can follow the person into adulthood. It’s classified into three main types based on the symptoms:
Predominantly Inattentive Presentation (ADHD-PI): Difficulty focusing, forgetfulness, disorganisation, trouble following instructions.
Predominantly Hyperactive-Impulsive Presentation (ADHD-PH): Fidgeting, talking out loud and any other disruptive or inappropriate behaviour, can’t wait to have a turn.
Combined Presentation: Both inattentive and hyperactivity/impulsivity symptoms
Symptoms of ADHD in Children
Children with ADHD may exhibit:
Inattention Symptoms:
Will make minor mistakes with school work
Inattentive to details while working or playing
Don’t seem to have heard you when you talk to them directly
Can’t follow instructions
Sensitive to surroundings
Hyperactivity and Impulsivity Symptoms:
Fidgets with hands or feet, or fidgets in their seat.
Runs or climbs in inappropriate situations.
Can’t sit still for quiet activities
Interrupts conversations or games
Acts without thinking about the consequences
Causes and Risk Factors
ADHD (Attention-Deficit/Hyperactivity Disorder) is a neurodevelopmental condition characterized by problems in attention, hyperactivity and impulsive behaviour. Despite what its exact cause is not established, some research into the factors seems to point at a mix of genetic neurological and environmental contributors for this disorder.
1. Genetics
ADHD is highly genetic and tends to cluster in families as seen with most other complex diseases.
Specific genes associated with dopamine function (e.g. DRD4 and DAT1) have been identified as being related to ADHD.
Having a parent or sibling with ADHD puts a child at increased risk for developing the disorder as well.
2. Brain structure and function
People with ADHD are also characterized by differences in brain structure (especially the prefrontal cortex responsible for executive function, basal ganglia and cerebellum– all areas associated with habitual processing).
Abnormalities in the brain regions with reduced levels of dopamine and norepinephrine, a cerebral neurotransmitter implicated in motivation/inert attention
3. Factors in Prenatal and the first year of life
Having increased exposure to lead, pesticides or using alcohol during pregnancy as result of toxicity
There is an increased risk for having ADHD, where the prematurity or a low birth weight is related.
Pregnancy maternal smoking, substance use or with high stress levels may be a factor too.
4. Environmental Factors
Early exposure to high levels of screen time, poor diet, and lack of physical activity may contribute to symptoms.
Severe neglect, abuse, or high-stress environments in childhood can impact brain development and executive function.
Diagnosis of ADHD
We can elicit signs of inattention, impulsivity and hyperactivity from detailed history of child’s early developmental pattern along with direct observation of child especially in situation that require sustained attention. The diagnosis requires persistent impairing symptoms of either hyperactivity/impulsivity or inattention in at least 2 different setting. It has to be distinguished from other conditions that have a lot of overlapping symptoms such as anxiety, depression or learning disability.
DSM-5-TR Scheme of Diagnostic Criteria
DSM-5-TR Structure and Content of the Diagnostic Symptom Categories
(6 or more symptoms in children, 5 or more in adults for at least 6 months)
The child is often neglectful of close attention or makes careless mistakes.
Has problems remaining engaged in a task or play
No longer appears to be listening when spoken directly
Does not honour promises or complete tasks, organizing Tasks and Activities
All of the tasks or activities are usually interrupted.
Prefers to avoid tasks that require persistent mind effort
Frequently misplaces things that he/she needs for school.
Easily distracted by aspects that are irrelevant
Distracted in daily activities
Hyperactivity-Impulsivity
Taps feet /hands, wiggles in the seat.
Stands from seat even when expected to remain seated
Runs ladders excessively inappropriate for age/ or restim (adults)
Has a hard time doing activities without making noise
On “The go” or acts like a “hot stove handle.”
Talk fast
Blurt out answers before questions have been asked.
Unable to sit and wait
Interrupts or intrudes on others.
Required for Diagnosis
Symptoms present prior to age of 12
Happens in two or more settings (e.g., home, school, work)
Must be impairment in social functioning, not accounted by another disorder
Treatment and Management
Commonly, the treatment of ADHD contains a mix of medication, behavioural therapy, lifestyle improvements and coping strategies. It varies from patient to patient depending on their age, symptoms level and personal choices.
1. ADHD medications
One of the initial treatments for ADHD, particularly when the diagnosis is moderate-to-severe
2. Stimulant Medications
They boost dopamine and norepinephrine in the brain to enhance attention, impulse control
Methylphenidate-based stimulants
Amphetamine-based stimulants
3. Non-Stimulant Medications
Beneficial for those that does not respond to stimulants or have clear contra-indications
Atomoxetine (selective norepinephrine reuptake inhibitor (NRI))
Guanfacine & clonidine — α2 agonists, for impulsivity and emotional regulation
Behavioural Therapy & Psychosocial Interventions
General recommendations for everyone with ADHD (especially children) and those who do not want to try medication
4. Cognitive Behavioural Therapy (CBT)
Improve executive function deficits, procrastination and emotional regulation
Teaches coping strategies for impulsivity and attention problems
4. Parent Training & Behavioural Therapy (For Children)
Parents receive training in Positive reinforcement techniques (reward-based reinforcement systems)
Consistent structure and clear expectations reduce behavioural issue
5. School interventions
IEPs (Individualized Education Plans) or 504 plans for Accommodations
Sufficient exam time, seating and movement break increases attention.
6. Coaches and support groups
ADHD Coaches — Personalized methods to work, time & organization
Support groups (for individuals/families) to bond and exchange coping mechanisms
Lifestyle & Natural Approaches
These approaches support Medical and Behavioural treatments.
1. Diet & Nutrition
– Omega-3 fatty acid (EPA/DHA) Found in fish oil, may improve focus
High protein less sugar Diet kept Blood sugar stable and you don’t experience the “high crash” of energy
Iron, Zinc and Magnesium– they are the major deficiencies that can induce symptoms
2. Physical activity and exercise
Promotes natural release of dopamine to increase attention
Activities like martial arts, swimming or team sports help to self regulate
3. Sleep Hygiene
ADHD often involved sleeping problems and ultimately worsens symptoms
Consistent sleep time, no screens before bed and relaxation techniques
4. Mindfulness and Relaxation exercise
Meditation, deep breathing or yoga for emotional regulation and a decrease on the stress
Supporting a Child with ADHD
Parents, caregivers, and educators play a crucial role in supporting children with ADHD. Here are some practical tips:
Communicate Effectively: Use clear and concise instructions.
Set Realistic Expectations: Focus on achievable goals and celebrate small successes.
Be Patient and Understanding: Recognize that ADHD behaviours are not intentional.
Encourage Strengths: Identify and nurture the child’s talents and interests.
Conclusion
ADHD is difficult to take care of, but with help children who have it can still live a high quality life. Young people identified early in the pathway may then be supported to receive best possible multi-professional treatment and service if needed for children. We as a team with teachers, parents and caregivers will do our best to make sure a child with ADHD has the same opportunities in life as anybody.
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