‘All problems become smaller if you don’t dodge them but confront them’, said William Hasley. This is certainly true when it comes to identifying ADHD early on. Early identification can lead to earlier intervention, and consequently to the best outcomes.
ADD/ADHD (Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder) is a well-known neurodevelopmental disorder. It is a varied condition of children who are inattentive, impulsive, and active at levels higher than expected for their age. For the sake of simplicity, I have used the term ADHD to mean both ADD and ADHD here.
ADHD affects 3-5% of children globally. Like most neurodevelopmental disorders, ADHD is more common in boys when compared to girls. This is also because boys tend to show more aggressive and externalising behaviours that are easier to identify. In contrast, girls tend to show more inattentive and internalising behaviours and are easily missed.
ADD/ADHD results from a genetic imbalance of catecholamine metabolism in the frontal brain. Various environmental factors play a secondary role in the causation of ADHD.
Why is it important to diagnose ADHD early on?
Individuals with ADHD, especially if undiagnosed and untreated, have high rates of low self-esteem, low mood, depression, and anxiety. Their attention difficulties can lead to progressive school failure, leading to poor outcomes in their education and eventually with their employment. People with untreated ADHD have an increased risk of injuries, getting involved in accidents and driving offences. Their impulsive behaviours can lead to drug and alcohol abuse, assaults and finding themselves on the wrong side of the law. These outcomes are all avoidable.
Moreover, children with ADHD are difficult to bring up and parent. They are liable to develop educational, behavioural & emotional problems. As a rule of thumb, the more severe the impairment or symptoms, the earlier ADHD is diagnosed. Hence a considerable number of people with mild ADHD, especially children who are inattentive without being hyperactive, miss getting the right kind of help and support. There is now a massive evidence base to show the advantages of early identification and treatment to minimise the impairments and effects of ADHD.
In this article, I have listed some of the warning signs or pointers that parents and teachers can look out for.
Warning signs of ADHD?
ADHD is a neurodevelopmental condition with three main categories of symptoms: inattention, hyperactivity, and impulsivity. Parents, caregivers, or teachers may notice the symptoms mentioned below.
‘Inattention’ could present as:
- Not paying close attention to details
- Appearing vacant or daydreaming, when engaged in an activity or class
- Making careless mistakes in schoolwork and other activities
- Appearing not to listen to what is being said
- Difficulty in organising belongings and tasks
- Difficulty in getting ready to go outdoors or to school
- Dislike for tasks that require sustained attention, e.g. homework
- Struggling to keep their mind on work or play for long
- Often losing things, e.g. pencils, books, toys, and assignments
- Easily distracted by unrelated sounds or stimuli
- Forgetful in daily activities, e.g. chores, homework
- Getting side-tracked easily
- Needing repeated instructions
‘Hyperactivity’ could present as:
- Excessively fidgety with hands or feet
- Difficulty sitting still and squirming in seat disproportionately
- Difficulty staying seated and hence gets up and moves around in class
- Unduly noisy in play
- Difficulty in engaging quietly in play or leisure activities
- Acting as if ‘driven by a motor’
- Seems to be ‘always on the go’ or are continually moving
- Excessive running around or climbing
- Struggling to get started on projects or tasks
- Can appear erratic
- Difficulty making friendships
- Has trouble keeping friends
- Can appear domineering
- Not picked or last to be picked up for group activities/team sports
- Peer rejection or not getting invited to play or parties
‘Impulsivity’ may present as:
- Difficulty in waiting for one’s turn
- Blurting out answers before the question is completed
- Interrupting in conversations
- Easily excitable and difficult to calm down
- Excessive talking
- Intruding into others’ games or activities
- Is difficult to please or amuse
- Talking out of turn
- Can be angry and resentful
- May threaten or scare others
- Social isolation or lack of good friendships
- Bullying or being bullied
For a child to be diagnosed with ADHD, there are specific criteria that need to be met as defined by the DSM-5 (APA, USA) or the International Classification of Diseases of the WHO. For example, the diagnostic criteria advise that difficulties in the realms of inattention, hyperactivity and or impulsivity should:
- Happen in multiple settings such as home and school
- Occur often
- Present since the early years/primary school years
- Present for at least six months
- Impair the child’s learning, social or extra-curricular activities
- In the absence of other conditions that mimic or present as ADHD
How does ADHD affect the child, family & friends?
ADHD can affect the child, their family, and friends in several ways. A child’s difficulty in paying attention can lead to unsatisfactory progress in learning and academic achievement. ADHD behaviours can make it difficult for the child to take part in group activities and team sports. These ADHD behaviours also make it difficult to keep friendships and could cause peer rejection.
Furthermore, a child’s non-compliant behaviour can be a significant burden on parental relationships and teacher-peer relationships. Lack of a ‘medical label’ of ADHD for a child can lead to various ‘social labels’ being given to a child or parent, e.g. ‘problem child,’ ‘poor parents’ or a ‘difficult family.’ All of this can lead to social isolation and exclusion fro m events such as birthday parties.
Consequently, a child and/or their family can develop low self-esteem, stress, low mood, anxiety, and depression. These may lead a child to bully or be bullied, and his or her parents to separate or divorce. These avoidable outcomes affect parental employment and the family’s income. They also can lead to suboptimal education and poor life outcomes for a child.
What to do if you suspect your child has ADHD?
The first thing to do is not to panic. Next, discuss your concerns with your child’s class teacher or TA (Teaching Assistant). You or your class teacher may decide to watch for a few months before deciding what to do next. You can also speak to your general practitioner (GP) about your concerns. Your GP may decide to wait or refer you to a neurodevelopmental or community paediatrician.
Alternatively, you could seek an independent practitioner if you are concerned about the long wait for an assessment. You should then collate all the information you may have on your child (e.g. reports from pre-school/school, and any other health or developmental records) and bring it to your appointment with the neurodevelopmental paediatrician.
A neurodevelopmental paediatrician will carry out a comprehensive neurodevelopment assessment and devise an individualised management plan. The plan will build on your child’s strengths and address their unique needs. Various non-medical measures such as behavioural, educational, and environmental interventions can be implemented to address the ADHD behaviours. Should these non-medical measures be insufficient in addressing all the child’s ADHD behaviours, then several medical interventions are available to address ADHD adequately.
The outcomes for children and adolescents are better if:
- A child is diagnosed and receives help
- Caregivers/teachers are given the necessary information, support, and advice
- Treatment adherence is maintained
As you can see from the above, identifying the warning signs of ADHD is crucial; if we are to help the child and family receive the help and support, they need and deserve. Doing so would enable the child to fulfil their potential.
- ADDISS: T: 020 8952 2800, web: addiss.co.uk
- Hyperactive Children’s Support Group, web: whacsg.org.uk
- CHADD, web: chadd.org (a leading US organisation)
- Gada S. Community Paediatrics. Oxford Specialist Handbook in Paediatrics. Oxford University Press. ISBN 978 0 19 969695 6. Published Sept 2012.
- Attention Deficit Hyperactivity Disorder: Diagnosis and Management. NICE Guideline, NG87. Published Mar 2018.
- Krull KR, Augustyn M, Torchia MM. Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis, UpToDate. Accessed Jan 2020.
- Posner J, Polanczyk GV, Sonuga-Barke E. Attention-deficit hyperactivity disorder. Lancet, 2020. Volume 395, Issue 10222, Pages 450-462, Elsevier Ltd.