I see a lot of children through my clinical work who have troubles with attention and concentration, and this may manifest as a variety of different presentations, for example:
- learning problems
- behaviour problems: like emotional dysregulation, oppositional or defiant behaviour, aggression
- social difficulties
- poor self esteem and/or mood disturbance
…and so on.
Attention Deficit Hyperactivity Disorder is a condition of development that causes children to have poor concentration and a limited ability to control their impulses. It is not an illness.
There are so many opinions and misconceptions out there about ADHD, and it is my opinion that general mainstream media does NOTHING to help this problem. As a paediatrician however, it is my job, and my personal mission to support and help children and their families that struggle with these sorts of issues and I take this responsibility very seriously.
ADHD affects children’s “executive functions.” These are the skills that everybody has that enable them to function in an orderly, efficient and appropriate manner. They include skills like:
- Attention and concentration
- Organisation and planning
- Impulse control
- The ability to control inappropriate/unnecessary movement (fidgeting) or speech
- Memory (specifically working memory)
- Task initiation and completion
So “having ADHD” means a lot more than a child being “hyper” or “hyperactive.” Boys are more commonly affected than girls, and in Australia it is said to affect between 3-5% of children. With appropriate therapy and intervention, children with ADHD can lead a completely normal life.
Children with ADHD typically show signs of:
- Inattention – poor concentration, not being able to follow a task through to the end, forgetting instructions
- Motor overactivity – being fidgety and constantly moving
- Impulsivity – have poor emotional regulation, having frequent accidents, doing things “without thinking.”
These difficulties can impact on a child’s ability to learn, to make friendships and to follow directions. It can make it hard for the child to follow instructions and control their own emotions, and this is sometimes interpreted as aggressive or even oppositional behaviour.
Skills in executive functioning are a product of age. That is, they improve as a child gets older.
For example, no one would reasonably expect that a 3 year old child might be able to pay attention to a reading task for 20 minutes, nor would they expect that a 2 year old could cross a busy road safely by themselves. My 4.5 year old daughter still has troubles with controlling her big emotions at times and her attention isn’t fantastic. I am not worried – she doesn’t start school until next year. She’s got time.
In fact, if you asked 100 parents of 3 year olds (boys and girls) if their child is hyperactive and/or have a poor attention span and/or do things without thinking, then 100% of them would respond a resounding “YES!”
This is why ADHD is not able to be diagnosed in very young children. In fact, most often it is not diagnosed before age 6 years or sometimes later. Poor attention and concentration and hyperactivity in little children is NORMAL!
As children get older executive functioning skills improve, to the point that when children start school (aged 5-6 years) we would expect that they would be able to sit for short periods of time to attend to simple tasks.
When children fail to develop these skills in attention, concentration and impulse control within a reasonable time frame AND it starts to interfere with the way that child is able to function at home and at school, we then start to consider whether a primary attention deficit is the problem. A paediatrician (after referral from your GP) will work with parents to collect information from school and home and if the symptoms cause significant impairment in functioning across contexts, only then will a formal diagnosis be considered. Not all children who are inattentive, over-active and/or impulsive have ADHD.
There are different types of ADHD, depending on the signs and symptoms that the child displays. They may be primarily “Inattentive type” (kids that are quiet and daydreamy); “Hyperactive/impulsive type” (kids that move around a lot and do not think before they act); OR they might display all of these and be diagnosed with “Combined type.”
If your child is diagnosed with ADHD then your paediatrician will discuss with you the options for intervention that are available.
I prefer to start with behavioural and environmental modification strategies. These include things like
- sitting the child towards the front of the classroom
- reducing excess noise and distraction (eg turning off TV and radio at homework time) where possible
- having a predictable routine and structure to the day
- making sure children have built in rest breaks
- keeping instructions brief and limiting them to one step at a time
- getting close and establishing eye-contact before giving an instruction
- bolstering their self esteem (and rewarding desirable behaviours and task completion)
- building social skills (eg supervision and scaffolding around play time with peers)
If there are problems with learning or classroom conduct, it is very important to make sure that hearing and vision have been tested recently to be normal.
Medication is another option for children with ADHD. Stimulant medication is the most common group of medicines used for this purpose and are effective and largely safe for children in the treatment of symptoms of ADHD. Side effects can and do occur, but can usually be dealt with by modifying the dose of medication the child is taking. It is best used in conjunction with non-medication strategies for optimum effect.
There is no single test to diagnose ADHD. A paediatrician will gather information from history and examination and piece these together to see if a diagnosis is appropriate
Kids with ADHD do not have an illness. They can and often DO lead a full and normal life with the appropriate support and/or intervention
Not all children who have poor attention and motor overactivity have ADHD
Management of ADHD may involve non-medication based strategies (environment & behaviour modification, counselling, school and home support) as well as medication in some instances.
I hope this has been useful to some of you out there.
Remember if you are worried or concerned about your child, seek the advice of your family GP who can refer you onto a paediatrician if need be.
Until next time,
xx Dr Megs