Attention Deficit Hyperactivity Disorder (ADHD)

What is ADHD?

Adult Attention Deficit Hyperactivity Disorder (ADHD) is a condition characterised by the core experiences of hyperactivity, impulsivity and inattention. While these experiences tend to cluster together, some people are mainly hyperactive and impulsive, while others are predominantly inattentive.

Experiences of ADHD are distributed throughout the population and vary in severity; only those with significant difficulties (for example; home, employment, education and social settings) meet the criteria for a diagnosis of adult ADHD.

Living with ADHD

Although the ‘D’ in ADHD stands for ‘disorder’, it is important to realise that ADHD is increasingly being seen as a neurodivergence rather than a disorder. Most people have heard of the problems of living with ADHD, but do not understand that for those with ADHD there are also strengths associated with it. For example, those with ADHD often report the experience of ‘hyper focus’, a state of flow in which they can focus intensely for long periods of time when the conditions which they need for focus are met.

For many with ADHD, when an activity is very interesting to them, when it is appropriately challenging and when there is a short time-based deadline, they can concentrate very successfully. When these conditions are not met, however, many with ADHD can find concentration very difficult. There are also other strengths sometimes associated with ADHD such as creativity and quick thinking.
However, people with ADHD and their family or carers do experience stigma and other difficulties with daily living because of the experiences associated with ADHD.

This is particularly when the environment or task does not meet a person with ADHD’s needs, these difficulties can include:

• Lack of attention to detail.
• Making many mistakes due to doing things too fast.
• Continually starting new tasks before finishing old ones.
• Poor organisational skills.
• Problems with getting organised
• Problems focusing or prioritising.
• Continually losing or misplacing things.
• Forgetfulness.
• Restlessness and edginess.
• Difficulty keeping quiet or speaking out of turn.
• Poor social timing, blurting out responses and often interrupting others.
• Mood swings, quick temper and irritability.
• Limited ability to deal with stress.
• Extreme impatience.
• Taking risks in activities often with insufficient consideration to potential consequences of own or others safety.

Possible causes

The exact cause of ADHD is not fully understood, although a combination of factors are thought to be responsible:

• Genetics or family history.
• Brain function and structure.

Other possible causes

• Premature birth (before 37^th week of pregnancy).
• Low birth weight.
• Brain damage either in the womb or first few years of life.
• Drinking alcohol, smoking or misusing drugs whilst pregnant.
• Exposure to high levels of toxic lead at a young age.

The evidence for many of these causes is inconclusive and more research is needed to determine if they do in fact contribute to the development of ADHD.

What can help?

For many with ADHD, the most important thing is for their different needs to be met as far as this is possible. This is particularly important at school and at home for children, but it is also important for adults, for example in the workplace.

The understanding of others of what ADHD means for those who live with it and of the strengths as well as the difficulties associated with ADHD is also important,Medication for adults with ADHD usually forms part of a comprehensive programme of support that addresses psychological, behavioural and educational or occupational needs.

After environmental modifications (like changes that are made to the physical environment in order to minimise the impact of a person’s ADHD on their day-to-day life) so that the different needs of those with ADHD are met and their strengths recognised, medication may be considered if appropriate.

Psychological interventions without medication may be effective for some adults with moderate difficulties. If difficulties remain despite some benefit from drug treatment, or there is no response to drug treatment, CBT can be useful and may be considered.

Things that might help

• Avoidance of alcohol.
• Avoidance of non-prescribed and illicit drugs.
• A balanced diet, good nutrition and regular exercise.
• Self-help materials.
• Using a diary, planner or organiser.

ADHD in Young People

ADHD is a common disorder in children and young people. It usually starts in early childhood with the core behaviours typically presenting from before the age of 7 years and symptoms sometimes persisting into adulthood. ADHD is a well-defined and widely accepted medical condition consisting of three key experiences:

• Inattention: The child cannot concentrate, skips from task to task, forgets instructions and is disorganised.
• Hyperactivity: The child is restless, fidgety and always fiddling, touching things, runs about and can’t sit still.
• Impulsiveness: The child speaks and acts without thinking and can’t wait their turn.  There may be outbursts of temper.

Behaviours cause significant problems not only at school, but also during after school activities and at home. Each individual child has a different mix of symptoms.

ADHD is common; it is reported as many as 1 in 20 children may have ADHD. Some people do not understand ADHD; do not be put off by this.  Talking to other parents can be a source at supported training programmes.  ADHD can have a significant impact upon family life and relationships with friends.

In those situations where the different needs of children with ADHD are not met, they may find it very difficult to be successful which is why it is so important that these needs are understood.

Parents of children with ADHD may need a great deal of support to help them manage their child’s difficulties. Parents or carers have to manage the day-to-day challenges of living with a child or young person with ADHD.

Parents also have to deal with school problems which are common in these children. Children with ADHD may require much more support and guidance than their peers in most of their everyday lives.

Caring for a child with ADHD can be both difficult and rewarding.  It is vital to realise that ADHD is not your child or your fault, it is an illness.  Children with ADHD can be creative, good at sports and multi-tasking.

Assessment by specialist team

The child and young person will undergo a full assessment of ADHD, this will include:

• A detailed history of presenting symptoms and co-existing conditions.
• Current medications and treatments (this will include alternative therapies, etc).
• Psychosocial, developmental and educational and mental health history.
• Impact of symptoms on educational, psychological, social and occupational functioning.
• Impact of symptoms on peer relationships and family life.
• Physical health, growth and developmental assessment, this may include height, weight, blood pressure, pulse and a discussion around your health.
• Observation in clinic settings.
• Child or young person’s view.
• School liaison may include an observation of your child and child’s teacher interview or questionnaires and  consideration of relevant accompanying reports for example, school, educational psychologist.
• Scoring of rating scales and developmental screening tools.
• Assessment of the child or young person and family needs.
• History of parent or carers’ mental health.

Assessment may also include

• Carer’s assessment which may include an assessment of your needs as a parent or carer.
• Occupational therapy assessment which may be included depending on needs identified by comprehensive assessment.

Once this information is gathered a formulation meeting will be held with you and all professionals involved in your child’s assessment.  This information will be shared with you and an explanation of the conclusion of the assessment and future strategies to support your child.

A cognitive assessment may be completed to assess the learning capacity of your child and highlight the strengths and weaknesses they may have.

Supporting someone with ADHD

Here are some suggestions for how you can best support a friend or family member with their ADHD:

• Do your research and find out as much as you can about ADHD,  not just the medical view but also the perspectives of people who have direct experience of living with ADHD.
• Understand, recognise and acknowledge the unique strengths and abilities of the person as well as the difficulties that they have.
• Often people with ADHD find concentration and completing tasks difficult, and where it might be tempting to step in and complete a task for your loved one, try to allow them space to do this. It can be demotivating for someone else to always be completing things for them.
• Have a discussion about situations they find challenging so that you can avoid those situations, places, experiences, and you can provide more help with certain tasks.
• Have a discussion about the situations and activities they find most rewarding or which they feel most successful and confident in and try to help them build these into their lives as much as possible.
• Building a routine can be helpful in allowing your loved one to plan and work on concentration.