Attention deficit hyperactivity disorder RET0252

Attention deficit hyperactivity disorder is a genetically determined condition that affects

those parts of the brain that control attention, impulses and concentration.

There is no specific test for ADHD but it is important that a psychiatrist or paediatrician
makes a diagnostic evaluation. If you suspect that your child or a child you know has
ADHD you may wish to alert their parent or teacher, so that the child can be referred
early and the condition can be identified. This will enable treatment to be started to
help the child achieve their full potential.

This fact sheet provides information on:

1. What is ADHD?
2. What are the symptoms of ADHD?
3. What are the different types of ADHD?
4. How is ADHD diagnosed?
5. What causes ADHD?
6. How is ADHD treated?
7. Further information

1. What is ADHD?

ADHD is thought to affect 3–7% of school age children but does also affect adults. The
best description of ADHD is that a person who has this condition shows disruptive
behaviours which cannot be explained by any other psychiatric condition and are not
in keeping with those of the same-aged people with similar intelligence and
development. These behaviours are usually first noticed in early childhood, and they
are more extreme than simple 'misbehaving'. People with ADHD have difficulty
focusing their attention to complete a specific task. Additionally they can be
hyperactive and impulsive and can suffer from mood swings and 'social clumsiness'.

ADHD develops in childhood and is most commonly noticed at the age of 5. Research
suggests that 80% of children diagnosed with ADHD continue to experience
symptoms during adolescence and 67% continue to have symptoms into adulthood.

2. What are the symptoms of ADHD?

The symptoms of ADHD are:

• Inattention
People who are inattentive have a hard time keeping their mind on one thing, and may
get distracted or bored with a task after only a few minutes. Focusing conscious,
deliberate attention to following instructions, and organising and completing routine
tasks may be difficult. Inattention can lead to making careless mistakes and losing
things regularly.

• Hyperactivity
People who are hyperactive always seem to be in motion, they can't sit still; they may
dash around or talk incessantly. Sitting through a lesson can be an impossible task.
They may talk excessively, interrupt others, roam around the room, squirm in their
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Rethink is the operating name of the National Schizophrenia Fellowship, 28 Castle Street, Kingston upon Thames, Surrey KT1 1SS Phone 0845 456 0 455, Fax 0208 547
3862, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2007, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice Line: 0208 974 6814 Monday-Friday 10am-3pm.
seats, wiggle their feet, touch everything, or noisily tap a pencil. They may also feel
intensely restless. Not all people with ADHD are hyperactive (see types of ADHD
below). Hyperactivity is usually easily observable, but in some cases, it can be
‘internal’ and can be experienced as anxiety.

• Impulsivity
People who are overly impulsive seem unable to stop their immediate reactions or
think before they act. As a result, they may blurt out answers to questions or
inappropriate comments, or run into the street without looking. Their impulsivity may
make it hard for them to wait for things they want or to take their turn in games. They
may grab a toy from another child or hit when they are upset.

3. What are the different types of ADHD?

The symptoms of ADHD (impulsivity, hyperactivity and inattention) are not seen to the
same degree in all people with this condition. As a result doctors recognise three types
of people with ADHD:-
• the predominantly hyperactive-impulsive type
• the predominately inattentive type
• the combined type.

There is also a fourth type, which does not fit into any of the three categories and
which doctors classify as ‘ADHD not otherwise specified’.

4. How is ADHD diagnosed?

Only health care professionals can diagnose ADHD. However, it is possible that a
child psychologist or psychiatrist, paediatrician, social worker, educational psychologist
or GP will be in involved in this process.

The healthcare professional carrying out the diagnosis must rule out any other
condition that might be causing the unusual behaviour or moods, such as learning
disability, hearing impairment, autism or depression. Sometimes, symptoms relating to
moods seem similar to those of bipolar disorder (manic depression). In this case, a
psychiatrist who has experience of bipolar disorder should assess the individual so
that the correct diagnosis can be made.

There is not one specific test for the diagnosis of ADHD, but is it likely that the
individual’s mental processes will be tested and their behaviour rated and compared
with the diagnostic manual DSM-IV.

ADHD can be diagnosed as mild, moderate or severe. Mild and moderate forms may
sometimes respond well to treatment without medication, but this will vary between
individuals.

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Rethink is the operating name of the National Schizophrenia Fellowship, 28 Castle Street, Kingston upon Thames, Surrey KT1 1SS Phone 0845 456 0 455, Fax 0208 547
3862, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2007, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice Line: 0208 974 6814 Monday-Friday 10am-3pm.
5. What causes ADHD?

ADHD has multiple causes. It is not, as might be imagined, caused by bad parenting.
The evidence suggests that the causes are genetic and neurobiological (physical
make up of the brain). Whilst some environmental factors will influence the way in
which the disorder develops, they should not be thought of as causing ADHD.

Genetic causes

ADHD has a significant genetic component: most differences in the severity of

symptoms are due to genetic factors. For example, if a family has one ADHD child,
there is a 30–40% change that another brother or sister will also have the condition
and a 45% chance (or greater) that at least one parent has the condition. If the child
with ADHD has an identical twin, the likelihood that the twin will also have the disorder
is about 90%.

Physiological causes

The brains of children with ADHD have been shown to be consistently different from
those of children without the disorder. Overall brain size is generally 5% smaller in
affected children than children without ADHD. While this average difference is
observed consistently, it is too small to be useful in making the diagnosis of ADHD in a
particular individual. Also there are differences in brain activity between people with
ADHD and those without. In people with ADHD, the brain areas that control attention
appear to be less active, suggesting that a lower level of activity in some parts of the
brain may be related to difficulties sustaining attention.

Research has also suggested that in a small percentage of cases, ADHD can be due
to injury to specific regions of the brain during its development. For example, use of
alcohol, tobacco or street drugs during pregnancy, premature delivery with associated
minor brain bleeding or accidental head injury after birth could cause ADHD-like
symptoms.

Environmental causes

ADHD is not associated with purely social factors such as poor parenting, family
stress, divorce, excessive TV viewing or video game playing, or diet, although some of
these factors make a pre-existing condition worse.

6. How is ADHD treated?

Most experts agree that the most effective way to treat ADHD is with a variety of
different approaches.

ƒ Psychiatry/psychology
Psychiatrists and psychologists have a major role in diagnosing ADHD, implementing
behavioural programmes, prescribing medication (psychiatrists only) and supporting
parents.
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Rethink is the operating name of the National Schizophrenia Fellowship, 28 Castle Street, Kingston upon Thames, Surrey KT1 1SS Phone 0845 456 0 455, Fax 0208 547
3862, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2007, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice Line: 0208 974 6814 Monday-Friday 10am-3pm.
 ƒ Behavioural therapies
Behavioural therapies are designed to help the family manage the illness and
improve patterns of behaviour in the person with ADHD. Behavioural interventions
can include:
• family therapy focusing on management strategies
• individual therapy focusing on changing behaviours.

ƒ Medication
Medications which stimulate the brain (psychostimulants) can be prescribed for
ADHD. They change levels of brain messenger chemicals which control the brain
and allow it to work in a normal way, helping the individual block out distracting
stimuli so that they can concentrate. This should also improve moods and help the
person stay calm. Effects associated with moderate doses of psychostimulants are
decreased appetite and insomnia. These effects occur early in treatment and may
decrease with time.

Additionally, antidepressant medications may be used as a second line of treatment

for children who show poor response to stimulants, who have unacceptable side
effects, or who have additional conditions.

American research has indicated that the most effective treatments for primary
school children are either a closely monitored medication treatment, or a treatment
that combines medication with intensive behavioural interventions.

American research has indicated that the two most effective treatment types for
primary school children are a closely monitored medication treatment and a
treatment that combines medication with intensive behavioural interventions, as
follows:

• school-based interventions and preventative measures, which can include: help

with reading, spelling, maths and organisation

• speech therapy

• physical education therapy

• counselling

• social skills training: many children with ADHD have difficulty socialising, as they
do not recognise the more subtle rules of communication so they frequently make
mistakes and are teased by other children; children are taught in groups to think
how their words and behaviour affect those around them

• coordination training: since many children with ADHD have coordination

problems, there are a few therapies that specifically help develop coordination
(known as sensory-motor integration); some children receive this therapy in
schools

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Rethink is the operating name of the National Schizophrenia Fellowship, 28 Castle Street, Kingston upon Thames, Surrey KT1 1SS Phone 0845 456 0 455, Fax 0208 547
3862, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2007, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice Line: 0208 974 6814 Monday-Friday 10am-3pm.
 • diet: some parents see an improvement in their child’s behaviour when the
following foods are removed from the child's diet:
ƒ caffeine – found in chocolate, coffee and some fizzy drinks
ƒ some cordials
ƒ artificial colourings

• parenting support: support for parents is a vital component in the combination of

therapies advised to tackle the disorder; it is particularly important as services to
diagnose and treat ADHD are seriously under funded and overloaded.

Although children with ADHD have unique problems, many of the principles of
parenting still apply, as individuals with ADHD need consistent discipline and a
structured lifestyle.

Parents can attend parenting classes, as well as join associations and self-help
groups to ensure their concerns and opinions are heard.

Further information

The Attention Deficit Disorder Information and Support Service (ADDISS) provides a
wide range of resources, information and support for everyone affected by ADHD.
ADDISS, 10 Station Road, Mill Hill, London, NW7 2JU
Phone: 020 8906 9068
Fax: 020 8959 0727
Email: info@addiss.co.uk
www: www.addiss.co.uk

Last updated 08/06

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Rethink is the operating name of the National Schizophrenia Fellowship, 28 Castle Street, Kingston upon Thames, Surrey KT1 1SS Phone 0845 456 0 455, Fax 0208 547
3862, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2007, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice Line: 0208 974 6814 Monday-Friday 10am-3pm.