All children get hyperactive sometimes, but for some it’s a real problem. Paediatrician, Dr Kerry Robinson, looks at identifying and treating Attention Deficit Hyperactivity Disorder

According to clinical guidelines produced by NICE, the National Institute of Clinical Excellence, 69,000 school age children in England and Wales have ADHD (that’s about 1%) However, there’s been a lot of controversy regarding the use of the stimulant drug, Ritalin, to treat ADHD in children and teenagers. Opponents claim that Ritalin is over prescribed and unnecessary, and rallies have been organised to try to stop the use of psychiatric medication in treating children.

The NICE guidelines show that 70% of children diagnosed with ADHD do not receive Ritalin. The truth of the matter is that the British public and the medical profession have been slow to accept Attention Deficit Hyperactivity Disorder (ADHD) as a real illness. Being a relatively new diagnosis, many doctors went through medical school hardly aware of its existence. This is not to say it did not exist. It did. It just wasn’t recognised. Now it has been identified and treatment is available.

What is ADHD?

ADHD, sometimes called ADD (Attention Deficit Disorder), is a psychiatric illness found predominantly in children who have three main behaviour problems:

• Hyperactivity
• Impulsive behaviour
• Short attention span

How does someone get ADHD?

We don’t really know. We know it’s much more common in boys, and research suggests there’s a genetic component. It’s thought that the genes fail to control the part of the brain involved with the chemical dopamine correctly. Dopamine is a natural chemical responsible for transmitting signals between nerve cells in the brain. An imbalance in the amount of dopamine in the brain causes abnormal behaviour. Using medication can redress this imbalance.

The symptoms of ADHD are nothing to do with bad parenting
Many parents who have one child with ADHD, have other children who behave normally and do well at school.

What should I do if I think my child has ADHD?
The first port of call would be your GP. If necessary you will be referred to a Paediatrician or Child Psychiatrist.

How is the diagnosis of ADHD made?

A child psychiatrist or paediatrician will do this by careful assessment. ADHD is likely to be diagnosed if eight or more of the following long term symptoms are present in a child before the age of seven,:

• Difficulty sustaining attention in tasks or play activities
• Being easily distracted
• Not seeming to listen
• Shifting from one uncompleted task to another
• Losing things necessary for tasks
• Interrupting or intruding on others
• Having difficulty awaiting turn in games or group situations
• Blurting out answers to questions
• Engaging in physically dangerous activities without considering the consequences
• Talking excessively
• Difficulty playing quietly
• Difficulty remaining seated
• Fidgeting or squirming in their seat
• Difficulty following instructions

1. Modifying behaviour: As a parent you can learn specific ways of talking and playing with your child, which have been shown to improve attention and behaviour.

These include:

• Anticipating problems before they get out of control
• Communicating clearly and with conviction
• Diversion when problems start to escalate
• Getting out and about out of doors
• Avoiding issues that aren’t important

• Confrontation
• Shouting
• Smacking
• Overuse of the word 'no'

How does Ritalin work?

Probably through the chemicals dopamine and noradrenaline. These are stimulant chemicals found naturally in the brain. In people without ADHD, dopamine and noradrenaline are released relatively steadily. In ADHD it is thought they are released in bursts, giving rise to the impulsive behaviour, hyperactivity and difficulty paying attention. Ritalin (and Dexamphetamine) is thought to increase the levels of these chemicals in the brain. By giving drugs to provide a steady supply of these chemicals, the surges are ironed out. Many parents notice a dramatic improvement when medication is started – children calm down, are able to concentrate better at school and respond more appropriately to parents and teachers.

What about side effects of medication?

Loss of appetite, headaches, problems sleeping and stomach irritation are some of the common side effects, but these need to be balanced against the benefits of the drug. Bad side effects are most pronounced when the drugs are first started, and usually settle over time.

Some children are on Ritalin for a long time, but good doctors will try ‘drug holidays’, at least once a year, to assess their behaviour without the drug. You have to bear in mind that, psychiatric illnesses take ages to treat, and the equivalent of a week's course of antibiotics is about six months on psychiatric medication.

What if I don’t want my child to take medication?

Understandable, but there are benefits to using medication: if Ritalin helps your child perform better at school, and so get a better education, mix better with their peers and function more effectively in the family setting, then it’s doing some good. Around 70% of children will continue to suffer from the condition into adolescence and 10% will continue to have symptoms in adulthood.

Children with ADHD who aren’t treated generally don’t do well at school, because they have difficulty concentrating. They can’t maintain friendships, lose confidence and eventually make a downward drift in society. They commonly develop ever more complex and deep-seated behavioural disturbances and end up in young offenders institutes and/or abusing drugs – all this could potentially be avoided with careful treatment both in the form of drugs and education.