ADHD is a complex neurodevelopmental condition estimated to affect up to 5% of the population (Polanczyk et al., 2007). The World Health Organization (WHO) recognises ADHD as a neurodevelopmental condition which affects the neurotransmitters ability to transfer messages through the frontal lobes of the brain.
ADHD is prevalent across the population – ADHD is a non-discriminatory condition affecting people of every age, gender, IQ, religious and socio-economic background. No-one yet knows what causes ADHD; however, research [LINK Chen Q, Brikell I, Lichtenstein P, Serlachius E, Kuja-Halkola R, Sandin S, et al. Familial aggregation of attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry. 2017;58:231–9.). ] has shown a strong genetic link and found that 80% of children with ADHD have a parent with ADHD. Other causes continue to be researched.
“No two children or teens with ADHD are the same”
Diagnosing and treating ADHD is a complex process as sufferers may also have co-occuring conditions such social communication difficulties, sensory processing issues, dyslexia, dyspraxia, Tourette’s syndrome and oppositional defiant disorder (ODD) to mention some. The diagnosis needs to be carried out by an expert and for a diagnosis of ADHD to be considered, the person must exhibit core symptoms (inattentiveness, impulsiveness, hyperactivity), demonstrate significant problems with daily life in several life areas (work, school, or friends) and have had the symptoms for a minimum of six months.
There is an excellent guide to ADHD here.
What is different about the ADHD brain?
The ADHD brain has a chemical imbalance resulting in the poor transmission of messages because of low levels of the neurotransmitter’s dopamine and norepinephrine, which carry messages from one neuron to another. For a clear explanation of the ADHD brain watch this video:
ADHD is not the result of damage to the brain but a dysfunction that means the brain doesn’t work in the way it should. Studies show that ADHD may affect certain areas of the brain that allow us to be organised, plan ahead, understand others’ actions, and control our impulses. Some ADHD brains have difficulty with working memory or executive function compared to the normal brain.
Research and imaging have shown differences in specific areas of the brain in people with ADHD. This MRI scan, shows a normal brain compared with the ADHD brain, which lacks dopamine:
What are classic symptoms of ADHD?
The symptoms depend on what type of ADHD you have (see below) but here are some classic ones:
- Significant attention problems (makes careless mistakes)
- Appears restless (always “on the go”)
- Fidgety
- Overactive
- Impulsive (act before thinking)
- Distractible
- Disorganised
- Have mood swings (unable to manage emotions)
- Speak before thinking by blurting out and interrupting
- Have trouble finishing work or school projects
- Impatient
What are the different types of ADHD?
Predominantly inattentive: Also called attention deficit disorder or ADD, predominantly inattentive ADHD has 6 or more inattentive symptoms and fewer than 6 hyperactive-impulsive symptoms, although hyperactivity-impulsivity may still exist to a certain extent.
Children with predominantly inattentive ADHD are less likely to be noisy or difficult or have difficulties getting along with other kids. They may sit still, but struggle being attentive. Such children are often overlooked because parents and teachers may not notice that the child has ADHD – as is often the case for girls.
Predominantly hyperactive-impulsive: Predominantly hyperactive-impulsive ADHD has the opposite combination compared to predominantly inattentive ADHD. Six or more symptoms are in the hyperactive-impulsive categories, and fewer than six inattentive symptoms. Children with predominantly hyperactive-impulsive ADHD are more hyperactive and impulsive, although inattention may still exist to some degree.
Combined hyperactive-impulsive and inattentive: As its label suggests, combined hyperactive-impulsive and inattentive ADHD occurs when one is inattentive, hyperactive, and impulsive. In these cases, six or more inattentive symptoms exist, as well as six or more hyperactive-impulsive symptoms. This is the most common type of ADHD among children.
To be diagnosed with ADHD, children must have any combination of these symptoms for at least six months at levels surpassing those of other children of the same age.
When do you first notice ADHD symptoms in your child?
Children and teens with ADHD may find life more challenging compared to their peers either at school or home or both. Symptoms of ADHD tend to be first noticed at an early age, and may become more noticeable when a child’s circumstances change, such as when they start school or even more to secondary school. Most cases are diagnosed in children between the ages of 6 and 12, however, diagnosis at a later ages also is prevalent in inattentive ADHD.
Can girls have ADHD?
Childhood ADHD is more commonly diagnosed in boys than girls. Girls with ADHD often have a form of the condition where the main symptoms relate to problems with attention rather than hyperactivity, which can cause less noticeable symptoms. It is therefore possible that ADHD could be underdiagnosed in girls, and could be more common than previously thought. You can find here a video on ADHD in girls and women. For in depth information on girls and ADHD, we recommend J Steers’ excellent book, ‘Understanding ADHD in girls in women’.
Is ADHD linked to intelligence?
ADHD can occur in people of any intellectual ability and those with the condition can be highly intelligent. There is a much higher incidence of having other learning difficulties such as dyslexia or dyspraxia aswell as ADHD. As a result of their ADHD and other learning difficulties, children and young people with ADHD sometimes under-achieve academically if not properly supported. This can be very much as a result of Executive Function challenges (working memory, focus, organisational skills) and not intelligence.
How long do you have ADHD for?
There is no clear evidence that those with ADHD see changes to their brain over the passage of time. There is more anecdotal evidence that people with ADHD report that their symptoms lessen over time as they grow up. Early diagnosis and treatments can make a significant difference to the individual as they learn coping strategies to overcome some of the difficulties they face. Those who are not properly supported can finding life very challenging, which can affect their self-esteem, result in them getting socially isolated and from developing other emotional and behaviour problems that can persist into adult life.
Do all children and teens with ADHD have behaviour issues?
ADHD is not a behaviour condition but we often find that due to the challenges children and young people with ADHD and its co-morbidities face there can be a deterioration in their behaviour. To learn more about this refer to our session dealing with Managing ADHD. Read here about the Myths of ADHD.
Why is ADHD so often associated with other conditions?
Children and teens with ADHD also often have difficulty with social communication issues and sensory processing. Similarly, ADHD frequently occurs alongside other conditions such as ASD, dyslexia, dyspraxia, pathological avoidance disorder (PAD), Tourette’s syndrome and oppositional defiant disorder (ODD). The challenges arising from suffering from ADHD and its co-morbidities also often lead to mental health issues such as anxiety and depression. Co-morbid conditions can be hard to disentangle, and this is part of the reason that specialist assessment is advised for a child with ADHD.
