Attention deficit hyperactivity disorder (ADHD) is a condition that is characterised by hyperactivity, impulsivity, restlessness and inattentiveness. If unsupported, it can lead to educational, social and psychological difficulties.

The condition is more prevalent in children and teenagers, but it can also affect adults. However adults may have differing symptoms to children – instead of hyperactivity, they may experience bouts of restlessness.

ADHD symptoms are typically noticed at an early age. This is especially true with ADHD in children when a child’s circumstances change, such as starting a new school. Children who have the disorder tend to get diagnosed between the ages of 6 and 12.

On this page we will explore the condition and how it affects children, teenagers and adults. We will also take a look at the symptoms, causes and what treatment is available – including counselling for ADHD.

Exploring the condition

ADHD is the most common behavioural disorder, identified in children, in the United Kingdom. Even though the exact figures are unknown, it is estimated that it affects between 2 and 5% of all children. 

A study conducted by Associated Chambers of Commerce and Industry of India in 10 major cities namely Delhi-NCR, Mumbai, Kolkata, Bangalore, Chennai, Hyderabad, Ahmedabad, Chandigarh, Jaipur and Lucknow, a report on which was published in the India Express in Sep 2011, provides an account of the prevalence of ADHD in India. 

According to this report, this study claims that the occurrence of attention deficit hyperactivity disorder (ADHD) in children with symptoms of absentmindedness and being abnormally active is on a rise in the cities of India and has been found more in boys than in girls. 

The study showed that ADHD prevalence rate has increased among boys to 11 per cent from six per cent while among girls it rose to 5.5 per cent from two per cent over the past six years among children of age three to 17 years.

"We interacted with around 1,000 school teachers and doctors. Teachers said that in every single class they have one to three children who are diagnosed with ADHD. 46 per cent of doctors or health care providers found that children at the age of four are more prone to this disease," Dr B K Rao, Chairman, ASSOCHAM Health Council said.

"Prevalence of children diagnosed with ADHD has gone up from four per cent to 11 per cent in the past six years. More boys are affected by ADHD than girls," he said.

Titled 'Rising numbers of ADHD kids in metropolitan cities' this study was conducted between the year 2005 to the year 2011.”

Attention deficit hyperactivity disorder can occur in people of all intellectual abilities. Yet it is far more prevalent in people who already suffer from learning difficulties. People who have ADHD may also suffer from additional problems such as anxiety and sleep disorders.

ADHD symptoms generally improve with age. However adults who were diagnosed at an early age may continue to experience some symptoms and their associated problems.

The different types

There are three different types of attention deficit hyperactivity disorder, and they are:

• Inattentive – Categorised by impaired concentration and attention.
• Hyperactive-impulsive – Categorised by hyperactivity without displaying inattentiveness.
• Combined – Involves all the symptoms and is the most common type.

 

To be diagnosed with attention deficit hyperactivity disorder, your child will have at least six symptoms of impulsiveness and hyperactivity or at least six symptoms of inattentiveness. Also, the symptoms that cause impairment will need to be present for at least six months before the age of seven. Some of the symptoms that cause impairment need to occur in more than one setting, for example at home and at school. The symptoms will interfere with your child’s ability to function in social situations, at school or at home.

ADHD symptoms

ADHD symptoms include impulsivity and hyperactivity and/or inattention. Children tend to display these at one stage or another. But the severity of the ADHD symptoms makes it inappropriate for a child at any age to display them.

The following symptoms may not start appearing until your child enters challenging environments like starting school. For adults, the symptoms may become apparent at work or in social situations.

• procrastination
• disorganisation
• poor attention to detail
• failure to complete tasks that require a lot of concentration
• always jumping from one task to another
• poor attention span
• not adhering to social norms
• frequently changes conversation topics and stops listening to others
• Hyperactivity

• cannot keep still while seated
• excessive talking
• increasing desire to get up to run/walk around
• has difficulty engaging in quiet activities
• wants to always be doing something

 

Hyperactive tendencies may vary depending on the person’s developmental stage and age.  Younger children with ADHD may have difficulty participating in group activities. They will also most likely want to be constantly moving about. For example, they may find it hard to concentrate when listening to a story.

School children display less frequent, but similar behaviour. They tend to squirm a lot, find it hard to stay in their seat, talk excessively or fidget.  In teenagers and adults, hyperactivity may lead to troubles when engaging in quiet activities and it may include

• feelings of restlessness

·Impulsivity

• answering questions before they have finished
• finding it hard to wait one’s turn
• starting conversations in inappropriate situations
• interrupting others, causing problems at work or in social settings
• impatience

It is possible that impulsivity could lead to accidents such as bumping into people and/or objects. ADHD in children could potentially be harmful in situations where they do not consider the consequences. Such situations include climbing trees without thinking about how they can get down.

ADHD symptoms can occur in children who do not have the condition. But for those who do, they occur far more frequently when they are at school, at home or even when spending time with friends. They may also affect the child’s ability to socialise and function normally.

ADHD is generally diagnosed when children exhibit some, or all of these symptoms in at least two different settings for a minimum of six months.

ADHD in children

Approximately 20 to 30% of children and teenagers with ADHD develop learning difficulties that may not improve with the introduction of ADHD treatment. The development of hyperactive behaviour can be linked with other disorders such as conduct and oppositional-defiant disorder.

Most children who have the condition will manage to adjust over time with supportive ADHD treatment. Some however may find it too much and drop out of school. Those who struggle with their treatment may find it harder in later life to hold down a job.

Warning signs

There are a number of warning signs associated with ADHD in children when an increase in responsibility occurs either in school or at home. They include:

• fidgeting – especially with their feet and hands
• talking a lot
• failing to complete projects or assignments at school or at home
• not listening to clear instructions
• getting poor grades at school
• not responding or paying attention to details
• finding it hard to get organised at school or at home

ADHD in adults and teenagers

Experts are unsure if ADHD in adults can develop if they did not have the condition in their childhood.  Over two thirds of children that have the condition will still exhibit symptoms when they reach their teenage years. Two thirds of these teenagers will still encounter a developed stage of these symptoms as adults.

Adults that have the disorder may find it hard to follow directions, remember information, organise tasks, complete assignments within a timeframe or concentrate. If these difficulties are not effectively managed, they may cause associated social, behavioural, academic or emotional problems.

Inattention can persist throughout childhood, the teenage years and then into adulthood. The impulsive and hyperactive symptoms tend to lessen with age.  If teenagers have had ADHD for a considerable length of their childhood, they may experience bouts of depression or anxiety.

Problems that ADHD can cause in adults:

• poor working memory
• depression
• poor organisational skills
• drug addiction
• alcohol abuse
• poor money management leading to debt problems
• emotional instability
• failure to stay in a relationship
• regular change in jobs or unemployment
• gambling

 

Causes of ADHD

The causes of ADHD haven’t been identified. However there are some factors that are believed to contribute to the disorder:

Genes

Studies have suggested that a number of genes that can be inherited may contribute to the likelihood of developing the condition.

Environmental

Many factors can affect brain development before birth and throughout early childhood. Examples include maternal smoking, alcohol or drug abuse while pregnant, a zinc deficiency or a very low birth weight. These may all lead to having an increased risk of ADHD.

Social

ADHD in children has been linked to social adversity in early life. For example, a child who has been taken into care or has had a deprived upbringing might have a higher chance of developing ADHD. The exact causes are not known, but they could possibly include the failure to obtain the ability to control their cognitive and emotional states.

Disrupted relationships at home are more common in families that have children with ADHD. If the child has the condition, troubled relationships with a strict or harsh parenting style could be a risk factor in developing further problems. Also, if the parents have untreated and unrecognised ADHD, it could have an adverse effect when trying to manage a child with the condition.

Diet

The influence of a person’s diet that may have on the development of ADHD has attracted a lot of media attention. A high intake of sugar, food additives, colourings and ‘E’ numbers are all thought to have potential links to ADHD. In some cases, to combat this, supplements and a controlled diet are implemented without consulting professional advice.

NICE (UK) published a set of ADHD guidelines in 2008 and came to the conclusion that there is not enough evidence to support a change in a child’s diet to treat or manage the disorder.

When is the right time to seek help?

Due to the symptoms of ADHD, it can be easy to mistake a child's natural tendencies and development of their personality for the disorder, and vice versa. Both teachers and parents may notice the development of ADHD. The child’s behaviour may make them seem ‘out of control’, and it can be particularly noticeable when they lose interest in tasks and activities quicker than their peers.

If ADHD is suspected, contact your Medical Family Doctor. The Doctor may then refer your child to a child psychiatrist (a doctor who specialises in children’s mental health), a child psychologist (a health professional who specialises in children’s behaviour) or a specialist paediatrician (a doctor who specialises in children’s illnesses). This is to eliminate any other problems, and to get a firm ADHD diagnosis.

There is no specific test to diagnose ADHD. Instead, it relies on monitoring your child’s behaviour and checking and recording symptoms.

This is of course a stressful time for parents. You might be upset, worried and frustrated. Once a positive ADHD diagnosis has been made, there are many adjustments you will need to make to help support your child.

ADHD treatment

There is no cure for attention deficit hyperactivity disorder. There are however different ADHD treatment options that can help keep it under control.  Sometimes a combination of approaches is required, and it is important to try them and see which the child responds best to.

Medication

Medicine may be prescribed, which will change the chemical levels in the brain. There are four types: methylphenidate, atomoxetine, lisdexamfetamine and dexamphetamine. As with all medicines, they can have side effects, which may include weight loss, headaches, mood swings and insomnia.

Talking therapy

Talking therapies include psychotherapy and counselling for ADHD. These can help the child talk about and deal with their problems. Talking therapies can also be useful for parents and can be combined depending on what works best. For instance, you could combine counselling with social skills training.

Some useful talking therapies are listed below:

Behavioural therapy

Behavioural therapy can help provide support to carers of children who have ADHD. It typically involves a reward system to encourage your child to control their ADHD symptoms.  You can encourage certain types of behaviour, such as sitting at the table to eat dinner. Then your child can be given a small reward for that good behaviour.  

 

Cognitive behavioural therapy (CBT)

CBT is a type of talking therapy that attempts to change how people think (cognitive) and what they do (behavioural).  CBT for ADHD can either be carried out one-to-one with a therapist or in a group setting.

 

Parent education and training programmes

Specifically tailored training programmes for parents whose child has ADHD are available. They can help you learn ways to speak, work and play with your child to improve their behaviour and attention span.

Social skills

This type of training involves your child taking part in certain ‘role play’ situations. This hopes to teach them how to behave in a social setting and how their behaviour affects others around them.

What should I be looking for in a counsellor or psychotherapist?

There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat someone with ADHD. However, the National Institute for Health and Care Excellence (NICE) UK, have developed a set of guidelines that provide advice for parents who have children with ADHD, about the recommended treatments:

• If your child is old enough to go to school, they should not usually be offered medication first.

• You should be offered a place on a course to help parents with their child's behaviour. Sometimes it is helpful if your child also attends a course of group treatment, which may be a psychological therapy called cognitive behavioural therapy (CBT) or social skills training.

• If your child is a teenager, one-to-one psychological therapy for them may be an option instead of a course for both of you.

• If your child has a learning disability as well as ADHD, you should be given the choice of group or one-to-one sessions for you and your child.

• If the treatment so far has not helped, your child should be offered medication. This should be alongside other support and treatment including courses for parents and children. Medication may also be offered if you and your child would prefer not to attend a course for parents or have psychological treatment.

Counsellors treating people with ADHD may have to adjust the way they work, therefore it may be worth seeking a professional who has had experience in this area.