Attention Deficit Hyperactivity Disorder (ADHD) in Children

Attention deficit hyperactivity disorder or ADHD as it is commonly referred to is a common mental disorder that is diagnosed in children. It can continue till the child reaches his teens and sometimes even adulthood. It can affect the child’s behaviour and performance at school as well as impact relationships with people.

What is Attention Deficit Hyperactivity Disorder?

ADHD causes children to become hyperactive, and they are unable to focus on the activities at hand. It becomes increasingly difficult for them to control their impulses nor are they able to pay attention to their studies at school. The symptoms of ADHD are at times difficult to diagnose and vary from person to person. During the early school years, a child may have difficulty in focusing on studies and paying attention to what is being taught. This is the time when ADHD is generally discovered to have affected the child. Daily activities like brushing teeth, getting ready for school, and finishing homework can become challenging for children who suffer from it.

Generally, it is the class teacher who notices the symptoms when he/she observes that the child is restless and has trouble sitting in a place for long. Kids with Attention Deficit Hyperactivity Disorder are also identified by their overexcited behaviour and animated way of interacting with others, along with peculiar attention issues.

Like ADHD, ADD in children (Attention Deficit Disorder) is also noticed quite early during their growing years. However, since kids with ADD are not hyperactive, they generally escape attention. They are mostly in their own world and seem to be daydreaming most of the time. It is a subtype of ADHD, and its formal name is ADD – Predominantly Inattentive Type.

Difference Between ADD and ADHD

ADD means Attention Deficit Disorder, while ADHD stands for Attention Deficit Hyperactivity Disorder. Hyperactivity is the key differentiator between both terms. The primary difference between ADD and ADHD is that those affected by ADHD are extremely hyperactive and are unable to sit still even for short time periods. It is their restlessness that gives a clue to their teachers and parents. They have attention issues, and their behaviour is often mistaken for rowdiness, which is generally not the case. As opposed to this, kids who suffer from ADD are thought to be moody, isolated, shy, and in their own dream world. They will never disrupt class sessions and can remain unnoticed in daily life, while they quietly suffer from this ailment. However, both disorders affect one’s ability to remain focused on daily activities like homework, interacting with other kids, and listening to the teachers.

ADD is a subtype of ADHD and is often used in place of ADHD by teachers and parents. It is formally known as ADHD – Predominantly Inattentive Type and is now recognised by this name in the medical world. Overall, there are three types of ADHD, the other two being ADHD-Predominantly Hyperactive-Impulsive Type and ADHD-Combined Type (this shows symptoms of both – Inattentive and Hyperactive-Impulsive types).

As opposed to ADHD, kids who are affected by ADD (ADHD-Inattentive type) are unable to follow instructions they receive from their parents and teachers. Following directions and completion of simple tasks becomes difficult for them and this projects an image of being forgetful and careless. Since they are slow to respond and cannot process a barrage of information, they appear sluggish to the outside world. Parents feel that their child is ignoring them or is being plain stubborn and this turns out to be quite a frustrating experience for them while raising the child.

Symptoms of ADD (ADHD-Inattentive type) are barely noticeable as related to a serious disorder and are muted as compared to other forms of ADHD like hyperactivity and impulsiveness. This results in the overlooking of such individuals, and the condition can then continue well into their teens and adulthood without being treated. Parents of children with ADD should remember that the act of ‘ignoring’ parents is not a willful one. Such children are simply unable to process information that allows them to focus on essential things in life.

How Common is Attention Deficit Hyperactivity Disorder in Kids?

As per various studies and surveys conducted the world over, ADHD is more common in kids than thought to be earlier. The percentage of occurrence in kids has grown over the years with children between the ages 4 to 11 years being diagnosed with it. However, kids between 2 to 5 years are also diagnosed with ADHD, and the number has steadily grown and risen significantly over the past few years. Studies have also shown that boys are more likely to be affected by this disorder or its variants than girls. Kids who suffer from ADHD may not have been diagnosed properly during their childhood, and this could lead to a late diagnosis during adulthood.

Who is Affected by ADHD?

This is a disorder that mostly occurs in children and is a difficult condition to diagnose. Males are three times more likely to be afflicted by ADHD than females. About 10% of men are likely to be diagnosed with this attention disorder during their entire lifetimes, while about 5% of women will be diagnosed as compared to men. Also, the average age of diagnosis is 7 years, while the typical symptoms will appear when a child is aged between 3 and 6 years. Children can be diagnosed at different ages. For example, the average age of a mild disorder is 8 years, moderate is 7 years, and severe is 5 years. The more severe the disorder, the earlier it is detected.

However, this is not a disorder that is common only with children since individuals over the age of 18 years may also have to deal with ADHD. Children living below the poverty line face an increased risk of getting diagnosed than children from higher income households.

Types of ADHD

As discussed earlier, Attention Deficit Hyperactivity Disorder is divided into three main types:

• Inattentive type
• Hyperactive-Impulsive type
• Combination type

To determine the type of ADHD, one has to study the symptoms. The diagnosis is complete if the symptoms have an effect on daily life. These symptoms must be monitored carefully as they can change over time. We already discussed the Inattentive type (ADD) in detail. Let us explore the other types too:

1. Hyperactive / Impulsive Type

This ADHD type is identified by various symptoms of hyperactivity and impulsiveness, with slight traces of inattention too. You can expect the child to be constantly engaged in one activity or another as he or she has difficulty in sitting still. This type will chatter constantly, is impatient, and will talk out of turn without worrying about its consequences.

2. Combined Type (Inattentive/Hyperactive/Impulsive)

As the name suggests, this type is a combination of the inattentive and hyperactive-impulsive behaviour where symptoms of both the categories are displayed. Children with combination type ADHD experience symptoms like hyperactivity during their pre-school years. Those who suffer from it display this behaviour at school, home, and during social interactions, often causing social friction.

Causes of ADHD in children

The following are a few:

1. Genes

Evidence shows that ADHD can be passed down from parents or relatives as there is a strong heritability factor attached to it. A child who is diagnosed with ADHD is more than likely to have a relative who suffers from the condition.

2. Diet

Certain dietary components may be responsible for this disorder. Young children and teenagers who indulge in an overdose of refined sugar, fat and sodium are twice as likely to be diagnosed with it.

3. Brain Injury

Children who suffer from brain trauma or injury due to a hit on the head, stroke or brain-tumour can experience irregular impulses and motor activity along with attention-related issues.

4. Social Circumstances

ADHD is known to be aggravated by some parenting styles and social circumstances. A stress-filled environment at home could also worsen the symptoms.

ADHD Symptoms in Kids

The following are the common symptoms of ADHD:

1. Symptoms of Inattention

A child suffering from inattentive ADHD has difficulty in absorbing and organising new information. You are likely to catch them daydreaming and becoming distracted easily. They will have trouble completing homework and will lose focus quickly.

2. Symptoms of Hyperactivity

A Hyperactivity ADHD child can be recognised through their constant fidgeting, squirming, and tapping of the feet. They will talk incessantly, even when not spoken to and are unlikely to interrupt others while they speak.

3. Symptoms of Impulsivity

A child who is affected by impulsivity will interrupt others while they speak and are also prone to starting conversations at inappropriate times. The child will have difficulty in waiting for his/her turn while answering questions.

Related Disorders

While diagnosing ADHD, the doctor is also likely to check the child for conditions that are similar and can coexist with it. These disorders include:

1. Learning Disability

Children diagnosed with ADHD are often found to have a specific learning disability which makes it difficult for them to learn math or reading. Dyslexia is often an accompanying disorder for such children and prevents them from reading and forming words.

2. Conduct Disorder

A large percentage of children who suffer from ADHD go on to develop conduct disorder which is serious antisocial behaviour. Such children may be prone to lying and stealing. They have frequent run-ins with the law and school authorities.

3. Tourette Syndrome

Though this is a rare syndrome, children who suffer from it are known to have ADHD. It is a severe neurological condition that causes repeat mannerisms and many nervous tics like a frequent clearing of the throat, frequent blinking, sniffing and snorting.

Risk Factors

Risk factors for ADHD include the following:

• Premature birth
• A parent or a sibling or any other blood relative with ADHD or any other mental disorder
• Use of drugs, alcohol, or excessive smoking during pregnancy
• Continuous exposure to a toxic environment and substances like lead that is found in paint or the piping system of homes and buildings

Complications

Children who are diagnosed with ADHD have a difficult life ahead of them since they are unable to interact with their peers properly and hence do not get accepted easily. Academic incompetence is quite common as they are unable to cope with classwork and other activities. They are also more accident and injury-prone compared to other children. Due to poor self-esteem and low confidence levels, ADHD kids often stray towards delinquent behaviour and are at an increased risk of alcohol and substance abuse.

Skills Affected due to ADHD in a Child

The following skills are likely to be poorer in children suffering from ADHD:

• Concentration: Following directions or maintaining a train of thoughts
• Impulse Control: Filtering of inappropriate thoughts or showing good judgement
• Organization: Time management, organizing items needed to complete a task
• Physical control: Staying still, not touching things or people

Diagnosis

ADHD in children cannot be diagnosed using a single test. It is diagnosed after a child shows all or a few symptoms of ADHD for six months or more. For children, psychologists, psychiatrists or paediatricians can diagnose the condition using standard guidelines that are set specifically for this purpose. The childhood ADHD test includes collecting relevant data and information from parents, schools, neighbours and friends. In this test, the psychiatrist compares the child’s behaviour with that of other children of the same age and also uses rating scales to document this behaviour.

Treatment

Once diagnosed, there are several treatments available for the child. These include:

1. Medications

ADHD medication is helpful in reducing impulsivity and hyperactivity while boosting physical coordination and the child’s ability to focus on the work at hand. Through regular use of stimulants, it is possible to enhance the release of chemicals like dopamine and norepinephrine that help in thinking and attention.

2. Behavioural Treatment for Childhood ADHD

Behavioural therapy is a kind of psychotherapy that helps a person and their families to cope with daily problems. It is helpful in changing behaviour to a certain extent. It is also helpful in teaching a child to monitor his own behaviour and learn social skills that are necessary to move about confidently in the society without assistance.

3. Other Treatments

In addition to the above, there are other options available too. These include:

• Avoiding food colourings and additives: This can help manage some symptoms as food colourings and preservatives may trigger hyperactive behaviour
• Adopt an allergen-free diet: Avoiding chemical additives, chocolates, foods containing salicylates (like berries, apples, chilli powder, tomatoes and more) and sometimes even milk and eggs may help improve behaviour
• EGG Biofeedback: This is a kind of neuropathy which measures the waves of the brain
• Enroll the child in Yoga or Martial arts: The discipline involved helps children to focus better
• Spending time outside: Spending 20 minutes outside in a natural setting can help improve concentration

Things You Can Do At Home

It is important to learn how to handle a child with ADHD at home as this can help reduce related complications:

• Create a routine that your child can follow. This includes all regular and important activities like carrying out household chores, watching television or playing games, mealtimes, bedtime and study routines.
• Pay attention to your child while giving instructions as multitasking while speaking to him/her could confuse the child.
• Praise and appreciate all the small tasks the child is able to carry out on his own.
• Be consistent with your expectations from your child and set limits that they can both understand and follow.

School Tips for ADHD Child

Students with ADHD can benefit a lot with a little help from teachers, and this needs taking a few steps around seating, information delivery, classwork and homework. Teachers should create a few warning signals like a hand signal or a note to stop behaviour that can disturb the class. Place the child in a distraction-free area during regular classwork and tests. Also, give one instruction at a time and make maximum use of visuals and charts to explain concepts.

Positive Effects of ADHD

While the world sees ADHD as a setback to life, there are many positive effects that it can have on the person. Here are some of them:

• People with ADHD are quite adept at adapting new strategies and looking at the positive side of life, easily recovering after a fall.
• Since they have faced challenges in life, they develop humility and self-respect, not to mention a quirky sense of self-deprecating humour.
• Children who suffer from ADHD are often more caring and love to share things with people they love and care for.

Do Children Outgrow ADHD?

Studies have shown that children with ADHD often grow up to become adults with the disorder. ADHD is much more than an annoying childhood disorder and could also lead to another psychiatric disorder during adulthood. However, a small percentage of children do grow up without showing any external signs of the disorder and go on to live normal lives too. With proper healthcare and education facilities, children with ADHD have a better chance at life as adults.

ADHD in children needs to be treated as a chronic illness because if it is left untreated, it can lead to numerous long-term complications and issues. This includes reading and writing troubles, difficulty in building and sustaining personal relationships, and OCD. In many cases, traits like hyperfocus, creativity, and leadership can serve as advantages to kids suffering from ADHD, as long as they receive proper guidance and support.