ADHD - Attention Deficit Hyperactivity Disorder

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ADHD

Introduction

Attention Deficit Hyperactivity Disorder, more commonly referred to by the acronym ADHD, is a spectrum condition involving a triad of behaviour difficulties: hyperactivity, impulsivity and inattention. Though there is some evidence of all three characteristics in those with ADHD most people are predominantly hyperactive and impulsive, while others are principally inattentive.

ADHD diagram

The characteristics of ADHD are distributed throughout the population and vary in severity. Only where this causes significant impairment (at least a moderate degree of psychological, social and/or educational or occupational impairment) will they meet the criteria for a diagnosis of ADHD. Diagnosis is usually based on the presence of symptoms before the individual is 7 years old though it may be later before a formal diagnosis is made. Diagnosis can only be made by a health professional such as a paediatrician specialising in behaviour and/or childhood development.

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How does ADHD present in children and young people?

Inattention - the following are frequently seen:

a short attention span - easily drifts away
easily distracted - attention quick drawn to any noises and movement
often make careless mistakes - e.g. copying errors
disorganised - often forgets or loses things
difficulty with time management - needs help with timetables
easily bored - quickly abandons tasks that are tedious or time consuming
poor listening skills - often struggles to follow instructions
poor concentration - requires frequent adult prompts to refocus
constantly flits from one activity to another
poor problem solving and planning skills - difficulty with starting tasks

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Hyperactivity - the following are frequently seen:

restlessness - unable to sit still - frequently wandering about
constantly fidgeting - e.g. picks at things; bites nails or pencils; plays with hair
unable to settle to tasks - may become non-compliant or disruptive when asked to do tasks
constantly on the go - lots of physical energy; doesn't choose quiet, calm activities
excessive talking - very chatty; often told off for talking in school

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Impulsivity- the following are frequently seen:

difficulty with turn-taking - wants to be first; will not wait in line, takes control
acting without thinking - rough play; hurts other accidently or purposely; does not consider consequences of actions
interrupting conversations - blurts out answers; shouts across room; no appreciation of social hierarchy and status of those they interrupt
little or no sense of danger - takes inappropriate risks; does not learn from experience; does not wear safety gear; often has or causes accidents

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Sensory Differences

There is growing evidence that many ADHD individuals have differences in the way they process sensory information. For example, ADHD children who struggle with sitting tend to sense less from their vestibular and proprioceptive systems and need frequent little movements to ‘boost the signal’. These children often enjoy and seek very physical games and sports.

ADHD individuals may also have increased sensitivity to sound, sight and touch, which are the main sensory channels for interacting with the world around them. A consequence of this is that they are easily distracted by novel stimulus such as movement. In busy environments like a classroom this may lead to sensory overload for some individuals.

ADHD children may also be more likely to pick their skin, bite nails, chew clothing etc as a way of coping with sensory needs. There is more information on the page about sensory needs.

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Working Memory

Poor working memory is associated with ADHD. This can make it hard to hold on to explanations and instructions. ADHD individuals are often easily distracted and this causes them to lose information they are storing in their short term memory. This leads to confusion and failure when doing tasks involving a number of steps. There is more information on our page about working memory. There is some emerging evidence that meditation exercises can improve concentration and focus in learning.

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Prevalence and Gender

ADHD is a common behavioural diagnosis with studies varying between 5% to 11% of all children. In terms of gender studies report a ratio of about 6 boys diagnosed for every girl with ADHD. However, many believe that girls are unrepresented in the data due to differences in the presentation of ADHD between the genders. Gender plays an important part in shaping our social, emotional and psychological behaviour. It should therefore not be surprising that most girls with ADHD present differently to boys with ADHD. Diagnostic criteria for ADHD tends to be based on male presentation and symptoms and this may account for the under representation of girls.

Girls also may be more likely to be of the inattentive type of ADHD and therefore be less problematic than the stereotypical idea of a hyperactive boy. Whereas boys tend to externalise their difficulties and get noticed; girls tend to internalise stresses and difficulties and hide them. This may put them at increased risk of developing self-harming behaviours and other mental health issues. ADHD girls can also be much better at masking their difficulties and may for example hide attention difficulties in the classroom by relying on friends for support.

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