ADD and ADHD: what are they?

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• What are ADD and ADHD?
• Signs and symptoms
• What causes ADHD?
• Other problems that can occur with ADD and ADHD
• The importance of assessment
• Reminders
• Books for more information

Our community is now more aware that some children who may have been called ‘bad’ or ‘naughty’ may have attention deficit disorder (ADD) or Attention deficit hyperactivity disorder (ADHD). ADD or ADHD are not the reasons for every type of difficult behaviour in children. It is important to have a proper assessment, so that the right kind of help can be given to your child.

While a teenager may have better control over his behaviour, many children do not ‘grow out of’ their ADD or ADHD, and they continue to have problems concentrating in high school.

What are ADD and ADHD?

ADD and ADHD are a group of behaviour problems where children have more difficulty with concentrating on what they are doing (problems with attention) than other children of their age. Some, but not all, of these children will also have a much greater activity level (hyperactivity) than other children of their age (i.e. they have ADHD).

These difficulties occur due to the way that the child's brain works. They are not caused by brain damage but specialised brain imaging tests can show differences in brain function compared to children without ADD or ADHD.

ADD and ADHD do exist, they are real, but there is a lot of disagreement about how many children have the condition. Some studies suggest that about 2% of primary school aged children have ADD or ADHD, while others have suggested that almost 18% have ADD or ADHD. Most estimates are between 5-10%. Boys are at least 4 times more likely to be diagnosed with ADD or ADHD than girls.

Signs and symptoms

Your school-age child may have ADHD if he is having difficulties both at school and at home and has had at least six of the behaviours listed below in either of the following groups. Remember that for younger children these are part of normal everyday behaviour. Children who are distressed or unhappy for other reasons, or who have other learning problems can also show these behaviours.

Inattention

The child often:

• misses details or makes careless mistakes in schoolwork or other activities
• has trouble organising tasks and activities
• loses things needed for tasks or activities, e.g. toys, school assignments, pencils, books
• has trouble sticking to tasks or play activities
• does not seem to listen when spoken to directly
• doesn't follow through instructions that he is able to understand, and does not finish tasks (e.g. at school or chores at home)
• tries to get out of doing things that require a lot of thinking and concentrating (these are hard work and tiring)
• is easily distracted
• is forgetful in daily activities.

Hyperactivity/Impulsivity

The child often:

• fidgets with hands or feet, or squirms in his seat
• leaves his seat in the classroom when he should be seated
• runs about or climbs excessively (more than most other children)
• has trouble playing quietly
• is continually ‘on the go’
• talks ‘all the time’
• blurts out answers before the questions have been completed
• has difficulty awaiting his turn
• butts into conversations or games.

Other behaviour

You might also notice the following:

• the child's behaviour pattern is different from most other children of about the same age
• the behaviours happen in more than one place, for example at home and school
• the behaviour has lasted for more than six months
• the behaviour pattern started before age seven years
• the child does not have other major health or development problems
• the behaviour is causing the child problems with schoolwork, friends and daily living.

The last thing listed here is very important - the behaviour pattern must be interfering with the child's ability to get on with his life, to learn or fit in with his world.

Adapted from the 'Diagnostic and Statistical Manual of Mental Disorders, DSM-IV’

What causes ADHD?

Despite at least 40 years of research worldwide there is no clear explanation for why ADHD happens in some children.

• Specialised brain imaging has shown slight variations in the way that a child's brain works. These variations cause the child's brain to deal with some activities, information and feelings in a different way from other children.
• Family inheritance partly explains ADD as it tends to ‘run in families’. Often other family members also have difficulties with their behaviour or with learning.
• For some children who have ADHD, some foods (such as sugar and food colourings) seem to trigger more ‘out of control’ behaviour, but food is not a trigger for many children with ADHD. Being at a party often triggers ‘out of control’ behaviour which might be due to foods, but the behaviour is more likely to be due to too much excitement.
• Sleep apnoea (blocking of the airway during sleep) is linked to problem behaviours in many children. Some research has shown that about 30% of children who have ADD or ADHD have some sleep apnoea. Signs of sleep apnoea include snoring (often loud snoring) and breathing that stops for a brief time during sleep. Not all children who snore have sleep apnoea, but if a child with ADHD also snores, this might be part of the problem.

There is not yet a full explanation for ADHD, which doesn't mean that it does not exist – we simply have to wait for some of the answers.

Other problems that can occur with ADD and ADHD

It is common for children with ADD or ADHD to have other problems.

• Many will not do well at school, and may have specific learning problems.
• Many children who are diagnosed with ADD or ADHD will have behaviour problems such as conduct disorders, anxiety disorders, mood disorders and motor coordination problems (be clumsy).
• In secondary school, a teenager needs to be better organised, and be able to concentrate for longer times compared to younger children. Although his behaviour may be better than when he was young, his problems with learning may be greater, and it can be worthwhile for him to continue taking medication if it has been useful when he was younger.

The importance of assessment

Without a full assessment of why a child may be having difficulties, there is a risk of overlooking very important aspects of the child's needs, and of using the wrong treatment for the problem. Insist on a thorough assessment for your child if you are worried about ADD or ADHD before you try any treatments.

The assessment should include:

• assessment of the child, including his development, behaviour, how well he manages at school
• psychology assessments to work out how he manages different tasks, including learning
• thinking about what is happening for the child at home and how your discipline works
• assessment of the child's school and friendships
• a family assessment: ADD and ADHD run in families, but stress within the family can trigger behaviour problems in children, so thinking about other people in the family is important
• checking that he can see clearly and has normal hearing
• checking to see if there are other reasons to explain your child's behaviour, such as sleep apnoea, illness or medicines.

Assessment should involve parents, teachers, psychologists, doctors and possibly others, depending on your child's needs. Brain scans and EEGs (Electroencephalograms or brain wave tracings) are usually not needed. They are not helpful in working out whether a child has ADD or ADHD, but they might be useful for some children, for seeing if there are some other problems such as epilepsy.

It is also important that other problems which often come with ADD and ADHD, such as specific learning problems and difficulties with movements (coordination), are fully checked and that a plan is made to help your child manage them if they are present.

Note: Preschool-aged children do many of the things that would be called ADD or ADHD in older children. ADD and ADHD does happen in the younger age group but extra care is needed in assessing young children's behaviour. 

Reminders

• Make sure that your child's behaviour is not caused by something else. Have a proper medical assessment.
• ADD and ADHD are only two of many possible explanations for inattentive, distractible or hyperactive behaviour in children.
• The management of ADD and ADHD is not simple. It involves many people – it is important to share difficulties and successes, especially with teachers.
• To really help your child, devote some extra attention to other areas such as behaviour and learning.

Books for more information

Barkley, R. A. (2000). Taking charge of ADHD: the complete authoritative guide for parents (revised edition). London: Guilford Press.

Cooper, P. & Ideus K. (1996). Attention deficit hyperactivity disorder: a practical guide for teachers. London: Fulton.

Green, C. & Chee, K. (1998). Understanding ADHD: a parent's guide to attention deficit hyperactivity disorder in children. Doubleday, Sydney.

Hallowell, E. M. & Ratey, J. J. (1995). Driven to distraction: recognising and coping with Attention Deficit Disorder from childhood through adulthood. New York: Simon and Schuster.

Ingersoll, B. D. (1995). Distant drums different drummers: a guide for young people with ADHD. London: Jonathon Cape.

Ingersoll, B. D. (1998). Daredevils and daydreamers: new perspectives on attention deficit hyperactivity disorder. New York: Doubleday.

Kurcinka, M. S. (1991) Raising your spirited child: a guide for parents whose child is more intense, sensitive, perceptive, persistent, energetic. US: HarperCollins.

Parker, R. N. (1992). Making the grade: an adolescent's struggle with ADD. Plantation (Fl): Speciality Press.

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