Attention Deficit Hyperactivity Disorder (ADHD) is one of the serious psychiatric conditions found in children in the preschool and early school years. It is characterized by inappropriate level of inattention, hyperactivity and impulsivity that is present before the age of seven. A child with ADHD faces lots of difficulties at home and school. It is hard for the young person to control his/her behavior and impulsivity and pay attention. The helpless child might express his/her problems to parents like ‘why am I different?’, ‘why am I called a troublemaker and headcase?’, ‘why don’t I understand lots of things at school which are not difficult to other children?’ and so on. When to suspect ADHD? All children, to a certain degree, will demonstrate restlessness, impulsivity (acting without thinking), or day dreaming. These may not be typical ADHD. However, it is worth suspecting ADHD/ADD if such behaviors begin to affect academic performance or social relationships, or in the circumstance that the child’s behavior becomes disruptive, challenging or beyond control. The signs of ADHD could be listed in two different categories. The most common hyperactive-impulsive signs include:

• Feeling restless, often fidgeting with hands or feet, or squirming while seated
• Running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected
• Blurting out answers before hearing the whole question
• Having difficulty waiting in queue or taking turns.

The inattention signs are the following:

• Often becoming easily distracted by irrelevant sights and sounds
• Often failing to pay attention to details and making careless mistakes
• Rarely following instructions carefully and completely losing or forgetting things like toys, or pencils, books, and tools needed for a task
• Often skipping from one uncompleted activity to another.

Many parents coming to clinic ask if it is their mistake that causing ADHD to their child. There are also concerns regarding the intelligence of the child leading to poor performance at school. ADHD is, in fact, neither caused by lower IQ nor by poor parenting. Rather, it is a neuro-psychiatric disorder with a genetic risk, and is influenced by environmental factors. Some other possible reasons might be alcohol or nicotine abuse by mother while pregnant, low birth weight, and brain infections, though there are no conclusive evidences to substantiate this. Guidance and support from counselors, parents, and teachers would help the young person with ADHD/ADD to achieve his/her full potential in the areas of attention and behavior. If right intervention is not made at right time the individual will be left with high risk of increased difficulty in achieving success in life and might develop the following problems in life:

• Emotional Problems: low self esteem, depression, which might lead to suicide.
• Behavioral Problems: risk taking behavior, oppositional defiant and conduct disorder, substance misuse, anti-social and criminal behavior.
• Physical health problems: arising from alcohol and drug abuse, accidents due to inability to see danger and impulsivity, psychosomatic disorders, cardiovascular diseases and so on.
• Educational Problems: poor academic performance due to lack of attention, suspension from school due to behavioral problems, leaving school early, etc.
• Relationship Problems: Fights with parents, siblings, and partners, difficulties with peers, poor social skills, domestic violence, divorce/separation, etc.
• Employment Problems: loss of job due to misbehavior or impulsive behavior, inadequate performance, etc.

The problems would be endless in any settings including home or social environment if an early intervention is not made. The individual might cause cost burden to other individuals and society in the form of accidents, insurance claims, etc. which might lead to social exclusion, causing further psychological damage to the individual. It is important to know who the right professional to be contacted if you suspect ADHD with your young person. The following table might give you an idea about the health professionals who are trained in this area: 

Specialty	Can Diagnose	Can Prescribe	Provide Therapy
Psychiatrist	Yes	Yes	Yes
Psychologist	Yes	No	Yes
Social Worker	Yes	No	Yes
Paediatrician	Yes	Yes	No
Neurologist	Yes	Yes	No

Assessment

As the symptoms vary so much across settings, assessment of ADHD is not straight forward, especially when inattentiveness is the primary concern. Hence, even if a parent or teacher notices only one of the three characteristics of ADHD namely, inattention, hyperactivity, and impulsivity, it is highly recommended to make appropriate referrals to the healthcare professionals without delay. It is not necessary to have all the three characteristics to be present for an ADHD/ADD diagnosis. Different assessment methods are employed by health professionals to diagnose ADHD/ADD. A clinician would look at the following aspects to make sure that none of these are raising the ADHD/ADD concerns:

• A sudden change in the child’s life—the death of a parent or grandparent; parents’ divorce; a parent’s job loss
• Undetected seizures
• A middle ear infection that causes intermittent hearing problems
• Medical disorders that may affect brain functioning
• Underachievement caused by learning disability like dyslexia
• Anxiety or depression.

The clinician might ask you to fill in a few forms like Conners’, Child Behavior Check List, and also would seek reports from the school. Careful and comprehensive assessment of an individual’s history, behavior and symptoms would help a healthcare professional to make a proper ADHD diagnosis. Hence it is very important to give clear and accurate information as much as possible to avoid misdiagnosis. The clinician might link in with your GP and/or school teachers in order to get clear and up to date information of the case.

Treatment

Effective treatment for ADHD/ADD includes the following:

• Medication
• Behavioral therapy and
• Psycho-education

No single treatment method is the answer for every child. In most cases a combination approach that involves medication, behavioral therapy and psycho-education show good result. When a child is prescribed with medication the parent needs to be fully informed of the side effects of that particular medication. Each child's needs and personal history must be carefully considered while planning a treatment package. In any case, it should be the parent who makes the final decision regarding medication for the child under his/her care.

© Copy Right: 2007, M.G. Lazarus PhD.