Living with
ADHD

What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental conditions that affects children.

As the name suggests, above normal levels of difficulty paying attention and hyperactivity are key features of the disorder, as is impulsive behaviour.

 

ADHD is a chronic condition. Children with ADHD may also struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age; however, some people may never completely outgrow their ADHD symptoms, but can learn strategies to manage it.

 

Early diagnosis and treatment make a big difference in the lives of people with ADHD. Treatment can also help deal with the symptoms of ADHD, and typically involves medications and behavioural interventions.

 

 

How do you know your child has ADHD?

The primary features of ADHD can range in severity and include the key features of inattention and hyperactive and impulsive behaviour.

ADHD symptoms typically start before age 12 years, but in some children, they may be noticeable in younger children.

 

ADHD occurs more often in males than females, and behaviours can be different in boys and girls; for example, boys may be more hyperactive, while girls may tend to be quietly inattentive.

 

There are three subtypes of ADHD:

  1. Predominantly inattentive: The majority of symptoms fall under inattention.
  2. Predominantly hyperactive/impulsive: The majority of symptoms fall under hyperactive and/or impulsive behaviour.
  3. Combined: This is a mix of symptoms.

 

Inattention

In a child who shows a pattern of inattention, symptoms may often manifest as difficulty sustaining attention and listening when spoken to, as well as distractibility and forgetfulness. Therefore, some children with ADHD may not follow instructions properly and forget to do daily activities like chores or homework.

 

Hyperactivity and impulsivity

A child with abnormal hyperactivity and who struggles with impulsivity may often exhibit general fidgety behaviour; for example, not being able to sit still or sit in one place for an extended period of time. This might also present as overly active and boisterous, noisy behaviour in inappropriate situations.
Hyperactive individuals have trouble sitting quietly or entertaining themselves, and always seem to be ‘on the go’, often talking excessively. A kind of ‘inner restlessness’ might also be indicative of hyperactivity, with an inability to relax peacefully. Excessive daydreaming is also linked to hyperactivity.

 

 

Typical developmental behaviour vs. ADHD

Most healthy children are inattentive, hyperactive or impulsive to some extent at one time or another; for example, it is typical for toddlers or pre-school aged children to have short attention spans and to be unable to stick with one activity for long, while in older children and teenagers, attention span often depends on the level of interest they have in what they are doing at the time.

The same is true of hyperactivity; young children are naturally energetic. In addition, some children just naturally have a higher activity level than others.

Therefore, children should never be classified as having ADHD just because they are different from their peers.

Many issues in childhood can lead to difficulty sustaining attention, but that is not the same as ADHD. It is likely that children who have problems in school but who get along well at home are struggling with something other than ADHD. Vice-versa, the same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.

 

When to see your doctor:

If you are concerned that your child shows signs of ADHD, see your paediatrician or family doctor. Your doctor may refer you to a specialist, such as a developmental-behavioural specialist, psychologist, psychiatrist or paediatric neurologist, but it’s important to have a medical evaluation first to check for other possible causes of your child’s difficulties.

 

 

What causes ADHD?

According to the South African Journal of Psychiatry, ADHD is estimated to affect 2-16 % of school-aged children.

The exact cause of ADHD is not clear. Factors that may be involved in the development of ADHD include genetics, the environment or problems with the central nervous system at key moments in development.

 

Risk factors for ADHD may include:

  • Genetics/having a family history, such as a parent or sibling, with ADHD or another mental health disorder
  • Exposure to environmental toxins, such as lead found mainly in paint and pipes in older buildings
  • Maternal drug use, alcohol use or smoking during pregnancy
  • Premature birth.

While sugar and watching too much televisions is a popular “suspect” by parents in causing hyperactivity, there is no reliable proof that these are a cause of ADHD.

Poor parenting is also NOT a cause of ADHD.

 

 

What are some of the potential difficulties of living with ADHD for my child?

ADHD can make life challenging for children who can have the following difficulties:

  • Academic difficulty in the classroom
  • A tendency for more accidents and injuries than other children
  • Poor self-esteem
  • A greater likelihood of struggling to positively interact with peers and adults
  • An increased risk of alcohol and drug abuse and other ‘delinquent’ behaviour.

 

What conditions are related to ADHD?

Although ADHD does not cause other psychological or developmental problems, children with ADHD are more likely than others to also have co-existing or related conditions, such as:

  • Anxiety disorders, which may cause overwhelming worry and nervousness, including obsessive compulsive disorder (OCD)
  • Mood disorders, including depression and bipolar disorder
  • Oppositional defiant disorder (ODD), generally defined as a pattern of negative and hostile behaviour toward authority figures
  • Conduct disorders, which are marked by antisocial behaviours such as stealing, destroying property, aggression and harming people or animals
  • Disruptive mood dysregulation disorder, characterised by irritability and inability to tolerate frustration well
  • Learning disabilities, including problems with reading, writing, understanding and communicating
  • Substance use disorders, including drugs, alcohol and smoking
  • Autism spectrum disorder, which is a condition related to brain development that impacts how a person socialises with others
  • Tic disorder or Tourette syndrome, disorders that involve repetitive, uncontrollable movements or unwanted sounds or verbalisations.

 

How is ADHD diagnosed?

In general, it is thought that children should not receive a diagnosis of ADHD unless the core symptoms start early in life (before age 12 years) or if symptoms do not create significant problems at home AND at school on an ongoing basis.

There is no one specific test for ADHD, but making a diagnosis will likely include:

  • History taking and physical exam: This is to help rule out other medical possible causes of symptoms, such anxiety or depression, hearing or vision impairments, seizure or tic disorders and Autistic spectrum disorders, amongst others. A family medical history should be taken, and school records should also be reviewed.
  • Interviews/questionnaires and ADHD rating scales: These are usually for parents, caregivers or teachers who know your child well. Different scales are used to help collect information about your child’s activity levels and behaviour.
  • ADHD criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

 

What treatment is available for the management of ADHD?

 

Effective management of ADHD in children includes a combination of medications, behaviour therapy, counselling and education services.

 

Stimulant medications

Stimulant medications (otherwise known as psychostimulants) are the most commonly prescribed medications for ADHD. Stimulants may help increase or balance levels of brain signalling chemicals called neurotransmitters; thereby improving the signs and symptoms of inattention and hyperactivity.

A common stimulant medication is methylphenidate.

There are different formulations of methylphenidate that affect how long the medication takes to act and how long the effects last. Methylphenidate can be short acting (effects lasting up to 3-4 hours) or long acting (7-8 hours), while formulations with an extended release mechanism may have a duration of action of up to 10-12 hours.
The methylphenidate medication your child is using may need to be given once daily (long-acting or extended release) or 2-3 per day (short-acting).

It may take some time to find the correct dose for your child and the dose may need to be adjusted if significant side effects occur or as your child matures.
Ask your doctor about possible side-effects of stimulants and how to take stimulant medications correctly.

 

If your child cannot take stimulants or experiences severe side-effects, your doctor may prescribe other medications that may be effective at treating ADHD, such as atomoxetine and antidepressants. However, these medications may take several weeks before they take full effect.
Contact your healthcare provider if you notice any signs of suicidal thinking or other signs of depression when taking these medications.

 

How do you administer stimulants safely?

It is very important to make sure your child takes the right amount of the prescribed medication safely for effective management of their ADHD. On the other hand, an overdose of stimulant medicine is serious and potentially fatal and there is risk of misuse and abuse.

Stimulant medications are considered safe when your child takes the medication as prescribed by the doctor; however, your child should see the doctor regularly to determine if the medication needs to be adjusted.

To make sure your child is using stimulant medications safely, you should adhere to the following practices:

  • Read and follow all package instructions and warnings carefully: Instructions will include how and when to take the medication and what side-effects to watch out for in your child. Depending on the formulation , the methylphenidate medication your child is using may need to be given once daily (long-acting or extended release) or 2-3 per day (short-acting).
  • Watch for health effects: Some research indicates that using ADHD stimulant medications increase certain heart problems (may increase blood pressure or heart rate) and the risk of certain psychiatric symptoms such as agitation. Before prescribing a stimulant, a doctor will usually assess your child for heart conditions or a family history of heart disease.
    Additionally, you should monitor your child during stimulant use and contact your healthcare provider immediately if your child has sudden new or worsening behaviour or exhibits psychiatric symptoms such as hallucinations (hearing or seeing things that are not real) when taking stimulant medication.
    Some ADHD medications can cause a slowing in growth, so you may need to closely monitor your child’s growth by regularly measuring their weight and height.
  • Store and administer medications carefully: Proper supervision is needed when a child or teenager takes medications; therefore, it is NOT recommended that a young person be responsible for taking their own medications by themselves.
    At home, store medication away from the reach of children and keep locked in a childproof container.

 

ADHD behaviour therapy

Children with ADHD often benefit from behaviour therapy and counselling, which may be provided by a mental health professional. Some children with ADHD may also have other conditions such as an anxiety disorder or depression which may benefit from these as well.

  • Behaviour therapy: Teachers and parents can learn behaviour-changing strategies.
  • Psychotherapy: This form of therapy is more commonly used in older children who can talk about issues that bother them, to explore negative behaviour patterns and learn ways to deal with their symptoms.

 

Living and managing

Some of the following suggestions may help create an environment in which your child can succeed:

At home:

  • Improve your child’s self-esteem: Show your child lots of affection by telling them that they are loved and appreciated. Focusing only on the negative aspects of your child’s behaviour harms relationships and negatively affects their self-confidence. It is also important to remember that all children have special talents and interests that you can foster; this can include sports, art or music, for example.
  • Use identified positive parenting techniques and discipline: Try to avoid situations that you know are difficult for your child, such as sitting through long periods or being in environments with lots of distractive elements, such as a busy shopping mall or a noisy sitting room where the television is playing. Use brief timeouts and appropriate consequences for discipline that rewards good behaviour and discourages negative behaviour. The idea is to interrupt and defuse out-of-control behaviour and allow your child time to regain control.
  • Work on organisation: Help your child stay organised and maintain a regular daily schedule and reminder system like diaries and/or charts for meals, naps and bedtime. Be sure your child has a quiet place to study. Moreover, try to help your child keep his or her environment organised and uncluttered by grouping objects in their room or play-space and storing them in clearly marked spaces
  • Encourage socialisation: Help your child learn social skills by encouraging positive interactions with peers.
  • Practise healthy lifestyle habits: Make sure your child gets enough sleep – fatigue or being over-tired often makes ADHD symptoms worse.
    It is important that your child eat a balanced diet for healthy development. Sugar increases hyperactivity and should therefore limited in your child’s diet.
    Regular exercise is good for health and has positive effects on behaviour when added to treatment. Additionally, try to limit your child’s screen-time, whether television or social media.

In school:

The best results occur when a team approach is used, with teachers working together with parents and mental health professionals.
Try to stay in communication with your child’s teachers and ask them to closely monitor your child’s work; offer positive feedback; remain patient and be clear about giving instructions.

Educate yourself about ADHD and available services. You can refer your child’s teacher to reliable sources of information on ADHD like found on My Dynamics and Let’s Talk. These resources will help you to learn all you can about ADHD and the opportunities that are available to help be your child’s best advocate.

 

 

Support for parents with children living with ADHD

Caring for a child with ADHD can be challenging.  Ask your child’s doctor if he or she knows of any support groups in your area.

Strategies for coping and to promote good relationships include:

  • Set a good example: The important point here, is that, although your child’s behaviour may be frustrating, you must remain calm and patient, especially if you feel your child is out of control. Speak quietly and calmly.
    Learning stress management techniques can help you manage stress.
  • Aim for wider healthy family or support network relationships: It is important for you to nurture your relationship with your partner, other children and the important people in your life.
  • Give yourself a break: Selfcare is important! You will be a better parent if you are healthy, rested and relaxed. Do not hesitate to ask relatives and friends for help. Make sure that caretakers (like babysitters or tutors) are knowledgeable about ADHD and can offer you the correct support.

 

Can ADHD be prevented?

To help reduce your child’s risk of ADHD, it is suggested you follow the behaviours below:

  • During pregnancy, avoid anything that could harm foetal development: This includes factors such as drinking alcohol, using recreational drugs and avoiding cigarette smoke.
  • Protect your child from exposure to pollutants and toxins: This includes avoiding exposure to cigarette smoke and heavy metals like in lead paint, for example.

Contrary to false information mainly spread on social media, there is NO link between ADHD and vaccines, nor with the development of ADHD and allergens such as gluten in wheat or lactose in dairy products.
As such, ALL children should receive a full immunisation schedule. Diets that eliminate certain nutrients have NOT been found to reduce the risk of ADHD in your child or to improve ADHD symptoms, and may actually harm your child’s health and development.

Your child should receive a balanced daily diet with the recommended dietary allowances of vitamins and minerals for healthy development.

 

 

 

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