Attention deficit hyperactivity disorder (ADHD)

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a developmental disorder that begins in early childhood. ADHD used to be called attention deficit disorder (ADD).

ADHD is often misunderstood. It can cause problems:

• concentrating
• becoming distracted
• being hyperactive (sometimes)
• being impulsive

This may cause people with ADHD to have problems with their:

• schooling
• friendships
• work
• family life

Around 1 in every 20 Australians has ADHD. While ADHD is more common in boys — it’s under diagnosed in girls and adults.

More than 3 in 4 children diagnosed with ADHD still have symptoms as an adult.

What are the symptoms of ADHD?

ADHD can present in 3 ways:

1. Inattentive symptoms — a person is easily distractible but isn’t hyperactive or impulsive.
2. Hyperactive-impulsive symptoms — a person has symptoms of impulsivity and hyperactivity.
3. Combined symptoms — a person has a mixture of symptoms including hyperactivity, inattention and impulsivity.

Inattentive symptoms

People with inattentive ADHD may have these symptoms:

• a tendency to start but not finish tasks
• putting off tasks that need sustained effort
• being easily distracted or daydreaming
• having trouble remembering things
• having difficulty organising tasks, activities, belongings or time
• losing things
• not following instructions
• not paying attention to detail and making careless mistakes
• struggling to focus and concentrate on tasks they find boring or tedious

Hyperactive-impulsive symptoms

People with hyperactive-impulsive ADHD may have these symptoms:

• fidgeting and squirming more than others
• talking non-stop and interrupting conversations
• blurting out answers before the question has been finished
• reacting quickly to situations without thinking about the consequences
• badgering their parent, partner or friends when they want something
• finding boredom intolerable
• looking for stimulation
• participating in risk taking or dangerous behaviour
• choosing a smaller reward now rather than a larger reward later

Combined symptoms

Some people have symptoms of both inattentive and hyperactive-impulsive ADHD.

What causes ADHD?

People with ADHD have differences in their brain anatomy and function. The exact causes of ADHD aren’t known. Genetic studies show that ADHD is an inherited disorder.

Research has shown that ADHD symptoms are related to the biology of your brain.

The following environmental factors may contribute towards the development of ADHD:

• maternal smoking during pregnancy
• maternal drinking during pregnancy
• premature birth
• low birth weight

Other environmental factors that can cause changes in your brain’s development and function include the following.

• Toxins: chemicals like lead can affect brain development.
• Home environment: if there is a lot of conflict in the home.
• Early childhood trauma: children who experience trauma in early childhood are more likely to show features consistent with ADHD. Most children with ADHD have not had early childhood trauma.

When should I see my doctor?

It’s normal for people to get restless and distracted from time to time. But when you have ADHD, your symptoms are persistent and interfere with your work or school and friendships.

If you are concerned that you may have ADHD, the first step is to see a doctor. They will most likely refer you to a psychologist.

A psychologist can only make a diagnosis after a detailed assessment of your behaviour.

There are many behavioural disorders that can cause symptoms of ADHD, especially in young children. It’s important to have a proper assessment.

Other reasons for people being inattentive, impulsive or hyperactive are:

• health or emotional problems
• learning difficulties
• lack of sleep
• brain injury

How is ADHD diagnosed?

There are clear criteria used to diagnose ADHD.

The symptoms of ADHD need to:

• have lasted for more than 6 months
• been present before the age of 12 years
• not match your developmental age
• have caused serious impairment at school, at home and socially

In children, the diagnosis is usually made by a:

• paediatrician (a doctor who specialises in children)
• child psychiatrist or psychologist

Your doctor can give you a referral to see these specialists.

To diagnose ADHD in adulthood, it needs to be established that your symptoms began in childhood.

How is ADHD treated?

There are many different treatment options for ADHD, depending on the needs of each person.

Treatment may involve different health professionals, including your:

• doctor
• psychologist
• psychiatrist
• paediatrician (child specialist)
• family therapist

Medicine for ADHD

If your ADHD is having a big effect on your life, you might consider taking medicine.

Stimulant medicines can lower hyperactivity and impulsivity. They may help you to focus and learn.

Stimulant medicines have been thoroughly researched for many years. They have been shown to:

• be safe
• improve concentration
• improve impulse control
• improve hyperactivity

The doses used to treat ADHD are not addictive and don’t cause withdrawal symptoms.

However, they can cause side effects like loss of appetite and difficulty falling asleep. For people who have side effects from these medicines, non-stimulant medicines are also available.

Psychological treatments

Cognitive behavioural therapy may help you develop strategies and skills for learning and controlling your behaviour.

Couples or family counselling may be useful for those people having relationship difficulties.

Nutrition and supplements

Taking fish oil supplements to raise levels of omega-3 may improve some symptoms of ADHD in some people.

The evidence suggests that fish oil is only of benefit in people that don’t have enough to start with.

Always check with your doctor or pharmacist before taking supplements to make sure they are right for you.

Good nutrition is also important.

ADHD across the life course

Caring for a child with ADHD

If the person with ADHD is a child, their parents and school teachers need to be involved in their treatment.

The first step is often to use positive parenting strategies. It can help to stick to a routine and help your child build their social skills.

Talk to the school to plan an environment where your child can learn.

If you are caring for a child with ADHD, below are some tips that can help.

• Have a routine.
• Try to keep any instructions clear and brief.
• Reward achievements and positive behaviour — this will help their self-esteem.
• Try to have one-on-one time with your child doing something they enjoy.

ADHD in teenagers

Many teenagers aren’t diagnosed in childhood. As they become older, they find it more difficult to cope with change.

In the teenage years, ADHD may show up as:

• often running late
• being disorganised
• worrying a lot
• feeling bad about yourself
• interrupting conversations
• daydreaming
• forgetting instructions
• saying things you shouldn’t say
• procrastination
• multi-tasking when you should remain focussed on one thing

Having some of these symptoms doesn’t mean you have ADHD. Everyone has some of these symptoms some of the time.

We now know more about ADHD. Your school will be able to get information, resources and expertise to support you.

It’s important to get help and support. When ADHD is not identified or treated, it may lead to self-medication. This may be with alcohol or illicit drugs, which can lead to addiction.

ADHD in adulthood

Some adults with ADHD:

• successfully learn to manage their lives
• just get through knowing they could achieve more
• struggle as they don’t get the help they need to reach their potential

Adults with ADHD may have:

• depression or anxiety
• problems with family
• problems at work

Complications of ADHD

It’s important that people with ADHD are diagnosed, treated and supported. This can help avoid problems in their lives.

Only 1 in 3 people has ADHD as their only diagnosis. Most people with ADHD often have other conditions such as:

• anxiety and depression
• learning difficulties
• autism

Obstructive sleep apnoea (a blocking of the airway during sleep) happens more often in people with ADHD. Poor sleep during the night can make it hard to concentrate the next day.

To best support a person with ADHD, it’s important to:

• get a proper assessment
• use strategies and treatments

Resources and support

You can find out more about ADHD from:

• your doctor
• other specialists who work with people with ADHD, such as psychologists
• an ADHD coach

The ADHD Foundation offers support and education. You can call them on 1300 39 39 19.

ADHD Australia has resources and a list of support groups across Australia.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.