ADHD should not stop me from reaching my dreams
Attention Deficit and Hyperactivity Disorder (ADHD) is a complex neurobehavioural problem that affects 2 – 16 % of school-going children.1,2 It is considered the most common psychiatric disorder in children and is known to persist into adulthood in 60 – 70 % of cases.2 Males are more likely to be affected than females.3 The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with daily functioning or development.3
What causes ADHD?
ADHD is inherited in most cases, which is why it tends to run in families.4 There is also evidence to suggest that environmental insults that occur around pregnancy, such as alcohol use, smoking during pregnancy and low birth weight, may increase the risk of ADHD.4
How is ADHD diagnosed?
An accurate diagnosis of ADHD is essential and should only be made by a specialist psychiatrist, paediatrician or other healthcare professional with training and expertise in the diagnosis of ADHD.2,4
The diagnosis of ADHD is based on the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5™) criteria:
Symptoms of inattention (at least 6 needed): 3
- Makes careless mistakes
- Difficulty sustaining attention
- Doesn’t listen
- Instructions not followed through
- Cannot organise
- Avoids sustained mental effort (e.g. schoolwork or homework)
- Loses important items
Symptoms of hyperactivity and impulsivity (at least 6 needed): 3
- Fidgets or squirms
- Cannot stay seated
- Runs/climbs excessively
- Cannot work/play quietly
- On the go
- Talks excessively
- Blurts out answers
- Cannot wait turn
- Interrupts others
Symptoms change as the child grows from childhood into adulthood.3 The main symptom in preschool is hyperactivity, whereas inattention becomes more prominent in school-aged children.3 During adolescence and adulthood, motor symptoms become less obvious but difficulties with restlessness, inattention, poor planning and impulsivity persist.3
How is ADHD treated?
The aim of treatment is to alleviate symptoms and optimise cognitive, social and emotional functioning, allowing the affected individual to reach his/her full potential.2,4 In children with mild to moderate ADHD, first-line treatment is a behavioural programme with or without medication.4 In moderate to severe ADHD, first-line treatment is medication plus a behavioural programme.4 In adults, however, behavioural treatment is less effective and medication is the cornerstone of management.2
The underlying problem in ADHD has been identified as an imbalance of two brain chemicals, i.e. dopamine and noradrenaline.1 Medicines that improve ADHD act on these chemicals and are effective in 75 – 90 % of cases.1
Stimulants are by far the best studied and the most effective medication for ADHD across all age groups.2 In addition to relieving the core symptoms of ADHD, stimulants improve associated features, such as academic performance and social functioning.2 Methylphenidate is the stimulant of choice.2,4 Long-lasting, extended-release formulations are preferred because they give more even efficacy and result in less troublesome side effects.4 They also avoid the need for medication at school, which can be potentially embarrassing for the child.4 In addition, a survey has shown that children with ADHD find the afternoon/evening period at least as difficult as the school day, which highlights the importance of a treatment that lasts the full day.7
What are the typical side effects of stimulants?
Typical side effects (headache, reduced appetite, palpitations, nervousness, initial insomnia and dry mouth) are usually mild and transient.2 Although there will always be concerns about the addictive potential of stimulants, studies have shown they actually reduce the risk of substance use disorder by 50 %.6
Children continue to grow while taking stimulants and any stunting in growth is reversible if the stimulant is discontinued during adolescence.6 Doctors will routinely monitor growth and, if affected, may reduce the dosage of the stimulant and institute a ‘drug holiday’ so that catch-up growth can occur.4
The non-stimulant atomoxetine, is an appropriate alternative for people who experience intolerable side effects or have a contra-indication to stimulants.2,4
Diet and supplements
Children and adults with ADHD should eat a well balanced, nutritious diet and exercise regularly.8 Supplementation with substances thought to be deficient (e.g. fatty acids) and elimination of substances thought to be harmful (e.g. artificial colourants and preservatives) is not routinely recommended.8 Should a relationship between specific foods and behaviour become apparent, a professional should be consulted before embarking on an elimination diet.8
Tips for parents:
- Don’t waste your time on self-blame: ADHD is inherited in the majority of cases and is not caused by poor parenting 9
- Learn about ADHD: look for accurate information and stick to reputable websites from non-profit organisations, governments or universities 9
- Make sure your child has a comprehensive assessment: this should include medical, educational and psychological evaluations 9
- Join a support group: check out the Attention Deficit and Hyperactivity Support Group of Southern Africa at: http://www.adhasa.co.za 9
Tips at home:
- Provide clear expectations: children with ADHD need to know exactly what is expected of them. Set limits and follow through with consequences 9
- Enforce discipline: consistently reward appropriate behaviour and respond to misbehaviour with alternatives such as time-outs or loss of privileges9
- Notice your child’s success: improve your child’s self-esteem by telling him/her exactly what he/she did well rather than focusing on what went wrong9
- Identify your child’s strengths: your child may be good at things like art, athletics or computers – encourage your child to build on these strengths 9
Remember that children with ADHD are: 10
1. Greydanus DE, Sloane MA, Rappley MD. Psychopharmacology of ADHD in adolescents. Adolesc Med. 2002;13(3):599-624.
2. Schoeman R, Liebenberg R. The South African Society of Psychiatrists/
Psychiatry Management Group management guidelines for adult attention deficit/hyperactivity disorder. S Afr J Psychiat. 2017;23(0):a1060.
3. American Psychiatric Association, 2013, Diagnostic and statistical manual of mental disorders, 5th ed., Arlington, VA: American Psychiatric Publishing, p. 59-63.
4. Fisher AJ, Hawkridge S. Attention deficit hyperactivity disorder in children and adolescents. S Afr J Psychiat. 2013;19(3):136-140.
5. Biederman J. Attention-Deficit/Hyperactivity Disorder: A Selective Overview. Biol Psychiatry. 2005;57:1215-1220.
6. Biederman J, Faraone SV. Attention-defi cit hyperactivity disorder. Lancet. 2005;366:237-248.
7. Coghill D, Soutullo C, d’Aubuisson C, Preuss U, Lindback T, Silverberg M, et al. Impact of attention-deficit/hyperactivity disorder on the patient and family: results from a European survey. Child Adolesc Psych Ment Health. 2008;2(1):31. doi:10.1186/1753-2000-2-31.
8. National Clinical Practice Guideline Number 72. National Collaborating Centre for Mental Health commissioned by the National Institute for Health & Clinical Excellence. British Psychological Society and Royal College of Psychiatrists, 2009.
9. Understanding ADHD. For parents & caregivers. National Resource Centre on ADHD, a program of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD®), 2017. [cited 2017 Nov 20]; Available from: http://www.help4adhd.org/Understanding-ADHD/For-Parents-Caregivers.aspx.
10. Tips for managing ADHD in the classroom. The Children’s Attention Project (CAP). Murdoch Children’s Research Institute. [cited 2017 Nov 20]; Available from: http://www.education.vic.gov.au/Documents/school/principals/participation/tipsmanagingadhdinclass.pdf.