This October is ADHD Awareness Month and Consultant Clinical Psychologist and Head of Psychology at Cygnet Hospital Sheffield, Dr Seb Thompson, has answered some common questions about the condition.
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that impacts someone’s attention and / or their levels of hyperactivity and impulsivity. Typically when someone has ADHD they tend to struggle with their attention, with hyperactivity, and with impulsivity although it is possible to just struggle with symptoms from one specific domain (e.g. just inattentive symptoms).
ADHD is a neurodevelopmental condition which means that there needs to be evidence of the presence of these traits before the age of 12. Usually these traits are present much earlier in childhood although a typical ADHD assessment would tend not to occur before the age of 7 years old. This is because prior to the age of 7 it can be difficult to distinguish between inattentiveness and hyperactivity that would be associated with the typical development of young children versus inattentiveness and hyperactivity that would be associated with the neurodivergent development as seen in children with ADHD. ADHD is definitely more prevalent and readily diagnosed in boys. However it is important to note that girls can also have ADHD and this condition often goes undetected in girls.
How does ADHD present itself?
The attention difficulties associated with ADHD could include difficulty sustaining attention on tasks for long periods (particularly when there is no immediate reward), making frequent careless mistakes, frequently misplacing or losing items, being easily distracted, appearing to be daydreaming, difficulties with planning and organisation, difficulties remembering to do tasks and difficulties following through with instructions.
The hyperactivity / impulsivity difficulties associated with ADHD could include being unable to sit still without fidgeting, excessive restlessness, finding the quiet to be uncomfortable, difficulty engaging in tasks quietly, difficulties in turn-taking, impulsively saying or doing things without thinking though consequences, as well as a tendency not to consider the risks of behaviour.
It is also important to note that the difficulties associated with ADHD must cause significant impairment for a diagnosis to be considered. This could be relate to academic, occupational or social functioning. Additionally the symptoms must be present across multiple settings i.e. across school and home.
What might they struggle with and how may it impact family?
If a young person (or adult for that matter) struggles with ADHD they are likely to experience the world in a very different way to those that do not have ADHD.
Imagine really wanting to pay attention to a conversation that is happening but you brain is not letting you. Imagine really wanting to focus on your homework but your brain is not letting you. Imagine really wanting to sit and watch a TV programme, or sit and eat a meal, or sit and relax and your brain is not letting you. The world can be a very frustrating place for young people with ADHD, particularly if they do not understand why their brain works in the way it does.
In addition to the core symptoms described above, young people with ADHD can often suffer with low self-esteem, depression and anxiety. Young people who get frustrated by their difficulties may stop trying at school, or lose interest in their hobbies because they can’t sustain the attention to take part. Some young people’s frustration can turn to anger, and them displaying behaviours that a school setting may consider disruptive. It often means that young people with ADHD are considered to be ‘naughty’ or ‘misbehaving’ when often the reason behind the behaviours that are disruptive are frustration and anger at not being able to do the things they want to be doing.
For a young person’s family it can be also frustrating at times, particularly if it seems that there is no reason why the young person has difficulties with e.g. following instructions, remembering things, or being unable to sit still. It is important to remember that there will always be a reason however, and that young people with ADHD are not choosing to be inattentive, or restless, or impulsive. They are not choosing to frustrate other people.
What are some misconceptions that may lead people to think their child has it when they don’t?
When you read the list of symptoms associated with ADHD, most of us will recognise that we can all be inattentive or restless from time to time. The difference with ADHD is the pervasiveness of the symptoms and how it can impact functioning and quality of life for the individual. Equally the difference between an ADHD brain and a non ADHD brain becomes more apparent as a child develops. Most toddles for example are hyperactive at times, and most 5 year olds will forget or lose things.
There are also lots of other reasons why someone might struggle with attention, hyperactivity or impulsivity that could look like ADHD but are in fact something else. For example is a child has hearing problems they could present as inattentive, but could also easily lose focus and become restless if they are not sure what they should be doing. Equally someone’s difficulties with attention, impulsivity and hyperactivity could be related other diagnoses such as autism spectrum disorder or learning disability. Other explanations for what seems like ADHD could include attachment difficulties, depression or experiences of trauma.
Of course a young person with ADHD could also have one of the other conditions as well but it is also possible that the other conditions might explain the ADHD type symptoms. For this reason it is important that a thorough specialist assessment is completed that considers all possible explanations.
How would one get a diagnosis, find information?
Diagnoses of ADHD are typically given by specialist ADHD assessment teams. Referrals to these teams tend to be made via school, or via CAMHS (Child and adolescent mental health services). However if a parents is concerned about possible ADHD and have already spoken to their school / local CAMHS services, they could also speak with their GP who should be able to signpost them to the relevant service in their area.
What would a diagnosis help with?
A diagnosis could be helpful on multiple levels. It could help explain to the young person (and their family) why their brain works in the way it does. It could help explain that they are not to blame for their ADHD, and that they haven’t done anything wrong to cause it. It can help explain that it simply is the way that some people’s brains work.
It can also be helpful in the sense that it can open the door for treatment whether this be pharmacological or psychological. It is this treatment which can help young people begin to live with ADHD and learn strategies to help them. It can also be useful for services around the young person e.g. education, in understanding how they can best support the young person and if they need to make any adaptations.
Finally it may also open the door for the young person (and their families) to connect with other people in their situation so they do not feel as alone. Doing this can help challenge a common belief that young people with ADHD have about themselves: that there is something fundamentally wrong with them. This simply isn’t true – they just see the world in a different way. In realising this it is hoped that young people with ADHD go on to realise their full potential, whatever that may be, just like young people without ADHD.
