Information about ADHD

ADHD stands for Attention Deficit Hyperactivity Disorder. It is the most common disorder that we see in Child and Adolescent Mental Health Services (CAMHS). About one third (1/3) of the young people attending CAMHS have a diagnosis of ADHD. In the general population, ADHD occurs in 3 - 5% of young people; so 1 in 20 to 1 in 30 children and adolescents in Ireland will have ADHD.

ADHD is made up of three main symptoms

1) Inattention
2) Hyperactivity
3) Impulsivity.

There are different types of ADHD.

• Some young people have mostly symptoms of hyperactivity and impulsivity (called “predominantly hyperactive/impulsive type ADHD”).
• Others have mostly symptoms of inattention (called “predominantly inattentive type ADHD” or “ADD”)
• Other young people have a mix of all the symptoms (called “combined type ADHD”).

   

No two young people with ADHD are the same!

The core symptoms of ADHD are:

What might difficulties with attention look like for a younger child?

What might difficulties with attention look like for an adolescent or adult?

ADHD inattention symptoms can look a bit different in adolescents and adults. Typical symptoms in an adolescent or adult include:

• Poor time management skills
• Avoiding tasks demanding attention
• Putting off tasks and activities (procrastination)
• Excessive multitasking leading to tasks being incomplete
• Problems with starting or completing tasks, or failure to switch to a different task when they should
• Needing to adapt a lifestyle to fit the benefits and the negatives of having a short attention span

   

• Needing support from staff (at school or in work) or external structure in order to get their work done

What might difficulties with hyperactivity look like for a younger child?

What might difficulties with hyperactivity look like for an adolescent or adult?

In adolescents and adults, ADHD hyperactivity symptoms may not be as obvious. Some typical features include:

• Experiencing a constant inner sense of restlessness
• Selecting a job or jobs that require working long hours, high levels of activity, or multiple tasks
• Avoiding jobs that require sedentary or low level activity
• Family tension resulting from constant activity

What might difficulties with impulsivity look like for a younger child?

What might difficulties with impulsivity look like for an adolescent or adult?

In adolescents and adults, impulsive symptoms include:

• Becoming easily frustrated
• Changing personal relationships or jobs frequently
• Difficulties with driving, which could lead to road traffic accidents
• Easily losing their temper
• Making hasty decisions
• Having low tolerance for stress
• Interrupting conversations
• Speaking out without thinking of the consequences

ADHD is often associated with other difficulties or conditions. Two-thirds or more of young people diagnosed with ADHD have at least one additional mental health or learning difficulty during their lifetimes. It is important that any difficulties are recognised and assessed so that they can also be supported or treated.

ADHD can often occur with specific learning difficulties, Autism Spectrum Disorder, tic disorders, speech and language disorders or sensory integration difficulties.
Some other young people with ADHD may also have diagnoses including Oppositional Defiant Disorder, Conduct Disorder, anxiety disorders, substance use disorders, mood disorders and sleep difficulties

Some of the difficulties are described in more detail below.

Emotional instability

Young people with ADHD often have sudden strong shifts in emotion. This may be seen as low tolerance for frustration, high levels of irritability and frequent crying spells or tantrums.

Social Difficulties

Many young children with ADHD can misunderstand social situations. They may wish to be popular, but don’t know how to make this happen. They can misread social cues, and say or do something inappropriate. They often do best in a small group.
Social difficulties often persist into adolescence and adulthood – someone with ADHD will often interrupt conversation, or speak over others. A person diagnosed with ADHD will often jump from one topic of conversation to another. They may not provide relevant background information making it difficult for their audience to successfully follow the conversation.

Poor Self-esteem

Young people with ADHD can be very sensitive underneath all of the hustle and bustle. They can have poor self-esteem because of their continued experience of failure. Some young people may put great effort into schoolwork, but achieve little. They try hard to be liked, yet are often unpopular. They want to belong, yet may be the last picked for teams because they have poor co-ordination skills.
Some young people with ADHD feel different to their peers. They can’t do things as well as they would like to, and they can give up quickly. They can often get into trouble for things they didn’t realise they did. The impacts of this on their self-esteem will long outlast the difficulties they may be having.

Developmental Co-ordination Disorder

Young people with ADHD can have co-ordination problems i.e. difficulties with gross motor control (e.g. running, climbing, catching a ball) or fine motor control (e.g. colouring, navigating buttons). Many young people with ADHD have difficulties with fine motor tasks in particular handwriting. A larger number of young people can have difficulty planning and co-ordinating the sequence of their activities or doing two things at the same time.

Some young people with ADHD have significant co-ordination difficulties. These types of difficulties can sometimes lead to a diagnosis of Developmental Co-ordination Disorder, commonly known as Dyspraxia.

Specific Learning Difficulties

A specific learning difficulty affects a young person’s ability to listen, think, speak, write, spell, or do maths problems. Young people with a specific learning difficulty may struggle with reading, writing, language, spelling, or maths. Sometimes young people may have difficulty in more than one of these areas.
For example:

• A specific learning disability in reading, is known as Dyslexia
• A specific learning disability in writing, is known as Dysgraphia
• A specific learning disability in mathematics, is known as Dyscalculia
• It is important to know about these difficulties so that a young person with ADHD can get the extra help they need.

• Is ADHD Inherited?

 We know that ADHD runs in families. Twin studies have shown a much greater risk of ADHD in identical twins (who share exactly the same genes), than in non-identical twins. There is also a much greater risk of a child having ADHD if their parent or sibling has ADHD. The rate at which the disorder is inherited is about 75%, which is similar to the rate at which children’s height is inherited. This means that genes play a significant role in developing ADHD.

Scientists are investigating which genes are most important in developing ADHD. It appears that it is a complex genetic disorder, with a large number of genes that can increase someone’s risk of developing ADHD.

Many of the genes that have been associated with ADHD are involved in the development of nerve connections in the brain. We know from brain imaging studies that brain connections in people with ADHD are different from those without ADHD.

• Is ADHD caused by illness or damage to the brain?

Most young people with ADHD have no history of brain injury or damage to the brain. However, studies using brain scans show that there are significant differences in brain structure and brain function when young people with ADHD are compared with those without ADHD.

Some of the brain areas that are particularly affected in ADHD include the frontal cortex, the limbic system and the basal ganglia. These brain areas play keys roles in attention, planning, organisation and emotion regulation.

The brain is made up of nerve cells called neurons that transmit signals in the brain. Signals travel through the brain in groups of cells called “networks”.

Studies have shown that some brain networks work differently in people with ADHD. These include those involved in;

• -  reward
• -  focus
• -  planning
• -  attention
• -  shifting between tasks
• -  movement

This may be because the nerve cells in these networks mature more slowly.

The brain chemicals dopamine and noradrenaline may also play a role in ADHD. These help to transmit signals between one nerve and another, and allow the brain to communicate effectively. The medicines that are effective in ADHD work to regulate the levels of these two brain chemicals.

• What environmental factors are important?

 Some environmental factors have been identified that may contribute to the development of ADHD.

These include:

• low birth weight
• exposure to cigarette smoke, alcohol, herbicides or pesticides as a fetus in the womb
• exposure to toxic substances in the environment, such as lead from old paint after birth.

Scientists do not yet understand how these factors play a role in developing ADHD.

Parents may worry that their own behaviour or how they brought up their child caused their child’s problems. There is no evidence that how parents behave can actually cause a child to develop ADHD. It is well established that parenting a young person with ADHD is much more challenging than parenting a young person without ADHD. The way a parent responds to the ADHD behaviours can influence how much of a problem they become.

Parenting interventions have been proven to improve the prognosis of young people with ADHD. These are typically programmes designed to help parents increase wanted behaviours and reduce unwanted behaviours.

What is the process of ADHD assessment?

It is very important that the diagnosis of ADHD is based on a comprehensive clinical evaluation, where all the information is drawn together like the pieces of a jigsaw.

The diagnosis is made by talking to parents / caregivers and the young person about patterns of behaviour, observing the young person, and getting reports of their behaviour at home and in school.

There are strict criteria for diagnosing ADHD in young people. To be diagnosed with ADHD, a young person must have;

• Six or more symptoms of inattentiveness or
• Six or more symptoms of hyperactivity and impulsiveness

In addition, for a diagnosis of ADHD

• Symptoms must be present for at least 6 months
• Several symptoms need to be present before the age of 12
• Several symptoms need to be present in two different settings (e.g. home and school)
• Symptoms must make the young person’s life considerably more difficult on a social, academic or occupational level
• Symptoms must not be related to an emotional challenge, and they should not better explained by another condition.

What is ADMIRE?

ADMiRE is a specialist service for the assessment and management of ADHD in South Dublin. Young people living within the catchment areas of Clondalkin, Ballyfermot/St James and Lucan can be referred to their local Child and Adolescent Mental Health Service (CAMHS) team for ADHD assessment. The referral can be made by their GP or another professional (e.g. primary care psychologist or private child psychiatrist). If the CAMHS team feel that ADHD assessment is indicated they refer on to ADMiRE.

Information leaflet about ADMiRE (PDF 3.12MB)

By the time many families meet a clinician to assess for ADHD, they may have had a difficult time; trying to find out whom to see, or being told that “there’s nothing wrong” or that they “need to be more strict”. Parents often attend feeling inadequate, guilty, disappointed or angry. They might be worn out trying to help their child, and may be feeling confused that their child does not seem to be learning, despite the fact that their other children are having no difficulties.

Once a young person has been diagnosed with ADHD, a plan will be made to help manage the young person’s symptoms, and to help them participate more fully at home, in school, and socially.

The plan will usually involve:

What does the research tell us?

The National Institute of Mental Health (NIMH) began a large treatment study in 1992 called the Multi-modal Treatment Study of Children with ADHD (or the MTA study). This study aimed to help families make important decisions about treatment.

This study took place over 14 months. The results of the study showed that stimulant medication is most effective in treating the symptoms of ADHD, either alone or in combination with behavioural therapy. This is true as long as the medication is administered in doses adjusted for each child to give the best response.
The MTA study (and many other large-scale treatment studies that have assessed the safety and effectiveness of ADHD medications) provides evidence that stimulant medication;

• reduces hyperactivity and impulsivity
• improves attention
• increases the ability to get along with others.

For this reason, stimulant medications remain the medications of first choice for treating individuals with ADHD.

While medicine alone is a proven treatment for ADHD, the MTA study found that combining behavioural treatment with medicine was useful in helping families, teachers, and children learn ways to manage and modify the behaviours that cause problems at home and at school. In addition, some children receiving the combination of medication and behavioural therapy were able to take lower doses of medicine.

Behavioural treatments in the MTA study included three approaches:

The MTA study found that children with ADHD who had other mental-health conditions (such as depression and anxiety) were especially helped by combined therapy that included behavioural modification as part of their treatment plan. Children with ADHD often have other developmental and learning disorders that respond to other types of treatment.

Behavioural Management

 There are a large number of programmes that have been designed to help parents increase behaviours they want to see in their children, and reduce unwanted behaviours. Most of these programmes are underpinned by a very similar psychological framework. Some examples of parent programmes include Parents Plus, Incredible Years, Triple P and 123 Magic.

Many primary care services nationally in Ireland run parenting programmes, and some CAMHS teams are also resourced to run these courses.

While it has been shown that parenting programmes won’t improve the core symptoms of ADHD (inattention, hyperactivity and impulsivity), they can have a positive impact on the young person’s relationship with their parent, and they have been shown to reduce other difficulties that are commonly seen alongside ADHD such as oppositional, defiant or conduct disordered behaviours.

ADMiRE parenting programme

In ADMiRE we run an 8 week parenting programme for parents of young people diagnosed with ADHD. There are two groups – for parents of children (6-11) and adolescents (12-17). This programme is adapted from the Parents Plus model, and has been developed by experienced CAMHS clinicians in conjunction with ADHD Ireland, a large and active advocacy group for ADHD in Ireland. Typically these groups are attended by about 8 – 12 families, and provide education about many aspects of ADHD and behavioural strategies. It is very important to understand the diagnosis of ADHD. A key focus of the parent programme in ADMiRE is to provide detailed information about ADHD, similar to the information in this booklet.

Many families attending ADMiRE have already tried parenting programmes that have suggested a wide variety of behavioural strategies, however many of these programmes have not been specifically designed for young people with ADHD.

Parent programmes that are ADHD-specific aim to facilitate training and discussion about strategies appropriate for different ages. They also consider the impact symptoms of ADHD will have on these strategies.

ADHD Parenting Support

ADHD is not caused by bad parenting or a lack of discipline and there is no doubt that parenting a child with ADHD can be a challenging experience. Parents will often benefit from seeking out further help and advice.

Parent support groups

These groups provide mutual advice, support and camaraderie amongst parents. ADHD Ireland run a monthly drop in ADHD specific parent support group and there is also a more general parent support group in Linn Dara CAMHS.

Support Strategies in School

It can be helpful for parents to let their child’s school know about their child’s diagnosis of ADHD so that they can understand them and help to support them.

There is lots of information and resources available to teachers, including that available from the National Educational Psychological Service (NEPS) or the Special Education Support Service (SESS) (link to resources for parents and teachers tab).

Schools may also find it helpful to link with their own NEPS Psychologist for a consultation around how to support the particular needs of a young person within the school. What type of school is best for my child with ADHD? All parents want the best education for their child. If your child has a diagnosis of ADHD it can be very difficult to know what is best, and where and how your child should be educated. Children with ADHD have a wide range of educational needs. The right educational setting will depend on your child’s individual abilities and needs. Children with ADHD may require an adapted environment with teaching tailored to their individual learning styles. Most children with ADHD are best placed in a mainstream school and may not require a statement of additional support needs to receive the supports they need in school. Others with additional learning difficulties may require an Individual Educational Plan (IEP) and may require resource hours and access to an SNA in the classroom. Pupils with ADHD are entitled to a full curriculum. A collaborative relationship between the young person’s parents, school teachers and clinical team is important. The information that can be shared between these three groups can be used to determine what the best treatment options for the young person are. In ADMiRE we often ask for information from school as well as home to ensure that we are managing ADHD as well as we possibly can.

Medication for ADHD

Medication does not cure ADHD, but can be a highly effective way to treat the symptoms of ADHD when it is taken as prescribed. It is important to note that none of the treatments for ADHD will cure the condition and so ongoing care and treatment monitoring are important. The type or extent of treatment is likely to change over time as children mature.

Though not a cure, medication treatment does allow the child, adolescent, or adult to better function and manage their ADHD and to benefit from academic and related interventions intended to improve their overall functioning in school, at home, at work, and in the community. A percentage of children may no longer require treatment as they grow into late adolescence and adulthood.

For further information on medication for ADHD please see our Medication page.

(adapted from https://www.additudemag.com)

ADHD has been recognised as a legitimate diagnosis by major medical, psychological, and educational organisations. It is described in the Diagnostic and Statistical Manual of Mental Disorders—the official mental health “bible” used by psychologists and psychiatrists. ADHD has a biological basis. We know that genetics play an important role. We know that there are some environmental factors that increase the risk of developing ADHD. We also know that there are many differences in the structure and function of the brain in someone with ADHD that ultimately lead to the symptoms of inattention, hyperactivity and impulsivity.

Myth #1: 

ADHD isn’t a real medical disorder 
ADHD has been recognised as a legitimate diagnosis by major medical, psychological, and educational organisations. It is described in the Diagnostic and Statistical Manual of Mental Disorders—the official mental health “bible” used by psychologists and psychiatrists. ADHD has a biological basis. We know that genetics play an important role. We know that there are some environmental factors that increase the risk of developing ADHD. We also know that there are many differences in the structure and function of the brain in someone with ADHD that ultimately lead to the symptoms of inattention, hyperactivity and impulsivity.

Myth #2:

ADHD is the result of bad parenting

When a child with ADHD blurts things out or gets out of their seat in class, it is not because they haven’t been taught that these behaviours are wrong. It is because they cannot control their impulses. The problem is rooted in brain chemistry, not discipline. In fact, overly strict parenting (which may involve punishing a child for things they can’t control) can actually make ADHD symptoms worse.

Myth #3:

ADHD affects only boys.
Girls have ADHD too, but it tends to be under recognised. The ratio of boys to girls with ADHD is about 3 or 4 boys to every 1 girl. ADHD may not be diagnosed as frequently in girls because they tend to present with more inattentive symptoms and fewer of the disruptive hyperactive or impulsive symptoms. Teachers in busy classrooms may not pick up on inattention as quickly as hyperactivity.

Myth #4:

Children with ADHD eventually outgrow their condition.

More than 70 percent of the individuals who have ADHD in childhood continue to have it in adolescence. Up to 50 percent will continue to have symptoms in adulthood. It is important to be linked in with professionals who can help assess and manage ADHD symptoms over time.

Myth #5:

ADHD medication will change my child’s personality

When prescribed properly, stimulants and other ADHD medications help most young people to be able to focus and concentrate and to reduce hyperactivity and impulsivity. They do not change a child's personality. If you notice a personality change (such as a lack of emotional response) or if your child is more irritable while taking medication, the dose of medication may be too high for them. If this happens you should talk with your child’s clinician about changing the dose.

Myth #6:
Children who take ADHD medication are more likely to abuse drugs as teenagers.

Actually, it is just the opposite. Having untreated ADHD increases the risk that an individual will abuse drugs or alcohol. Appropriate treatment reduces this risk. The medications used to treat ADHD have been proven safe and effective over more than 50 years of use. These medicines do not cure ADHD, but they are highly effective at easing symptoms of the disorder.

Myth #7:

People who have ADHD are stupid or lazy—they never amount to anything.

Many well-known, high-achieving individuals have ADHD, including top executives such as Sir Richard Branson, famous athletes such as Simone Biles, actors, celebrities including Paris Hilton, Ryan Gosling, Howie Mandel and many others (see https://addadult.com/add-education- center/famous-people-with-adhd/ for a very long list!)

ADHD – A final thought

People with ADHD can think differently. They are often highly imaginative, creative and innovative. Many have a keen memory and sense of observation. Some can ‘hyperfocus’ on things that are of interest. People with ADHD may thrive and be more productive when they are multitasking.
Different ways of thinking and working can be incredibly beneficial. The most influential discoveries, inventions and developments in our world today come from people who are able to think ‘outside the box’. It is perhaps not surprising that many famous, high-achieving individuals have ADHD! 

The information on this website was compiled by the HSE ADMiRE team and ADHD research group in Trinity College Dublin, and was partially based on the following publications / websites: 

• “Attention Deficit Hyperactivity Disorder – Information Booklet for Parents”. Compiled by members of the St. James’/ Clondalkin Multidisciplinary CAMHS Team
• “Attention Deficit Hyperactivity Disorder (ADHD) Information Pack for Parents”. NHS Tayside, Child and Adolescent Mental Health Service, Perth.
• American Academy of Child & Adolescent Psychiatry and American Psychiatric Association ADHD: Parents Medication Guide.
• ADHD Ireland website https://adhdireland.ie/
• The National Attention Deficit Disorder Information and Support Service (ADDISS) Website http://www.addiss.co.uk/