It is expected and typical for children to be active and to struggle with impulse control, particularly when younger and still developing. However, for some children, there could be an underlying difficulty, such as attention deficit hyperactivity disorder (ADHD).
Someone with ADHD may have difficulty with inattention; finding it difficult to concentrate for long periods of time, and be easily distracted. They may also come across as overactive; being fidgety, finding it hard to sit still, and talking a lot. Being impulsive is another characteristic of ADHD; saying or doing things without thinking, difficulty following instructions or interrupting other people. Children might alternative struggle with attention but not present with hyperactivity. A diagnosis can only be considered if such difficulties are negatively interfering with the child’s wellbeing and evident across various settings (i.e. home and school). Children under the age of 6 cannot be diagnosed with ADHD in the UK.
It is important to think that there can be other causes of inattentiveness or excessive activity; some examples being children who might be anxious or stressed, children from families where sitting still and focusing has not necessarily been reinforced over their development, children who need more sensory input, gifted children who aren’t being mentally stimulated, children with learning difficulties, or early childhood adversity. Therefore it is important to seek clarity and tailor home and school environments to your child’s specific needs.
What causes it?
ADHD can occur for various reasons. There are some genetic and neurobiological predispositions to ADHD, and sometimes ADHD can be found in one’s family history. The levels of certain neurotransmitters – the chemicals that deliver messages in the brain – can be different in children with ADHD. Noradrenaline, linked to our ability to pay attention, and dopamine, linked to our ability to control impulses, have been found in lower levels in children with ADHD.
There are environmental factors that can contribute to inattentiveness, impulsivity and hyperactivity, such as:
- Being born prematurely and/or low birth weights
- The use of alcohol, drugs or smoking during pregnancy
- Home environments not positively reinforcing a child’s ability to focus
- Parent-child attachment difficulties
It is estimated the approximately 5% of children aged 6-18 will meet criteria for a diagnosis of ADHD.
Exercise: Exercising is one of the easiest and most effective ways to reduce the symptoms of ADHD. Physical activity immediately boosts the brain’s neurochemical levels—all of which affect focus and attention. Exercising can also expend extra energy and facilitate sleep.
Sleep: Good quality sleep and consistent routines can help. However, children with ADHD can struggled to getting to sleep so the following suggestions can help:
- Set a regular bedtime (and enforce it).
- If background noise keeps your child up, try a sound machine or a fan.
- Turn off all electronics (TV, computer, video games, iPhone) at least an hour before bed. Electronics are stimulating and biological keep the brain awake.
- Limit physical activity in the evening.
Diet: Good diet is very important. Schedule regular meals or snacks no more than three hours apart. This will help keep your child’s blood sugar steady, minimizing irritability and supporting concentration and focus.Try to include a little protein and complex carbohydrates at each meal or snack. These foods will help your child feel more alert while decreasing hyperactivity. Avoid sugary foods and foods that are not nutritious. Include sources of zinc, iron, and magnesium in your child’s diest. Many children with ADHD are low in these important minerals. Boosting their levels may help control ADHD symptoms.
Behavioural: There are behavioural strategies to help your child.
- Follow a routine that is simple and predictable, so that it does not over tax your child’s concentration and mental energy. Having a balanced schedule is good as well, time for school work, after school activities and ‘chilled time’.
- Use clocks and timers to help your child keep track of time, and allow additional time when getting ready, e.g. in the mornings for school to avoid stress.
- Set an example for good organization. Set up your home in an organized way. Make sure your child knows that everything has its place. Role-model neatness and organization as much as possible
- Break instructions down into chunks to help children retain information. For example; don’t give long lists of things to do but give information/instructions one at a time. Gently guide your child back on track if they get distracted.
Medication: Medication can be effective for some children, but for other medication does not have the same impact. There can be side effects of the medication so careful consideration needs to be given, and the benefits need to outweigh these side effects. It is important to discuss this with your GP or CAMHS practitioner.
What can CAMHS do to help?
If you are concerned about your child then your GP can refer to CAMHS. When referring it would be helpful to include information about your child’s inattentiveness and activity levels at home as well as at school (e.g. a report from school pertaining to your child’s behaviour and psychological wellbeing). Your CAMHS practitioner will complete an assessment which may involve a developmental history, a school observation, liaising with teachers and requesting a formal school report and potentially other forms of assessment.
If symptoms meet the criteria for a diagnosis of ADHD as outlined in the Diagnostic Statistic Manual (DSM-V) then an official report will be sent to school with recommendations to support your child in school. Since ADHD is an intrinsic difficulty the main change will come from the system around the child (rather than all expectations being placed on the child). Part of this will involve parents attending a post diagnostic parents group to help understand how they can best support. Medication might be considered in some situations, but is dependent on certain biological indicators.
Children under the age of 6 cannot be diagnosed with ADHD in the UK.
If you are concerned please ask your GP to refer to CAMHS. If you could include a school report that indicates some of these concerns that would be helpful for the process.