ADHD symptoms and diagnosis

Attention deficit hyperactivity disorder (ADHD) is a chronic (long lasting) condition that can have a serious impact on the lives of affected children, parents and families. ADHD is more common in boys than girls, and it can persist into adulthood. Generally, the ability to control symptoms like impulsivity improves with time, but not everybody with ADHD will ‘grow out of it’.

From time to time, most children won’t pay attention or will seem ‘hyperactive’, but this doesn’t necessarily mean they have ADHD. Likewise, many people are impulsive at times, and this may just be a normal part of their personality. For ADHD to be diagnosed, a child should have significant and ongoing problems in more than one setting — for example, at home and at school.

ADHD is a somewhat controversial condition in that some people feel it is a label that ‘over medicalises’ ordinary or even bad behaviour, while others feel it is underdiagnosed and they have been punished for ‘bad behaviour’ when they should have been treated for a disorder. Because ADHD can overlap with both normal behaviour and a variety of other conditions, it is important that the diagnosis is only made after a very thorough assessment by a medical specialist who is skilled in this area.

What causes ADHD?

ADHD is caused by problems with brain development — scientists believe that neurotransmitters (chemical messengers) in the brains of people with ADHD do not work properly. There also seem to be structural changes in the brain. Although the exact cause of ADHD remains a mystery, several factors seem to be involved.

Genetic factors are probably the most important — many children with ADHD have at least one close relative with the disorder. Several genes may be involved and, as always, how these are expressed is influenced by the presence of other factors, including:

  • exposure of the developing fetus to tobacco, alcohol or other drugs;
  • low birth weight;
  • history of a head injury; and
  • environmental agents — high levels of lead may be associated with a raised risk of ADHD, and research continues into whether other chemicals may contribute to the disorder.

So far, research into whether diet significantly affects ADHD symptoms has been inconclusive.

Symptoms of ADHD

Children with ADHD can have problems with inattention (being unable to concentrate), hyperactivity (always being ‘on the go’) and impulsivity (lack of self-control). When assessing ADHD, hyperactivity and impulsivity tend to be grouped together.

ADHD symptoms
Inattention symptomsHyperactivity / impulsivity symptoms
  • Finds it hard to concentrate
  • Makes careless mistakes
  • Does not seem to listen
  • Avoids difficult tasks
  • Becomes distracted easily
  • Is disorganised and forgetful
  • Does not follow through on instructions, can’t finish work
  • Tends to fidget or squirm
  • Gets up during class when not supposed to
  • Runs about or climbs in inappropriate situations
  • Has difficulty playing quietly
  • Often interrupts others
  • Finds it hard to wait for a turn
  • Often ‘on the go’ or acts as if ‘driven by a motor’
  • Talks excessively
  • Blurts out answers before questions have been finished

Some children mostly have inattention symptoms, others primarily have hyperactivity and impulsivity symptoms; however, most children have a mixture of both types. ADHD symptoms often emerge gradually over a period of many months.

Diagnosing ADHD

Sometimes a child’s teachers will be the ones to notice that something is wrong; in other cases the situation concerns parents or caretakers before a child starts having problems at school. However, the diagnosis of ADHD should only be made by a professional with special training in this area — your GP will generally refer you and your child to a paediatrician (specialist in children’s health) or a child psychiatrist for a thorough assessment. Other professionals such as child psychologists may also be involved.

For a diagnosis of ADHD, a child must have had symptoms to an extent that causes significant problems for at least 6 months, and these must have started before the age of 7 years. The symptoms must be evident in at least 2 settings (such as home and school) — this ensures the child is not having issues just with a particular teacher. When assessing a child, doctors also take into account what’s appropriate for the child’s developmental level — for example, it’s normal for a preschooler to have a short attention span.

There is no single test for ADHD. Doctors have to rule out other disorders that might be causing the symptoms, such as hearing loss, learning disabilities, bipolar disorder or an overactive thyroid. To do this, the specialist will usually examine your child and ask you all about their medical and developmental history and current behaviour. The specialist will probably also ask for information from your child’s teachers.

As part of the diagnostic process, you will generally be asked to fill in questionnaires and specific rating scales concerning your child’s behaviour, and your child may need to undergo neuropsychological tests — a series of written and spoken questions. These can be time-consuming but they help give a fuller picture of your child’s mental state and development.

A mixed picture

At the end of this process, your child may be diagnosed with ADHD. This resolves confusion about their behavioural problems, and it can pave the way to moving forward with adhd treatments.

However, the picture may be more complex than a diagnosis of ADHD alone. Children with ADHD commonly also have other conditions, such as anxiety, learning difficulties or disruptive behaviour disorders. These may be detected during the ADHD assessments. If so, remember that help is available for these disorders, as it is for ADHD, and seeking assistance will give your child the best chance of reaching their full potential.

Last Reviewed: 19 October 2012
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References

1. National Health and Medical Research Council (NHMRC). Clinical practice points on the diagnosis, assessment and management of attention deficit hyperactivity disorder in children and adolescents (published September 2012). http://www.nhmrc.gov.au/guidelines/publications/mh26 (accessed Nov 2012).
2. National Institute of Mental Health. Attention deficit hyperactivity disorder (ADHD) (updated 2008). http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml (accessed Nov 2012).
3. American Academy of Pediatrics. ADHD: Clinical practice guideline for the diagnosis, evaluation and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011 Nov; 128(5): 1007-22. http://pediatrics.aappublications.org/content/early/2011/10/14/peds.2011-2654.full.pdf+html (accessed Nov 2012).
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