Attention Deficit Hyperactivity Disorder in Children (Child ADHD) – Frequently Asked Questions

Full information: Attention Deficit Hyperactivity Disorder in Children (Child ADHD)

• How is ADHD Diagnosed?
• Would my GP know how to diagnose ADHD?
• Can an ADHD child learn at school without being medicated?
• Can a child diagnosed with ADHD outgrow this condition?
• What are the medications available for ADHD?
• Are there Different Stages of ADHD?
• If my husband has ADHD what are the chances our children will have it?
• I have heard of the FAILSAFE diet improving ADHD without medication- does this really work?

How is ADHD Diagnosed?

ADHD can be a difficult condition to diagnose but it is very important to get the diagnosis right. ADHD is diagnosed based on the behaviour of the person. It is often a teacher or babysitter who will first notice a child’s behaviour. The signs that are often seen first include a child losing interest in playing a game, losing toys or school supplies, being restless or being disruptive in classes. In adults there can be other signs such as difficulty with long conversations or forgetting appointments.

Once these early signs are discovered the person needs to be carefully assessed by a health care professional. For children this assessment will include:

• An interview with the child and their family.
• Talking with the child’s teachers about the child’s behaviour in class.
• Performing standard questionnaires and tests (these include the ADHD Rating Scale, Conner’s Questionnaire, Gordon Diagnostic System or similar tests).
• Other tests may be performed to assess the child’s social, psychological and intellectual development.

All this information is then taken together to assess if the child has ADHD or if there is another cause of the child’s behaviour. Other causes of inattentive or disruptive behaviour include:

• A learning problem,
• A hearing problem (including an ear infection)
• Anxiety or depression
• A sudden change in the child’s life such as the parent’s separating or the death of a close relative.

The diagnosis is finally made if the child’s behaviour and situation meet the Diagnostic and Statistical Manual IV (DSM-IV) criteria. The doctor will carefully consider the child’s behaviour, the results of the questionnaires and any other tests performed and if the DSM-IV criteria for ADHD are met then the diagnosis of ADHD is made. After the ADHD is correctly diagnosed and assessed treatment options can be considered.

Learn more about:

• ADHD
• Inattention
• Hyperactivity
• Impulsivity

Would my GP know how to diagnose ADHD?

Your GP is an excellent place to start. GPs often see a wide variety of conditions and most will have extensive experience with diagnosing ADHD. A GP will often be able to rule out other common causes of behavioural problems. Most GPs will refer children with ADHD to specialists (a paediatrician or children’s psychiatrist) for final diagnosis and treatment.

The main treatment for ADHD of stimulant medications and these are restricted in some states to prescription only by specialists.

Can an ADHD child learn at school without being medicated?

ADHD is a label that describes a very large group of behavioural problems. There are different types of ADHD as well as different severities. This means that the way ADHD affects the individual child is almost unique. The question therefore should not be ‘can a child with ADHD learn without medication?’ but rather ‘can your specific child learn at school without medication?’ This will depend on many things but the main point to consider is how is the child currently doing at school? If the child is being disruptive or not paying attention in school then they may benefit from medication. It is also important to ensure that the diagnosis of ADHD is correct and that there is not another reason for the child’s learning difficulty, such as a hearing or vision problem.

If the child does have ADHD and is experiencing difficulties at school a trial of medication may be started. The child may be assessed (using a tool like the Connor’s questionnaire) before starting medication and then after a week or more on medication. If the medication makes a big difference in the child’s behaviour or performance at school then it should be continued. It is important to repeat the warning that children with untreated ADHD can experience long-term social, psychological and behavioural problems.

If you are concerned about your child and whether they need medication to learn at school please discuss this with the doctor who is caring for your child as they will be able to give the most accurate answer for your child.

Learn more about ADHD medication.

Can a child diagnosed with ADHD outgrow this condition?

This is a difficult question to answer but there have been some important discoveries in the last few years that have shed some light on the matter. Research now suggests that not all children with ADHD will have this condition for the rest of their lives. In fact one study found that only 15% of children with ADHD still had the condition at the age of 25. However, this is much lower then other study that found that 65% of children will still have problems with ADHD at the age of 25. It is also possible for the type of ADHD to change, meaning that their behaviour will change. For example a child who is inattentive will become hyperactive or impulsive, or a child who is a combined type will become mainly inattentive or impulsive. Up to 50% of children with ADHD will change type. Currently there is no reliable way to predict wether a child will outgrow their condition or change type, however, research is continuing.

What are the medications available for ADHD?

Stimulant medication is the main form of medication available for ADHD. There is a large quantity of very good scientific evidence that shows that stimulants are an effective way of treating ADHD. The two main drugs currently available in Australia are Methylphenidate and Dexamphetamine. Both are stimulant medication and their brand names include Concerta, Ritalin and Attenta as well as some generic brands.

The only other medication currently available for ADHD is Atomoxetine (Strattera). Your doctor will discuss which medication is best for you/your child.

The use of stimulant medication does not increase the risk of drug abuse or addition later in life.

Numerous other medications have been tried for ADHD but these seem to be of little benefit to people with ADHD and the use of these medications is restricted to only specific patients.

Are there Different Stages of ADHD?

There are no defined different stages of ADHD itself. However, there are several ways to think about staging in ADHD.

In many children with ADHD (up to 50%) the type of ADHD will change. For example a child who was mainly hyperactive or impulsive will become mainly inattentive. The change may be less obvious with only some particular behaviours changing. This change can be thought of as different stages of ADHD. However, this will be different for all people with ADHD, some many not change at all while some may even be “cured”. Another way of looking at stages is one looking at the way that ADHD impacts the child’s life. In this system the main problems of ADHD are grouped into stages 2 to 4 as summarised below:

• Stage 2: child aged less than 7. Main problem is low self esteem
• Stage 3: child aged 8-12. Main problems are disruptive behaviour, learning delay and poor social skills
• Stage 4: child aged 13 and above. Main problems include substance abuse, exclusion from school, criminal behaviour.

 

Therefore, although there are no defined stages of ADHD there are several ways of thinking about ADHD in terms of different “stages”.

If my husband has ADHD what are the chances our children will have it?

There is no doubt that ADHD does run in families. The population rate of ADHD in children is around 5%, however, of children with ADHD 35% will have a parent or sibling with ADHD. There has been some suggestion that the risk of children developing ADHD if one of their parents has the condition is as high as 40-57%. It is however important to remember that while genes do play an important role, other factors are also involved. Whether an individual child will have ADHD depends on both genetic and environmental factors and this interaction is not yet fully understood.

The exact genetics of ADHD are still being studied and there is currently no genetic test available for ADHD. It is also unclear if genetics increases the risk of all ADHD or just some types of ADHD. This is still being researched and there may one day be a separate familial type of ADHD recognised.

I have heard of the FAILSAFE diet improving ADHD without medication- does this really work?

There are two very important points to address with this question:

1. Whether diet can improve ADHD; and
2. Whether diet can improve ADHD enough to stop medication.

 

To answer the first question the answer is yes, diet may improve ADHD in some children. The FAILSAFE diet is a diet developed at the Royal Prince Alfred Hospital in the 1980s and is a diet free of additives and low in salicylates, amines and flavourings. The diet includes eating fresh meat, white fish, eggs, milk, yoghurt, cottage cheese, butter, grains, peeled potatoes, beans and a few green vegetables like cabbage. There is now growing evidence that such a diet can improve ADHD, especially reducing hyperactivity as well as reducing irritability and improving sleep.

The answer to the second question is probably no. Although diet can improve ADHD and some children will be better off with a diet free of preservatives or sugar the changes are usually not significant enough to stop medication.

Another important note is that while there is some evidence that diets (such as the FAILSAFE diet) can improve ADHD it is a very restrictive diet and as such very few people will be able to maintain this diet over any considerable period of time. Especially taking into account that some children are fussy eaters at the best of times and a highly restrictive diet will probably not work. Worsening the problem is that many children with ADHD will be quite impulsive and this will make strict adherence to the diet even more difficult. This poses a problem as even supporters of the diet agree that the diet must be strictly followed for it to work. If a child has even a few slip-ups this would destroy any benefit of the diet. On the other hand the medication for ADHD is both safe and effective and it has been shown beyond doubt that the medication improves the long term outlook of children with ADHD.

There is no scientific evidence that the FAILSAFE or any other diet is of any significant benefit to adults with ADHD.

References:

1. Arnold L. Alternative treatments for adults with attention-deficit hyperactivity disorder (ADHD). Ann N Y Acad Sci. 2001; 931: 310-41.
2. Arnold L. Treatment Alternatives for Attention Deficit Hyperactivity Disorder 2008. available from: http://www.turnertoys.com/ADHD/AlternativeTreatments.htm
3. Biederamn J, Faraone S, Mick E, Spencer T et al. High Risk of Attention Deficit Hyperactivity Disorder Aoung Children of Parents with Childhood Onset of the Disorder: A Pilot Study. The American Journal of Psychiatry 1995; 152(3): 431-6.
4. Carter C, Urbanowicz M, Hemsley R, Mantilla L etal. Effects of a few food diet in attention deficit disorder. Arch Dis Child. 1993; 69(5): 564-8.
5. CMPMedica Australia. eMIMS. Version 5.01.0088. St Leonards: CMPMedica Australia; 2007.
6. Faraone S, Perlis R, Doyle A, Smoller J, Goralnick J etal. Molecular Genetics of Attention-Deficit/Hyperactivity Disorder. Biol Psychiatry 2005; 57: 1313–23.
7. Harpin VA. The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Arch Dis Child 2005; 90:2-7.
8. Jensen, et al. Cost-Effectiveness of ADHD Treatments: Findings from the Multimodal Treatment Study of Children With ADHD. American Journal of Psychiatry 2005; 162: 1628–36.
9. Joober R. Sitting on the edge: when to treat symptoms of inattention without the full DSM-IV criteria of ADHD. J Psychiatry Neurosci 2007;32(6): 447.
10. McCann D, Barrett A, Cooper A, Crumpler D etal. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet 2007; S1: 1-8.
11. National Institute of Mental Health. Attention Deficit hyperactivity Disorder. US Department of Health and Human Services. Available from: http://www.nimh.nih.gov
12. National Institute of Mental Health. Attention Deficit hyperactivity Disorder. US Department of Health and Human Services. Available from: http://www.nimh.nih.gov
13. NSW Health. Attention Deficit Hyperactivity Disorder (AHDH). 2008. Available from: http://www.health.nsw.gov.au/public-health/adhd/index.htm
14. Robert Needlman. How Is ADHD Diagnosed? 2004. Available from: http://www.drspock.com/article/0,1510,4500,00.html.
15. Schab D, Trinh N. Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. J Dev Behav Pediatr. 2004; 25(6): 423-34
16. Todd R, Huang H, Todorov A, Neuman R etal. Predictors of Stability of Attention-Deficit/Hyperactivity Disorder Subtypes From Childhood to Young Adulthood. J. AM. Acad. Child Adolesc. Psychiatry 2008; 47(1): 76-86.
17. Waldman I, Gizer I. The genetics of attention deficit hyperactivity disorder. Clinical Psychology Review 2006; 26: 396–432.

Useful information:

For more information on childhood ADHD and its symptoms and treatments, as well as some useful tools and animations, see Childhood ADHD.

For more information on ADHD in adults and its treatments, as well as some useful tools and animations, see Adult ADHD.