Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity that impairs a child’s functioning and/or development.

ADHD is a common childhood neurodevelopmental disorder. Children with ADHD may have difficulty paying attention, controlling impulsive behaviours (acting without considering the outcome), or being overly active.

ADHD is typically diagnosed in school-aged children when there is a disruption in the classroom or difficulty with schoolwork. It is more common in boys than in girls.  ADHD is thought to affect 3–9% of school-aged children.

Children with ADHD may experience low self-esteem, strained relationships, and poor academic achievement. Symptoms may lessen as they become older. Some children,  never fully recover from their ADHD symptoms. They can, however, acquire strategies to be successful.

Causes

Some of the possible causes of ADHD are as follows:

• Anatomy and function of the brain: ADHD may be associated with decreased activity in the parts of the brain that control attention and activity level.
• Heredity and genes: ADHD is frequently passed down through families. A child with ADHD has a one-in-four chance of having an ADHD parent. Another close family member, such as a sibling, is also likely to have ADHD. ADHD is sometimes diagnosed in a parent at the same time as it is diagnosed in a child. 
• In some cases, severe head injuries can result in ADHD.
• ADHD is more likely to develop when a child is born prematurely.
• Prenatal exposures: the exposures such as alcohol or nicotine from smoking, raise the risk of ADHD development.

ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than others to also have conditions such as Oppositional defiant disorder (ODD), Conduct disorder, Disruptive mood dysregulation disorder, Learning disabilities, etc.

Types 

There are three different types of ADHD, depending on which types of symptoms are manifested in the individual:

• ADHD Predominantly Inattentive Type: It is difficult for the child to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The child gets easily distracted or forgets details of the daily routines.

• ADHD Predominantly Hyperactive-Impulsive Type: The child fidgets and talks a lot. It is hard for the child to sit still for long (e.g., for a meal or when doing homework). Younger children tend to run, jump or climb constantly. The child feels restless and has trouble with self-control and exhibits impulsivity. A child who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. Children find it hard to wait for their turn or listen to directions.
• ADHD Combined Type: The child exhibits symptoms of the above two types.

         Because symptoms can change over time, the manifestation of challenges may change over time as well.

‍

Myths vs. Facts of ADHD

Let’s get to know certain myths and facts about ADHD:

Myth: ADHD is not a real condition.

Fact:   ADHD is a scientifically proven medical condition.

Myth: People with ADHD only need to try harder.

Fact: ADHD is not a problem of motivation or laziness. Children and adults who have it are usually trying as hard as they can to sustain attention.

Myth: Children with ADHD can not ever focus.

Fact: It’s true that children with ADHD mostly have trouble focusing. But if they are very interested in something, they may focus on it intensely. It’s called hyperfocus.

Myth: Only boys have ADHD.

Fact:  Usually, Boys are more than twice as likely as girls to be diagnosed with ADHD. Girls usually are  more likely to be overlooked and remain undiagnosed.

Myth: Children with ADHD will outgrow as they grow older.

Fact: Children don’t completely outgrow ADHD, though some symptoms can lessen or disappear as they get older.

Myth: ADHD is caused due to bad parenting.

Fact: ADHD is caused by differences in the brain, not bad parenting. But some people see children fidgeting, being impulsive, or not listening and assume that it’s due to a lack of discipline

Signs and Symptoms: How to identify ADHD? (or) How can I know if my child has ADHD?

It is common for children to become restless, distracted and most children find it difficult to remain still and focused for a long period of time. However, in children with ADHD, their inattention and hyperactivity are noticeably greater for their age/grade level and impair their daily functioning both in the classroom and at home.

The following are some of the signs that can be observed in children with ADHD

General Signs of ADHD:

• Behavioural challenges in terms of inattention and/or hyperactivity are predominantly present for at least 6 months period and occur in two or more settings such as at home, in school, with friends, relatives, or other public places.
• Behavioural challenges in terms of inattention and/or hyperactivity must be predominantly present before the age of 12 years of age. 
• Behavioural challenges in terms of inattention and/or hyperactivity interfere with daily life functioning and affects the quality of performance in different domains of life.

Inattention:

• Difficulty in maintaining or sustaining attention for a long period of time.
• Makes careless mistakes at work, activities, and assignments.
• Difficulty paying close attention to details.
• Doesn’t respond/reply when spoken to directly – seems distracted and zoned out.
• Difficulty following instructions.
• Avoids tasks or activities that require sustained focus or attention.

Restlessness and Hyperactivity: 

• Often fidgets or plays with things or taps hands/feet etc.
• Squirms in the seat.
• Often standing from the seat
• Keeps moving around while remaining seated is expected.
• Often runs about or climbs over things where it is inappropriate.
• Seems ‘on the go' and motor-driven (on his/her toes) all the time.

Impulsivity and Lack of Self-Regulation: 

• Talks excessively where it is inappropriate.
• Difficulty waiting for turns.
• Complete sentences and lines of other people in conversation.
• Blurts out answers before a question has been completed.
• Often interrupts or intrudes on others by taking over and completing tasks or activities.
• Loses things and materials. 

 Challenges in Executive Functioning:

• Difficulty completing work, activities, and assignments on time.
• Difficulty organizing tasks and activities
• Difficulty  keeping materials and belongings in order.
• Messy or disorganized work.
• Gets distracted, side-tracked easily.
• Forgets daily tasks and activities.
• Difficulty meeting deadlines.
• Difficulty managing time. 

Prevalence of ADHD: How common is ADHD? (or) How many children are affected with ADHD?

Global Scenario:

Analysis of studies from across the globe reveals that the worldwide prevalence of ADHD among children is found to be at 7.2% (Thomas et al., 2013).

The 2016 National Survey of Children’s Health (NSCH) reveals the following details:

• 9.4% of children within the age range of 2-17 years have been diagnosed with ADHD in their lifetime and currently, 8.4% of children globally are diagnosed with ADHD. 
• ADHD is more common among boys than girls.
• 23% of children with ADHD i.e., 1 out of every 4 children diagnosed with ADHD don’t receive any support or intervention.
• 63.8% of children with ADHD have other comorbidities or co-occurring conditions like Oppositional Defiant Disorder (ODD), Conduct Disorder, Autism Spectrum Disorder, Anxiety, and Mood Disorders.

Indian Scenario:

A research study by Venkata, J.A & Panicker, S.A. (2013) revealed the following details: 

• 11.32% of primary school-aged children are at risk for developing ADHD.
• More prevalent among boys (66.7%) compared to girls (33.33%).
• ADHD tends to be more common during the age range of 9-10 years. 
• More common among children from the lower socio-economic groups (16.33%).  ‍
  

Crucial Steps Involved in Early Detection of ADHD

Key Aspects of Early Identification

The following steps are to be followed by caregivers, parents, and/or educators to ensure early identification of children with ADHD so that early intervention can be designed to support the child’s needs.

Screening: 

If a child is suspected to display signs of ADHD- the first step is to take the child for screening by administering an observation checklist to determine if the child is displaying red flag signs of ADHD in terms of inattention, hyperactivity, and/or impulsivity.

If the behavioural challenges of the child are persistent in two or more settings for over 6 months and impair the child’s performance and functioning, then formal diagnosis from a certified/licensed professional would be needed to start early intervention. 

Formal Assessment or Diagnostic Evaluation:

Finally, the child needs to be taken for a 'Formal Assessment/Diagnostic Evaluation' to formally diagnose the condition by a certified/licensed professional, in order to support the child better through early intervention.

Brief on Intervention - What can be done to support children with ADHD?

Core Aspects of Early Intervention

A combination of the following interventions can be used to support children with ADHD and their families which can be customized for children and their family’s needs and requirements. 

Behavioural Intervention 

Using Behaviour Therapy (BT) techniques to strengthen positive behaviours and eliminate unwanted behaviours are recommended to support children with ADHD.

Behavioural intervention in the classroom is used to help educators support children with ADHD and improve their academic outcomes.

Organizational Skills Training

Using organizational skills training to train children with ADHD in executive and daily life functioning is found to be effective.

Social Skills Training 

Social skills training can be used to teach one or more appropriate social behaviours to children with ADHD.

Medication

Medication in the form of stimulants and non-stimulants are prescribed by licensed clinicians to manage symptoms of ADHD in everyday life. Finding the right medicine with the appropriate balance is crucial.

Parental Orientation and Training 

By increasing awareness among parents about the condition, its manifestation, impact along with a home-based plan to manage behavioural challenges in children with ADHD are found to be beneficial.

ADHD Support Groups

Support Groups are helpful to parents to connect with fellow parents who share similar experiences and concerns. This helps them to build networks and better deal with children with ADHD by learning from one another.