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What is ADHD?

Well, essentially its a neuro-biological condition (children with ADHD have different 'wired' brains), that is pervasive ( affects the child in in different settings) and is life long. The child has been born this way. It is not a behavioural problem per se or due to "bad parenting". It isn't a made up condition by doctors and drug companies. It is thought to be partly genetic although there is no specific gene identified. In many families there is no history of any near or distant family member affected.  

A child with ADHD has significant core difficulties with Inattention, Impulsivity and Hyperactivity that affects them at home and at school and where there is evidence that these core difficulties are impacting on the child's social, emotional and learning development. In addition for a diagnosis to be considered the child needs to be at least 6 years old, the difficulties to have been present before this age and for more than 6 months. 

 

Although for professionals there are relatively strict guidance and criteria for the diagnosis of ADHD in reality it is not an easy diagnosis to make. There is no specific test for ADHD. From my experience and opinion I don't think this difficulty is necessarily a bad thing. Its not very often I meet a "child bouncing off the walls" that is a "nightmare" to take out in public or to social occasions with very exhausted and stressed parents. ADHD can affect children in different more subtle ways than the so called typical extreme. Its nature and impact on the child changes over time and can also affect boys and girls differently.

 

It is also important to remember that there are many factors that affect a child's behaviour such as social and family circumstances, other medical problems, learning difficulties and other neuro-developmental disorders such as Autism. These may be the actual cause of the "ADHD type" behaviour or be present in a child that does have ADHD. As you can imagine therefore it isn't always easy to separate out these different strands, what is the primary cause and what are the consequences we are seeing in the child's behaviour.

In my opinion there needs to be an effort made to gather as much information as possible from different sources to build up a true and full picture of the child's strengths and difficulties before coming up with any diagnosis, if there is one. This should include at a minimum a detailed medical and developmental history by an experienced health professional (paediatrician or psychiatrist), physical examination and information regarding the child's behaviour from different sources eg parents and teachers. This sometimes requires 2-3 appointments.

 

There is no test for ADHD. A recent development is the role of QbTest in helping with the assessment and diagnosis. It is a tool and should not be done or interpreted in isolation. You can read more about QbTest here. I don't offer Qb Test myself but if I think its important to do I will recommend where it can be done. Then when available I will use it as another piece of the jigsaw in understanding the child's difficulties. 

 

In my practice I never rush to diagnose without a thorough assessment and information gathering and sometimes a watch and wait policy if the initial assessment is inconclusive. This doesn't mean doing nothing but on the contrary actively monitoring the child's behaviour and development with regular consultations and communication with both parents and usually the school. Although the core difficulties are always present they may become more obvious over time, as demands and expectations increase at home and at school especially transition from Primary to Secondary school.

 

I rarely rush to start medical treatment after a diagnosis. In many cases behavioural strategies used at home and at school can be very helpful in managing and supporting the child's difficulties. These behavioural strategies do not actually "treat" the underlying core problem of inattention, impulsivity, hyperactivity but can help with managing the impact. Medical treatment can vey helpful in cases where there a significant worries about the child's behaviour and or where other strategies have not been successful.

Read further at NHS site