ADHD is the general name for behavioural disorders, which are the most common reason for children to visit a psychologist or psychiatrist. These disorders should not be underestimated because, as they progress with the child’s age, they can inhibit the child’s normal development. Many factors contribute to the diagnosis of ADHD.

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) manifests itself quite early – usually by the age of 5. The child is not persistent in his or her activities and quickly gets bored with a new activity or toy. He or she starts doing several activities at once and does not finish any of them.

ADHD occurs in 4-8% of children of early school age (6-9 years), more often in boys than in girls. The prevalence of the condition decreases with age, with a 50% lower prevalence in successive 5-year age groups. However, some features of the syndrome persist even into adulthood (60%).

Until some time ago, there was a perception that ADHD was more prevalent in boys, but more and more information now indicates that girls are just as likely to suffer from Attention Deficit Hyperactivity Disorder. Unlike boys, in whom hyperactivity symptoms tend to predominate, attention deficit hyperactivity disorder is more prevalent in girls and thus may not be diagnosed at all or misdiagnosed.

Causes of ADHD

Several factors contribute to the occurrence of attention deficit hyperactivity disorder:

  • genetic predisposition (gene encoding D4 and D5 receptor);
  • low dopamine activity in mesolimbic and cortical structures;
  • trauma during pregnancy;
  • low birth weight;
  • hypoxia in the child during birth;
  • impaired neuronal inhibitory processes;
  • heavy metal poisoning;
  • damage to the central nervous system;
  • smoking by pregnant women;
  • head injuries;
  • neglect (e.g. failure to help a child learn);
  • an unhealthy diet containing too many preservatives, simple carbohydrates or artificial colourings;
  • use of psychoactive substances during pregnancy;
  • FAS syndrome – occurring in pregnant women who abuse alcohol.

What are the symptoms of ADHD?

Symptoms mainly concern:

  • attention and concentration disorders – there is a difficulty in focusing attention and listening to others, lack of attention to detail, constant absent-mindedness, forgetting things, lack of good organisation; the child makes mistakes through his distraction; he cannot concentrate his attention on tasks that do not interest him. In addition to this, he/she has problems with planned activities, e.g. household chores – he/she puts them off until the last minute; he/she often loses objects and toys and is not able to remember where he/she left a certain object. In addition, the child avoids doing activities that require a lot of commitment and prolonged concentration; he/she seems not to listen to what is being said;
  • impulsiveness – the child often takes risks, is impatient, disturbs others, tries to get their attention all the time; answers questions before someone finishes asking them; expresses his or her emotions and thoughts without thinking, with no regard for whether or not it is “appropriate” to do so; cannot wait patiently for his or her turn in group games;
  • hyper-mobility – the toddler is constantly on the move, often without any purpose; when he has to stay in one place for a while, he starts fidgeting, plays, becomes disengaged from the activity; cannot stop himself from speaking; often has difficulty in continuing a task he has started and abandons it; is unable to adapt his behaviour to the situation (it is often inappropriate); is unable to be quiet when playing and finds it difficult to rest in peace and quiet.

The above symptoms of ADHD occur with different severity in each child.

Where to seek help?

If you observe symptoms in your child that make you suspect ADHD, consult a psychologist or child psychiatrist. Early detection of the behavioural disorder and its treatment prevents the child’s adaptation difficulties from worsening in the school and family environment.

Diagnosis of ADHD

For a correct diagnosis, the collaboration of several specialists is necessary: a psychologist, a psychiatrist, a paediatrician and sometimes a paediatric neurologist. It is very important to conduct a thorough interview with the child’s parents, during which the specialist obtains information about the child’s functioning both at home, at school and among peers. Sometimes, for this purpose, it is necessary to provide the doctor’s office with a written opinion from the school teacher, teacher or educator who has daily contact with the patient. Sometimes, with the consent of the parents, the doctor contacts these people personally. In addition, parents and teachers are asked to fill in special questionnaires about the child.

During the diagnostic process, the psychologist performs special tests to assess the child’s intellectual ability to remember, concentrate and associate. Motor skills and coordination are also assessed.

It is necessary to rule out other medical conditions and mental problems that may produce symptoms similar to those of ADHD. Thus, a psychologist or psychiatrist should differentiate between ADHD and the following conditions:

  • anxiety disorders,
  • adaptation problems (new situations),
  • behavioural disorders,
  • mental retardation,
  • bipolar affective disorder,
  • obsessive-compulsive neurosis,
  • difficulties in mastering school skills.

According to researchers, almost 70 per cent of children suffering from ADHD are observed to have at least one additional mental health condition. This usually includes dyslexia, conduct disorders and anxiety disorders.

In addition to this, it is important to ensure that the symptoms present are not related to neurological or somatic disorders. These include: side effects of certain medications, visual impairment, hearing impairment, epilepsy, lead poisoning, thyroid disorders, use of psychoactive substances such as designer drugs.

Treatment of ADHD

The treatment regimen for ADHD is developed individually for each child. It takes into account his or her age, general health status, the depth and type of symptoms present and the young patient’s susceptibility to specific therapeutic procedures. The treatment programme may consist of:

  • psychotherapy,
  • peer group therapy for the child,
  • psycho-educational classes for parents,
  • family therapy,
  • pharmacological treatment.

Pharmacological treatment mainly uses methylphenidate, which is a psychostimulant drug. It is responsible for inhibiting dopamine release into the synapse and dopamine reuptake from the synaptic gap. This agent has a calming effect on the child, while also improving concentration. Importantly, it is reimbursed in Poland. Despite its positive aspects, it may have side effects: lack of appetite, sleep disorders and stunted growth. It may be addictive.

Another preparation is atomoxetine hydrochloride. Alpha2-adrenergic receptor antagonists, which lead to a reduced release of norepinephrine, and some certain antidepressants (SSRIs, TLPD) also show good effects. In children showing aggressive behaviour, haloperidol is administered.

In addition to pharmacological treatment, psychotherapy and systematic work on the child suffering from ADHD are important. His/her daily schedule should have its own order, the child should be given short tasks to perform.

Complementary therapeutic methods:

  • family therapy (especially when conflicts are present in the family),
  • aggression and anger management training (recommended for children who show aggression towards others),
  • individual psychotherapy for the child (e.g. in cases of low self-esteem, emotional disorders),
  • training to help master school skills and improve motor coordination and concentration disorders (e.g. sensory integration).

Also supporting ADHD therapy is the use of the Burden Quilt on a daily basis, which helps soothe nerves and gives a greater sense of security.

Note: In the USA, children with ADHD are prescribed amphetamine derivatives, but these are not used in Poland as they have a strong addictive effect.

There are studies that claim that ADHD resolves in more than 70 per cent of cases in adolescence. However, it is not known why this happens.

ADHD and prognosis

If left untreated, the disorder can cause health and emotional complications. If left to their own devices, the child struggles in school, performs well below their potential, is considered an unschooled child and is therefore often rejected by peers. This results in low self-esteem and emotional problems that gradually build up. This is particularly evident in adolescents, who may come into conflict with the law during adolescence and act deliberately to their own detriment. Adults with untreated ADHD are much more likely to experience problems in their professional and personal lives.

In 70 per cent of cases, ADHD symptoms persist into adolescence and in up to 10 per cent into adulthood.

Health complications of ADHD:

  • suicide attempts,
  • cigarette addiction,
  • alcohol and drug addiction,
  • injuries (due to accidents, fights),
  • anxiety disorders,
  • depressive disorders,
  • overeating leading to obesity,
  • sleep problems.