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What is ADHD?
ADHD is a neurobiological disorder and is the most common psychiatric disorder diagnosed in children, affecting five to 12 per cent of school-age children, according to the Canadian ADHD Resource Alliance (CADDRA). The numbers can be further broken down by gender, with some eight to 10 per cent of boys and three to four per cent of girls under the age of 18 diagnosed as having ADHD.
ADHD has three key components or symptoms: inattention, hyperactivity and impulsivity. And how these symptoms cause impairment determines the subtype of ADHD one is diagnosed with. These subtypes are the combined subtype (which involves all three symptoms and is the most common type of ADHD), the hyperactive-impulsive subtype and the inattentive subtype.
ADHD is a highly genetic condition, determining some 80 per cent of cases, explains Dr. Margaret Weiss, a clinical professor of psychiatry at the University of British Columbia and a world-renowned expert in the field. The other 20 per cent of ADHD cases may be linked to environmental factors, such as traumatic brain injury, lead poisoning, prenatal events and alcohol or cigarette exposure in utero.
What are the signs of ADHD?
"When ADHD is present, it causes a lot of impairment. It's not something you have to go looking for," explains Weiss. Although children may be symptomatic as early as age 4, the condition is more apparent when children transition into Grade 1, where they must sit and work for extended periods of time. Fuller understanding tends to occur around Grade 3, when the children themselves may realize something is wrong, perhaps due to rejection by classmates, trouble with schoolwork or conflict with parents.
Parents may notice that their child:
• has difficulty getting ready in the morning without supervision
• may fight during any attention-demanding tasks, such as homework
• may be preoccupied with attention-relieving tasks, such as Lego or Internet games
About half of the children who have ADHD may also be oppositional, displaying temper tantrums or defiance.
At school, teachers may find that a child:
• is not focusing
• does not complete his work
• marches to the beat of his own drummer
• has difficulty meeting his academic potential because he focuses on the wrong task
ADHD also comes with associated features, though not all children have them. These features may include:
• ear infections
• problems with coordination
• learning disabilities
• sleep apnea
How is ADHD diagnosed?
If you suspect your child has ADHD, the first step is to visit your family doctor or pediatrician. Depending on what province you reside in, your child may then meet with a child psychiatrist, psychologist or general practitioner with a special interest in ADHD, as well as further specialists, depending on your child's particular issues. The doctor will conduct a full clinical evaluation that includes a developmental history, a standardized rating scale and obtaining collateral information from parents, teachers and other caregivers.
The doctor will then determine whether the symptoms are normal for your child's age, whether they're consistent with ADHD and whether they could be due to some other cause, such as a learning disability, substance abuse or other psychological disorders.
How is ADHD treated?
Weiss says presenting the results of the assessments to the family – including the child – has an enormous, positive consequence as the blame for behavioural issues moves from the child to the ADHD.
Once the condition is understood, "wraparound devices" are needed, which usually include a combination of medication (usually a stimulant such as methylphenidate [Ritalin] or lisdexamfetamine [Vyvanse]) and psychosocial interventions (such as parent training, learning assistance, lifestyle interventions and occupational and sleep treatments) as well as special education in school.
"No two children are the same," notes Weiss. "The treatment has to be individualized."
While there is no cure for ADHD, certain symptoms – particularly hyperactivity – may lessen by adulthood. But in one-third of cases, symptoms and some impairment will persist, while in another third of cases, adults will meet the full diagnostic criteria for ADHD.
For more information on ADHD, visit the website of the Centre for ADHD Awareness, Canada.