ILibrary: My child may have ADHD

My child may have ADHD – what next?

03:12 | Posted by Sidharth |

If you think your child might have ADHD, you’re likely to go through the following process.

Talking to your GP

Your GP is likely to:

ask about your child’s medical history and your family medical history
talk about your child’s behaviour and whether they're underperforming at school
check your child’s hearing and sight (or make referrals for these to be checked) to rule out behaviour problems caused by not being able to hear or see properly
look for signs of any intellectual disability, autism, epilepsy or depression.

Talking to the school

Your school may already know there's a problem.

It may ask you to get the medical side checked out before it can refer your child for an assessment for a statement of special educational needs.

In practice, the medical and educational referrals tend to happen at the same time.

Referral to medical specialists

This depends on your local health authority. Your GP may refer you first to a community paediatrician or possibly to a specialist ADHD team.

Other specialists may be involved such as:

psychologist
psychiatrist
paediatrician (particularly one experienced in behavioural or development problems)
speech and language therapist
occupational therapist.

How long does it take?

The time from referral to the first meeting and assessments depends on the workload of the specialists.

Some areas tend to have longer waiting lists, which can be anything from three months to a year. This includes speech and language therapy, occupational health and mental health specialists.

Access to care

GPs will usually refer your child to a specialist – although lessening, the problem tends to be the waiting time.

If you’re faced with a long wait, ask if the specialist can give any advice on behaviour management that you can try before your child is assessed.

If you're willing to accept a cancellation slot at short notice, this sometimes helps to get an earlier appointment.

Your GP or school may be able to recommend private specialists, who can assess your child. They’re likely to have a shorter waiting list, though assessments can be expensive.

Assessment

The assessments vary depending on which specialist you see. They include:

observation of your child in a situation, such as school or home or at the specialist’s office
looking at written evidence, for example a teacher’s comments about difficulties your child has experienced. It’s also worth keeping a home behaviour diary too, so you can pinpoint examples and show you’ve already tried to find triggers for your child’s behaviour
physical tests: an occupational therapist may check your child’s physical abilities including ‘gross motor skills’, such as catching a ball or hopping, and ‘fine motor skills’ such as handwriting or threading beads
written or oral tests: a speech and language therapist will check how well your child understands what he hears and how he can express himself. An educational psychologist may do IQ tests.

The specialists may also want to discuss things with you and find out more about how your child reacts in certain situations and how you’ve tried to manage things so far.

With ADHD, you can never predict a child's behaviour. They may be able to do something one day and not the next. They may behave absolutely perfectly while they're being assessed and then be difficult the next day.

Diagnosis

The paediatrician or psychologist will confirm:

if your child has ADHD
what type of ADHD it is – combined, primarily hyperactive or primarily inattentive
how severe the ADHD is – mild, moderate or severe, and what degree of 'impairment' is identifiable
whether your child has any other conditions as well as ADHD, such as oppositional behaviours or conduct disorder, coordination problems, learning difficulties, anxiety or depression, or problems with social interaction communication and obsessive behaviour (that may indicate the need for an autism assessment).

Treatment

Treatment depends on the age of your child, the type of ADHD he has and any other conditions. It should be tailored to the individual child, and may include:

counselling for the child and parents from a psychologist
behaviour management advice
strategies to help your child learn and deal with social problems, eg teasing by other children
strategies to increase your child’s self-confidence and self-esteem
one-to-one help at school
medication (tends not to be for children under six, except in severe cases). Most of the types of medication offered are neurostimulants that work by changing levels of brain chemicals called neurotransmitters. These work by ‘controlling’ and ‘inhibiting’ part of brain, making the brain work in a more efficient way – so your child can concentrate better and behave more calmly.

Treatment issues

Below is a checklist of questions you may like to ask the specialists.

Where and when will any counselling take place?
Who is going to be involved with the strategies (parents, teachers, one-to-one help)?
Who will oversee the strategies and review whether they’re working or not?
When and where will the review take place, and who needs to be there?
When and how often will your child need to take medication? (what side-effects may be encountered and how often will medication be reviewed? How long will medication be required?)
Will he need to take it at school?
How does the school manage medication?

Long-term care

ADHD is a long-term condition.

Many clinicians talk of 'care rather than cure'. Some children appear to grow out of it, but many don't.

Management comprises a mix of compassion and common sense, based on a reliable foundation in 'evidence based' practice.

Research shows that up to 60 per cent will still show signs of ADHD as adults, often sufficient to cause difficulties at work or college and with relationships.

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