Symptoms of ADHD
The symptoms of ADHD fall into three main areas:
- hyperactivity
- impulsivity
- inattention.
To get a diagnosis of ADHD, symptoms must:
- have been present for at least six months
- be greater than expected for the child's age and intelligence (ie more than just being a busy toddler)
- have a negative impact (or cause 'impairment') in at least two settings, for example at home, work, school. Sometimes parents don't feel there's a problem at home – either because they don't have other children to compare the ADHD child to, or because they've adjusted to their child's behaviour and are handling it well
- have developed before the age of seven
- not be caused by another condition, such as a mood, anxiety, personality or autistic spectrum disorder that could cause the same symptoms.
The presence of six or more of the nine symptoms of hyperactivity, impulsivity and inattention are necessary for a diagnosis.
Three ADHD 'subtypes' are currently recognised. The most common are:
- the 'severe' or 'combined' type – when significant degrees of hyperactivity, impulsivity and inattention are observed
- 'predominantly inattentive' subtype (seen more commonly in girls)
- the 'predominantly hyperactive and impulsive' subtype (observed most in younger children.
Hyperactivity
Your child often:
- fidgets with hands or feet or squirms in seat
- leaves seat when expected to remain there
- runs about excessively and inappropriately
- has difficulty in playing quietly
- is 'on the go'
- talks excessively.
Effect on social relationships and self-esteem
Your child might:
- go on and on about a subject and can take over a conversation
- 'act silly' in a group to get attention but not fit in
- damage other children's toys etc, without meaning to
- play too roughly in the playground and hurt other children
- have poor motor skills (eg can't catch or throw a ball).
Other children may feel your child is being bossy, silly, clumsy, too rough or will make their team lose. So, they may avoid your child in the playground and won't invite her to parties.
Your child may be the last one chosen for a team. This can make your child feel rejected and develop low self-esteem.
Isolation in the playground can also make your child more at risk of beingbullied – or becoming a bully themself.
Effect on parents
Keeping up with your child to make sure they're safe can be exhausting! You may worry that you've done something wrong because your child doesn't behave as well as their peers.
It can place a strain on friendships with other parents, particularly if their children are hurt or things are damaged by your child.
Effect on educational success
Your child can miss things because they are fidgeting and doesn't hear what's being said. They may fall behind without extra help to cover the ground missed.
Impulsivity
Your child often:
- blurts out answers before the question is complete
- cannot wait for his or her turn
- interrupts or intrudes on others.
Effect on social relationships and self-esteem
Impulsivity means your child might:
- speak without thinking, so they will be socially clumsy
- barge into games
- have volatile moods, so other children won't know what to expect from them
- have a short fuse and lash out when frustrated.
These behaviours will make them unpopular, leading to feelings of rejection and reduced self-esteem. It's also likely that other children will egg them on to bad behaviour or tease, knowing they are easily wound up and will overreact.
Your child will need monitoring to make sure they aren't aggressive with other children. They may be tempted more than others to try alcohol, drugs or abuse substances because they do not think about the consequences until it's too late.
Effect on parents
Your child will say things that may hurt or embarrass you or others, putting a strain on relationships. Inability to wait will mean they will interrupt you constantly, which can be wearing.
Effect on educational success
Your child may focus on only part of a question and rush answers leading to underachievement in tests. This may mean they are placed in a group with a lower ability, which they may find frustrating and embarrassing and so rush through things even more.
Inattention
Your child often:
- has poor attention to detail and makes careless mistakes in schoolwork, work or other activities
- has difficulty in sustaining attention
- does not appear to listen when spoken to directly
- does not follow instructions or finish tasks
- has difficulty organising tasks and activities
- avoids or dislikes tasks that require sustained mental effort
- loses things necessary for tasks or activities
- is easily distracted
- is forgetful in daily activities.
Effect on social relationships and self-esteem
She'll forget the rules of a game, won't answer or makes silly mistakes – so other children won't choose her to be on their team or will tease her in the playground. Your child may believe she's stupid and her self-esteem will drop. She'll need lots of reassurance.
Effect on parents
When your child loses things, doesn't answer or do what you ask her to do, it can be exasperating. You may end up shouting and then feeling guilty because your child didn't do it deliberately.
Effect on educational success
Children with symptoms of inattention often don't perform to their full potential and are therefore more likely to get lower grades, fail more exams and spend less time at school.
Symptoms of inattention may also affect short-term memory, making it difficult for your child to do two things at once, so handwriting and presentation may be poor. Your child may therefore have problems structuring schoolwork and may find it hard to know where to start with a project or homework.
In middle or senior school, your child may be confused by the constant change of teacher and room.
Outcome of ADHD
Unsurprisingly, the combination of difficulties presented in children and young people diagnosed with ADHD is associated with increased rates of observed social and educational failure, anxiety and depression – which is often accompanied by a marked reduction in self-esteem.
Early use of cigarettes, alcohol and illicit drugs, together with problems of adolescent adjustment and behaviour are more common, may lead to inappropriate sexual experimentation, delinquency, offending and involvement with the criminal justice system.
Fortunately, there's some evidence that early diagnosis and management may help some of these adverse long-term consequences. This is the main challenge for professionals and families setting out to treat, support and care for this group of children and young people towards adulthood.
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