Attention deficit hyperactivity disorder (ADHD)

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) WHO-EM/MNH/214/E What is ADHD? Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders. It affects 5–8% of children, mostly boys, and often lasts into adulthood. ADHD affects a child’s learning and their functioning in daily life. It has three main features: • inattention – not being able to stay focused • hyperactivity – excess movement that is not appropriate to the setting or excessive fidgeting, tapping or talking • impulsivity – acting hastily without thinking, and in a way that may have high potential for harm. Common signs and symptoms of ADHD The symptoms of ADHD are not the same among all children. The condition can range from mostly poor attention to mostly hyperactivity and impulsivity or a combination of both. The symptoms may occur sometimes in children who do not have the condition; the difference in children who do is that the symptoms are frequent, severe and cause problems in functioning: • Children with poor attention may often be forgetful, easily distracted, not able to stay focused on a task and finish it, seem not to be listening, disorganized, take time to start doing things and lose their personal possessions frequently. • Children with hyperactivity may often be restless, fidgety, full of energy or “always on the go”, loud, continuously chattering, unable to stay seated (in the classroom, workplace, etc.), running about or climbing in inappropriate places and unable to play or do leisure activities quietly. • Children with symptoms of impulsivity may often do things without thinking, have difficulty waiting for their turn in games or in a queue, interrupt people in conversation, blurt out answers before the question is finished, look intrusive and start using other people’s things without permission. What causes ADHD? The exact causes of ADHD are not clear. Some factors may possibly have a role, such as: • genetics – ADHD can run in families • having a significant traumatic experience as a child • being born prematurely • brain injury • exposure to environmental toxins, such as high levels of lead, at a young age • the mother smoking, using alcohol or having extreme stress during pregnancy, or being exposed to lead during pregnancy. Parents need to remember: this has not happened to your child because you have not been doing a good job as parents. Do not blame yourselves. When to seek help for your child It is important to seek help from a mental health professional (psychologist or psychiatrist) if you think your child has ADHD. • If a child has ADHD but it is not diagnosed, they may be mislabeled as naughty and irresponsible and be blamed and punished for their behaviour. • Punishment can worsen their behaviour. • When children with ADHD do not receive care and support, they may drop out of school. • Children with ADHD tend to have more accidents and injuries of all kinds than children who do not have ADHD. Treating ADHD ADHD cannot be cured so that it stops completely, but treatment can help to control the symptoms and improve the child’s functioning in everyday life, at home and at school. A treatment plan needs to be set by a specialist, and carrying out the treatment plan requires good communication and teamwork between doctors, parents and school teachers. A standard treatment plan for ADHD includes: • Medicines. Not all children with ADHD need medicines, but for many they are necessary. Medicines can reduce hyperactivity and impulsivity, improve the child’s ability to focus, work and learn and improve their physical coordination. The most common medicines used to treat ADHD are stimulants such as methylphenidate (Ritalin). Other drugs like antidepressants may be used if stimulants have serious side effects or are ineffective, or to boost the effects of stimulants • Psychotherapy. This can help patients and their families cope better with everyday problems. Parents and teachers help the child to gain control over their behaviour by establishing clear rules, lists of chores and other structured routines. • Education and training. A child with ADHD needs to learn about social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Parents need to learn about ADHD, how it affects their family and how to deal effectively with negative feelings that may develop within their home because of their child’s disruptive behaviour. Medicines such as stimulants that are used to treat ADHD are not addictive Some parents worry about stimulants and the potential risk of that their child will abuse them or become dependent on them. There is no good scientific evidence to suggest that this is a problem. However, there is a concern that other people might misuse or abuse stimulant medication. When giving medicines to children: • Make sure your child takes the right amount of the prescribed medication at the right time. • Do not make children or teenagers responsible for their own medication without proper supervision. • At home, keep medication locked in a childproof container. An overdose of stimulant drugs is serious and potentially fatal. • Do not send supplies of medication to school with your child. Deliver any medicine yourself to the school nurse or health office. • Never double the dose if your child misses a dose of medication. • Never stop giving the medication without discussing this first with your doctor. • Never give your child’s medication to anyone else, even if you feel they have the same problem. How can you help your child with ADHD? Parents and teachers can help children with ADHD function better and feel less frustrated by following some simple steps: • Make a schedule for all activities, from wake- up time to bedtime, and try to follow the same routine every day. Children with ADHD find it difficult to cope with unpredictable and rapid changes. • Organize your home so that everything (clothes, toys, school items) has its place, and keep each thing in the right place. • When you ask your child to do something, give them simple, clear and consistent instructions. Stand near them, look at them and tell them slowly and calmly what you want them to do – do not shout across the room. • Break any task, like doing homework or sitting at the dining table, into smaller timespans such as 15–20 minutes. • Look for good behaviour and praise it. Children with ADHD often receive and expect criticism. • Be careful about your child’s diet; some food additives and colouring may make their symptoms worse. • Children with ADHD usually respond well to positive reinforcement. Rewarding or reinforcing a new good behaviour every time it occurs can encourage positive new habits. • Make sure that you give yourself a break periodically and do not neglect your other relationships, including your relationship with your partner. How can teachers help a child who has ADHD? As a teacher you may find it difficult to deal with students affected by ADHD. You should get more information about ADHD so that you understand it well and can support students affected by it. But these simple tips can help: • Children who have ADHD often also have learning problems, so look out for such problems and give the child the support they need. • Help to build the child’s confidence and social skills. • Provide simple written information about their tasks and daily schedule, and stick it somewhere that is easily visible to the child. • Monitor the child’s work closely and give them positive feedback. Be flexible and patient. • Praise and reward the child for every little bit of progress they make. • Be very clear and specific in any instructions you give. Be clear about what you expect the child to do. Break tasks into smaller steps. Keep your instructions brief, and help the child to follow through the tasks step by step. Correct and redirect any interruptions carefully so that you do not harm their self- esteem. You can use gestures or signs that have been previously agreed between you and the child. • Try to include some physical movement in your lessons. Alternate between seated activities and those that allow some movement, or ask the child to run some errands. • Give specific consequences immediately following misbehaviour. You can discuss and agree the consequences of misbehaviour with the child in advance, so they know what to expect. Focus on the behavior, not the child. This is one of a series of factsheets produced by the World Health Organization (WHO) to give the general public more information about mental disorders and how they can be treated. You can download all the factsheets free of charge from the WHO website at: www.emro.who.int/mnh. © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).