ADHD

We do shared care with GPs for ADHD medication.

What is it?

Attention -deficit/hyperactivity disorder is a diagnosis in people with either short attention span, hyperactivity or both.  They can often concentrate on the things they enjoy.  Watch https://www.youtube.com/watch?v=OM0Xv0eVGtY to see why.  It can look different in women which is why a large number have been missed .  https://www.youtube.com/watch?v=EMpt40zNK-w.

Types of ADHD

Some people want to talk about ADD verses ADHD. ADD is an old term.  Now we talk about ADHD – Inattentive presentation, ADHD – Hyperactive presentation and ADHD – Combined presentation.

“Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level”:

Inattentive Type

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
  • Often has trouble holding attention on tasks or play activities.
  • Often does not seem to listen when spoken to directly.
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
  • Often has trouble organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
  • Often loses things necessary for tasks and activities (e.g. things needed for school, pencils, books, tools, wallets, keys, paperwork, glasses, mobile phones.
  • Is often easily distracted
  • Is often forgetful in daily activities.

Hyperactive Type

  • Often fidgets with or taps hands or feet, or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected.
  • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
  • Often unable to play or take part in leisure activities quietly.
  • Is often “on the go” acting as if “driven by a motor”.
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed.
  • Often has trouble waiting their turn.
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

There are other features as well, including the symptoms MUST have been present before 12 years of age. 

Combined Type

Many people have a combination of both types.

Causes of ADHD

ADHD is not caused by poor parenting BUT any difficulties in attachment (relationships with the parent’s mother, father and partner and the relationship with the child) can make the symptoms worse.  Working through your relationship with your child to make it as secure as possible is very important in ADHD.  This work is done with the help of a psychologist. 

Genes for ADHD have been found in research.  They are not offered as a diagnostic test as a person can have the gene and not have any problems.  The gene found is associated with dyslexia as well. 

A diagnosis of ADHD is more likely in the following settings:

  • people with a close family member diagnosed with ADHD
  • people with autism spectrum disorder
  • children in out of home care
  • people with epilepsy
  • people with intellectual disability or developmental delay as a child
  • people with oppositional defiant disorders
  • people with anxiety disorders
  • people with preterm birth
  • people with birth weight less than 1.5kg (3 pounds 5 ounce)
  • people with tic disorders.
  • people with sleep disorders

Making a Diagnosis

They must be seen in two or more settings.  It can be quite difficult to diagnose ADHD once a child goes to high school as often, the teachers don’t know your child as well.  So, they cannot complete the questionnaires needed to show evidence in another setting.  In this setting the help of a psychologist may be needed. 

We do not need information from both parents to diagnoses ADHD.  However out of respect, it is recommended both parents are involved in the diagnosis, if they have regular contact with the child.

Many children work hard to hold the symptoms together at school and at the parent’s house that the spend less time at.  If you want to know more https://www.attachmentproject.com/blog/adhd-and-attachment-theory/

Treatment of ADHD

Medication: In children 5 years and older medication is strongly indicated with a large body of evidence. 

Non-Medication Treatment

  • Parenting/Family training is strongly recommended for children presenting with hyperactivity less than 5 years of age.
  • Parenting/Family training is recommended for all young people 5-17 years of age and is strongly recommended if they have Conduct Disorder and/or Oppositional Defiance Disorder.  This is by a psychologist. 
  • Parenting/Family training is recommended because parenting a child with ADHD is not neurotypical parenting.  This does not imply bad parenting. 
  • Cognitive Behaviour Therapy is recommended for children 5-17 years of age and strongly recommended for adults with ADHD.  However, it will NOT be sufficient on it’s own.  A diagnosis of ADHD is not needed for this. 
  • ADHD Coaching is suggested from 13+ years of age.
  • The national guidelines indicate that OT will not settle ADHD. 

National Guidelines

Updated National; Guidelines were released in October 2022.  Below is a link to the summary.

https://adhdguideline.aadpa.com.au/wp-content/uploads/2022/10/AADPA_ClinicalFactsheet-FINAL.pdf​

Knowing how to parent a child with ADHD is very important.  However, the treatment needed in childhood is medication.  How MUCH medication is increased or decreased by HOW you, your partner, your parents, the teacher all relate to your child AND how you child relates to all of these people. A psychologist can help with this.   Anxiety makes ADHD worse.  I am often asked to increase AADHD medication when the real issue is anxiety.  A psychologist can help with this. 

People with ADHD can access NDIS

Resources I Am Aware Of To Read

Is Dexamfetamine Addictive: From Dr Alison Poulton https://www.poultonadhd.com.au/:

Our literature review investigating the evidence that dexamfetamine is addictive found a dearth of evidence and a lot of innuendo. The only actual evidence that we could find was 4 poorly documented cases.

This is not only heartening for patients and parents of children treated for ADHD. But it matters clinically that the whole arduous and restrictive processes around prescribing for ADHD is underpinned by evidence that is essentially anecdotal.

Our article “Does Dexamphetamine Cause Addiction? A Narrative Review” has been published in Psychoactives and is
available online at the following links: https://url.au.m.mimecastprotect.com/s/dDiqCD1vlpTOZAz41hWflTjf8mB?domain=mdpi.com
PDF Version: https://url.au.m.mimecastprotect.com/s/YgQhCE8wmrt6jx2EmiwhZT7sWCa?domain=mdpi.com

Resources For Teachers

Reference  

  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
  • Centre For Disease Control and Prevention