Hyperactivity

Impulsivity

The ADHD child and the family
Often labeled a 'naughty' child, the ADHD child is often shouted at by adults. Dr Holford says, "If a parent doesn't understand that the child has this condition, the parent might increase discipline in order to try to control the child. But this makes it worse."

Parents of a child with ADHD are often criticised because it appears that their child is out of control and needs more discipline. Bedtime and bath time can be particularly difficult and parents often find parenting an ADHD child exhausting.

"Visiting others is often difficult and stressful. Parents of an ADHD child might even give it up all together," says Dr Holford. "For example, when visiting, a child with ADHD will climb on the furniture, spill the tea and pick up ornaments, whereas children who don't have ADHD think about the consequences of actions prior to acting and know not to pick up ornaments."

ADHD often runs in families, which Dr Holford says can make for "a chaotic family" in which a parent has trouble organising and coping. This doesn't usually help a child with ADHD. "But," she says, "a parent who has ADHD has an understanding of what it feels like to grow up with ADHD, which can help the ADHD child dramatically."

Unfortunately, children with ADHD often feel picked on, misunderstood and usually suffer from low self-esteem. So it's critical that parents, caregivers and teachers understand the condition and try to help the child feel good about himself.

Diagnosis
While ADHD can only be diagnosed between the ages of 5 and 7 when a child starts school, signs are often present earlier. However, Dr Holford says that this is not always the case.

If an ADHD child is given the freedom to focus only on the tasks he likes, the condition might not be obvious early on. For example, a child brought up on a farm, who has been given the freedom to run around freely all day, might not present as problematic because the family coped well in the situation.

But when the ADHD child goes to school, he is expected to concentrate on or perform tasks that are only moderately interesting or not at all interesting to him. This is when it becomes obvious that he can't concentrate or sit still for a period of time appropriate for his age group.

Diagnosing ADHD is not always easy for several reasons. Firstly, other medical conditions, such as undetected seizures or medical ailments affecting brain functioning, can present similar symptoms to ADHD, so a doctor has to rule out other possible causes of ADHD-like behaviour.

Secondly, diagnosis requires special skills because ADHD is often confused with other conditions, such as:

Thirdly, there are different subtypes of ADHD which sometimes make ADHD difficult to diagnose. The three subtypes are:

A GP, paediatrician, or psychiatrist should be able to rule out any other causes of your child's behaviour and make a diagnosis. But because levels of expertise in ADHD differ widely it's best to look for a specialist in the condition.

Fortunately, according to a survey published in the Journal of Child and Adolescent Mental Health, paediatricians and psychiatrists in South Africa have adequate knowledge of ADHD, its diagnosis and treatment.

If you're concerned that your child might be ADHD chat to your GP or paediatrician. They can refer you to a specialist, such as a psychiatrist, who can diagnose ADHD, provide counselling and also prescribe medication.

Remember though that a child can't be diagnosed ADHD until the age of 5.

Treatment
For young children under the age of 5 doctors will only advocate behavioural treatment (management and coping skills).

Behavioural therapy and social skills training can help a child cope with his condition by teaching him new behaviour. "For example," Dr Holford says, "you can ask a child with ADHD 20 times to pick up his toys, but he won't listen. This could make a parent angry and lead to punishment. It's far better for you to tidy up the toys with your child."

Small behavioural management techniques can make it easier for a family to manage ADHD. It's usually only when a child starts school that medication is prescribed, so the child can concentrate and achieve his potential.

Treatment, including the medication prescribed, will depend on various factors, including your child, his age, the severity of his condition, his scholastic needs, any other medical conditions he might have and the family environment.

Tips on coping with ADHD

If you suspect your child is showing early signs of ADHD and might be more than just an "active toddler", seek help. The necessary guidance and treatment from a specialist in the field of ADHD can completely change your family’s life and ensure that your ADHD child achieves his potential and grows up to be a well-adjusted individual.

ADHD defined
Attention Deficit Hyperactivity Disorder (ADHD) is a family of related chronic neurobiological disorders that interfere with a person’s ability to:

ADHD affects about 2-5% of grade school children and is one of the most common psychiatric disorders among children. Children with ADHD experience difficulties across multiple settings including home, school, and peer relationships.

Resources
ADHD Support Centre of Southern Africa, Tel (012) 802 1077, www.adhdcentre.co.za
Attention Deficit and Hyperactivity Support Group of Southern Africa
Tel (011) 888 7655, www.adhasa.co.za
Department of Pediatrics, Johannesburg General Hospital Tel (011) 488 3239