How ADHD is Diagnosed in Children

What is ADHD?

Attention Deficit Hyperactivity Disorder is a neurodevelopmental condition that affects attention, self-control, and executive function (planning and completing tasks). Kids with ADHD usually cannot keep still, are inattentive and have trouble doing homework or other activities. 

What causes ADHD?

The cause of ADHD is unknown. But brain scans of individuals affected by ADHD show differences in brain structure and activity.

Based on a 2017 study, certain parts of the brain including the amygdala, accumbens, and hippocampus are smaller in children with ADHD than those of typical children. These parts of the brain are associated with emotional regulation, reward processing, motivation, and memory formation and consolidation.

Another study showed that the frontal cortex part of the brain of children with ADHD matures a few years later compared to neurotypical children although they eventually develop normally. The frontal cortex is also related to the ability for self-control, focus, reward, and remembering things. 

Aside from the difference in brain structure, individuals with ADHD also have differences in the biochemistry of the brain. Individuals with ADHD seem to have lower levels of dopamine, one of the many chemicals in the brain called neurotransmitters that relay messages between brain cells. Dopamine plays a role in reward-motivated behaviour.

These and many other studies on ADHD prove that it is a real condition and not a result of bad parenting, eating too much sugar, laziness, or lack of willpower as others may believe. 

Most experts agree that genetics play a role in the development of ADHD. This condition tends to run in families. 

How is ADHD Diagnosed?

Kids, in general, are physically active. They like running around, climbing, jumping and so on. They sometimes do things without thinking. Sometimes, they may also have a hard time finishing tasks or following directions. So when is it ADHD and when are kids just being kids?

There is no single test to determine whether someone has ADHD. Brain imaging is not yet used to diagnose ADHD and is mostly done for research purposes although this may change in the future.

A psychologist or a developmental pediatrician will evaluate the child based on the presence of symptoms. To be officially diagnosed with ADHD, the following criteria must be met.

• Several symptoms present in childhood (before 12 years old) 

Kids 16 and under must have at least six or more symptoms of inattention or six or more symptoms of hyperactivity-impulsivity. 

• Symptoms must be present in multiple settings (home, school, social settings, etc)

If a child behaves differently in different settings, it is worth looking if other factors cause the child to act that way. 

• Symptoms interfere with or reduce daily functioning

• Symptoms are not better explained by other mental health or medical conditions 

Sometimes, the inability to focus might be caused by other mental health or medical conditions like depression, anxiety, bipolar disorder, insomnia, etc and may not necessarily mean that a person has ADHD. This does not preclude that other conditions may occur simultaneously with ADHD. 

• The symptoms should be present for at least six months 

ADHD Symptoms

Individuals with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interfere with functioning or development:

These are the symptoms of inattention in ADHD. 

• 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 (such as schoolwork or homework).
• Often loses things necessary for tasks and activities
• Is often easily distracted
• Is often forgetful in daily activities 

These are the symptoms of hyperactivity and impulsivity in ADHD.

• Often fidgets with or taps hands or feet, or squirms in their seat.
• Often leaves the 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)

The following ADHD presentations can occur

• Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity are present 
• Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, are present
• Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, are present

What to expect during an ADHD evaluation

During an ADHD evaluation, the evaluators will do the following.

• Ask you about your child’s detailed health information including ongoing mental or medical problems, developmental milestones, sleep patterns, and more
• Ask you about situations at home and at school that could impact your child
• Look into how your child is doing in school. They may interview teachers and look at report cards and results of standardised tests.
• They will also ask you to fill out a rating scale for ADHD

Treatment of ADHD

Treatment of ADHD may include medications and behaviour therapy. 

Medications

Stimulant drugs are used to treat symptoms of ADHD. They help balance the chemicals in the brain thereby helping the child focus and reduce hyperactivity and impulsivity. 

Two types of stimulants are currently being used for the treatment of ADHD: amphetamines and methylphenidates. Both drugs help increase dopamine levels in the brain although the mechanism of action is different for each type.

Medications can affect each individual differently. Some people with ADHD will respond to one type of drug better than the other although it is not fully understood why. 

There are potential side effects when taking these medications such as mild reduction in appetite, sleep difficulties, and nervousness or agitation. It is important to talk to your child’s doctor about the pros and cons of medication.

Sometimes, it may take some time to find the right dose and medication for your child. As your child matures, the dose may be adjusted as well. 

Stimulant medications are generally considered safe but they should be taken as prescribed. Parents should supervise their child who is taking the medication to prevent the risk of abuse and addiction. 

Both amphetamines and methylphenidates are Schedule 8 drugs which means they can’t be dispensed without a prescription from an authorised medical practitioner. 

Behaviour therapy 

Behaviour therapy aims to strengthen positive behaviours and eliminate negative ones. This can be combined with other treatment options like medications as well. 

Behaviour therapy involves the use of the following techniques.

• Positive reinforcement - rewarding the child for good behaviour
• Response cost - unwanted behaviour will result in loss of privileges or rewards

Other Ways to Help Kids with ADHD

Individuals with ADHD need to get proper treatment to help manage their condition. In addition to getting treatment, there are many other ways to help kids with ADHD such as the following.  

Parent training

This can guide parents in dealing with their child’s behaviour. Parents are taught to focus on catching good behaviour and rewarding them, creating a routine for the family, giving specific and clear instructions, minimising distractions at home, and other techniques to improve how they deal with their children. 

Social skills training

Social skills training aim to help kids with ADHD improve social interaction and prevent interpersonal difficulties. Programs like this usually focus on controlling emotions, problem-solving skills, and communication skills. 

Lifestyle changes

Lifestyle changes will not cure ADHD but are beneficial for children (even those without ADHD). Here are some of the things you can do at home.

• Encourage kids to do regular exercise

Regular exercise is important for everyone. It may also help individuals with ADHD. Some researches show that exercise can boost neurotransmitter levels in the brain which may help relieve ADHD symptoms. 

• Establish a routine for the children/family

A structured environment can help provide organisation and predictability. It can help children to focus on one thing at a time. 

• Prepare a balanced meal for the family

Many studies have been conducted to determine how diet can affect children with ADHD. The effect of supplementation with vitamins, amino acids, minerals, and omega-3 fatty acids for individuals with ADHD are being studied, but the results are not yet conclusive. 

Nevertheless, everyone can benefit from a balanced diet. Proteins, for instance, provides amino acids which are important building blocks of neurotransmitters. Some vitamins such as vitamin B6 and vitamin C, and minerals such as iron and zinc are also important in making or regulating some neurotransmitters like dopamine. It is therefore just logical to try to get enough of these in your diet.  

The key here is a balanced diet. Megadoses of vitamins, minerals, and amino acids are not necessary and may even cause harm. Supplements may help if it is determined that your child is indeed suffering from a vitamin or mineral deficiency. 

• Encourage children to get enough sleep

Fatigue and lack of sleep can make even the best-behaved kids (and adults) cranky. For kids with ADHD, lack of rest can make their day even more challenging than it already is so it is important to help them establish a regular night-time routine to help them sleep. 

• Help in organisation

Children and teens with ADHD may need more help when it comes to organising their lives. Use calendars, reminders, and charts to help kids manage their daily activities at home and in school.  

School accommodations

Ask your school about programs and accommodations for children with ADHD. Keep your communication lines open with your child’s teachers so that you can work together for their best interests. 

Takeaways

• Attention Deficit Hyperactivity Disorder is a neurodevelopmental condition that affects one’s attention, self-control, and executive function.

• The cause of ADHD is not yet clear although many experts believe that there is a strong genetic component to this condition. 

• The brain structure and activity of people with ADHD are different and these differences can affect how they regulate their attention, emotion, and behaviours.

• A qualified health professional like a developmental paediatrician or a psychologist can make a diagnosis of ADHD based on the presence of symptoms and a thorough review of the patient’s medical and developmental history and specific situation. 

• ADHD can be treated with medication and therapies.

• Having a healthy and balanced lifestyle can help children with ADHD cope better with their daily activities. 

• Children with ADHD can thrive in a supportive environment (at home and school). Training parents and working with schools and teachers can help in establishing a supportive environment for children with ADHD.