Attention-Deficit Hyperactivity Disorder (ADHD) is characterised by inattention, impulsive behaviour, hyperactivity, and issues with mood regulation.
In children and young people, ADHD looks like struggling to concentrate or pay attention, difficulty following directions, acting impulsive and fidgeting, and finding themselves easily frustrated or angry.
Many parents believe they know ADHD when they see it. It’s a common point of discussion in parenting circles and ADHD is one of the most commonly referenced DSM-5 disorders in popular media.
However, there are myths surrounding ADHD that can cloud our vision. These myths may mean parents and teachers look only for so-called “classic signs” of ADHD. Too often, it can also mean failing to recognise an underlying issue masquerading as ADHD.
That’s why it’s so important to have a child formally assessed for ADHD by a specialist Child Psychiatrist or Paediatrician.
Why Should You Seek Out an ADHD Assessment?
If your child’s experience seems to be dominated by impatience, hyperactivity, distractedness, and struggles with the demands of school, you might consider bringing them in for an ADHD assessment.
ADHD assessments are critically important to the health and development of children.
It’s not enough to observe those symptoms and stick the ADHD label on a child. ADHD is listed in the DSM-5, and it is a complex diagnosis that benefits from a thorough assessment provided by a professional who not only understands the disorder but who has a specialty in human growth and development.
Why seek out a formal diagnosis? ADHD is not an uncommon diagnosis, but it’s often mistaken with other diagnoses such as:
Learning difficulties
Language problems
Mood disorders
Autism spectrum disorder
Vision or hearing problems
Seizure disorders
Sleep disorders
Brain injury
Side effects of medical problems or medications
Mistaken diagnosis can happen at any age, but they are particularly prominent among children under five: a language delay may present as ADHD.
Keep in mind that ADHD can also be part of a dual diagnosis. ADHD and comorbidities can include (but aren’t limited to):
Autism spectrum disorder
Sleep disorders
Depression
Tics and Tourette syndrome
Disruptive behaviour disorders
How is ADHD Assessed?
Thorough assessment of ADHD would include gathering evidence of impairment in multiple settings - child/adolescent, parents/carers, teachers and health professionals.
There are several phases in an ADHD assessment. The results of each phase work together to provide a clearer view of the child’s experience for comparison against the DSM-5 criteria.
Initially GPs may be approached. If, on the basis of this discussion it is suspected that
a child/adolescent has ADHD and/or has behavioural, emotional or cognitive symptoms causing significant and persistent impairment to them, the family or at school, the GP can provide information and referral to a specialist Paediatric Psychiatrist (Child Psychiatrist) or Paediatrician.
Holistic and comprehensive assessment for possible ADHD by a specialist would involve:
a comprehensive medical, developmental and psychiatric assessment of the child/adolescent
full clinical and psychosocial assessment of the child/adolescent and their family. this should include discussion about behaviour and symptoms in the different domains and settings of the person's everyday life and
a cultural and social assessment of the meaning and significance of the behaviours
seeking out available explanations for the presentation, including but not restricted to alternative medical diagnoses
additional psychological assessment and testing, such as Cognitive (IQ) testing and educational assessments, if warranted.
whether the symptoms are developmentally excessive for the child’s developmental age and associated expectations
Generally a comprehensive assessment tool such as Conners 3/4 may also be employed. This will involve a series of interviews/questionnaires with the child or young person as well as other important people in their life, including their parents or guardians, teachers, or coaches.
How is ADHD Diagnosed?
Once appropriate and comprehensive assessment is done by the specialist Child Psychiatrist or Paediatrician the child/adolescent may be diagnosed with ADHD. The diagnosis of ADHD is a clinical judgment based on the application of the DSM-V criteria. The DSM-V criteria must be met for a diagnosis of ADHD to occur. Additionally following conditions must be met:
Several symptoms were present before age 12 years.
The symptoms are pervasive, occurring in 2 or more important settings including social, familial, educational and/or occupational settings.
The symptoms clearly causes at least moderate psychological, social and/or educational or occupational impairment based on interview and/or direct observation in multiple settings
The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
What are the subtypes of ADHD Diagnosis?
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
What Kinds of ADHD Treatment Are Available?
Once your child has an ADHD diagnosis, you can then work together with your specialist Paediatric Psychiatrist to find a treatment that matches your child’s symptoms, needs, and experiences. A holistic and child-centered approach is recommended in the management of ADHD in children/adolescents.
Pharmacological management
use of stimulant medications can reduce core ADHD symptoms and improve social skills and peer relations in children and adolescents diagnosed with ADHD
Not all children and adolescents with ADHD will require, or benefit from, pharmacological management. The use of clinical judgement is required to evaluate the harms versus benefits of stimulant use for each individual case upon discussion with the child/adolescent and their family.
If medication is to be used in management, stimulants are presently the first line of treatment.
If pharmacological treatment is implemented, it should be based on a comprehensive assessment under the direction of a paediatrician or child/adolescent psychiatrist.
Treatment aims to help relieve the symptoms and help your child better concentrate, regulate their moods, and improve other symptoms, like poor sleep.
Therapy
As well as taking medicine, different therapies can be useful in treating ADHD in children, teenagers and adults. Therapy is also effective in treating additional problems, such as conduct or anxiety disorders, that may appear with ADHD.
Some of the therapies that may be used are outlined below.
Psychoeducation
Behaviour therapy
Parent training and education programmes
Social skills training
Cognitive behavioural therapy (CBT)
Depending on your child’s needs, you may opt for a medicine or therapy or a combination of the two. It’s important to remember that ADHD therapy isn’t just for your child: parents, children, teachers, carers and anyone else regularly working with your child participate in these programs, too.
Managing ADHD means working together as a team to help support your child. So, don’t be afraid to lean into additional therapies, including family counselling, as you navigate your child’s upbringing with an ADHD diagnosis.
Which specialist to approach?
When choosing which specialist to go you need to consider the child, child’s age and your family’s needs. When making your decision, remember only paediatricians and child psychiatrists can prescribe medication for ADHD in many states in Australia. Of course families need to keep in mind Paediatricians don't see patients over the age of 17 while Child Psychiatrists (as they are also Adult Psychiatrists) can continue to treat patients which is excellent for continuity of care.
What Are Some Common ADHD Myths?
One of the reasons it’s a struggle to recognise the signs of ADHD is because it falls prey to many myths. There are still many non-evidence based assumptions about what ADHD is, what people with ADHD experience, and even whether ADHD is real. Knowing these myths can help you see past them and educate your child and those they interact with about what it means to have ADHD.
Myth #1 ADHD Isn’t Real
Although ADHD is commonly referenced in popular media, there’s still a stigma associated with the disorder. One of the reasons stigma exists is because many people still don’t know or believe that ADHD is a DSM-5 disorder.
For many people, ADHD comes with a sort of contempt not seen with other diagnoses: they see it as a child who is lazy or uncontrollable or even as the product of bad parenting. In reality, studies show people with ADHD may have differences in brain development compared to people who don’t have ADHD. ADHD may even be hereditary.
ADHD stigma is a huge problem for young people, who internalise the stigma as they develop their identities. They have trouble seeing their strengths and even understanding a realistic version of themselves.
Myth #2 ADHD Only Impacts Boys
ADHD manifests itself in different ways in different people. Not all kids with ADHD will experience hyperactivity. Girls and young women may experience hyperactivity in different ways, such as hyper-talkativeness.
This myth is why ADHD assessment and diagnosis is so important. Parsing a child’s behaviours and experiences is the only way to know whether they demonstrate symptoms of ADHD or of another disorder or even a medical condition.
Myth #3 ADHD is Always a Struggle
ADHD can manifest itself in ways that can make it difficult for children and young people to fit into traditional classrooms or even in workplaces. However, there is now more awareness of neurodiversity and more options that come with it.
What’s more, ADHD can present itself with some characteristics associated with extraordinary success. People with ADHD are as likely to be energetic, creative, and driven, particularly when they have the tools and support needed to manage their symptoms.
How can we help with ADHD Assessment, Diagnosis and Treatment?
Our team of Psychologists and Psychiatrists who are experts in ADHD can provide comprehensive assessment, diagnosis and treatment of ADHD based in Sydney, NSW
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