Attention Deficit Hyperactivity Disorder (ADHD)

Diagnosis

Defined in ICD-10 as part of Hyperkinetic disorder (a more severe form of ADHD).  Requires the following to be present:

• Developmentally inappropriate levels of:
  • Inattention AND
  • Hyperactivity AND
  • Impulsivity
• Persisting for >6 month and be significantly impairing and pervasive across domains
  • Must also be in children <7 years (older and it is counted as manic).

Why is it important?

2/3rds of adults who had ADHD as a child continue to have problems as adults.

Assessment

Full assessment involving interviews with parents and child (alone/together), as well as information from schools, physical evaluation and cognitive tests should be done.

Management

Psychoeducation- inform the parents and child about ADHD, give them resources and advice about treatments.  Inform the GP and school.

Specific treatments

NB in children <6 years old, there are issues of diagnostic uncertainty so pharmacological treatment is not recommended and does not have a large evidence base.  If <6- parent training programmes are most commonly used.

• Psychological
  • Parent training
  • Behavioural classroom management strategies
  • Social skill
  • Diet: elimination and supplementation
• Pharmacological
  • Methylphenidate
  • Dexamfetamine
  • Atomoxetine