Does your child have ADHD? How to learn the signs and the best ways to treat it
- The condition is a common developmental behavioural disorder affecting between 5 per cent and 11 per cent of school-age children
- Symptoms include inattention, hyperactivity and impulsivity
Kathy Nichols is well informed about attention deficit hyperactivity disorder, better known as ADHD. She had to be. She raised four children with the condition.
Born in the US, Nichols arrived in Hong Kong in 1990 with her husband and children aged 15, 12, seven and two. All four were diagnosed in the US.
“My seven year old was overactive – he moved all the time,” says Nichols over coffee at a Central cafe. “When he was at nursery school [in the US] he was not able to sit still. The teachers assured me it was normal. ‘Don’t worry, little boys are often a little antsy.’ Of course he didn’t settle.”
Nichols said it was 1988, a time when ADHD diagnosis was in its infancy and when the effects of Ritalin – a stimulant used to treat ADHD – were only just surfacing. Ritalin affects parts of the brain and central nervous system and has been a highly effective treatment for ADHD.
“I was anxious about giving medication to my children,” Nichols says. She soon changed her mind. “[My son’s] life changed the day he started with the medication. He came through the back door and he had the biggest smile on his face and said, ‘I didn’t get in trouble today and I learned so much.’ Of course I welled up.”
ADHD symptoms vary from person to person, but are characterised by a combination of inattention, hyperactivity and impulsivity. Symptoms also manifest differently in males and females.
“With my girls, ADHD manifested differently. Overactive behaviour in girls is, more often than not, seen in social conversation – ‘Chatty Cathys’ – and the inattentive type of ADHD in both boys and girls is seen as a quiet, distracted day-dreamer,” Nichols says.
“There was none of the overactive behaviour, which also diminishes with age. By age 11 or 12, it’s often no longer an observable symptom – these young boys are no longer racing around … however, their minds, their thoughts, their ideas are still running helter-skelter.”
Although precise causes of ADHD have yet to be identified, heredity has been linked. If a child has ADHD, there is a one in four chance a parent does too, whether it has been diagnosed or not. That is according to Focus, a Hong Kong charity dedicated to improving the education of children with learning difficulties.
ADHD is one of the most common developmental behavioural conditions and affects between 5 per cent and 11 per cent of school-age children. In a typical Hong Kong classroom it’s likely that at least one student has ADHD, though they may go completely undiagnosed, according to Focus.
Nichols says the most important thing for children with mainstream learning differences – such as ADHD, dyslexia, dysgraphia and dyscalculia – is to be given an opportunity to learn to the best of their abilities and potential.
She explains that the common perception of ADHD is that children – mostly boys – are hyperactive and cannot concentrate, but the impact is much wider, more diverse and often more subtle. Those with ADHD have a lot more difficulty in the development and use of their executive functions than most others of the same age. These difficulties can affect academic achievement, social and professional success, and even marital relations.
A University of Hong Kong study published in The Lancet Psychiatry journal in September found that there had been a dramatic increase in the number of children in Hong Kong given medication to treat ADHD. The study found that in 2001, only one in every 2,500 children took medication. By 2015, it had increased to about one in 70.
The study’s co-author, Professor Patrick Ip, says he does not think doctors are using the drug for ADHD excessively. Instead, the researchers say the sharp increase is the result of a better understanding and awareness of a condition which leaves people unable to control their impulses or with difficulty paying attention. But Ip says more research needs to be done.
“Renewed efforts are needed to improve the consistent identification and treatment of ADHD across the international community and to develop consensus on best practices and to implement such practices,” he says. “Further research is needed to show the longer-term safety and effectiveness of ADHD medications to develop evidence-based guidelines, particularly in adults.”
Common signs of ADHD
For a child to be diagnosed with ADHD, the signs have to be present for at least six months. Girls and boys frequently display different symptoms. Boys with ADHD frequently stand out more than girls. Girls, regardless of which kind of ADHD they have – the hyperactive-impulsive kind or the inattentive, day-dreamy kind – seem to compensate better in school.
How is ADHD diagnosed?
There is no single test to diagnose ADHD. A comprehensive evaluation is necessary to establish a diagnosis, rule out other causes, and determine the presence or absence of coexisting conditions.
The evaluation should include a careful history and a clinical assessment of the individual’s academic, social and emotional functioning and developmental level. It should be made by a developmental paediatrician, paediatric neurologist or psychiatrist, or a developmental, clinical or educational psychologist at PhD level.