Attention Deficit Hyperactivity Disorder (ADHD) -
The private assessment, diagnosis and treatment involves -
- A full developmental and clinical / social history
- Mental state examination to rule out other psychological problems which may manifest similarly.
- Consideration given to academic performance, liaison with school teachers as appropriate (done with your consent)
- I use gold standard Conners Questionnaires alongside the above.
- Occasionally we may do blood tests / ECG prior treatment with medication.
- Medication information, initiation, monitoring - often I will link up with the GP so the surgery can provide repeat prescriptions
- Once settled on optimal dose, follow up reviews tend to happen once every 4-6 months.
To find out more about ADHD, read on -ADHD is a relatively common condition affecting 2 - 5 % of children and adolescents. The incidence and prevalence varies depending on which clinical criteria (ICD 10 or DSM) are used.
Those affected display symptoms in three areas - hyperactivity, difficulty sustaining attention and impulsive behaviours. Certain number of these features need to be present to meet diagnostic threshold and the difficulties noticed across at least two settings i.e school and home. A variant, Attention Deficit Disorder (ADD) is also recognised, here the symptoms relating to overactivity / impulsivity are not dominant. Such presentations where difficulty relating to inattention is the main problem tends to be seen more in girls and being less obvious likely to be overlooked and less reported.
A variety of theories spanning bio-psycho-social factors have been considered by researchers. Family history tends increase chances of getting the condition as do problems during pregnancy including drug use. Inconsistent parenting may often be part of the equation.
This will typically involve a clinical interview spanning the early development, ruling out medical and social causes (childhood abuse) as if these explain the presentation better, ADHD may not be diagnosed. Corroborating the findings by acquiring information from school is vital and often done by direct communication / school observations (if need be) and use of specialised questionnaires which are also completed by parent/s and the young person unless too young.
Though the diagnosis can be made at a relatively early age of 3 - 6 it is very common in my practice to see teenagers who have not been diagnosed until very late, in some cases as late as late teens or in young adulthood (adult ADHD is now increasingly recognised).
ADHD is best understood as a neurodevelopment condition wherein the evolved frontal cortex (larger thinking brain at the top) is not sending down sufficient dampening signals (chemicals such as dopamine) to quieten the lower primitive brain structures from where random behaviour, inattention and impulse arise.
Treatment in milder cases and pre school children helping the child train it self to use the regulatory control of the larger thinking brain more. This is complemented hugely by parents learning the right skills by attending individual or group parenting sessions.
Medication is used above age of 6 and in moderate - severe conditions or where the above efforts have not yielded sufficient benefit. The medication used may be stimulant (first choice) or non-stimulant variety and would supplement the deficient chemicals such as dopamine when used in clinical doses thereby producing a clinical benefit.
Why is it important to treat ADHD?
Left untreated, these children tend to by virtue of their lack of regulatory control get in trouble due to their behaviour and poor academic performance. This leads to being "told off" by adults who are in a position of authority and in time may get worse effecting exclusion from mainstream schooling for periods of time and at times permanently. Such experiences other than impacting a sense of self lead to an antagonistic attitude towards adults and presents as Oppositional Defiant Disorder which may eventually acquire a flavour of Conduct Disorder leading to anti-social behaviours and contact with legal system. Young people may end up drug taking as a way of sensation seeking (a common need seen in those with ADHD) and at times self help. The consequences of not treating ADHD thus can be significant in terms of potential for poor long term outcomes.