Attention Deficit Hyperactivity Disorder (ADHD) -
The private assessment, diagnosis and treatment involve -
- A full developmental and clinical/social history
- Mental state examination to rule out other psychological problems which may manifest similarly.
- Consideration is given to academic performance and liaison with school teachers as appropriate (done with your consent)
- Use standard ADHD Questionnaires alongside the above.
- At times, additional tests may be required, e.g. QB or TOVA computerised continuous performance tests, WISC (for IQ) and further testing for Autism Spectrum Disorders. These are done independently at additional costs, and we will make suitable recommendations.
- Occasionally, we may require blood tests / ECG before treatment with medication.
- Medication information, initiation, and monitoring - we will be happy to draw up a shared care agreement, which would allow your GP / Surgery to provide repeat prescriptions in keeping with standard shared care protocols. This is entirely at the discretion of the GP.
- Once settled on the optimal dose, follow-up reviews tend to happen once every 4-6 months or yearly when under shared care with the GP.
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 vary depending on which clinical criteria (ICD 10 or DSM) are used.Presentation:
Those affected display symptoms in three areas - hyperactivity, difficulty sustaining attention and impulsive behaviours. A certain number of these features need to be present to meet the diagnostic threshold, and the difficulties are 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, tend to be seen more in girls and are less likely to be noted and reported.
Causal factors:
A variety of theories spanning bio-psycho-social factors have been considered by researchers. Family history tends to increase the chances of getting the condition, as do problems during pregnancy, including drug use. Inconsistent parenting may often be part of the equation.
Diagnostic process:
This will typically involve a clinical interview spanning the early development, ruling out medical and social causes (childhood abuse), and if these explain the presentation better, ADHD may not be diagnosed. Corroborating the findings by acquiring information from the 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 around 5, 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).
Preschoolers under 5 may be assessed for the probability of a diagnosis, but firm conclusions may be deferred until a child is close to age 6 or above.
Preschoolers under 5 may be assessed for the probability of a diagnosis, but firm conclusions may be deferred until a child is close to age 6 or above.
Treatment:
ADHD is best understood as a neurodevelopmental 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 helps the child train itself 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 the age of 5 and in moderate - severe conditions or where the above efforts have not yielded sufficient benefit. The medication used may be a stimulant (first choice) or a non-stimulant variety and would supplement the deficient chemicals, such as dopamine, when used in clinical doses, thereby producing a clinical benefit.
Initial private prescriptions have to be paid for separately as medication costs are separate and paid directly to the pharmacy.
Initial private prescriptions have to be paid for separately as medication costs are separate and paid directly to the pharmacy.
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 have a 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 present as Oppositional Defiant Disorder, which may eventually acquire a flavour of Conduct Disorder, leading to anti-social behaviours and contact with the 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 the potential for poor long-term outcomes.
Further reading on subtle nuances in the diagnostic process - click here
Further reading on subtle nuances in the diagnostic process - click here
