True to their nature, children are known to act up every now and then. But at some point, if the child is constantly fidgety and hyperactive, as parents you are likely to worry if your child has Attention Deficit Hyperactivity Disorder (ADHD). To provide you with a more thorough understanding of ADHD in children, we spoke to Dr. Lim Boon Leng, a psychiatrist from Dr BL Lim Centre for Psychological Wellness, Gleneagles Medical Centre.
What exactly is ADHD in children?
ADHD is the one of, if not the most commonly diagnosed behavioural disorder in children. Children with this condition are usually hyperactive and unable to focus or control their impulses.
Dr. Lim states that in Singapore, around one to two out of every 40 children are diagnosed with ADHD. For reasons beyond the understanding of science, ADHD in children seems to affect more boys than girls.
ADHD affects children and teens and can continue into adulthood.
What are the causes of ADHD?
The exact cause of ADHD in children remains at large but researchers say that these factors could potentially lead to ADHD:
- Chemical imbalance in the brain
- Poor nutrition, smoking, alcohol or substance abuse during pregnancy
Contrary to popular belief, watching too much television or consuming sugar does not cause ADHD in children.
What are the signs of ADHD in children?
Dr Lim explains that the hallmark symptom of ADHD in children is difficulty in paying attention. The ADHD child is always on the go, will talk excessively and is unable to play quietly.
There are two domains of symptoms – attention deficits and hyperactivity. These are the symptoms in the attention deficits or inattention domain:
- Problems listening, following instructions & finishing tasks
- Easily loses his belongings
- Tends to daydream
- Makes careless mistakes
- Avoids activities involving sustained concentration
- Avoids activities that appear to be ‘boring’
ADHD in children causes them to be hyperactive and fidgety.
The term Attention Deficit Disorder (ADD) is the layman term that displays only the symptoms in this domain, it is not a diagnosis on its own. The formal diagnosis is still ADHD.
There are the symptoms in the hyperactivity domain:
- Restless, unable to sit still
- Runs and climbs on things constantly
- When seated, tends to squirm and fidget
ADHD in children also causes them to have impulsivity. They often have trouble waiting for their turn to do something, interrupt others or simply blurt out their answers.
When can you start looking out for ADHD in children?
According to Dr. Lim, whilst symptoms of ADHD in children may be prominent at an even younger age, parents can start to look out for signs when the child is about 5 to 6 years old.
How do you know it’s not just them acting up?
Many of these symptoms are similar to that of your regular, naughty child. As such, it makes ADHD in children rather difficult to identify. Some parents even take great offence to teachers suggesting that they get their child diagnosed.
Dr. Lim wishes for parents to know that the wilful refusal of completing tasks or homework, deliberate aggression and disobedience are at times confused with ADHD. However, in ADHD, being messy, ignoring instructions and being restless are due to poor attention and hyperactivity.
It is not intentional and the child cannot control the behaviour.
It is important to get a professional diagnosis for sometimes that which appears to be ADHD might be something else altogether. Do also take into consideration if your child is suffering from anxiety or depression, has a medical condition or a sudden traumatic or life-changing experience. These may cause the child to display behaviour that resembles ADHD.
If a child has experienced some kind of trauma, it may cause him to act in a manner that can be mistaken for ADHD.
What are the options for treatment?
In his practice, Dr. Lim mostly starts to diagnose ADHD for children above the age of 5. This is because, unless they are very severe, inattention and hyperactivity can be quite common in children between the 3 to 5 years of age. They may improve naturally as they mature.
ADHD in children can be treated with medications. Currently, two main types of medications are available – stimulants and norepinephrine uptake inhibitors. They help ADHD by increasing the level of neurotransmitters (chemical messengers) in the brain called dopamine and norepinephrine. Behavioural modifications and therapy are also useful treatments and are always given alongside medications.
Lifestyle changes to improve the condition?
Dr. Lim affirms that there has not been any proof that dietary changes can improve ADHD symptoms and studies have consistently shown that dietary changes have no bearing on ADHD symptoms.
The exception to this is fish oil which has shown to improve attention deficits symptoms and decrease hyperactivity in some cases.
Parents should adopt positive parenting styles. These will usually include setting up firm and consistent boundaries and routines for the child, rewarding and encouraging positive behaviour and meting out the appropriate consequences for bad behaviour.
Adjustments to communication styles are important. Parents need to catch their child’s attention before speaking to them rather than just yelling at them. Use as little words as possible as the ADHD child has poor attentional span and will not be able to follow long instructions.
If your child has ADHD, be firm but compassionate. Do not aggravate the situation by yelling.
Words from the expert…
Dr. Lim wishes to tell all parents that ADHD in children is not unlike any other medical problems. ADHD children are not lazy, naughty or deliberately wilful. As such, what parents need to do is not be punitive but to approach the symptoms with patience and compassion and to assist the child with managing his or her symptoms.
A teacher’s perspective
I have noticed that ADHD in children is becoming increasingly common these days. In almost every class, there are at least one or two children with the condition. The sad thing is that sometimes they start actively believing that they are not as good as their friends and that they are different. Some even feel outcast.
Sometimes it is even a self-fulfilling prophecy. Students who are rather bright and high-performing before the formal diagnosis, start throwing in the towel and giving up on themselves upon being diagnosed with ADHD.
What’s even more heartbreaking is that when these children open up, they share how they feel when people misunderstand them. They mentioned how people misunderstand them and assume that they use their condition as an excuse for bad behavior. The worst part is when parents compare them to their older siblings who do not have the same condition and ask them why they are being so difficult.
My heart shattered when I heard that parents could bring themselves to make such a comparison. Some parents are trying their best to help their child, some are in denial and others simply cannot afford the medication. It’s really sad.
But in all honesty, they aren’t that different. Some children with absolutely no conditions behave far worse than them. Knowing their triggers and working around them, keeping them constantly engaged and making minor changes in the daily lesson planning, to accommodate children with ADHD, goes a long way in creating an inclusive environment for them.
They can end up very successful. And some of them are incredibly sweet children. My heart goes out to them.
What it's like for a mother
A mother confesses that she has a difficult time dealing with her child who has ADHD.
My child has ADHD and while I love him more than anything in this world, I’d be lying if I said that there aren’t days when I lose my head. I do get frustrated, I do yell at times, and I may have said a few things that I wish I hadn’t.
I know that it’s not his fault but I’m only human and dealing with an ADHD child can be really trying. And it often leaves me feeling guilty and regretful.
I’m also constantly anxious about how he’s coping in school, if he’s getting bullied or ostracised and ultimately about what the future holds for him.
I wish it didn’t have to be my child, but I have accepted it and I’m doing my best to work around his condition.
We hope that we have helped you to have a better understanding of ADHD in children. If a child that you know, or your own child has this condition, please be more forgiving of their behaviour and do get them treated.