Many of us take for granted our ability to pay attention to tasks that require us to be focused for extended periods, we take for granted our ability to electively shift this attentional focus from one thing to the other when it is necessary to do so. Many of us may not stop to think of the role that being attentive plays in helping us to encode information in our environment to store it in memory, to learn, to function socially, to plan and to see that plan through. But for some, the world functions very differently in all these ways and it can be quite challenging indeed. What I am speaking about here is Attention Deficit/Hyperactivity Disorder (ADHD), which is a neurodevelopmental disorder that has its origins in childhood and typically is characterised by problems with attention and concentration, and in some instances hyperactivity, impulsivity and associated behavioural problems. In this blog, I want to focus on some of the basics –setting the foundation for later blogs where I will speak in greater depth about the process of assessment and intervention among other considerations for those willing to follow this psychoeducational journey with me.
Globally, this disorder affects anywhere from 5-12% of school-age children, and within Australia specifically 1 in every 20 individuals have a diagnosis of ADHD (that’s just about a million people across the entire country). ADHD can look different in different situations and this is part of the reason it can be quite challenging to diagnose. Despite some commonality in its features, I recount the description of Dr. Sharon Burney in stating that it is a disorder that has many “faces” meaning many varied forms of expression. Indeed, the same child/adolescent under different conditions can appear to be quite different, and this holds true for children with and without ADHD. Therefore, ADHD can look different in the same child in different contexts, and some children without ADHD can exhibit behaviours that are associated with ADHD when they are in certain situations/contexts. When we therefore assess for the presence or absence of ADHD, we look for a persistence in the pattern of certain target behaviours (chiefly inattention, hyperactivity and impulsivity).Having as much information from as many different sources as possible is therefore crucial to a thorough assessment. It is not just a temporary reaction to a stressful period or event.
ADHD can present with inconsistencies whereby, for example, a child will complete tasks requested of them sometimes (especially if there is a strong incentive or reward) and not others, or get a good mark in one instance and a poor mark in another. ADHD is not a disorder that reflects a skills deficit, meaning the issue is not the child’s capability to perform the individual tasks, rather it is the difficulties focusing attention and in some instances the tendency towards impulsivity that interfere with how consistently they are able to do the things they need to or ought to do. They can often be so distracted because they are indeed “attracted” to so many things taking place around them.
Only 30% of children have a diagnosis of ADHD only, most have one or more co-occurring disorders. These disorders tend to include: another disruptive behaviour disorder (such as oppositional defiant disorder or conduct disorder), anxiety disorders, learning disorders, and others. Therefore, thorough and comprehensive assessment is strongly recommended so that the treatment plan addresses all the moving parts of what is usually a complex problem.
For many children with ADHD there can be improvement as they get older, especially with solid evidence-based intervention. However, half or more of these children may continue to experience some difficulties (even if there is some improvement) as they move into adulthood.
But, do all children with ADHD present the same way? The short answer is, no. The disorder when diagnosed is associated with different subtypes which represent the child’s most frequently observed and impairing behaviours. One classification, and the most common, is ADHD combined type, where the child displays problems with attention as well as hyperactivity/impulsivity. Another grouping is ADHD the hyperactive subtype (significant difficulties with hyperactivity mainly) and finally ADHD the inattentive type (significant difficulties with attention and concentration mainly). While the first two subtypes tend to be more behaviourally obvious and often prompt parents and teachers to sound the alarm that something may indeed be atypical, the inattentive type can be more readily overlooked and for this reason it tends to be diagnosed much later in the child’s academic life and sometimes missed altogether until adulthood!
Symptoms can change over time as well. Some children who are quite hyperactive in the earlier school years become much less so by the time they get to high school. Similarly, some children that struggle with inattention, but not with hyperactivity, have a delayed onset in academic difficulties until later in preparatory school and sometimes not even until high school. In short, this happens because relative to their intellectual ability, as the academic tasks become more complex there is more demand on their attentional system, and it is under these conditions that the symptoms begin to show themselves more clearly.
If this information has piqued your interest, know that there is so much more to come as we continue to discuss this very relevant topic. Undoubtedly, deepening our understanding about various mental health issues and their complexities can help us to learn how we might respond to them more effectively. Until next time – take care of yourselves and look out for each other.