Although many children are inattentive, easily distracted or impulsive, in some children these behaviours are exaggerated and persistent, compared with other children of a similar age and stage of development. When these behaviours interfere with a child’s family and social functioning and with progress at school, they become a matter for professional concern.
Attention Deficit Hyperactivity Disorder (ADHD) is a diagnosis used by clinicians. It involves three characteristic types of behaviour – inattention, hyperactivity and impulsivity. Whereas some children show signs of all three types of behaviour (this is called ‘combined type’ ADHD), other children diagnosed show signs only of inattention or hyperactivity/ impulsiveness.
Hyperkinetic disorder is another diagnosis used by clinicians. It is a more restrictive diagnosis but is broadly similar to severe combined type ADHD, in that signs of inattention, hyperactivity and impulsiveness must all be present. These core symptoms must also have been present before the age of seven, and must be evident in two or more settings.
The strongest evidence supports:
• use of medication, where ADHD is diagnosed and other reasons for the behaviour have been excluded. These treatments have few side-effects and are effective in 75% of cases when there is no depression or anxiety accompanying ADHD. High doses can be avoided if behavioural treatments accompany medication;
• introduction of parent education programmes and individual behavioural therapy where there is insufficient response to medication. These need to be provided in the school as well as home, as they do not appear to generalise across settings;
• for children also experiencing anxiety, behavioural interventions may be considered alongside medication; and
• for children also presenting with behavioural problems (e.g. conduct disorder, Tourette’s Syndrome, social communication disorders), appropriate psycho-social treatments may also be considered by medical professionals.
Evidence also supports:
• making advice about how to teach children with ADHD-like behaviour widely available to teachers, and encouraging them to use this advice.