ADHD

with thanks to Dr Monika Bajaj, neurodevelopmental paediatrician practising privately in east London.

ADHD is a chronic life long disorder of self-regulation with symptoms persisting in >70-80% adolescents and >50% adults.

It is real disorder with real long-term risks, just to quote a few impacts….

  • Up to 30% of children may have depression and up to half of girls with ADHD may attempt self-harm
  • Children with untreated ADHD are >5 times more likely to participate in fights and underachieve at school
  • Adults with ADHD are 9 times more likely to end up in prison, more likely to experience financial problems and being fired from a job.
  • Adults with ADHD have a higher mortality compared to those without mainly due to causes such as driving accidents, substance abuse, obesity and co-morbid problems (Dalsgaard et al. Lancet 2015, May;385(9983):2190-6)

Red Flags:

  • Organisational skills problems (time management, memory, late and unfinished homework and projects)
  • Erratic work and academic performance
  • Family/marital problems
  • Poor sleep and other household routines
  • Difficulty managing finances, impulsive shopping
  • Compulsive addictions – sex, gambling, video gaming, exercise, eating
  • Frequent accidents secondary to recklessness
  • Speeding tickets, car and motorbike accidents
  • First degree relatives with ADHD
  • Low self-esteem, chronic under-achievement

ADHD is usually diagnosed after the age of 6 years to allow for the child to mature. Almost all children have times when their behaviour seems unacceptable and age inappropriate. However, when behaviours happen many times a week or daily, ADHD ought to be looked for. NICE guidance allows children to be treated after the age of 5 years and medication makes a huge and quick difference along with psychoeducation and behavioural management.

Resources: The Canadian ADHD Resource Alliance (www.caddra.ca is an excellent resource for professionals with free downloads).

US guidelines have recently changed to allow treatment of some 4 year olds with debilitating features of ADHD (https://www.healthychildren.org/English/news/Pages/Practice -Guideline-for-the-Diagnosis-Evaluation-and-Treatment-of- ADHD.aspx)

UK support group: https://www.borntobeadhd.co.uk/

 

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