Key questions about ADHD

What are the telltale signs of attention deficit hyperactivity disorder (ADHD) in children and at what age does it usually occur? Are adults also at risk of developing the condition later in life?

There are two main domains of symptoms: attention deficits and hyperactivity. A child with ADHD may have problems listening, following instructions, and finishing tasks and is forgetful. Such children are distractible, tend to daydream, and make careless mistakes. They will avoid activities that require sustained concentration or find it boring. In the hyperactivity domain, they are restless and cannot sit still. They may run and climb on things constantly and, when seated, may tend to squirm and fidget.

Most children get diagnosed with ADHD at around five years of age and older. Unless very severe, inattention and hyperactivity can be quite common in children ages three to five, which may improve naturally as they mature so a few symptoms do not make ADHD. Children are only diagnosed if they fulfil the strict diagnostic criteria and have symptoms across multiple settings in their life, causing significant dysfunction. 

No, adults do not develop the condition in later life. Some adults may have had symptoms since childhood but were left undiagnosed and only sought help when older. 

This disorder is usually reported to affect boys more than girls. Why is this the case?

Though the prevalence is the same across genders, the condition manifests differently in boys and girls. Boys are more likely to be hyperactive, restless, disruptive, and noisy. Girls tend to have inattentive symptoms, are dreamy, and often quiet. Since girls do not display outwardly difficult behaviour, they are less likely to be noticed and diagnosed. 

What are the risks of undiagnosed ADHD for both genders?

Undiagnosed ADHD can lead to difficulties in academic, career, and social aspects of life. Consequentially, they may develop low self-esteem. In later life, they are more likely to have lower paying jobs and are prone to antisocial personality disorder, criminality, substance abuse, depression, and anxiety disorder.

Since there's no known cure for ADHD, how can it be managed?

What parents need to do is not be punitive but approach the symptoms with patience and compassion and consult a child psychiatrist on how to manage the symptoms.
Some specific approaches they can adopt 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 few words as possible as the ADHD child has a poor attention span and will not be able to follow long instructions.  

ADHD can also be treated with medication. Currently, two main types of medication  --  stimulants and norepinephrine uptake inhibitors -- can help ADHD patients by increasing the level of neurotransmitters (chemical messengers) in the brain. Behavioural modifications and therapy are also useful treatments and are always given alongside medication.

Dr Lim Boon Leng is a psychiatrist at Dr BL Lim Centre for Psychological Wellness in Singapore.

This story was originally published in the Global Health and Travel issue of August-September 2018.