Children and adolescents with ADHD
Welcome to our patient information on children and adolescents with ADHD. When you have ADHD or ADD, it is important that you know about the condition, so you can handle your challenges in the best possible way.
Department of Child and Adolescent Psychiatry offers diagnosis and treatment of children and adolescents with ADHD in Central Region Denmark, usually through outpatient consultations.
What is ADHD/ADD?
ADHD/ADD is a mental developmental disorder that causes attention difficulties and sometimes hyperactivity and impulsivity to such a degree that it results in functional impairments.
ADHD is an abbreviation from the US diagnostic system used in international research and is short for ‘Attention Deficit/Hyperactivity Disorder’.
ADD is short for ‘Attention Deficit Disorder’, also called inattentive or quiet ADHD. For ADD, the main problems are the attention issues, while hyperactivity and impulsiveness are less prominent. However, regardless of the symptoms affecting the child/adolescent, the basic difficulties are the same, and so are the principles of treatment.
Basic difficulties in ADHD and ADD
Studies from many countries show that approximately 2-5% of the population have ADHD/ADD.
Previously, ADHD was categorised by different subgroups based on the most prominent symptoms. For example, one might suffer from ‘ADHD with predominant attention deficit’. New scientific studies show that symptoms may change over time in the same individual. For example, while hyperactivity and impulsivity may be the most prominent ADHD symptoms during childhood, attention deficit could become the most prominent symptom in adult life.
Consequently, the new US diagnostic criteria do not include the subcategories. However, many books and articles still describe two major types of the disorder: ADHD and ADD.
Hvad skyldes ADHD?
Hjernens opmærksomhedsfunktion udgøres af flere netværk i hjernen. De arbejder i et komplekst samspil, og deres udvikling er i høj grad biologisk bestemt. Det vil sige, at der er en stor grad af arvelighed bag ADHD/ADD. Der er derfor en stor sandsynlighed for, at flere i samme familie kan have ADHD/ADD.
Videnskabelige undersøgelser viser, at rigtig mange faktorer kan påvirke hjernens udvikling. For tidlig fødsel og påvirkninger under graviditeten kan også have betydning for, om barnet udvikler opmærksomhedsvanskeligheder.
People with ADHD generally suffer from three ‘core symptoms’:
- Attention deficit
- Difficulty concentrating and paying attention, distractibility and tiredness.
- Motor agitation and verbal overactivity.
- Speaking and acting before thinking.
Together, these three areas constitute the core symptoms for diagnosing ADHD in both children, adolescents and adults. People with ADD primarily suffer from attention deficit.
Variation in symptoms
The symptoms of ADHD/ADD may vary greatly from person to person and may change in intensity over time and between contexts. Symptoms are often most evident in unfamiliar situationswhere there is no clear structure, and less evident in familiar, well-structured situations. Symptoms may also change during childhood and adolescence.
Our ability to stay concentrated and pay attention as well as managing our level of activity and our impulses develop with age; a small child has a shorter attention span, is more restless and more impulsive than older children, adolescents and adults. It is therefore important to assess what can be expected of the person in terms of age and developmental stage
When do the symptoms equate to an ADHD / ADD diagnosis?
In order for the symptoms to warrant an ADHD/ADD diagnosis, the symptoms cannot be temporary or a reaction to sudden trauma or stress. The symptoms must have been present before the age of 7 – at home, at school and upon medical examination. Furthermore, the symptoms must put significant strain on the general well-being and the ability to function in different situations.
Our ability to pay attention plays a key role in our ability to process all the input we receive throughout the day.
To pay attention, we need energy and a steady energy level. Over the course of a day, our energy level fluctuates, and most people have most energy in the morning and feel most tired in the evening. Demanding tasks such as doing homework, reading a book in aforeign language or cleaning your room is something that most children and adolescents would prefer to do when they feel rested and full of energy. When you have ADHD or ADD, you tire out and lose attention more quickly than others. You may therefore need breaks or support to stay focused and concentrated.
The ability to pay attention needs to be flexible so that we can easily focus on what is important.
We also often need to be able to focus our attention on several things simultaneously, e.g. paying attention to what you are doing, while also paying attention to how others react to it, as this is important for our social skills. It is also important to be able to get on with tasks or chores, to be able to maintain focus over time and to complete tasks. These things can be difficult for a person with ADHD or ADD.
When you have ADHD or ADD, you are more easily distracted and disturbed by noise, bustle, visual impressions or your own thoughts, which also makes it difficult to stay focused. You end up doing something other than what you were supposed to do – looking out the window instead of reading, disappearing in the middle of a game or forgetting plans you made because you get distracted by other things.
In addition, the brain has difficulty regulating your energy level when you have ADHD or ADD, and you may therefore sometimes be very restless and sometimes very exhausted and drowsy. You may seem lazy, absentminded, sloppy and forgetful when you are in fact working hard to stay focused in your everyday life.
Being hyperactive means having difficulty staying still. Some people may find it hard to have to sit still for a long time, and experience discomfort or that they are itching to stand up. Others experience a more discreet sense of unrest that is less visible to the outside world. They may bob their knees, fidget with their clothes, fold down the corners of the pages in their books or pick their eraser to bits. In children and adolescents, hyperactivity is often expressed through constant movement, but it can also be expressed verbally through talking a lot, singing or making noises. They unconsciously activate themselves so that they do not fall asleep. Hyperactivity may become less prominent with age, so that it is experienced as a form of internal agitation and restlessness instead. But for some, it persists throughout life.
In general, children, adolescents and adults with ADHD or ADD may find it difficult to control impulses because they lack some of the control mechanism that normally develops as you grow older and more mature. As a result, they sometimes act before they think, and may thus say or do something ill-considered that they later regret. Impulsivity can be the cause of conflicts, quarrels, regret and defeatism, but it can also lead to dangerous situations, e.g. if a child impulsively runs across the road to catch a ball, or an adolescent impulsively gets tempted on a night out and does something ill-considered and risky. Other signs of impulsivity in everyday life are interrupting people, finding it difficult to wait your turn or stand in line and eagerly responding to questions at school before the question has been fully asked.
The symptoms make children and adolescents more vulnerable
Attention deficit, impulsivity and hyperactivity make both children, adolescents and adults more vulnerable to stress and change. Your threshold for stress is lower. Depending on what resources and support are available to you, most people experience stress symptoms develop when the demands made of them cross this threshold. Some children have such obvious symptoms of ADHD and ADD that they have difficulty paying attention in class, socialising with other children or being quiet in class as early as primary school. Other children may, with extra effort and support from their family, be able to keep up in class in the early school years. It is not until later that they experience problems because the demands for self-control, attention and a good overview become much greater. This is why older children and adolescents are often referred for an examination with symptoms of stress which may actually be caused by an underlying attention deficit disorder. They may experience sadness, anxiety or irritability and have mood swings. Other adolescents have behavioural difficulties. They may be more frustrated, yell and perhaps even be violent. What many of these young people have in common is that they have all experienced symptoms of ADHD throughout their lives.
In addition to the three core symptoms, many people with ADHD or ADD are often emotionally unstable and may have difficulty controlling their temper. They may get angry or very sad easily without quite understanding why. These emotional fluctuations can be confusing and stressful for both the person experiencing them and for the people around them
Typical concomitant difficulties
Difficulty maintaining an overview
ADHD/ADD is often accompanied by difficulty planning ahead and overcoming tasks and everyday routines. For example, common morning rituals can be difficult to overcome if you have ADHD – both the order of events and the amount of time needed to get dressed, brush your teeth, have breakfast, pack your bag and catch the bus can be very challenging.
Short-term memory struggles
Many people with ADHD/ADD often struggle with their short-term memory, which we use in everyday life when we need to remember practical things, such as bringing a hat and gloves, what time the train leaves or a message with several elements.
Many people with ADHD/ADD have had trouble sleeping since they were very little. Sleep can be improved if they get help with their ADHD, but separate pedagogical or medical sleep treatment is often necessary as well. Poor sleep can also cause symptoms of ADHD, and a good night’s sleep is therefore very important.
Many people with ADHD/ADD may have a hard time in social contexts. Among other things, this is expressed through difficulty keeping up with a conversation and paying attention to other people’s reactions. As a result, friends can become annoyed with the person who has ADHD because they cannot quite ‘adjust’ to the others, talk too much or say something that is out of context.
Many people with ADHD/ADD may experience low self-esteem, sadness or irritability and exhibit aggressive behaviour. This is often because having ADHD is stressful, but this can often be remedied by understanding their difficulties and showing support or helping them
Hvordan stilles diagnosen?
No simple test
There is no simple test or study that can determine whether a child has ADHD/ ADD.
A diagnosis can only be determined after a conversation with and assessment by a psychiatrist.
To get a diagnosis, the ADHD or ADD has to affect the child/adolescent to such a degree that he or she is not thriving. There can be many different reasons for why someone is not thriving. A thorough examination of the child and his or her surroundings is therefore necessary in order to exclude any other causes.
During the examination, the psychiatrist will ask about health conditions, family relations, school conditions and many other matters that may affect the child.
As ADHD is congenital, information on both the child’s development and current life situation is needed. The information must be obtained from the child himself/ herself and from relevant relatives in the child’s immediate environment. The difficulties of ADHD/ADD affect the child/adolescent in many different situations. The psychiatrist therefore also obtains information from the school and possibly from after-school care institutions or similar. The psychiatrist may use different questionnaires to gather the information more systematically, and additional psychological examinations may also be included in the diagnostic process.
The final diagnosis is made on the basis of an overall assessment of the results of the entire examination.
The most important element in the treatment of ADHD is understanding. Many of the symptoms – such as restlessness, difficulty sitting still, being noisy and having difficulty remembering what is being said or what was agreed – may bother or perhaps even provoke other people. They often think that children, adolescents and adults with ADHD behave like they do deliberately to irritate others. This is very rarely the case.
Furthermore, people with ADHD have difficulty noticing their effect on others. It therefore often comes as a big surprise when they find out that other people are bothered by their behaviour. It is therefore important that the people around them understand and accept that people with ADHD do not have the same conditions for learning as others do.
You cannot tell whether a person has ADHD/ADD just by looking at them, but it can be crucial for a child’s development and learning that the school is aware of the diagnosis and can take appropriate considerations. It is therefore a good idea to be open about the diagnosis, even if that can be difficult. The right understanding and pedagogical support is very important for children’s or adolescents’ development and to ensure that they are thriving.
Organization of the treatment
Once diagnosed with ADHD, the psychiatric contact person will, based on their own professional judgement and the conversations with the child and parents, decide what kind of treatment is necessary. Treatment may include:
- Social support options
- Medical treatment for ADHD and concomitant difficulties.
Psychoeducation Teaching about the disorder is called psychoeducation. Psychoeducation is an important part of the treatment for ADHD/ADD, and is offered to both the child/adolescent and the relatives. All relevant aspects of ADHD/ADD will be discussed. Particular attention will on how to handle life with ADHD/ADD. In addition, you will receive information about the support options that are available at home or at school. Teaching can be done in groups or individually.
Social support options
Some form of support from the municipality will often be needed. The psychiatric contact person will often be able to assist with contacting the municipality. For example, the person with ADHD/ADD may need help with daily tasks at home, mentoring at school or work, or applying for disability compensation study grants (SU) if they are studying. Changes to the physical environment are often also necessary at school or work, e.g. in the form of shielding the person from possible distractions.
For school-age children, there is a need for a special pedagogical approach at school with, e.g., shielding from distractions and the option of taking breaks as well as help with creating an overview of assignments.
In children, adolescents and adults with moderate to severe ADHD/ADD, medical treatment is often necessary and is what has the most documented effect. The medication works by increasing the amount of signal substances in the areas of the brain affected by the disorder. In general, medication has a good effect on attention deficit disorders. Many people with ADHD/ADD experience that medication helps them concentrate and be more calm and reflective. Symptoms are often diminished and well-being increased in children and adolescents once the right medication has been found. Finding the right medication can take time, as everyone responds differently to medication.
What can be done to prevent ADHD/ADD?
In the vast majority of cases, ADHD/ ADD is a life-long disorder. Consequently, there will not be periods in which you are ‘recovered’ and completely free from symptoms. However, there may very well be times where you are doing better or worse than normal. It will often be the case that stressful events in the life of the child/adolescent will worsen the symptoms. Fortunately, there is much that can be done to avoid getting too stressed. The next sections will go into detail about this.
What can you do yourself if you are suffering from ADHD/ADD?
Today, there are many different options for support – both for students and for people who are working. The municipality is responsible for establishing support for you and your family if you need it. In the Danish Folkeskole, the Pedagogical Psychological Counselling service (Pædagogisk Psyko logisk Rådgivning (PPR)) is responsible for ensuring that you receive support and help. In higher education, you can contact your student counsellor and the State Educational Grant and Loan Scheme (Statens Uddannelsesstøtte (SU)) for special pedagogical support (SPS) and other forms of help.
Get to know your disorder
Receive an offer of education in collaboration with your parents
Make use of your psychiatric contact person
Talk to your doctor, nurse or psychologist.
Talk to your relatives
It is important that you talk to your relatives about the difficulties you have in connection with your ADHD.
Avoid excess alcohol
Think about how much you drink at parties and on nights out. Excessive alcohol consumption can often worsen your ADHD.
This can often help reduce stress, restlessness and discomfort.
Make reasonable demands of yourself
Many people with ADHD think that they can do much more than they actually can.
Make sure to plan your day
Use a weekly calendar and a structured daily schedule. Fill out your calendar with your parents or other people you trust.
Make sure to get your sleep and eat a healthy diet
Turn off your computer and TV at fixed times. It is important to maintain a stable circadian rhythm, also called sleep-wake cycle. Try setting an alarm to remind you of when it is time to go to bed.
Be open about your disorder, when appropriate
This allows others to show consideration and help you.
What can relatives do?
As a relative, it is important to take the time to learn what it means to have an attention deficit disorder. Being a relative to children and adolescents with ADHD can involve many challenges. You need to be understanding while also setting clear limits for the child.
Many parents may feel ashamed, powerless and inadequate. It is important to realise that there is no perfect recipe for how to act and be the parent of a child with ADHD or ADD. Today, there are countless courses and groups where relatives have the opportunity to get guidance and share experiences with other families.
What can you, as a relative do for yourself?
You can get a better understanding of the nature of ADHD if you take a class (psychoeducation) together with the child/adolescent who has ADHD or ADD. This often relieves the guilt and feeling of inadequacy that many parents have. You can also get help for how to handle daily challenges at home in the best way. You can join an association for patients and relatives such as ADHD-foreningen or SIND’s advisory service for relatives. The associations hold meetings and courses and have advice lines.
It is also important that you give yourself permission to meet your own needs. You cannot have the energy to help and be the responsible one all the time.
Perhaps your family might need extra support from the municipality? The psychiatric contact person can usually help with this.
If you, after several years of being emotionally overburdened, are developing distinct symptoms of anxiety or depression yourself, you should consult your own doctor to get help and support. In some cases, a referral to a practising psychologist will be possible with a subsidy from health insurance. If the child/adolescent with ADHD/ADD has siblings, you must be particularly aware of their needs and reactions.
What can you, as a relative, do to help the child/addlescent with ADHD?
The most important thing is to have knowledge about the disorder, the most common symptoms and dysfunctions and the treatment. It is a good idea to regularly participate in follow-up conversations with the psychiatric contact person.
Planning and undertaking many specific tasks is difficult for children/adolescents with ADHD/ADD and they will often require support, e.g. through opening and dealing with emails, cleaning up their room or keeping track of their finances.
Important information often needs to be repeated and possibly written down. It can be difficult to find the right balance of how much help you should provide. Especially for parents during the phase where the child with ADHD/ADD goes from being an adolescent to being an adult and therefore wants to make it on their own without the interference of the parents.
Parents of at-home adolescents with ADHD/ADD can support their children by helping to structure their everyday life and help them to maintain a stable circadian rhythm. Among other things, it can be helpful to use aids such as calendars, mobile phones and weekly schedules. It is also important to support any medical treatment.
Fra Psykiatrien i Region Midtjylland:
- Temaaftener om psykisk sygdom
- Medicin mod ADHD (på vej)
- Patientinformationer om ADHD fra vores lokale afdelinger
- Her kan du få råd og støtte: Bruger og pårørendeforeninger
Brug ikke informationen på denne side til at stille dine egne diagnoser, og følg kun instruktionerne i vejledningen, hvis hospitalet har henvist dig til siden.