What is ADHD?
ADHD stands for Attention Deficit Hyperactivity Disorder.
It is well recognised neurodevelopmental condition.
ADHD is a lifespan condition that impacts upon people to varying degrees throughout their lives. The way in which ADHD impacts upon a person may change during their lifetime.
ADHD is a spectrum of traits and there are many variables and complexities and every child with ADHD is different.
ADHD is associated with other neurodevelopmental conditions such as autism, dyslexia, dyspraxia and Tourette’s.
ADHD and other neurodevelopmental conditions are lifelong but need not be framed within a ‘deficit’ model. The impact on day to day life depends on expectations and demands matching the individual’s strengths.
When to suspect ADHD LINK
The importance of knowing whether your child has ADHD or not:
A diagnosis can help your child understand more about themselves and provide an answer to ‘why’ they may find certain things more difficult. Sometimes children with ADHD develop negative beliefs about themselves such as ‘I must be stupid /bad/lazy’, or ‘no one likes me’ because they find school difficult, get ‘told off’ more than others, or struggle more within their relationships. Knowing that they have ADHD can help children see that it is not their ‘fault’ and empower them to learn different ways to manage their ADHD.
Families often find that getting a diagnosis prompts others to make the changes and adjustments needed to support their child. This can involve the child receiving additional educational support and/or their teachers altering their approach/ enabling adaptations to be made to the school environment.
Although it is a personal choice, people diagnosed with ADHD can find that medication helps them manage their symptoms. Medications can help a person concentrate, control their impulses, plan ahead and follow through with tasks. However, to access medication, a person requires a definitive diagnosis of ADHD. Therefore, accessing a comprehensive diagnostic assessment is crucial if medication is something you wish to pursue.
Research suggests that undiagnosed ADHD can lead to poorer academic, financial and psychosocial outcomes for people. ADHD can often be an underlying factor in other problems such as substance misuse, anxiety, depression, gambling difficulties as well as higher divorce rates. A timely diagnosis is important to ensure a person gets the treatment and support they require to live a happy life and achieve their potential.
I think of ADHD within the context of the neurodiversity paradigm and have become increasingly uncomfortable with the 'D" (Disorder) bit of ADHD, that there is something inherently wrong or not-normal that needs fixing. But, it is the term we have presently that is accepted and used in assessment and diagnosis / identification.
Learn more about Neurodiversity: LINK1 LINK2
What does it look like?
Officially, ADHD is recognised to have three core characteristics: Inattention, Impulsivity and Hyperactivity although in reality and in my experience it is a lot more complex and broader than this:
Examples of inattention in children include short attention span and easily distracted, difficulties listening and following out instructions, appearing forgetful and losing things, not learning for mistakes and unable to stick to tasks that are boring or time-consuming
Examples of impulsivity and hyperactivity include not able to sit still/fidgeting/excessive movements, unable to wait their turn, little or no sense of danger, acting without thinking, excessive talking, struggling in situations where there is an expectation to be calm or quiet.
Hyperactivity is not always external and visible. It can be internal and described as racing, constant, chaotic thoughts, 'busy and noisy brain'.
Other common features are:
Some ADHD specialists refer to ADHD as a disorder of 'self-regulation'. Self-regulation requires that a person have intact executive functions.
Executive function refers to brain functions that activate, organise, integrate and manage other functions. It enables a person to account for short and long-term consequences of their actions and to plan for those results. It also allow a person to make real-time evaluations of their actions and make necessary adjustments if those actions are not achieving the desired result. This is hard to do when working memory, time management and organisation skills are affected by ADHD.
In ADHD, this system matures more slowly than in a 'neurotypical brain'.
Here is a list of executive functioning skills:
Self-awareness: Simply put, this is self-directed attention.
Inhibition: Also known as self-restraint - the ability to 'not' speak or act but to stop and think before speaking or acting.
Non-Verbal Working Memory: The ability to hold things in your mind. Essentially, visual imagery - how well you can picture things mentally.
Verbal Working Memory: Self-speech, or internal speech. Most people think of this as their "inner monologue."
Emotional Self-Regulation: The ability to take the previous four executive functions and use them to manipulate your own emotional state. This means learning to use words, images, and your own self-awareness to process and alter how we feel about things.
Self-motivation: How well you can motivate yourself to complete a task when there is no immediate external consequence.
Planning and Problem Solving: Experts sometimes like to think of this as "self-play" — how we play with information in our minds to come up with new ways of doing something. By taking things apart and recombining them in different ways, we're planning solutions to our problems.
This can result in difficulties for example with starting and persevering with a task or work, forgetting the steps to complete the work, unable to remember more than one thing at a time, easily distracted, unable to prioritise, problem solving especially when something doesn't go to plan, feeling overwhelmed and heightened emotions.
A combination of these difficulties can impact on the child's day-to-day functioning, specifically on ability to engage in a school setting or exam setting or self-regulate in social settings.
Executive function difficulties become more evident as the child gets older especially after transitioning to secondary school when school structure and timetables change and as academic expectations increase e.g., increased emphasis on independent learning.
However, with the right support and strategies, and occasionally medication, over time children can learn to navigate their unique and powerful minds, transforming potential chaos into a symphony of productivity and innovation.
Further reading regarding executive functions LINK1, LINK2 LINK3
Emotion regulation difficulties are also common. Emotions can be more intense making even typical playful interactions feel overwhelming. These include over-thinking, anxiety and difficulties regulating emotions and feelings that can lead to feeling overwhelmed easily.
Sleep difficulties
How all of this plays out in any one child depends on age, gender, cognitive/learning ability, the presence of other neurodevelopmental difficulties / differences, and family / social factors.
However, it is important to stress that ADHD is a pattern of both strengths and challenges. This will make some environments easy to deal with and other environments more difficult. School can be one aspect of childhood that children with ADHD find more challenging than their peers.
For example, some of the strengths associated with ADHD include:
Inattention: Eager for stimulation, drives imagination, creativity, innovation, and invention.
Impulsivity: Curiosity, enquiring mind.
Hyperactivity: Drive, energy, enthusiasm, and ambition.
Others may include ability to hyper-focus, lateral thinking Visual memory and the ability to think in pictures and see patterns in complex information, quick wit, and humour.
Further reading about positives LINK
Famous people with ADHD LINK
Girls with ADHD
Girls tend to be overlooked and diagnosed later than boys, because their ADHD traits tend not to fit the ADHD stereotype and can appear to be more subtle.
Girls with ADHD who are presenting with attention differences or difficulties are often seen as daydreamers.
Girls presenting with hyperactive-impulsive symptoms may be seen as being a chatterbox, described as 'scatterbrain', bossy, being a perfectionist, over-emotional or even “hormonal", difficulties maintaining friendships, excessively hair twirling, picking nails or skin. Will often describe constant racing thoughts and feelings of anxiety.
Girls often compensate for any difficulties that they are experiencing by masking their ADHD and the longer their ADHD is unrecognised the increased risk for low mood, anxiety and depression, especially during teenager years.
Read More re ADHD
ADHD Assessment & Diagnosis (identification)
Referral
I am happy to see children / young people up to their 18th birthday.
If 18th birthday is coming up soon it may be advisable to see an adult specialist.
As well as ADHD, if you are very concerned regarding a mental health problem such as depression or your child has expressed suicidal or self-harm thoughts, then it would be advisable to see a Psychiatrist.
I only accepts referrals from the ADHD Foundation or via Ghosh Medical Group.
By accepting an appointment to see me, you have agreed that the focus of the consultation will be to decide if ADHD is the cause or contributing factor to your child's difficulties.
Formal assessment for any conditions other than ADHD will require a separate appointment.
I apply a child focused and holistic approach to a detailed neurodevelopmental assessment that will consider
family/schooling/lifestyle factors including negative / adverse early life experiences.
medical problems and conditions that can be confused with ADHD
co-existing conditions (co-morbid) such as autism, dyspraxia, dyslexia, sensory processing difficulties as well as learning/emotional/mental health difficulties that if not causing may be contributing to the child's difficulties.
Part of the assessment process involves evaluating how much of a role, if any, these other factors play and attempting to identify and exclude these.
This is vitally important because, although getting a timely diagnosis of ADHD is important, it is also crucial that a child or young person isn’t wrongly diagnosed with ADHD.
As such, an ADHD assessment is not a simple or tick box exercise and should never be diagnosed on the basis of just a behavioural checklist even ones that claim to be validated.
Assessment
1. I follow NICE guidance as a minimum standard. My holistic assessment is supported by objective scientific evidence using QbTesting for all children. This is 'gold standard'. Read further regarding QbTest LINK.
2. The first appointment is 90 minutes and F2F. I do not offer video consultation for the first appointment.
3. This will involve taking a detailed history, examination and informal observation. This will include talking to your child about their life, experiences and difficulties. This is an important part of my assessment and in my opinion best done F2F. This is why I do not offer online assessments.
4. I will also review the ADHD screening assessment completed by the ADHD Foundation or GMG (they will have sent me all the reports including QbTest result) prior to your appointment) and the health-development questionnaire you completed pre-clinic, this will help to focus on areas of concern for you and your child.
5. As a large part of your child's day is spent in school, for my assessment, I will always require feedback from your child's teacher/s.
6. Even if you feel the school do not share your concerns, their opinion is still an important part of my holistic approach. School feedback is one of many pieces of the jigsaw I will consider. The ADHD Foundation will have requested school feedback. If this has not been completed then please contact me and I will send the relevant forms to be completed by the school (teacher/SENCO).
7. If school feedback isn’t readily available for the first appointment (has left school or summer holidays) it will still be helpful if you can bring any school reports, learning plans etc.
8. Also, please bring any letters or reports from any therapists (e.g speech) or specialists your child has seen in the past. I like to have as much information as possible to get a full and holistic picture of your child's health and neurodevelopmental profile.
Diagnosis
1. Depending on evidence gathered and complexity, I aim to give my opinion on diagnosis i.e., does your child have ADHD or not, at the first appointment.
2. However, in some cases, if your child's difficulties are complex that cannot be covered during the appointment or if I need to request further information (school, other professionals) a 2nd or 3rd appointment will be required. This will also apply if following the initial assessment, I feel your child may need additional assessments/tests to help me to diagnose or deal with your child’s condition. Examples include psychology, psychiatry, speech/language therapist and occupational therapist.
3. Once assessment is completed, with your consent, I will email a Summary Assessment and Diagnostic Report outlining my findings/opinion/recommendations for parent/child/teacher. I will send a copy to your GP. You should expect to receive this report, in most cases, within 14 working days. The cost of this summary clinical report is included in your appointment fee. I keep this report brief and to the point, to minimise overall cost to you. One or two queries regarding the report I am more than happy to discuss via email, otherwise may require a further appointment (F2F or Video).
Support, Therapy, Treatment including Medication
1. Through a holistic approach, I view each patient as a whole rather than a single symptom to be treated.
2. I will discuss support/therapy options at the first or second appointment.
3. Not all children with ADHD require medication. If medication is the right choice for your child then it is important to note that medication is more likely to be effective if part of a multi-modal psycho-educational approach with school and home-based ADHD specific support and behavioural strategies. I will discuss some of these strategies during the first few appointments but for more detailed practical support I would recommend discussion with the school SENCO and the ADHD Foundation.
4. Further reading regarding ADHD Psychoeducation and Support / Training for Parents and Others: LINK1 LINK2 LINK3
5. Further information regarding Medication Titration
Other Neurodevelopmental Assessments
1. For autism, I can certainly do an assessment/autism screen and advice on whether it is likely but for a formal diagnosis this usually requires a team approach using standardised autism diagnostic tools. A young person may have autism and ADHD together. For appointment and likely costs please contact me.
2. For 'motor dyspraxia' (Developmental Coordination Disorder) I recommend an initial assessment by a Paediatric Occupational Therapist followed by a medical assessment by a Paediatrician. If the former is done then please contact me regarding likely costs.
3. For sensory processing difficulties ( I do not use the term disorder) you will need an assessment by a specialist paediatric occupational therapist.
4. General concerns regarding development and behaviour