Attention Deficit Hyperactivity Disorder

Information for Professionals


Referral to a child and adolescent psychiatrist is appropriate where medication is being considered or where the diagnosis is not clear. If second or third line treatment is being considered then referral is indicated.
Children who are very active, have trouble sitting still (except to play computer games), are easily distracted, talk and interrupt a lot and do things without thinking first may well have Attention Deficit Hyperactivity Disorder. These features can also occur in younger children as part of normal development, it is important to compare the concerns with the child’s developmental age and the expectations. In addition, an anxious child or a child who has had a significant stressor may experience these symptoms.

When the child is simply unable to stay in their chair during a meal or a school lesson and constantly interrupts conversation and fidgets the need to consider this diagnosis may be quite clear. In some situations it may be harder to distinguish these features, for example in very bright children they may continue to do well academically and be seen as “deliberately naughty” because adults can not imagine that such a bright child could not choose to stay quiet or sit still for a few minutes. Another factor can be a child with developmental delay or a disorder on the Autism spectrum.

Treatment is initially simply identifying the difficulty and providing information to the parents and (with appropriate consent) the most important teachers involved. For some children simply having an explanation that allows the adults to be less anxious about the child’s responses and a calm, clear approach from these adults is sufficient. For other children, omega-3 fatty acids (fish oil) 1 and/or a specific program to enhance parenting may be helpful. When these are not enough, medication with a stimulant (methylphenidate or dexamphetamine) on school days is usually effective, and the child having more “thinking time” and it being easier for the child to settle allows better patterns of interactions to develop. Often these children will function better on the days off medication as well (despite the medication itself being out of their system).

Treatment is aiming to prevent or reduce the secondary problems of being seen as “naughty”, the social and academic losses that can ensue from this in the longer term and to improve the child’s function at the time.
1. Omega-3 fatty acids taken from sources which are tested to ensure they do not contain excess heavy metals and in doses as per the studies reviewed under the NICE guidelines (National Institutes of Clinical Excellence, UK)