Attention Deficit Hyperactivity Disorder (ADHD) has come to the forefront in recent years with the availability of more information regarding this condition. It is a nervous system connected developmental behavioural disorder which affects 3 to 5 per cent of the general population. It has a very wide spectrum of involvement and with the recognition of many types of presentations and different degrees of severity it has now become a condition that is diagnosed quite regularly.

Activity is quite a normal phenomenon for a child. It is not uncommon for many children to be described as not being able to remain still or in one place for any length of time. Most of their activities are generally purpose driven and aimed at some sort of achievement. They are also appropriate for the age and the circumstances. Some of these may be quite mischievous and naughty but they are done randomly and with a definite idea behind them. In between all these activities, the child is normal, may remain quiet and able to concentrate on other things. Being impish and playful is generally considered to be a part and parcel of childhood.

In contrast however, children with ADHD show up a rather relentless pattern of lack of concentration with or without increased aimless activity (hyperactivity) together with forgetfulness, poor impulse control, sudden impetuous behaviour and distractibility. Generally the parents or care-givers have no power over these features and the child seems to have boundless energy which is misplaced into non-productive ventures. The parents generally say that there is no controlling the child, whatever the circumstances. This is a group of impulsive children with significant behavioural problems caused by a genetic dysfunction and not by poor child rearing practices.

The most common features of ADHD consist of distractibility, difficulties with concentration and focusing, short term memory loss, procrastination, problems of organising ideas and belongings, tardiness, impulsivity, weak planning and execution. However, not all children with ADHD exhibit all these symptoms. The symptoms of ADHD could be categorised into two broad groups. They are inattention symptoms and hyperactivity or impulsivity symptoms. Most ordinary children show some of these behavioural traits at some time or another. However, in them it does not occur to the point where they seriously interfere with the child’s work, relationships, studies or cause anxiety or depression. As many children do not often have to deal with deadlines, organisation issues and long term planning, these types of symptoms often become evident only during adolescence or adulthood when the general life-style demands become greater.

Many affected children are not able to devote close attention to details and are quite prone to making careless mistakes in schoolwork and other activities. They have problems of concentration and paying attention to tasks or play and do not appear to listen when spoken to. They have trouble organising activities and they often avoid, dislike or do not want to do things that utilise mental effort for a long period of time such as schoolwork or homework. They frequently lose things and are easily distracted. The hyperactivity component shows up as fidgeting with hands or feet or squirming in the seat. They often get up from the seat when remaining in it is expected. Frequently they run or climb inappropriately and do have trouble playing or enjoying leisure activities quietly. These children appear to be generally "on the go" or often act as if "driven by a motor" and tend to talk excessively. Impulsiveness is shown up as blurting out answers before questions have been finished and they often have trouble waiting for their turn. They tend to interrupt or intrude and tend to butt into conversations or games.

ADHD is most commonly diagnosed in children, but over the past decade it has been increasingly diagnosed in adults as well. About 60 per cent of children diagnosed with ADHD retain the condition into adult life. Hyperactivity is common among children with ADHD but tends to disappear during adulthood. However, over half of children with ADHD continue to have symptoms of inattention throughout their lives.

Not every child who is overly hyperactive, inattentive, or impulsive has ADHD. Even normal children sometimes blurt out things they didn’t mean to say or jump from one task to another or become disorganised and forgetful. As so many other children show up some of these behaviour patterns at times, the definitive diagnosis of ADHD requires that such persistent behaviour is persistent and be demonstrated to a degree that is inappropriate for the individual’s age. The diagnostic guidelines also contain specific requirements for determining when the symptoms indicate ADHD. The behaviours must appear early in life, generally before the age of 7 and continue for at least 6 months. Above all, the behaviours must create a real handicap in at least two areas of the child’s life such as in the schoolroom, on the playground, at home, in the community or in social settings. This means that a child who shows some symptoms but whose schoolwork or friendships are not impaired by these behaviours would not be diagnosed with ADHD. Nor would a child who seems overly active on the playground but functions well elsewhere receive an ADHD diagnosis.

Structural, functional and chemical abnormalities have been described in the brains of patients with ADHD. The three main problems that have been found are a delay in physical development in some brain structures, reduction in the blood supply to certain areas of the brain and some disturbances in the production and handling of certain chemical substances. A very recent study in the United States of America has shown that in normal persons earlier developing areas of the brain such as those responsible for motor behaviour influence the later developing areas which play a major role in executive functions. The researchers noted that in children with ADHD, certain subtle chemical changes in these areas are probably responsible for an imbalance of the influence of some of these areas of the brain over others. These changes were mostly noted in older children with ADHD when compared to their healthy counterparts.

Management involves a combination of medications, behaviour modifications, life style changes, and counselling. It is generally fair to say that no single form of treatment is the answer for every child. A child may sometimes have undesirable side effects to a medication that would make that particular treatment unacceptable. It is also important to note that if a child with ADHD also has anxiety or depression, a treatment combining medication and behavioural therapy might be best. Each child’s needs and personal history must be carefully considered and an individual programme of management designed.

Behaviour therapy helps those with ADHD develop more effective ways to work on immediate issues. Rather than helping the child understand his or her feelings and actions, it helps directly in changing their thinking and coping and thus may lead to changes in behaviour. The support might be practical assistance, like help in organising tasks or schoolwork or dealing with emotionally charged events. Sometimes, the support might be in self-monitoring one’s own behaviour and giving self-praise or rewards for acting in a desired way such as controlling anger or thinking before acting. They need a lot of help in getting things organised.

Both parents and children may need special help to develop techniques for managing the patterns of behaviour. In such cases, mental health professionals can counsel the child and the family, helping them to develop new skills, attitudes, and ways of relating to each other. The parents are the best advocates for a child with ADHD but they need to foster good partnerships with everyone involved in the child’s treatment. This includes teachers, doctors, therapists and even other family members.

Once a child with ADHD has successfully navigated the early school years, special problems may come up with the teenage years. This period is a challenging one even for normal children. For the child with ADHD these years are doubly hard. All the adolescent problems such as peer pressure, the fear of failure in both school and socially, low self-esteem are that much more difficult for the ADHD child to handle. The desire to be independent and to try new and forbidden things such as alcohol, drugs, and sexual activity, can lead to unforeseen consequences. At this stage, more than ever, rules should be straightforward and easy to understand. Communication between the adolescent and parents can help the teenager to know the reasons for each rule. When a rule is set, it should be clear why the rule is set. When rules are broken, as they will often be, the response for the inappropriate behaviour should be as calm and matter-of-fact as possible. Punishments should be used only sparingly and rarely. Communication, negotiation and compromise are three cardinal tools that could be used to defuse volatile and potentially harmful situations. Teenagers, especially boys, begin talking about driving by the time they are about 15. It has been shown in scientific studies that youth with ADHD, in their first 2 to 5 years of driving, have nearly four times as many automobile accidents, are more likely to cause bodily injury in accidents, and have three times as many citations for speeding as young drivers without ADHD.

The diagnosis of ADHD implies an impairment in life functioning. Many adverse life outcomes are related with ADHD. Early on a student with ADHD will have problems with work completion, productivity, planning, remembering things and meeting deadlines. Oppositional and socially aggressive behaviour are seen in 40-70% of children at this age. Even those with average to above average intelligence show chronic and severe under achievement. In the Western world, as much as 46% of those with ADHD have been suspended from school and around11% had been expelled. Sadly, 37% of those with ADHD do not get a high school diploma even though many of them had received special education services. The combined outcomes of the expulsion and dropout rates indicate that almost half of all ADHD students never finish high school. Only 5% of those with ADHD will get a college degree compared to 27% of the general population.

However, all may not be lost. Sometimes special skills can be nurtured to provide quite stunning results. Some of these children have been known to excel even in sports. A case in point is Michael Phelps, the record-breaking champion Olympic swimmer who won a record eight gold medals in the recent Beijing Olympics. He struggled with ADHD as a child. It is to his eternal credit that he is able to talk freely about early life problems with ADHD. He is a shining example of what could be achieved in ADHD with commitment.