What is ADHD in children? Psychiatrist DR MICHELLE TAM gives us some insights on diagnosing and treating kids with Attention Deficit Hyperactivity Disorder (ADHD.)
What is ADHD and what does it look like in kids?
In Attention Deficit Hyperactivity Disorder (ADHD), there are three main “clusters” of symptoms: inattention, impulsivity and hyperactivity. I feel that the inattention cluster sometimes gets missed, because it’s not as obvious as, say, the hyperactivity cluster. Also, it’s important to watch out for kids who aren’t necessarily loud and disruptive, but rather, unable to sit still, or who fidget a lot. There are also other factors that play a part in this.
With ADHD in children, the demands of a school’s curriculum can play a part; in the adult’s perspective, it can be the work environment. Diet, exercise and general health are really important factors, too, because they are the essence of a stable life routine – the more stable the routine, the easier it is to optimise the regulation of the clusters mentioned earlier.
How do you differentiate between a mood disorder – depression, for example – and ADHD in children?
They are actually quite different on a variety of levels. ADHD is a neurodevelopmental condition, while mood disorder is not. The triggers and factors that contribute to the two are also quite different. Sometimes it can be a challenge to distinguish if both are present – we do this by evaluating the history of any problems, along with current symptoms and functioning, as well as the coping mechanisms.
If a child is showing signs of impulsivity, for example, we need to identify what triggers it. Sometimes, ADHD in children coexists with an anxiety condition, particularly if the latter is performance-related and the two things are driving each other along, so to speak.
How has the approach to diagnosing Attention Deficit Hyperactivity Disorder in children evolved?
As psychiatrists, we use DSM 5 to diagnose ADHD in children. We ask questions and try to understand the context for the pattern of behaviour coming about. I also involve the parents and/or the caregiver, and also the school to get a “collateral” history of behaviour. This is important to give us a 3D picture. This consistency of observation is important – for example, to see whether the behaviour pattern is present in more than one setting like home and school.
How do you go about prescribing pharmacological treatment for children with ADHD, or those who might have a concurrent mood disorder?
The mainstay of treatment for ADHD is medication alongside cognitive training and other behavioural approaches. There are many categories of medication; you can look at it from a stimulant/non-stimulant perspective, or from a duration of-action perspective, for example, the 4-hour option, 8-hour option or 12/13-hour option.
That’s a conversation for the psychiatrist to have with the family so we can collectively decide on the regime and what works better for them in that given life stage. We also discuss medication management: how to use it properly, understanding any potential side effects, and addressing any reservations families might have.
This article addressing the question of what is ADHD in children first appeared in the Autumn 2024 issue of Expat Living magazine. Subscribe now so you never miss an issue!
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