Our approach to treating ADHD in children and adolescents:
The first step in treating ADHD is receiving a diagnosis to understand what type of symptoms are causing the most difficulty.
We believe that psychoeducation should always be one of the approaches in treating ADHD symptoms, regardless of severity, as per the guidelines set out by England’s National Institute for Health and Care Excellence (NICE). Psychoeducation involves your psychiatrist providing information about your child’s specific type of ADHD so that both you and your child can better understand and cope with the symptoms. Your psychiatrist will also take into account all environmental factors when providing you with the best support for your child’s unique circumstances. We also recommend a combination of parenting interventions, environmental changes, and lifestyle interventions (stress relief techniques, nutrition and exercise).
We can also prescribe medication when the above approaches don’t sufficiently improve symptoms. The discussion about whether a child should take ADHD medication or not can be a complex one and it is important to explore all options and have an ongoing dialogue with the child (depending on the age) as well as with the parents.
Testimonial for Dr Sala:
I can't find enough good things to say about our first appointment yesterday with Dr Sala. I am so appreciative of how well prepared she was, how well she put Minnie at ease and managed to include and acknowledge her despite the fact that she couldn't see Minnie, her amazing professionalism and ability to draw all the elements together in a way that really resonated with us both, and made us feel really understood. What a wonderful person and a gifted professional.
Minnie said she feels as if more was achieved in that session than everything else put together so far. She has been so much happier, more confident and at ease since the appointment. I know this is a process and we have a long journey ahead of us but it feels like we've found the right person to guide us in the right direction. Thank you. - Louise, Mother of Minnie, nearly 7
What is the difference between ADD and ADHD?
ADHD is the official term used for the condition. When somebody does not have significant symptoms of hyperactivity, this is called ADD (Attention Deficit Disorder, inattentive subtype).
However, the terms ADD and ADHD can be used interchangeably and often people just use the term ADHD even if they are describing somebody without the Hyperactivity component.
In this article, we use the term ADHD referring to both ADHD and ADD.
What is ADHD?
Attention-deficit hyperactivity disorder (ADHD) is a common disorder that affects a child’s attention span, concentration, impulsiveness and ability to learn. ADHD is a lot more common than you might think, with the global prevalence estimated to be around 7%. Despite the high prevalence, ADHD is underdiagnosed in most countries, meaning that many children never receive an official diagnosis or treatment. Girls and older children, who may not have obvious symptoms such as overactivity or impulsive behaviour, are also more likely to be undiagnosed.
Some children with ADHD are very high-functioning, which means they may have developed strategies to mask their symptoms, or they might be able to perform very well in academic settings. Even if children are high-functioning, they will still benefit from an official diagnosis and support so that they can better understand the reason for any of their difficulties.
Undiagnosed ADHD can lead to serious problems later in life as it is associated with a high risk of addiction, which is why it’s so important to provide support and treat symptoms. Children and teenagers with undiagnosed ADHD often struggle with anxiety or depression. They might feel different from their friends and classmates. Their teachers may unknowingly single out their behaviour, or label them as a class clown, or failure. Alternatively, school reports may not mention any difficulties at all, especially in the case of females, if the behaviour is not apparent or disruptive in class.
Some parents have only started noticing their child’s difficulty with attention since they started working from home with their families, due to the lockdown caused by the COVID-19 pandemic. While this may be normal to some extent, especially during such stressful circumstances, if you think the behaviour of your child is unusual or their schoolwork is being affected, it could be helpful to receive a private child ADHD assessment from a UK clinic.
What are the symptoms of ADHD?
Symptoms of ADHD typically fall under three main categories of hyperactivity, impulsivity and inattention. Although everyone has tendencies towards these symptoms sometimes, if your child seems unable to control their behaviour or if their relationships or school performance is being negatively affected, this may indicate ADHD.
Fidgeting, being unable to sit still, running around, climbing things, feeling restless, always moving around - this behaviour will be more extreme than what is expected of usual children’s behaviour, and the child will feel they are unable to control their hyperactivity.
Not thinking about consequences or risks, no sense of danger, interrupts conversations or blurts answers out, talks excessively, or cannot wait their turn.
Difficulty concentrating, difficulty listening or following instructions, becomes distracted quickly, finds it hard to complete tasks or schoolwork, procrastinates, makes careless mistakes, forgets things, or loses belongings.
Inattention can be hard to diagnose, and sometimes children will zone in and out while someone is talking or start daydreaming, this becomes problematic if it occurs all the time as it will interfere with their education and ability to learn.
Children with ADHD will often struggle academically, either because they find it difficult to concentrate or they cannot complete schoolwork or tests on time. They may also get into arguments or fights with other children, their teachers or parents.
Children with undiagnosed ADHD may feel frustrated and ashamed of their symptoms, which can sometimes lead to anxiety, depression or addiction problems later in life if untreated.
What are the different types of ADHD?
There are three main subtypes of ADHD that are classified according to the child’s symptoms:
Inattentive ADHD (or ADD). The main problems are difficulty sustaining attention and concentration.
Hyperactive-impulsive ADHD. Problems with impulsive behaviour and hyperactivity.
Combined ADHD. Includes both of the above types. It tends to be more severe than the two other subtypes.
What symptoms or conditions are associated with ADHD?
Some young people may also have other mental health conditions alongside ADHD. Common issues that typically co-occur with ADHD include:
- Behaviour problems, such as oppositional defiant disorder
- Sleep problems
- Physical health conditions (epilepsy, allergies, gastrointestinal problems)
While the presence of these other conditions can make it more challenging to diagnose and treat ADHD, we often find that a holistic treatment approach can make an enormously positive impact. Once other conditions are treated, the symptoms of ADHD become much more manageable.
Although each child will have unique limitations and strengths, our ultimate goal is to enable all children to reach their full potential and live fulfilling lives.
What causes ADHD?
ADHD is a complex neurodevelopmental disorder that is caused by a combination of genetic, environmental and biological factors. The heritability of ADHD is relatively high, at 74%, meaning that someone’s genetics will significantly influence whether they develop ADHD or not. However, it’s not a simple case of specific genes that increase the risk for ADHD. Instead, researchers have identified that the genetic risk comes from small mutations in many different genes, with each of these genes contributing a small amount of risk (known as polygenic risk). Due to the vast number of genes involved, scientists still don't understand precisely why some children and adolescents develop ADHD, while others don't.
Some environmental factors may also increase the risk for ADHD, including smoking, alcohol or drug use in pregnancy, exposure to environmental toxins and premature birth. These environmental factors can place a degree of biological stress on the individual, which then increases their risk of developing ADHD, particularly if they already have an increased genetic risk.
Several biological factors might also be associated with ADHD, such as inflammation. Specifically, children with ADHD have lower amounts of the anti-inflammatory hormone cortisol. Cortisol helps our body to absorb nutrients and is involved in regulating cognitive function and reward-seeking behaviour. Neuroimaging studies have also shown that children with ADHD have altered patterns of brain activity, compared to children without ADHD.
Although it might be scary to learn about these biological factors involved with ADHD, the good news is that many of the treatments for ADHD help to regulate these biological mechanisms (such as cortisol and brain activity). Receiving a private child ADHD assessment from a UK clinic, as well as the required treatment, often leads to a considerable reduction in stress for both the parents and the child. Stress reduction reduces inflammation and improves cognition, which can subsequently improve ADHD symptoms.
Does ADHD go away?
Although ADHD is a lifetime condition, the good news is that symptoms almost always improve with some type of treatment. In some children, the symptoms may improve over time so that they require less support or management of their symptoms as they grow older.
Some children with ADHD, with the right support and education, can develop strategies to circumvent challenging behaviours. Unfortunately, some children may have an increase in difficult symptoms and their needs will be more complicated. This is usually the case for children who also have behavioural difficulties, such as oppositional defiant disorder.
How do you treat a child with ADHD?
Every child will have a unique set of symptoms and circumstances contributing to their ADHD symptoms.
Once ADHD is diagnosed, as well as any other potential conditions, we will develop a personalised treatment plan specifically for your child. We will develop this with your input, based on your child’s needs and unique circumstances. The treatment will include an integrated approach so that your child can achieve their full potential, both academically and socially.
A treatment plan for ADHD may combine any of the following evidence-based approaches:
Psychotherapy (psychological therapy or talking therapies)
- Cognitive behavioural therapy (CBT)
- Family therapy (systemic therapy)
- Play therapy
- Social skills therapy
- Interpersonal therapy
- Mindfulness-based cognitive therapy
- Information and support so that you and your child can better understand and cope with their ADHD symptoms
- Parenting techniques to take a positive and proactive approach to supporting your child
- Learning techniques tailored to your child’s specific ADHD symptoms
- Behavioural learning techniques developed in association with your child’s school
Medication (if required)
- Medication for ADHD works well for children, with approximately 60-80% of children showing an improvement in their symptoms
- Commonly prescribed ADHD medications include Methylphenidate (Ritalin, Concerta, Medikinet), Lisdexamfetamine (Elvanse), Atomoxetine (Strattera) and Guanfacine (Intuniv)
Stress reduction approaches
- Mindfulness techniques
- Mind-body exercises
Diet and lifestyle interventions
- Nutritional and dietary changes
- Sleep therapy
When recommending a treatment plan, we will always follow the current guidelines that are based on evidence-based methods. Popular complementary treatments, such as stress reduction techniques and lifestyle interventions, may also carry a substantial benefit for your child and are low-risk to implement. We always emphasise the importance of formulating a treatment plan that is appropriate for your child under the guidance of a healthcare professional.
Can Omega-3 help ADHD?
Many people supplement their diets with Omega-3, which is a fatty acid that is commonly found in foods such as oily fish, nuts and spinach. New research shows that Omega-3 supplements may help to improve symptoms of ADHD, but the results of studies are mixed.
Specifically, studies have shown that children with ADHD who have low levels of Omega-3 may show some improvement in their symptoms after Omega-3 supplementation. However, children who already have relatively high levels of Omega-3 saw some of their symptoms worsen. The research in this area is still in the early stages, so we can’t jump to any conclusions yet.
These results demonstrate that when it comes to nutrition, there is no ‘one size fits all’ approach. It also highlights the need for personalised medicine using evidence-based methods, which is when a practitioner designs a personalised treatment plan for an individual using a combination of biological markers and private child ADHD clinical assessment. We take a personalised medicine approach at London Psychiatry Clinic because we understand that every child is different and needs to be treated as such.
ADHD and addiction in Teenagers
Young adults with ADHD have an increased risk for all types of addictive behaviour in young adults. There have been some interesting studies, in particular, looking at cannabis use and alcohol use in adolescents and how ADHD seems to have a significant role.
More importantly, this relationship can be a life-long tendency and appropriate diagnosis, treatment and education during the teenage years can have a very beneficial long-term effect.
One of our Child & Adolescent psychiatrists, Dr Regina Sala, has significant expertise in the diagnosis and treatment of adolescents with ADHD and substance use and has published scientific articles on this topic.