Attention Deficit Hyperactivity Disorder: Recognition, Reality and Resolution

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Some people are predominantly hyperactive and impulsive, while others are largely inattentive. These symptoms change over time: overt hyperactivity often decreases with age, while impulsive behaviour and poor attention are enduring. ADHD is strongly influenced by genetic factors and there is mounting evidence for neurobiological influences on brain structure and function. Girls with ADHD are more likely to have the inattentive form of the disorder and tend to be less disruptive than boys, so their ADHD may be overlooked.

Daydreaming and poor concentration may cause problems at school, but girls may also develop severe cognitive and language impairments and social difficulties. Children with impulsive behaviour have less ability to think of the consequences of actions or words.

They can be disruptive and prone to accidents, with frequent visits to GP surgeries and accident and emergency departments. Settings may include home, school, work, holiday, social activity, and consultations although temporary masking may occur. Domains may include schoolwork, homework, family relationships, physical risks, friendships, driving, household tasks, money management, partner relationships, and childcare. Symptoms can overlap with those of related disorders that commonly coexist with ADHD. Children and young people with ADHD appear less socially skilled, and exhibit more noncompliant, inappropriate, and negative behaviours in social settings than their peers.

Some children with ADHD are more likely to develop antisocial behaviours, particularly those who have the early onset of conduct disorder symptoms, learning problems, and environmental adversity. Attributing difficult behaviour to 'bad parenting' is unhelpful as parents may be struggling to cope with their child with ADHD and may have ADHD themselves.

Children and adolescents with ADHD may be unable to fulfil their learning potential and often achieve poor academic outcomes: there is a higher incidence of truancy, dropping out of school, and expulsion. Danny Danny was a year-old boy whose parents mentioned their concerns about his difficult and unruly behaviour to the GP over the years. He had been given a second fixed-term exclusion from school.

G.D. Kewley

From an early age, Danny was argumentative and oppositional, very black and white in his points of view and never wrong. At preschool, his parents thought that he was very bright.

Glossary of terms

He spoke early, took great interest in things around him, and had lots of friends. As the years went by, he very much underachieved. His self-esteem was low and he really did not enjoy anything much in life. A trial of psychostimulant medication strengthened his concentration and impulse control and over the next few months there was a clear improvement in his academic standard, self-esteem, and motivation.

Bridget Bridget was a 7-year-old girl whose parents expressed their concern to their GP that she was saying she was not good at anything, she did not want to go to school, and she had no friends. They noted that she seemed very anxious. Before starting school, they had always felt that she was a fairly bright girl but they noticed that she tended to drift off and daydream.

On specific questioning, it became apparent that at school, Bridget was switching off, not listening to the teacher, and appeared to be in a world of her own.

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She was not making progress with her reading or maths and her writing was clumsy. When asked, her teachers felt that if Bridget was able to stay attentive, she would be able to cope with any learning or handwriting difficulties. Bridget was referred for assessment and was diagnosed with inattentive ADHD. She was started on a low-dose psychostimulant medication and became brighter, more socially confident, and less anxious.

Her academic work improved rapidly and she felt much happier at school. Support for parents and carers to optimise parenting skills can help them to achieve the above-average parenting needs of children and young people with ADHD.


Individuals with ADHD can present to their primary care professional with a wide range of difficulties and in a variety of complex ways see Box 4, below. It is useful to detect core symptoms of ADHD, but these may be masked by a number of factors including coexisting conditions, private schooling attributed to smaller classes and hence fewer distractions and more opportunity for educational professionals to detect difficulties with struggling students and provide individual support , being gifted and talented, and receiving an inordinate amount of parental or other supports.

Questionnaires or rating scales may help to identify core symptoms. Assessment of the severity of suspected ADHD in a child, young person, or adult is a clinical judgement, which takes into consideration the level of impairment, pervasiveness, individual factors, and familial and social context. The views of children and young people are useful to determine the level of impairment they perceive. By , it wound up in a much different place: ensuring that ADHD is treated comprehensively throughout the lifespan of children and adults.

ADHD in Europe: Advances in Policy and Treatment

The resolution acknowledges that ADHD is likely undertreated due to inadequate training of care providers, inequalities of access to care, stigma , and misconceptions about ADHD. We parents are anxiously waiting to see how these principles will be put into practice.

  • ADHD Mythology | SpringerLink;
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  • Resolve ADHD to improve diabetes self-management;
  • Bonet Perot expects concrete progress at the national level in one to two years. Both EU and U. As a mom who has faced the exorbitant costs of counseling sessions for my child and private behavioral management training programs for me, I am interested in whether European countries will help parents piece together comprehensive treatment in an affordable way.

    There are some encouraging signs. Similarly, German authorities ensure that pediatric centers and special education centers offer specialized ADHD parent training. The emphasis on families, and the investments that some European countries have made in families who are coping with ADHD, gives me hope that European countries are not only catching up with the United States, but, in some cases, might even go further.

    Recognizing and understanding the influence of ADHD can limit its negative effects on diabetes self-management. Attention manifests in two states: hyperfocus and hypofocus. During the hyperfocus mode, the patient experiences an intense form of mental concentration on a thought or behavior of interest. This includes daydreams, memories, work, hobbies, and other wants or desires. During the hypofocus mode, the patient experiences a severe lack of focus brought on by mental or physical exhaustion after a period of hyperfocus or avoidance of undesirable tasks.

    The inattentiveness found in ADHD presents as a type of avoidance that can be interpreted as procrastination. The more emotional patients become about their diabetes, or in general, the stronger inattentiveness becomes. If patients come to accept their diabetes or reduce their anger and resentment about having the disease, inattentiveness can be reduced, improving active diabetes management.

    However, a reduction of negative emotions will not resolve every aspect of ADHD that affects diabetes management. Some behavioral issues that stem from years of living in this pendulum of hyper- and hypofocus can be addressed with cognitive behavioral therapy. It is 30 minutes later, and the patient has the same thought and remembers the forgotten glucose check; then a split second later that thought is gone. Frustrated and annoyed at himself, the patient may or may not check his blood glucose before taking insulin. During the hyperfocus state, people living with diabetes have a tendency to ignore or not notice what is happening in their environment or with their body, and they can miss symptoms of hypoglycemia.

    Such a heightened state of focus causes patients to avoid the rest of the world around them. After patients with ADHD are diagnosed and treated to resolve the attention issues, they can be expected to improve in all of the above areas of functioning, including diabetes management.

    Medication can help remove some blocks that interfere with diabetes management, but patients still have work to do.