ADHD = Attention-Deficit/Hyperactivity Disorder
The three components are Attention-Deficit, Hyperactivity and Impulsivity. Having all three is referred to as ‘combined type’; the other two categories are the hyperactivity/impulsivity type and the attention deficit type, which used to be called ADD.
Many people have an image of children with ADHD that may contribute to the problem. The image may be of badly behaving boys bouncing all over the place, ruining the schoolroom for everyone else. The child is often blamed for not listening, not concentrating, and not following instructions. The parents may be blamed for not exerting enough control – partly because ADHD can be accompanied by challenging behaviour.
ADHD symptoms are often noticed by parents while the child is still pre-school. But most Paediatricians and Child Psychiatrists are reluctant to diagnose this early, and medication is not recommended before the age of six years. A diagnosis of ADHD requires the observation of ADHD symptoms in school as well as either at home or in the clinic.
Children with ADHD often achieve well below their potential, can be frequently in trouble, and may find it difficult to keep friends, sometimes drifting towards antisocial companions. Difficulty getting off to sleep is a frequent issue.
Perhaps as a result of all this, children with ADHD can often be very anxious, or even depressed. It is also common for children with ADHD to have other learning or neurodevelopmental issues such as dyspraxia, dyslexia, other specific learning difficulties, or generalised Learning Disability.
This type is often missed – or just dismissed as stupidity or laziness. It is particularly common in girls, who may just sit at the back of the class day-dreaming, and whose AD(H)D is therefore more likely to be missed than boys’.
The signs to look for in your child are having a shorter attention span than others of the same age, making silly mistakes, forgetting things, or poor organisation. They often appear to be incapable of listening or carrying out instructions. They tend to keep changing from one task to another, and they certainly can’t stick to doing anything that takes much time or that they think is boring. They really can’t change their behaviour.
Does your child show any of the following? An inability to sit still; constant fidgeting; being a constant chatterbox; always interrupting; and doing things without thinking. These features can make children with ADHD pretty unpopular, especially with their teachers, and also sometimes with their fellow children.
It can seem to others as if the child is just being selfish, since they may interrupt conversations, or have difficulty taking turns in games or sports. They are often prone to accidents, showing little awareness of danger or risk.
Autistic Spectrum Disorders
There is also an association, due probably to linked genes, between ADHD and other neurodevelopmental conditions such as tics and Autistic Spectrum disorders (ASD). Sometimes, ASD or Learning Disability may mask ADHD; at other times, ADHD may mask ASD. Tics may erupt after starting stimulant medication.
Our ADHD service for children and adolescents
Psychiatry-UK offers a specialist diagnostic ADHD service for children and adolescents which fully complies with NICE guidance for the assessment and treatment of ADHD.
One issue that we are well aware of is that there may be varying agreements in place for shared care in different regions in the UK and this can cause major issues if you are unlucky in the postcode lottery but we will work with you to try to sort out any issues with local services and your GPs if your child has a diagnosis of ADHD from us.
The process and costs
The assessment of a child for ADHD is always going to involve input from the child’s school and can take some time to complete.
The first stage is to fill in our children’s ADHD referral form and to pay the initial consultation fee of £700 (If booking online please choose ‘ADHD/ADD in Children‘ from the list of treatments on the booking form). We will then send out rating scales to you and to your child’s school for them to complete before we see you. Once these have all been returned we will contact you to arrange the consultation.
The consultation will last up to 90 minutes. It will initially be with the child and you, the parent or or guardian, and then with the child alone. This is then followed by another brief chat with you to give you feedback on the consultation and the outcome of the ADHD assessment.
It is at this point that the psychiatrist will discuss options for medication with you. The psychiatrist will then write to you and your GP, setting out the diagnosis and the treatment plan that you have agreed.
If you have decided to try medication, the next stage is to go through titration which is the process of working out the right medication and the correct dosage. You will have to provide us with a weekly report on how your child is doing on the medication with measurements of their weight, blood pressure and pulse. If you want you can get your own blood pressure monitor, or we can lend you one.
The fee for the titration is £105 per month, including a prescription each month and, if you use one of our monitors, we ask you for a £50 deposit. We will also charge you £25 for any extra prescription that we send out and you will also have to pay the pharmacy for the medication which can cost anything from £70 to £150, depending on which drug works best for your child.
Titration can take between a month and three months. When we all agree that your child is on the correct medication, we have another online consultation, but only for half an hour, and the psychiatrist will then write to your GP to ask them to take over prescribing as a shared care agreement.
Some GPs are still a bit wary of prescribing stimulants to children and in some areas of the UK there are local guidelines that do not allow them to work with any psychiatrists except those from their local service. We are happy to help in challenging such restrictive and unfair practices when we come across them.
Follow up appointments
After titration, the period in which the psychiatrist works out the correct medication and the correct dose for your child, there will also have to be follow up appointments. Initially they will every three, then, after six months, these will change to every six months.
Communication with the GP
The Psychiatrist will write to your GP with a report of the assessment and treatment. Once the child or young person is stabilised on stimulant medication, then the GP will be asked to continue the prescribing.
With some other medications such as Guanfacine, this will be requested too however it may not be possible for this to be prescribed by the GP.