1. What is ADHD and how common is it?

Attention deficit hyperactivity disorder (ADHD) is a medical condition characterized by inattention, hyperactivity, and impulsivity. It often first appears in childhood and can continue into adulthood. ADHD affects approximately 8 to 10 percent of children aged 4 to 17 years, making it one of the most common childhood disorders. It occurs two to four times more frequently among males, particularly for hyperactivity and impulsivity symptoms.

2. What are the symptoms of ADHD?

ADHD symptoms can be categorized into three groups: hyperactivity, impulsivity, and inattention. Children with ADHD may experience one or more of these symptoms, which may change in frequency or pattern as they grow. Hyperactivity includes excessive fidgetiness, talking, difficulty remaining seated, and restlessness. Impulsivity involves difficulty waiting turns, blurting out answers, disruptive behavior, and intruding on others. Inattention encompasses forgetfulness, being easily distracted, disorganization, underachievement, and poor concentration.

3. What are the presentations of ADHD?

There are three presentations of ADHD:

• Predominantly inattentive presentation (previously known as attention deficit disorder)
• Predominantly hyperactive-impulsive presentation
• Combined presentation

The specific presentation is determined based on a child’s predominant symptoms and can change over time.

4. What causes ADHD?

ADHD is a neurobiological condition influenced by a child’s environment. Factors that may contribute to ADHD include:

• Lower brain activity in areas controlling attention and activity levels
• Genetic predisposition, as ADHD often runs in families
• Rare cases of environmental toxins (e.g., lead exposure) causing ADHD-like symptoms
• Significant head injuries leading to ADHD-like symptoms in some children
• Preterm birth increasing ADHD risk
• Prenatal substance exposures (e.g., alcohol or nicotine)

Please note that ADHD is not caused by excessive sugar intake, food additives, food colorings, allergies, or immunizations.

5. How is ADHD diagnosed?

ADHD diagnosis involves meeting specific criteria defined by the American Psychiatric Association. These criteria include symptoms being present in multiple settings, persisting for at least six months, appearing before the age of 12, impairing function in various activities, being excessive for the child’s developmental level, and not being better explained by other mental disorders.

6. How is ADHD treated?

While there’s no specific cure for ADHD, various treatments help manage the condition. Each child’s treatment plan should be tailored to their individual needs and may include:

• Long-term management plans with target outcomes, follow-up activities, and monitoring
• ADHD education for the child, parents, and other caregivers
• Collaboration between doctors, parents, teachers, and other healthcare professionals
• Parent training in behavioral management
• Behavioral school programs
• Medication

7. Is long-term planning necessary for ADHD treatment?

Yes, long-term planning is often needed, as ADHD is a chronic condition similar to asthma or diabetes. This involves continuous management by families, schools, and other caregivers.

8. How important is education in ADHD treatment?

Educating everyone involved with your child is a crucial part of ADHD treatment. As a parent, learning about the condition through reading and discussions with experts can help you manage ADHD’s daily impact on your child and family. This knowledge will also enable your child to learn self-help strategies.

9. What conditions can coexist with ADHD?

Up to 50% of children with ADHD may also have other psychological and developmental disorders, such as learning disabilities, disruptive behavior disorders (oppositional defiant disorder and conduct disorder), anxiety, mood disorders (depression or bipolar disorder), and autism spectrum disorder.

10. When should caregivers seek help for their child?

If caregivers suspect their child has ADHD, they should first talk to the child’s teacher and/or school staff to determine if the child has behavioral difficulties in multiple settings. The next step is to consult with the child’s healthcare provider for evaluation and potential referral to a specialist, such as a developmental behavioral pediatrician or child psychiatrist.

Dr Neel Saini

MD, FRCPC, FAAP, Consultant Pediatrician

There is  no single test available for the diagnosis of ADHD.  The diagnostic process requires  collection of information from several different sources. I want to see if the child has similar spectrum of symptoms in different situations and locations. It is also important to ascertain whether the severity of symptoms are severe enough to impact his life.  The impact on life may occur because of poor academic performance, inability to make friends or if it  is impacting quality of life in any other way.

Children’s with ADHD have 3  clusters of symptoms  that include  inattention, hyperactivity and/or impulsivity.  It is important for us to look at the child’s behavior individually  and compare  to that of other children of similar age. It is also essential that information is provided by  primary caregiver as well as other individuals who spend significant time with the child  such as teachers, daycare workers, or his/her coaches.

• Easily distracted and avoids any task that require sustained attention
• Forgetful and needs constant reminder and redirection
• Loses and  misplaces both normal belongings such as gloves or pencils
• Does not seem to respond when spoken directly
• Often  fails to  pay attention to details and makes careless mistakes

Symptoms of hyperactivity & impulsivity:

• Often fidgets and squirms often on the go and appears to be driven like to motor
• Cannot participate in leisure activities quietly
• Talks excessively
• Cannot wait for  his/her turn
• Blurts out answers  before question is completed
• Interrupts and intrudes on others

ADHD Diagnostic Criteria:

In order for us to make a diagnosis confidently following criteria must be met:

• The symptoms must occur in 2 or most settings such as home  school daycare or other social situations and must be causing  some impairment.
• Children ranging between 4-17 years of age should have at least 6 or more symptoms while children 17 years and older must have 5 or more symptoms to qualify for the diagnosis of ADHD.
• Symptoms  must have started before the child  reaches that 12 years of age however these symptoms may have not been recognized until the child is older.
• Symptoms should have continued for more than 6 months  and  must impair the child’s ability to function at home or school.   It may affect schoolwork or relationship with friends or siblings.
• In addition to looking at your child’s behavior, I do a physical and a thorough neurologic examination. A detailed medical history is necessary to understand the child’s behavior and rule out medical conditions that may affect his/her behavior.

I also like to screen children additionally for anxiety, depression, learning disorder,  developmental coordination disorder, aggression, sleep problems etc.

Dr Neel Saini

MD, FRCPC, FAAP, Consultant Pediatrician