Is it ADHD or just bad behaviour?

Photo: Shutterstock
Photo: Shutterstock 

All kids will act out at some point, especially in the preschool years.

"It's part of growing up," said Sydney-based General Paediatrician Dr Reshma Nikam. "However, most kids learn very quickly that not listening to a parent and throwing tantrums has consequences. If a child continues misbehaving in spite of these, this is a red flag that something else is going on – although not necessarily ADHD."

There are two types of ADHD, Nikam said. "The first is the inattention type, where the child fails to give close attention to detail, is forgetful, easily distracted, and struggles with organising tasks. The second is the hyperactive-impulsive type, where the child fidgets excessively, has difficulty remaining seated and sitting quietly, and talks out of turn.

"The challenge for any parent or professional is to understand why a child is behaving inappropriately. It is a difficult task."

Diagnosing ADHD

"The first port of call is a GP, who will refer to paediatrician. They will meet up with the family every couple of months to see if the suggestions made have made a difference to the child's behaviour," Nikam said. "With ADHD you need to have these symptoms for at least six months, and in more than one setting, for example both at school and at home. If you see these behaviours consistently for a period of more than six months, then your child should be evaluated.

"A comprehensive medical assessment will cover factors such as progress during pregnancy, any infections around the time of pregnancy, and family history. There is a strong genetic component to ADHD."

A developmental assessment, and an educational and psychosocial evaluation will then be performed, with the complete evaluation involving several office visits, Nikam said.

"There are so many other factors that can represent as inattention. Along with ADHD it's important to rule out other conditions, or coexisting conditions because quite often they go in hand in hand. It's not uncommon to find ADHD coexisting with oppositional defiant disorder, conduct disorder, a learning disorder or even autism."

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Certain questionnaires also help the specialist to arrive at a diagnosis. The specific ADHD scales available, completed by the child's parents and teachers, are more than 90 per cent accurate, Nikam said.

"With all the different modalities of diagnosing these conditions, ADHD is being picked up a lot more than what it was in the past."

Various therapists might get onboard to help reach a diagnosis.

"For example a psychologist might complete an IQ assessment of the child to help diagnose whether what they have is solely ADHD, and/or if it's a speech, sound, or working memory problem. A hearing and vision assessment might be done because quite often children with behavioural issues have hearing difficulties. "

ADHD is the most common childhood mental health disorder. The current figures in Australia are in one in 20.

"It's important to diagnose in a timely manner so that early intervention can begin and help assist the child reach [their] full potential."

And if it's not ADHD? "If after a good medical history and assessment it's determined that a child does not meet the criteria for ADHD, it is important to identify what is causing this."

Sleep for example can have a significant impact on behaviour. Online parenting courses such as Triple P (Positive Parenting Program), and the Raising Children Network offer helpful information and guidance on how to best manage these behaviours, Nikam said. 

For more information visit Healthshare, a joint venture with Fairfax to improve the health of regional Australians.