Attention Deficit Hyperactivity Disorder (ADHD) is a condition that causes behavioural and/or learning difficulties to the extent that the student may not reach his or her full potential academically and socially.
The condition is multi-factorial. Difficulties in most cases are due to a genetically-based problem in brain function, with diminished function in some of the neuro-transmitters that allow brain cells to communicate with one another.
A student with ADHD is most commonly diagnosed by a paediatrician or a child psychiatrist, or occasionally by a general practitioner with special experience. Psychologists may make or suggest the diagnosis, but refer students to one of the above specialists if medication is required.
Information from a variety of sources is required before the diagnosis is confirmed. The student will generally be screened by the medical practitioner for a range of medical conditions, including problems with vision and hearing. Teachers may be consulted about the student's classroom behaviour and attention. Formal questionnaires are often used. Input from a guidance officer is often needed to check for learning difficulties.
Learning difficulties commonly co-exist with ADHD. Also, a student with unrecognised learning difficulties may have an apparent problem with attention, because it is difficult to attend to learning tasks that are inappropriate for the student's learning abilities.
The National Health and Research Council recommends that as a minimum, the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-1V), be used for diagnosis.
DSM IV uses a check list of symptoms to determine which Type is present. For a diagnosis of ADHD by DSM-IV criteria:
ADHD may be associated with other conditions, including anxiety, oppositional and defiant behaviour, conduct problems, learning difficulties, coordination problems, sensory problems, and sometimes with other medical conditions.
Parents and carers of children with ADHD often have significant difficulties. In part, this is because the condition is genetic, and in part because such children put a great deal of stress on their families. It should not be assumed that difficulties the parents/carers may have are the main or only cause of the ADHD symptoms.
Children with ADHD vary greatly in their presentation, depending on the subtype, and on the presence or absence of associated problems, and on many other factors.
If a student is being evaluated by a specialist for symptoms suggesting ADHD, the student's teacher may be contacted. There are a number of questionnaires and/or standardised checklists that may be used to help in the diagnosis.
School staff should attempt to answer the questions as objectively as possible, based on their experience with the student, and in comparison with others of the same age or developmental level. Answers to questions will be more accurate if staff do not attempt to make their own judgement about the cause of any difficulties, before filling out the questionnaire.
When available, classroom observations by guidance officers of the child being assessed for possible ADHD can be invaluable. A guidance officer's evaluation of the student's learning profile is also an important part of the overall assessment.
Where a student has not been assessed, but a teacher has concerns about symptoms of possible ADHD, the initial steps should occur within the school, to assess and manage the observed difficulties.
Classroom management strategies for the observed difficulties, whether attentional or learning problems or disruptive behaviour, or both, should be implemented. Support staff within the school, and from the District Support Service may be helpful in assessment and management. Initial discussions with the parents should focus on the nature of the observed difficulties and on gaining an understanding of the parents/carers’ perceptions of the student.
The management of a student with ADHD may include the use of medication.
The most commonly used medications are Methyphenidate (brand names RitalinTM or AttentaTM), and Dexamphetamine.
The two medications work very similarly. Both help to correct the imbalance of neurochemicals and affected children are better able to concentrate and better able to inhibit impulsive behaviour. Some children will respond better to one medication than the other and it can not be predicted with certainty which will be the better medication for a particular student.
Generally both medications have clinical effects within about 30 minutes, and benefits wane after about 3 to 5 hours. However, there is wide individual variation in metabolism and occasionally the effect is either shorter or longer lasting.
Methylphenidate (RitalinTM or AttentaTM) usually has a shorter effective life than Dexamphetamine. The short duration of action mean that these medications usually need to be taken during school hours. The timing of any medication needed during school hours may vary from student to student. Some trial and error may be needed to determine the best timing for a particular student. In many cases apparently minor changes in timing may have a significant impact on the benefits or possible adverse effects of prescribed medication.
Side effects of the two drugs are similar and are generally mild, if any. Younger children are more likely to experience side effects than older children.
Side effects during times of peak drug action (half an hour to one and a half hours after the dose) commonly include appetite suppression. For this reason, for most children, it is best if medication is taken with or immediately after food. If given before food, it should be immediately before. Some children will need extra supervision to encourage them to eat lunch.
Other side effects that can be observed at peak times include a subdued effect, irritability or tearfulness. More often, however, mood improves on medication.
Headaches and abdominal pains are infrequent side effects. Tics (brief sudden movements, only partly under the student's control) may occur rarely, in part because there is a genetic link between ADHD and tic disorders.
Depending on the student, medication begins to wear off most commonly 3 to 4 hours after a dose. The symptoms of ADHD that were present before medication will then usually re-appear. In addition, some children experience a period of rebound at these times and will become especially hyperactive or irritable for a period of time.
Varying the timing and the amounts of medication will usually resolve these rebound problems. However, this means that accurate timing of the school-administered doses is important to avoid preventable side effects.
A number of medications are available for management of ADHD other than stimulants. Some of these may be administered outside school hours.
One that may be needed during school hours is ClonidineTM, or CatapresTM. These tablets should be given with food. The tablets can have an effect on blood pressure, and the student's body adapts to this, so it is very important that doses of this medication are not missed.
If medication is being used as part of the student's management, issues of respect, privacy and confidentiality are vital. Personnel assisting in the administration of the medication should demonstrate sensitivity and consideration.
It is important that there is careful monitoring of the effects of the medication in all settings including home, school and other activities. This will help ensure that the outcomes of treatment are positive. Some specialists will ask for information from teachers to monitor the effects of medication. In these circumstances, accurate reporting of observed changes in the student is very important.
Students requiring stimulant medication during school hours need to be supervised by school personnel. Most students with ADHD who require medication will not be able to self manage reliably. This will have an adverse impact on the success of their educational and behavioural management within the school environment.
Also, students with ADHD who self-administer medication within school hours can pose a safety hazard. Such students may lose, give away their medication or be pressured to give or sell their medication to others.
In the occasional case where a student self-manages medication reliably, this should be recorded in the medical action plan. Because of the safety issues, parents should be requested in writing to allow the student to have only one day's medication in his or her possession.
Medication is only one component of management of ADHD. If further information is required on the other aspects of the condition or the multi-modal approaches in the management of children with ADHD, the relevant support materials provided to schools should be consulted.
This page has been produced by the Department of Education
Questions concerning its content may be directed by email to ServiceCentre@education.tas.gov.au or telephone 1800 816 057.
This page was last modified on 7th March 2008. The URL for this page is: http://www.education.tas.gov.au/school/health/students_health_care_requirements/specificmedicalconditions/attention_deficit_hyperactivity_disorder_adhd.
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