Gastro Centre

Attention Deficit Hyperactivity Disorder (ADHD) Frequently Asked Questions

• How is ADHD Diagnosed?
• Would my GP know how to diagnose ADHD?
• Can an ADHD child learn at school without being medicated?
• Can a child diagnosed with ADHD outgrow this condition?
• What are the medications available for ADHD?
• Are there Different Stages of ADHD?
• If my husband has ADHD what are the chances our children will have it?
• I have heard of the FAILSAFE diet improving ADHD without medication- does this really work?
• Why does my child still not behave like "other" children after 3 different stimulants have been used?
• My 12 year old son has ADHD- what else can I do to make his life easier in other ways, i.e. diet, exercise, and other things that may help him to keep his attention?
• Are there more natural medications available?
• How does ADHD medication work and do they have to be taken for your whole life?
• My son has been diagnosed with ADHD and his school teacher and osteopath would like me to take him off his medication to see if they feel it is manageable. Do you think it's a good idea to take him off and then put him back on?
• Would my son have ADHD. He is 13 years old and gets angry very easily, he has punched a hole in his bedroom wall and does not like to hear the word 'no', swears when he can't have his own way. He has always been like this.
• Is fish oil good for ADHD?

How is ADHD Diagnosed?

ADHD can be a difficult condition to diagnose but it is very important to get the diagnosis right. ADHD is diagnosed based on the behaviour of the person. It is often a teacher or babysitter who will first notice a child's behaviour. The signs that are often seen first include a child losing interest in playing a game, losing toys or school supplies, being restless or being disruptive in classes. In adults there can be other signs such as difficulty with long conversations or forgetting appointments.

Once these early signs are discovered the person needs to be carefully assessed by a health care professional. For children this assessment will include:

• An interview with the child and their family.
• Talking with the child's teachers about the child's behaviour in class.
• Performing standard questionnaires and tests (these include the ADHD Rating Scale, Conner's Questionnaire, Gordon Diagnostic System or similar tests).
• Other tests may be performed to assess the child's social, psychological and intellectual development.

All this information is then taken together to assess if the child has ADHD or if there is another cause of the child's behaviour. Other causes of inattentive or disruptive behaviour include:

• A learning problem,
• A hearing problem (including an ear infection)
• Anxiety or depression
• A sudden change in the child’s life such as the parent's separating or the death of a close relative.

The diagnosis is finally made if the child’s behaviour and situation meet the Diagnostic and Statistical Manual IV (DSM-IV) criteria. The doctor will carefully consider the child’s behaviour, the results of the questionnaires and any other tests performed and if the DSM-IV criteria for ADHD are met then the diagnosis of ADHD is made. After the ADHD is correctly diagnosed and assessed treatment options can be considered.

Learn more about ADHD
Inattention
Hyperactivity
Impulsivity

Would my GP know how to diagnose ADHD?

Your GP is an excellent place to start. GPs often see a wide variety of conditions and most will have extensive experience with diagnosing ADHD. A GP will often be able to rule out other common causes of behavioural problems. Most GPs will refer children with ADHD to specialists (a paediatrician or children’s psychiatrist) for final diagnosis and treatment.

The main treatment for ADHD of stimulant medications and these are restricted in some states to prescription only by specialists.

Can an ADHD child learn at school without being medicated?

ADHD is a label that describes a very large group of behavioural problems. There are different types of ADHD as well as different severities. This means that the way ADHD affects the individual child is almost unique. The question therefore should not be ‘can a child with ADHD learn without medication?’ but rather ‘can your specific child learn at school without medication?’ This will depend on many things but the main point to consider is how is the child currently doing at school? If the child is being disruptive or not paying attention in school then they may benefit from medication. It is also important to ensure that the diagnosis of ADHD is correct and that there is not another reason for the child’s learning difficulty, such as a hearing or vision problem.

If the child does have ADHD and is experiencing difficulties at school a trial of medication may be started. The child may be assessed (using a tool like the Connor’s questionnaire) before starting medication and then after a week or more on medication. If the medication makes a big difference in the child’s behaviour or performance at school then it should be continued. It is important to repeat the warning that children with untreated ADHD can experience long-term social, psychological and behavioural problems.

If you are concerned about your child and whether they need medication to learn at school please discuss this with the doctor who is caring for your child as they will be able to give the most accurate answer for your child.

Learn more about ADHD medication

Can a child diagnosed with ADHD outgrow this condition?

This is a difficult question to answer but there have been some important discoveries in the last few years that have shed some light on the matter. Research now suggests that not all children with ADHD will have this condition for the rest of their lives. In fact one study found that only 15% of children with ADHD still had the condition at the age of 25. However, this is much lower then other study that found that 65% of children will still have problems with ADHD at the age of 25. It is also possible for the type of ADHD to change, meaning that their behaviour will change. For example a child who is inattentive will become hyperactive or impulsive, or a child who is a combined type will become mainly inattentive or impulsive. Up to 50% of children with ADHD will change type.

Currently there is no reliable way to predict wether a child will outgrow their condition or change type, however, research is continuing.

What are the medications available for ADHD?

Stimulant medication is the main form of medication available for ADHD. There is a large quantity of very good scientific evidence that shows that stimulants are an effective way of treating ADHD. The two main drugs currently available in Australia are Methylphenidate and Dexamphetamine. Both are stimulant medication and their brand names include Concerta, Ritalin and Attenta as well as some generic brands.
The only other medication currently available for ADHD is Atomoxetine (Strattera). Your doctor will discuss which medication is best for you/your child.

The use of stimulant medication does not increase the risk of drug abuse or addition later in life.

Numerous other medications have been tried for ADHD but these seem to be of little benefit to people with ADHD and the use of these medications is restricted to only specific patients.

Are there Different Stages of ADHD?

There are no defined different stages of ADHD itself. However, there are several ways to think about staging in ADHD.

In many children with ADHD (up to 50%) the type of ADHD will change. For example a child who was mainly hyperactive or impulsive will become mainly inattentive. The change may be less obvious with only some particular behaviours changing. This change can be thought of as different stages of ADHD. However, this will be different for all people with ADHD, some many not change at all while some may even be "cured".

Another way of looking at stages is one looking at the way that ADHD impacts the child's life. In this system the main problems of ADHD are grouped into stages 2 to 4 as summarised below:

• Stage 2: child aged less than 7. Main problem is low self esteem
• Stage 3: child aged 8-12. Main problems are disruptive behaviour, learning delay and poor social skills
• Stage 4: child aged 13 and above. Main problems include substance abuse, exclusion from school, criminal behaviour.

Therefore, although there are no defined stages of ADHD there are several ways of thinking about ADHD in terms of different "stages".

If my husband has ADHD what are the chances our children will have it?

There is no doubt that ADHD does run in families. The population rate of ADHD in children is around 5%, however, of children with ADHD 35% will have a parent or sibling with ADHD. There has been some suggestion that the risk of children developing ADHD if one of their parents has the condition is as high as 40-57%. It is however important to remember that while genes do play an important role, other factors are also involved. Whether an individual child will have ADHD depends on both genetic and environmental factors and this interaction is not yet fully understood.

The exact genetics of ADHD are still being studied and there is currently no genetic test available for ADHD. It is also unclear if genetics increases the risk of all ADHD or just some types of ADHD. This is still being researched and there may one day be a separate familial type of ADHD recognised.

I have heard of the FAILSAFE diet improving ADHD without medication- does this really work?

There are two very important points to address with this question:

• Whether diet can improve ADHD; and
• Whether diet can improve ADHD enough to stop medication.

To answer the first question the answer is yes, diet may improve ADHD in some children. The FAILSAFE diet is a diet developed at the Royal Prince Alfred Hospital in the 1980s and is a diet free of additives and low in salicylates, amines and flavourings. The diet includes eating fresh meat, white fish, eggs, milk, yoghurt, cottage cheese, butter, grains, peeled potatoes, beans and a few green vegetables like cabbage. There is now growing evidence that such a diet can improve ADHD, especially reducing hyperactivity as well as reducing irritability and improving sleep.

The answer to the second question is probably no. Although diet can improve ADHD and some children will be better off with a diet free of preservatives or sugar the changes are usually not significant enough to stop medication.

Another important note is that while there is some evidence that diets (such as the FAILSAFE diet) can improve ADHD it is a very restrictive diet and as such very few people will be able to maintain this diet over any considerable period of time. Especially taking into account that some children are fussy eaters at the best of times and a highly restrictive diet will probably not work. Worsening the problem is that many children with ADHD will be quite impulsive and this will make strict adherence to the diet even more difficult. This poses a problem as even supporters of the diet agree that the diet must be strictly followed for it to work. If a child has even a few slip-ups this would destroy any benefit of the diet. On the other hand the medication for ADHD is both safe and effective and it has been shown beyond doubt that the medication improves the long term outlook of children with ADHD.

There is no scientific evidence that the FAILSAFE or any other diet is of any significant benefit to adults with ADHD.

Why does my child still not behave like “other” children after 3 different stimulants have been used?

It is important to realise that ADHD is actually a serious condition and as such the treatment of ADHD can be quite difficult. The mainstay of treatment are stimulants and (if taken correctly) these work in about 80% of children.

Without knowing the specific details it is impossible to comment specifically why your child does not behave like "other" children. Some of the possible reasons for the behaviour may be:

• Your child may be one of the small number of children for whom the medication will not work
• The dose of the medication may not be right for your child. Is your child taking the medication as prescribed and not missing any doses?
• Has your child been correctly assessed for ADHD and is that the only condition your child has? ADHD can exist alongside other conditions such as Oppositional Defiance Disorder or possibly a hearing or learning difficulty.
• Does your child only behave differently in a particular environment (such as at school) as this may suggest that something specific is influencing, distracting or scarring your child in that one situation.

Everyone is different and some children do behave differently to others, the question to ask yourself is, is this different behaviour causing problems for your child (eg are they not learning in school or find it difficult to make friends)? If this behaviour is causing problems then discuss it with your doctor.

My 12 year old son has ADHD- what else can I do to make his life easier in other ways, i.e. diet, exercise, and other things that may help him to keep his attention?

Assuming that your son is already on an appropriate dose of stimulant medication there are several things that you can try to help your son.

Diet can make an improvement to ADHD.  There are many different diets that are meant to help with ADHD. Some of the more popular diets are ones that remove all forms of preservatives or artificial colours and flavours from the diet. There is now growing evidence that these diets can help reduce hyperactivity. Another possible diet is the few foods diet that tries to limit the number of foods eaten. Although this diet has been shown to be useful in some children with ADHD the diet is very hard to maintain (especially in teenagers) and is of little practical use.

What may prove more useful are dietary supplements. While there is no scientific evidence for the use of "megavitamins" (vitamins given at very high doses) there are some other supplements worth trying. There is some evidence that zinc and iron supplements may help reduce hyperactivity in some children. Zinc may also help make ADHD medication work more effectively. It is important to consult your doctor when starting Iron or Zinc as too high levels are potentially dangerous. Another supplement that has recently become popular is fish oil or Omega-3 and Omega-6 essential fatty acids. There are conflicting reports about fish oil with some reports showing reduced aggression and hyperactivity while others showing no benefit. Other benefits of fish oils include other health benefits (such as heart and memory benefits) and because fish oils come in odourless capsules they are easy and convenient to take. Although countless other supplements (such as magnesium, vitamin B6, various herbs, etc) and dietary restrictions (such as eliminating yeasts or sugar from the diet) have been tried in the past there is just no substantial evidence that any of these supplements help with hyperactivity or attention.

Exercise is another simple change that may help improve attention. The amount or type of exercise that is most helpful is currently not known but there is little doubt that exercise has benefits in reducing impulsivity and hyperactivity.

Yoga is also under investigation for possible use in ADHD. A recent study found that yoga training can help improve all the symptoms of ADHD and is especially useful when combined with medications. More research is needed to show how useful yoga actually is in children with ADHD.

Another treatment option may be some counselling or Cognitive Behavioural Therapy. Not all children are suitable for such therapy and because such therapy can be expensive and time consuming it is important to discuss this with your doctor who may then suggest a particular therapy that may work for you and your child.

Although these alternative therapies may help to improve your son’s attention it is important not to stop ADHD medications and to discuss any big changes (such as starting a restrictive diet or counselling) with your doctor.

Are there more natural medications available?

The simple answer to this question is no. There are many “more natural” treatments for ADHD but these are not intended to replace medications but rather to help the medication work. There are lots of these complementary therapies available for ADHD. In short there are diet, exercise and herbal complementary therapies available.

Diet can make an improvement to ADHD. Some of the popular diets for ADHD are ones that remove all forms of preservatives or artificial colours and flavours from the diet. These diets can help reduce hyperactivity. Another diet is the few foods diet that limits the number of foods eaten. Although this diet has been shown to be useful in some children with ADHD the diet is very hard to maintain (especially in teenagers) and is of limited practical use.

Some dietary supplements are also useful in ADHD. The supplements that have been shown to have a benefit in ADHD are zinc, iron and fish oils (omega 3 essential fatty acids). These supplements can reduce hyperactivity and aggression in some children. Taken in large quantities iron and zinc can be dangerous so if you do choose to try these consult with your doctor about how much is suitable for your child. The benefit of these dietary supplements is that they come in tablets and are very easy to take. 

Exercise is another simple change that may help improve attention and provide an outlet for excess energy. The amount or type of exercise that is most helpful is currently not know but there is little doubt that exercise has benefits in reducing impulsivity and hyperactivity. Related to exercise, Yoga is another possibility. Yoga combined with appropriate medication has been shown to improve behaviour in ADHD.
Another possibility may be some counselling or cognitive behavioural therapy. This type of treatment is costly, time consuming and only suitable for some children with ADHD. If counselling is considered it should be discussed with your doctor to see if your child would be suitable to this sort of treatment.

There are some herbs available for ADHD. Ginkgo is one such herb that is commonly suggested but there remains no evidence that it is effective in ADHD. Also available are some calming herbs or teas that are supposed to help reduce hyperactivity. These can actually be dangerous as they can interact with medication.

An important warning that should be repeated is that all these strategies and therapies for ADHD are an addition to stimulant medication and should never be used as a replacement for medication. As some of these therapies (such as some supplements and herbs) can be dangerous in too high amounts or can interact with medication it is important to discuss any changes to treatment with your doctor to ensure that it is safe.

It is also important to remember that stimulant medication (the main type of medication used to treat ADHD) is very effective (helps around 80% of children with ADHD) and has very few side effects. Stimulant medication does not increase the risk of drug abuse and does not result in reduced height. There has been media coverage criticising stimulant medication but the scientific evidence clearly shows that this type of medication is both safe and effective in treating ADHD.

How does ADHD medication work and do they have to be taken for your whole life?

The main type of ADHD medication is stimulant medication. In Australia two different drugs are available, Methylphenidate (Attenta, Concerta and Ritalin) and Dexamphetamine. Both work in much the same way, increasing the amounts of two important brain chemicals called dopamine and noradrenaline. These two brain chemicals affect many different things including mood, sleep patterns, energy levels and concentration. Because of the complexity of these brain chemicals it is still not clear precisely how these medications work to give such excellent symptom control in ADHD.

To answer the second part of this question, ADHD can change throughout life. About half of all children with ADHD will change the type of ADHD (meaning their behaviour will change) throughout their lives. By the age of 25 as few as 15% of ADHD children will still have behavioural problems. These people will not need to continue their medication. However, there will be people who will continue to have problems with ADHD and they will need to continue their medication. It is important to never try to stop the medication without the consent of your doctor. This medication needs to be stopped gradually in a controlled manner. If the person feels that they no longer need medication then they should see their doctor to discuss the risks and benefits of stopping medication.

My son has been diagnosed with ADHD and his school teacher and osteopath would like me to take him off his medication to see if they feel it is manageable. Do you think it’s a good idea to take him off and then put him back on?

No, it is definitely not a good idea to take him off medication and then try to put him back on. This is for several reasons:

• The first is withdrawal. Stopping ADHD abruptly after any period of being on the medication can result in withdrawal symptoms. These can include depression, fatigue or hyperactivity.
• Going off and on may seem innocent but look at what is happening in the child’s brain- the medication affects two very important brain chemicals that also regulate mood, sleep, energy, concentration, fine muscle movement as well as other important body functions. Starting and stopping this medication causes the levels of these chemicals to change rapidly and this can result in unwanted side effects.
• Another reason is that to be truly effective ADHD medications should be taken continually over a long time. The medication has the greatest benefit over the long term as it allows children with ADHD to learn, play and develop normally. Going on and off the medication will affect how the child learns and interacts with the world.
• Another reason is that the dose of the medication is often tailored and adjusted to the current situation. After taking the child off the medication if you find that he needs to go back on his medication the previous dose may not work, or may be too high. It may then take a long time to readjust the dose to be effective again.
• The last reason is that just as a doctor started the medication, the doctor must supervise any changes in dose or indeed stopping the medication. 
  While I am sure that both your teacher and osteopath have good intentions and want what is best for the child it is important not to experiment with the child’s health and development. If you think that your child may be able to decrease their medication it is important to discuss this with the doctor caring for your child and follow their advice.

Would my son have ADHD. He is 13 years old and gets angry very easily, he has punched a hole in his bedroom wall and does not like to hear the word ‘no’, swears when he can’t have his own way. He has always been like this.

Not knowing the particular details it is impossible to say whether he has ADHD or not. However, the behaviour is not entirely typical of ADHD. ADHD is most often characterised by problems like:

• Not giving attention to schoolwork (making numerous careless mistakes or not finishing schoolwork)
• Not listening when spoken to
• Not follow instructions, however, this is not a deliberate disobedience but rather a lack of attention
• Avoiding doing anything (such as schoolwork) that will take a lot of time and effort.
• Often losing things (such as school supplies or books)
• Being easily distracted.
• Often fidgeting or getting up from their seat for no reason
• Talking excessively.
• Often interrupting others, for example doesn’t wait their turn in games or interrupts during conversations

The behavioural problems must also be present in two different settings (such as at school and at home).
What your child may have is Oppositional Defiant Disorder (ODD). ODD often exists along with ADHD. ODD is characterized by:

• Often losing your temper
• Often arguing
• Refusing to comply with rules or instructions. Unlike in ADHD here the child consciously refuses to follow instructions.

The most important thing to remember is that if the behaviour is causing problems at home or school then it is important to investigate for the possibility of ADHD or ODD. The best place to start is to go to your family GP. From there, you may have to see a specialist (such as a paediatrician or child psychiatrist) to have your child formally assessed (using interviews with the child and questionnaires for you and possibly the child’s teachers).

There is good treatment for both ADHD and ODD and if your child does have a behavioural problem it is important to treat the problem to ensure that your child does not have ongoing behavioural problems that can become more serious as time goes on.

Is fish oil good for ADHD?

This is still a controversial issue. Fish oils (particularly omega 3 essential fatty acid) have been shown to have numerous benefits for heart health and some mental health illnesses (such as schizophrenia) but there is no solid evidence that fish oils help with ADHD. In some studies fish oil has been shown to decrease hyperactivity, decrease disruptive behaviour and improve academic achievement but some other studies have shown that this is not the case. It will probably be many years before a conclusive answer about fish oil in ADHD is found.

Fish oil, however, does have many proven benefits, usually has no side effects, does not seem to interfere with medication and is simple to take in capsule form. Therefore, it is reasonable to try fish oil to see if it helps in your particular situation. As long as you don’t stop the ADHD medication, adding fish oil may be a good thing to try. However, please be patient, fish oils will take at least several months to have a noticeable effect so don’t expect a miraculous change as soon as you start the fish oil.

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