Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity that impact daily activities, often affecting performance at school, work, or in social settings. The condition can be categorized into two main areas: inattention and hyperactivity/impulsivity.

1. Inattention
Children with ADHD often show a pattern of inattention, making it challenging to stay focused:
⦁ Difficulty organizing tasks and activities: They struggle to manage and complete tasks efficiently.
⦁ Easily distracted: Their attention is often diverted by irrelevant stimuli or thoughts.
⦁ Forgetfulness in daily routines: They frequently forget chores or errands.
⦁ Does not seem to listen when spoken to directly: They appear to be inattentive even without distractions.
⦁ Frequently losing items: Important things like school supplies or toys are often misplaced.
⦁ Avoidance of mentally intensive tasks: They resist activities that require sustained focus, such as homework.
⦁ Incomplete task follow-through: They start tasks but rarely finish them.

2. Hyperactivity and Impulsivity:
This domain includes symptoms that reflect restlessness and impulsive behaviours:
⦁ Excessive talking: They often speak continuously without pausing.
⦁ Difficulty waiting their turn: Impatience is evident, whether in conversation or activities.
⦁ Running or climbing in inappropriate settings: They struggle to conform to situational expectations.
⦁ Frequently leaving their seat: They get up when expected to remain seated, such as during class.
⦁ Interrupting others: They often intrude on conversations or games.
⦁ Always ‘on the go’: They exhibit a constant need to be active.
⦁ Inability to play quietly: Even during leisure activities, they struggle to stay calm.
⦁ Answering questions prematurely: They respond before questions are fully asked, showing impulsivity.

Diagnostic Process

The diagnostic process should include:
⦁ A full clinical and psychosocial assessment.
⦁ A detailed developmental and psychiatric history.
⦁ An assessment of mental state and observer reports.
Diagnosis should be made using the DSM-5 criteria, which define ADHD as a persistent pattern of inattention and/or hyperactivity that interferes with functioning or development

Management of ADHD According to Irish Guidelines

Non-Pharmacological Interventions:
⦁ Offer non-pharmacological treatments like ADHD-specific Cognitive Behavioural Therapy (CBT) and occupational therapy for those who cannot take medication or prefer not to.
⦁ Coaching, structured supportive psychological interventions, and regular follow-ups are recommended.
Pharmacological Management:
⦁ First-line medication: Lisdexamfetamine or methylphenidate.
⦁ If the first choice is not effective, consider switching between lisdexamfetamine and methylphenidate after a 6-week trial.
⦁ Atomoxetine can be offered if stimulants are ineffective or not tolerated.

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