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Attention-deficit/hyperactivity disorder is a combination of various behavioural problems that is seen in children. It can occur in adult life, however it often goes unnoticed the older one gets.

The two most common signs of ADHD are

  • Lack of attention (6 of the 9 criteria)
    • inability to focus on activities or loss of interest
    • difficulty to focus on activities such as games or tasks
    • seems not to listen or pay attention when spoken to
    • unable to follow instructions or finish tasks
    • difficulty to organise tasks and activities
    • avoids tasks or activities that involve a degree of concentration
    • misplaces items that are needed to perform certain tasks
    • easily distracted by external stimulus
    • often absent-minded during daily activities
  • Hyperactivity or impulsivity (6 of 9 criteria)
    • moves around in chair or shakes feet or hands
    • stands up in situations were it is expected to remain seated
    • runs around or climbs on things where it is inappropriate
    • inability to play games in a calm manner or remain calm in games that are relaxing
    • is often doing own things and keeps on going
    • talks more than normal
    • answers questions without thinking about the meaning or consequences
    • difficulty waiting for own turn
    • pushes others away or is wants to impose own ways

Children can also have ADD where there is no sign of hyperactivity or impulsivity.

Before a GP diagnosis a child with ADHD or ADD other specialists or therapist may have already been involved in the assessment of the behaviour. The condition needs to affect and the people around him or her in both the home and school setting.

The GP will provide advice and referrals to other specialist. First instance it will be concerning behaviour management. If this has little effect the GP can consider Methylphenidate

Behaviour management consist of

  • Daily structure that is well planned with clear routines
    • time; for instance wake up, dine, sleep every day at same time
    • language; use short clear sentences when speaking
    • space; provide space for everything
  • Use pictures and visual cues to structure the day or space
  • Recognise good behaviour and applaud appropriately with treats or words of encouragement
  • Do not place unrealistic goals
  • Involve the child in finding solution
  • Provide tasks that are somewhat more challenging so they can remain focused
  • Make sure child has enough space and time to keep physically active
  • Remain patient

Prescribed medication include Methylphenidate or Dexaphetamine (both are controlled drugs and fall under opiate law)

  • Methylphenidate 5 mg one tablet twice a day (short-release dose). This can be increased to three times a day, consider the last daily dosage about 4 hours before bedtime due to side effects (difficulty falling asleep)
    • Increase daily dose by 2.5 mg to 5 mg per week to reach a maximum daily dose of 60 mg per day
    • Typical maximum daily dose depending on weight is 0.6 to 0.8 mg per kg in 2 or 3 doses.
    • In case of rebound effect and problems with compliance, consider switching to delayed-release dose Methylphenidate 18mg once a day (equivalent to 5mg three times a day)

Side effect includes difficulty sleeping, decreased appetite, headache, abdominal pains and easily agitated. Typically these side effects resolve after one or two weeks of starting medication and completely disappear once it is stopped.

At the start of treatment the GP will follow-up to assess the following

  • Effect of drug on behaviour
  • How long does the drug last for, is there rebound behaviour issues
  • Compliance with the regimen especially if child is attending high-school
  • if there are any side effects
  • presence of psychological symptoms (aggression, mood swings, suicidal thoughts, anxiety, agitation, depression or psychotic episodes)
  • If growth stops, heart rate increases or blood pressure also increases
    • GP should check blood pressure if headache occurs

The GP wil refer or deliberate with a paediatrician or paediatric psychiatrist in the event of

  • child being less than 6 years of age
  • severe disability and able to function at home or at school
  • possible pre-existing psychiatric issues
  • when treatment or therapy seems ineffective

ADHD is a complex condition that is typically seen in school-aged children. There needs to be the presence of hyperactive, impulsive and lack of paying attention to tasks or activities. It takes a multi-disciplinary approach to diagnose a child with ADHD and starting medication needs to be considered after other management options are tried. The GP will follow-up the child regularly while on oral medication to assess side-effects and rebound symptoms.