ADHD in Children and Youth

Welcome to Albert Road General Practice’s patient resource page on ADHD in children and youth. Here, we aim to provide you with valuable information about this complex neurodevelopmental disorder and its management. Please note that while this information is helpful, a formal diagnosis should be made by a paediatrician or child psychiatrist. Our role as general practitioners is to aid in early detection, coordinate care, and provide education and support to parents.

About ADHD in Children and Youth

ADHD, or Attention Deficit Hyperactivity Disorder, is a condition that arises from a combination of genetic, environmental, and psychosocial factors. It is typically not diagnosed before the age of 5 years. This disorder affects approximately 5 to 7% of children and is more common in boys. It can also run in families and may persist into adulthood. There are three subtypes of ADHD: inattentive, hyperactive, and combined. The combined subtype is more prevalent in boys, while girls are more likely to have the inattention subtype, which may go undiagnosed until high school when independent learning and organizational skills become more critical.

Children with ADHD exhibit consistent and persistent behavioral patterns characterized by inattention, impulsivity, and/or hyperactivity that impact various aspects of their lives, including learning and socialization. These behaviors are observed in two or more settings, such as at home and school. The child’s behavior often triggers negative responses from caregivers, peers, and others, leading to low self-worth, anxiety, and depression. ADHD can coexist with other behavioral, emotional, or neurodevelopmental disorders such as anxiety, autistic spectrum disorder, oppositional defiant disorder, and learning difficulties.

Treatment for ADHD typically involves a combination of behavioral and educational strategies, often complemented by medication. It’s important to note that there is no conclusive evidence supporting alternative treatments, dietary supplements, or elimination diets for ADHD. Relying on such methods may delay appropriate support and treatment.

Assessment

During the initial consultation, our focus will be on understanding the main concerns of the caregiver, conducting a brief examination, and identifying the child’s strengths. Subsequent assessments should ideally involve the caregiver(s) alone. Here’s what to expect during the assessment process:

1. Initial Assessment:
   • We will take a detailed history of the concerning behavior observed at school and home.
   • We will briefly explore the child’s background, home and family situation, and the caregivers involved.
   • We will engage with the child and perform a physical examination, paying attention to signs of restlessness, disruptiveness, impulsivity, or inattentiveness.
   • Ear, nose, and throat examination will be conducted, and growth percentiles will be plotted.
   • If the child is of indigenous background or shows signs of hearing concerns, we may arrange an audiology review.
2. Follow-up Appointment:
   • We will provide screening tools for the caregivers to use at home and school, such as the Parent and Teacher Vanderbilt Assessment Scale.
   • You will be asked to complete the screening tool and return for a longer appointment without the child.
   • During this appointment, we will review the screening tool results and explore hyperactive, impulsive, and inattentive symptoms further.
   • We will also conduct a comprehensive background biopsychosocial assessment.
   • If learning difficulties are a concern, we may suggest an educational psychology assessment, for which a mental health plan may be needed. We will provide appropriate referrals for further evaluation:
     • Suitably qualified child psychologists
     • SPELD Victoria (no referral necessary, but costs are involved)
     • Speech and language assessment for younger children
3. Diagnosis and Differential Diagnosis:
   • Based on the assessments, we will determine whether a diagnosis of ADHD is necessary.

Management

Effective management of ADHD requires a comprehensive approach that includes both pharmacological and non-pharmacological interventions. Please keep the following points in mind:

1. Resist Pressure to Diagnose:
   • It is essential to resist parental pressure and our own internal pressure to rush into a diagnosis. Hastily giving a diagnosis can potentially cause longer-term harm.
2. Initial Management:
   • We will refer your child to a non-acute paediatric medicine specialist for a formal diagnostic assessment and further management. If urgent circumstances arise, we will ensure to highlight your concerns on the referral.
   • We will provide education and address common concerns regarding the diagnosis of ADHD. Please note that only paediatricians or psychiatrists can initiate pharmacological treatment, while non-pharmacological treatment focuses on creating a supportive environment and managing challenging behaviors and difficulties.
   • We will provide general ADHD information and online resources for parenting and school support. You can find additional information on websites such as The Royal Children’s Hospital Melbourne and Raising Children.
3. Psychological Treatment:
   • We may recommend a Mental Health Plan for ongoing paediatric psychology referral to provide behavioral strategies, social skills training, and parental support. This treatment approach also addresses co-morbid conditions such as anxiety and depression.
4. Lifestyle Modifications:
   • Modifying lifestyle factors can have a positive impact on managing ADHD symptoms. We suggest:
     • Encouraging regular physical activity and ensuring adequate sleep.
     • Promoting a healthy diet.
     • Monitoring and supervising screen time to strike a balance between its benefits and potential harms.
5. Ongoing Support and Monitoring:
   • We will regularly review your child’s progress, provide support, and make referrals as needed.
   • We will assess the home and school situation for any new challenging behaviors or situations.
   • We will discuss lifestyle, diet, sleep, and exercise.
   • If medications are prescribed, we will use SafeScript to monitor their use and manage any adverse effects. Regular monitoring of blood pressure, heart rate, height, and weight will also be conducted.

Remember, our team is here to support you and your child throughout the process. By working together, we can help your child manage their ADHD symptoms and optimise their overall well-being. For more information and resources, please visit reputable online sites such as ADHD Australia and Parents for ADHD Advocacy Australia.

If you have any further questions or concerns, please don’t hesitate to contact us.