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Attention Deficit Hyperactivity Disorder (ADHD)

If you have a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) this means that you can struggle with paying attention, have high levels of energy and react quickly to things. This can get in the way of everyday life such as school, hobbies and making friends, although how much it affects someone can vary from person to person.

Tasks such as sitting still, concentrating and following instructions are much harder for people with ADHD as they often feel restless or fidgety, can be easily distracted and can talk a lot, which makes activities such as school lessons and doing homework even more difficult.

People with ADHD can sometimes find it harder in social situations such as making friends or playing games as they can find it hard to follow conversations, wait for things and take turns. Sometimes people with ADHD also have difficulties with getting to and staying asleep.

ADHD is a result of the brain being wired slightly differently to people who do not have ADHD. Although there is no cure for ADHD, the difficulties experienced, such as high energy levels, difficulties concentrating and reacting quickly, can be helped and managed in many ways including receiving extra support in school, learning techniques and strategies to help you cope and sometimes taking medication.

CAMHS Attention Deficit Hyperactivity Disorder (ADHD) Referral Guidance

What we do, what we don’t do and what you can do if you are worried about your child

Many young people struggle with concentrating. Many young people are impulsive and have high levels of activity. All of these factors can be related to age and developmental stage as well as being traits unique to the individual. Sometimes when a young person is displaying a lot of behaviours associated with these traits, in many aspects of their life and it is causing them significant difficulties, we might consider a diagnosis of Attention Deficit Hyperactivity Disorder.

ADHD is a neurodevelopmental condition that effects behaviour and includes symptoms of inattentiveness, impulsivity and hyperactivity. An ADHD diagnosis can include a combined presentation of inattention, impulsivity and hyperactivity; a predominantly inattentive presentation or a predominantly hyperactive-Impulsive presentation. This guide will help you to know how to best support your young person if they are experiencing some of these difficulties and also when to consider when you might need to make a referral to CAMHS. This is not an exhaustive list; young people may experience symptoms which may not be included in this guide.

Green: 

Coping/needs for support; These are experiences that most young people will have from time to time, 

Type and nature of worry

Children and young people to go through phases where they are restless and inattentive. These difficulties can be short term, have no long term impact on daily functioning at home and at school. These difficulties are often completely normal and do not necessarily mean the young person / child has ADHD. These difficulties can be managed with consistent parenting approaches, the love and support of parents / carers and good home school communication.

What you might see or a young person might report

  • Struggling to get to sleep at night; having restless sleep or early morning waking.
  • Struggling to get ready for school on time.
  • Struggling to listen to and carry out instructions.
  • Struggling to be organised.
  • Struggling to develop  friendships.
  • Struggling to manage social situations.
  • Displaying difficult behaviour when asked to do something they don’t want to do (ignoring, shouting, running off, becoming verbally / physically aggressive).
  • Not wanting to go to school.
  • Feeling restless and fidgeting.
  • Poor eye contact.
  • Difficulties paying attention (even to things such as films or TV programmes)?
  • Difficulties turn taking and can interrupt others.
  • Easily distracted, starting things but not completing them.
  • Appearing forgetful and disorganised.
  • Impulsive and reactive, not always appearing to understand risks (e.g., not looking both ways before crossing a road).
  • Can be chatty, distracting and being distracted by others.
  • May seem to be disinterested or daydreaming (glazed over).
  • (this list is not exhaustive)

Things to try, support and Next Steps

  • Give your child regular opportunities to talk about what they are struggling with and how they are feeling.
  • Are they getting enough sleep? Make sure that you have a consistent night time routine. Have a set bedtime. Make sure that all screens are off a minimum of one hour before bed time.
  • www.hampshirecamhs.nhs.uk/issue/sleep
  • Behavioural strategies (- make sure all adults looking after the young person are consistent, stick to one plan.
  • www.hampshirecamhs.nhs.uk/issue/managing-challenging-behaviour/
  • Stay calm (ask for help from someone in the family; take a break; pick your battles- the child will respond better.
  • Use goals to work towards, charts and rewards can be helpful.
  • Use pictorial guides or lists to prompt routines and help with organisation.
  • Say your child’s name and look at them to get their attention when talking to them.
  • Only give one instruction at a time (break things down into small steps).
  • Get your child to pack their school bag the night before school.
  • Support your child’s interests
  • Support your child to problem solve areas of organisation that they find difficult.
  • Make sure your child has opportunity to let off steam (outside play, physical activity, social clubs).
  • Seek support from the school teacher or home school link worker.
  • Consider talking to the SENCO (Special Educational Needs Co-ordinator) at school.
  • Consider parenting classes (your child’s school should have knowledge of any available in the local area.)
  • Minimise distractions particularly when trying to work.
  • Repeat messages or important information regularly.
  • Present information verbally and in writing where possible.
  • Role play and practice skills such as turning taking, how to do activities safely (such as crossing the road), and reducing impulsivity/ reactivity.
  • Change activities regularly to reduce boredom and restlessness.
  • Look at our useful resources below for a range of support that can be accessed.

 

Amber:

Needs help; These are challenges that some young people experience and may need some support with.

Type and nature of worry

The degree to which a young person struggles with attention; hyperactivity and impulsivity are persisting and may be having a longer term impact  on daily functioning at home and at school

What you might see or a young person might report

  • Moderate difficulties (inattention, hyperactivity and impulsivity) affecting functioning so that the child may be falling behind at school.
  • Difficulties  are  present across different environments (e.g. home and school).
  • Difficulties must have been present across time (i.e. not a short term response to a challenging circumstance and usually noticeable from early childhood or on starting school).
  • Families might also find themselves struggling to do things as they normally would as they may make adjustments to accommodate how the young person is managing.

Things to try, support and Next Steps

As well as the steps in Green and Amber the following might be helpful:

  • Share concerns with your child’s school/ college.
  • Access pastoral support from school/ college.
  • Consider physical problems, bullying or change of family / social circumstances. Talks to your GP or school about school support or local counselling services.
  • Access and support your young person to access ADHD resources (podcasts, videos, downloads links) on the Hampshire CAMHS website and other resources below.
  • Notice when your child is doing well, celebrate achievements  or any small changes.
  • Reinforce behaviours you want to see.

 

Red

Needs Specialist Treatment or a Crisis Response; These are difficulties that cause a significant impact and a young person may need specialist support.

Type and nature of worry

When a young person has a significant amount of features usually associated with ADHD, which have been present since childhood and are problematic across all environments such as at home and at school, it might be worth considering an ADHD assessment. You would consider this when these difficulties with attention, activity and impulsivity are severe and enduring, are causing  significant disruption to a young person and are significantly disrupting daily life such as school/ college and socialising. Despite trying advice in the green and amber stages, the young person still experiences ongoing difficulties. The young person may be failing to meet expected academic levels due to poor concentration.

Some children with ADHD also have other mental health difficulties like any other young person might.  If this is the case they may benefit from some therapeutic intervention for this. Some children with ADHD might have specific learning difficulties (assessed by school and / or Educational Psychology Services and / or Paediatricians) and social communication problems which may need further consideration as well as an ADHD assessment.

What you might see or a young person might report

As well as the features in Green and Amber, the following might also be present (this list is not exhaustive):

  • Moving from one activity to another without completing one
  • May not play for long and not enjoy playing with toys and games. May prefer active games
  • May struggle to sit still and watch television or a film for any length of time.
  • Will often appear not to hear when spoken to
  • If you ask your child to do something they will often forget what you have asked them to do
  • They may be constantly fidgety, make lots of noises, and talk all the time (even in situations where it is not appropriate).
  • Often doing something that they should not be doing like talking, being disruptive in class
  • Be easily distracted by things going on around them
  • Be impulsive and accident prone
  • Have problems settling for bed and getting to sleep
  • Becoming agitated, oppositional or aggressive towards others when they are struggling with expectations placed on them.
  • Reactive and impulsive behaviour such as running away which may place them or others in danger
  • Family and school functioning may be disrupted and families and / schools are required to make significant adjustments to accommodate how the young person is managing or responding
  • Examples of this include: failing at school or leading to problems in relationships at home to the detriment of development.
  • The symptoms above cause significant distress or impairment in social, academic or occupational functioning

Things to try, support and Next Steps

As well as the steps in Green and Amber the following might be helpful:

  • Once above strategies have been tried and after 10 weeks if still concerned –consider referral to CAMHS. You can do this by visiting your GP or school and asking them to make a referral or make a self-referral. These referrals go to CAMHS SPA via www.hampshirecamhs.nhs.uk
  • Depending on the context and/ or the extent of the difficulties, other services may be helpful. There may be a role for other services such as Children’s Services or other statutory or voluntary organisations that can support families.

Useful Resources: