ADHD in children: causes and diagnosis

The mechanism of ADHD has not yet been fully elucidated. Experts assume that it is involved, among other things, in the incorrect regulation of the metabolism of dopamine , serotonin , or noradrenaline (see the article Neurotransmitters : messengers inside the brain ). Apparently, genetic factors also play an important role . The possible influence of lack of oxygen during childbirth is also discussed, as well as the risk factors to which the child was exposed in the prenatal period (ie in the mother’s womb ), for example various infections . Premature birth , excessive consumption of peppermint during pregnancy , or the use of drugs or tobacco may also contribute to the development of ADHD . ADHD can also be negatively affected by inconsistent parenting.

How does ADHD manifest itself?

The main symptoms of ADHD are inattention, impulsivity and excessive activity – that is, one that deviates from the usual behavior of children of a given age. The criteria according to ICD-10 ( International Classification of Diseases ) are used for diagnosis . ADHD can manifest itself differently in each child, but the diagnosis is facilitated by the presence of some main symptoms. These are divided into three main areas: inattention, hyperactivity and impulsivity.

Main symptoms of inattention:

• the child must make a great effort to maintain attention,
• the child has difficulty noticing details and makes mistakes due to inattention,
• it is difficult for the child to listen and follow instructions,
• the child must make a significant effort to complete a task or activity,
• it is difficult for the child to make prolonged mental effort,
• the child often puts away or forgets his things,
• the child’s attention is easily distracted by various external stimuli.

The main symptoms of hyperactivity:

• constant restlessness of the hands and feet,
• the child has to make a significant effort to sit still or play,
• the parent feels as if their child “is still running some engine somewhere inside”.

The main symptoms of impulsivity:

• when a child speaks, his flow of words is hard to stop,
• the child has difficulty waiting until it is his turn to express himself on the given topic,
• disruptive behavior towards others.

ADHD diagnosis

The diagnosis of ADHD needs to be established in a social context: a specialist can pronounce the diagnosis of ADHD only if the child’s behavior is really disturbed to a great extent and if at least seven of the above symptoms are present. In addition, it is virtually impossible to reliably diagnose ADHD before the age of 7. In many cases, ADHD persists into adulthood.

If the diagnosis of ADHD is to be established, the symptoms must be clearly manifested and the child’s development is consistently behind by at least six months in several areas (school, free time, home activities, etc.). At the same time, it is necessary to carefully monitor the environment in which the child lives, so that it is possible to at least roughly trace the conditions that may contribute to the emergence of “disturbed” behavior.

Children with ADHD often also suffer from other mental disorders , such as social behavior disorders, depression , anxiety disorders , learning disabilities, autism spectrum disorders or tics . If restlessness and hyperactivity are caused by a disorder other than ADHD (e.g. anxiety disorder ), the specialist cannot pronounce the diagnosis “ADHD”.

How is ADHD diagnosed in young children?

In young children, the symptoms are not as obvious as in schoolchildren. To some extent, hyperactivity or impulsivity is part of the normal development of preschoolers. Young children with ADHD find it difficult to tolerate when adults do not want to comply with them, and behave noticeably defiantly, i.e. much more significantly than other children in the “defiant phase”. In addition, they may be less able to estimate impending danger, which brings with it a higher risk of injury.

From history to behavioral observation

The doctor usually begins the diagnosis by taking a careful medical history. Not only medical, social, psychological and family factors are taken into account, but also the course of the mother’s pregnancy and the development of the child to date. The child’s behavior and way of playing are also observed. The expert should notice not only the child’s weaknesses, but also the strengths, as these can then be used very well in therapy . It will also ask the parents about their reactions to their child’s behavior (for example, do they punish him in any way, and if so, how?) and what feelings they have associated with it (for example, helplessness or anger).

The diagnosis also includes a physical examination, weighing and measuring the child. Sometimes a blood sample is also necessary (e.g. to determine the level of thyroid hormones ) , or an EKG , EEG or examination using some imaging methods (e.g. magnetic resonance ). In some cases, the knowledge of an occupational therapist can also help .

Psychological examination

A psychological examination is always part of the diagnosis of ADHD in childhood. Depending on the child’s age, appropriate tests are used to help establish the correct diagnosis. In addition, the psychologist focuses on diagnosing the child’s development and possible giftedness. In some cases, videos can also help, allowing the psychologist to observe family dynamics (especially the relationship between parents and child) from a different perspective.

Who can I contact?

If you suspect that your child has ADHD, contact the attending pediatrician who, if necessary, will give you a recommendation to visit a child psychiatrist or other specialist specializing in psychosomatics or ADHD. Then the necessary examinations should follow, and in the case of a confirmed diagnosis of ADHD, the doctor can suggest a specific method of treatment.