A background sketch

In cognition, mood and motor function children are more capable and can exert more control than infants, but less so than adults. The ADHD child is capable in these three areas of mental function, but has problems in their control.

Attention-deficit/hyperactivity disorder refers to problems with governing attentional resources (sustained, selective, executive), and appropriately directing / inhibiting behaviour. The feature of impulsiveness may cover both of these abilities (risk taking, tantrums, gratification). The first signs usually appear by the age of 6y (i.e. are often evident in pre-schoolers), symptoms are maximal between the ages of 8 and 14y and attenuate through adolescence. However, in a few of these areas of function the effects may remain in some adults. There is evidence suggesting that such a residuum underlies later social instability (e.g. in partnerships, occupation, interactions with the authorities).

Any child can aggravate and frustrate the parent(s) or care-giver according to these characteristics. It is their quantity, quality and pervasiveness that makes the distinction and offers grounds for considering the descriptive term and diagnosis ADHD. To be successful therapeutic help should be offered not only to the child, but to the adults inevitably involved in supporting the child in his or her development (e.g. care-giver, parent, teacher).

There are three aspects of the use of the term ADHD that can be a source of controversy and are of concern to researchers, therapists and parents alike, albeit to varying degrees.

  1. One is the need to agree on and to be able to communicate about the types of diagnosis possible in different societies. In North America use of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) allows for an inattentive type, a hyperactive-impulsive type and a combined type. It is therefore possible to have a diagnosis of ADHD without being inattentive. In the International classification of diseases (ICD-10) inattentiveness is necessary for a diagnosis, although the disorder is called 'hyperactivity disorder' or hyperkinetic syndrome! Gradually this gap is being bridged with the development of new instruments for use in Europe and the Americas (e.g. 'hypescheme').

  2. Second, an area of current active investigation concerns the other features that frequently occur alongside "ADHD" (the technical term is 'comorbidity'). These can come in three 'types': a) with features of aggression in terms of verbal or non-verbal behaviour against people, their 'rights' or property [externalising features called oppositional or conduct problems], b) with features of emotional withdrawal (internalising features that can include depression) and c) other rather different disorders where hyperactivity and problems with attention can be marked (e.g. complex tics, childhood autism). The presence of such additional features must have an influence on the form of therapy a clinician should offer, and thus it is a matter of concern for current scientific investigation whether comorbidity reflects a variant or a separate entity with separate aetiologies and bases (a separate phenotype).

  3. Third no one should overlook that some of the overt features of "ADHD" can reflect a quite different origin or different problems from those embedded in the developmental history, family or social environment of the ADHD child. At a first look some ADHD-like symptoms can emerge as a result of individual exposure to environmental toxins, allergic-like responses to some diet characteristics, or reflect the very first signs of the emergence of other illnesses (e.g. bipolar disorder).
    This is why the pervasive problems of a child should be meticulously examined by a Health-Services professional.