What is Attention-Deficit/Hyperactivity Disorder (ADHD)?

Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent childhood disorder characterized by challenges in sustaining attention, impulsive behavior, and hyperactivity. Early identification plays a vital role as ADHD symptoms can lead to an increased risk of developing oppositional behavior, low self-confidence in learning, and academic difficulties. ADHD is relatively common in children, with a prevalence rate of approximately 6-7%. We strongly encourage parents to have their children assessed if they consistently exhibit symptoms in both school and home settings.

Symptoms of ADHD

❖ Inattention

• Short attention span
• Easily distracted during tasks
• Prone to making careless mistakes
• Frequently forgetful or misplacing things
• Difficulty listening to instructions attentively
• Avoidance of tasks that require sustained mental effort
• Struggles to stay engaged in tasks that are tedious or time-consuming

❖ Impulsivity

• Disturb others
• Act without thinking
• Interrupt conversations
• Difficulty waiting or delaying gratification

❖ Hyperactivity

• Fidgety behavior
• Restlessness or excessive physical movement
• Difficulty sitting still, especially when uninterested in a task

Classification of ADHD

According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V), ADHD is classified into three types of presentations:

❖ Predominantly Inattentive presentation: Individuals primarily exhibit significant Inattention symptoms of inattention as listed above.

❖ Impulsive and hyperactivity presentation: Individuals primarily exhibit significant symptoms of impulsivity & hyperactivity as listed above.

❖ Combined presentation: Individuals exhibit both significant symptoms of inattention and Impulsivity/hyperactivity as listed above.

Etiology of ADHD

ADHD is a complex disorder with multiple contributing factors. The expression of this disorder is influenced by a combination of genetic, neurological, and environmental factors:

❖ Heredity: Evidence from family, twin, and adoption studies strongly suggests a significant hereditary component in ADHD.

❖ Abnormal Brain Development: Neuroimaging studies have revealed that ADHD is associated with abnormal brain development. Individuals with ADHD exhibit differences in structural development and functional activation in areas such as the prefrontal cortex, basal ganglia, anterior cingulate cortex, and cerebellum.

❖ Brain Injury: Hypoxic–anoxic brain injury and traumatic brain injury particularly in the prefrontal regions, can contribute to the risk of developing ADHD.

❖ Pregnancy and Birth Complications: Certain factors during pregnancy and birth are associated with an increased risk of ADHD, including exposure to alcohol or tobacco, prolonged labor, premature delivery, significantly low birth weight, and high body lead levels.

The following factors do not directly cause ADHD but may exacerbate its symptoms:

❖ Poor parenting

❖ Excessive sugar consumption

❖ Excessive use of electronic devices, e.g., mobile phones

❖ Social and environmental factors, such as poverty or family chaos

Who should consider undergoing an ADHD assessment?

For children between the ages of four and six, the demands of academic tasks increase significantly, and the social world becomes more complex. During this period, the symptoms of ADHD in children tend to become more noticeable. If a child consistently exhibits symptoms of inattention, impulsivity, and hyperactivity for more than six months in both home and school settings, it is recommended to undergo a formal psychological assessment and explore possible treatments. Early identification and intervention are crucial as they enable children to enhance their learning and social skills, ideally during the preschool years before oppositional behavior develops, which can further complicate the situation. Additionally, early intervention may reduce the need for medication or lower the required dosage.

ADHD Treatments

There are five main types of treatment for ADHD:

❖Behaviour Training: Repeated practice in a group or individual setting is used to improve attention span, executive function, social skills, and emotional regulation in children.

❖Brain Training: Non-invasive treatments such as EEG-based neurofeedback therapy is used to monitor and condition brain waves to the desired frequency, enhancing different brain functions.

❖Parenting Training: This focuses on equipping parents with conflict resolution skills and strategies to manage temper tantrums effectively.

❖ Environmental Modification: Teachers can employ classroom management skills to create a supportive learning environment for children with ADHD. Accommodations for homework and examinations can also be implemented.

❖ Medication Treatment: This may involve the use of psycho-stimulant medications, prescribed and monitored by a healthcare professional.

ADHD Assessment at Neuroscientist

Service Target

❖ Children aged 3 - 16

Content of Service

❖ Clinical Interview: A thorough interview with parents will be conducted to gather detailed information about the child's development, challenges, and any relevant background information.

❖ Cognitive Function and Intelligence Assessments: Assessments will be administered to assess the child's cognitive abilities and rule out the possibility of cognitive delay as a contributing factor to attention and behavior problems.

❖Neuropsychological Tests: We utilize a variety of neuropsychological tests to assess the child's attention and executive functions in comparison to peers of the same age. These tests help identify specific areas of strengths and weaknesses.

❖ Behavioral Rating Scales: Standardized rating scales will be employed to assess the severity of ADHD symptoms. These tools provide valuable insights into the child's behavior and aid in determining the appropriate course of intervention.

Referral & Follow-Up

❖ Our psychologist will prepare a comprehensive report (English) that integrates the findings and explains the assessment results during a report meeting.

❖ If the assessment indicates significant features of ADHD, we will provide appropriate interventions and treatment recommendations tailored to the child's needs based on the conclusion drawn, ensuring a targeted and effective approach.

❖ For children who exhibit significant features of ADHD, we may recommend referrals to specialized healthcare services. This includes referring children to the Child and Adolescent Mental Health Centre of the Hospital Authority for medication treatment if desired. For children under six years old, we may direct them to pre-school rehabilitation services offered by the Social Welfare Department, such as the Early Education and Training Centre (EETC) or On-site Pre-school Rehabilitation Services (OPRS). Children over six years old can submit the assessment report to their school for school-based support.