ADHD in children and young adults

Regardless of the symptoms displayed by the child/adolescent, the primary difficulties are the same. In principle, the treatment is therefore the same.

ADHD manifests itself in many different ways. Some are most bothered by their restlessness. Others have most problems with attention. However, new studies show that symptoms may change over time in the same individual.

For example, even if a person primarily has problems with hyperactivity and impulsivity as a child, problems with attention may very well be the clearest symptom in adult life.

People with ADHD generally suffer from three ‘core symptoms’:

• Attention deficit
  ADHD sufferers have difficulty concentrating and are easily distracted
  
  
• Hyperactivity
  They find it difficult to sit still and may move about a lot
  
  
• Impulsivity
  They tend to talk and act without thinking.

These three areas together make up the core symptoms of ADHD. People with ADD especially have problems with attention.

ADHD/ADD symptoms may vary greatly from person to person. They may also change over time. Correspondingly, the surroundings are of importance to the symptoms. The symptoms often manifest themselves most clearly when there are no fixed settings or in an unknown situation. They are seen less in small, familiar and structured contexts.

Our ability to concentrate and to control our impulses improves with age. A small child is able to concentrate for a shorter period. Small children are often also more impulsive than older children. If a child has difficulty concentrating, it is therefore necessary to assess whether this involves symptoms of ADHD or whether the child’s abilities correspond to his or her age.

To make an ADHD diagnosis requires that the symptoms have been present for an extended period of time. In addition, the symptoms must have been present before the age of 7 – both at home and in school. The symptoms must also affect the child’s day-to-day life. The child may have difficulty concentrating at school or holding on to friendships.

Our attention plays an important role in our daily lives. Good attention makes it possible to relate to what you experience throughout the day.

Attention requires energy. Our energy level fluctuates during the day. Most people feel most refreshed early in the day and tired in the evening. Demanding tasks (like doing homework, reading a book or cleaning up) are something most children and adolescents handle best when they are rested. When you have ADHD or ADD, you tire out mentally and lose your attention more quickly than others. You may therefore need breaks or support to stay focused.

Hyperactive persons find it difficult to remain at rest. Some people may feel bodily discomfort if they have to sit still for an extended period of time. Others experience a ‘tingling’ sensation so that they need to stand up. Others display a more discreet agitation. It is less visible outwardly. They may dangle their feet or fiddle with their clothes.

In children and adolescents, hyperactivity is often expressed by them being constantly in motion. However, they may also be very talkative or make sounds. Hyperactivity may become less noticeable with age. Instead, it is experienced in the form of inner agitation and restlessness. But, in some persons, it persists throughout life.

Children, adolescents and adults with ADHD or ADD may all have difficulty controlling their impulses. The reason for this is that they lack some of the restraints that are normally developed when growing up. This may mean that they act without thinking. Therefore, they may say or do something rash that they will subsequently regret.

Impulsivity can be the cause of many conflicts and remorse. It may also lead to dangerous situations. For example, if a child impulsively runs across a road or a young person impulsively lets himself or herself be tempted to act in a risky manner in the nightlife.

Other signs of impulsivity in daily life are that you:

• interrupt other people while they are speaking
• have difficulty waiting for your turn or queueing
• eagerly answer in school before the whole question has been asked.

ADHD/ADD results in a lower stress threshold. Depending on the resources and support available to them, most children and adolescents with ADHD/ADD develop stress symptoms when the demands made of them become too high. This may, for example, manifest itself in the form of stress or irritable mood.

Some children with ADHD/ADD already have difficulty keeping up in classes in the first years at school. They may also have problems socialising with other children. Other children may, with extra effort and support, be able to keep up in class in the early school years. It is not until later that they experience problems because the demands for self-control, attention and a good overview become higher.

This is the reason why older children and adolescents are often referred with symptoms other than ADHD/ADD. For example, they may experience sadness, anxiety or be highly irritable. Other adolescents have behavioural difficulties. They may be more frustrated and perhaps even be violent. What many of these young people have in common is that they have all experienced symptoms of ADHD throughout their lives.

In addition to the three core symptoms, many children and adolescents with ADHD or ADD often feel that their emotions fluctuate greatly. Therefore, they may find it difficult to control their temper. They may get angry or very sad easily without either themselves or the people around them quite understanding why. The many emotions may be confusing and burdensome for both the persons experiencing them and for the people around them.

Difficulty maintaining an overview

Many people with ADHD/ADD find it difficult to plan and manage tasks. For example, ordinary morning rituals may be difficult to manage if you have ADHD. For example, it may be difficult to estimate how much time you need to spend getting dressed, brushing your teeth, eating breakfast and packing your bag.

Short-term memory

Many people with ADHD/ADD often have problems with short-term memory. We use our short-term memory in everyday life when we need to remember practical things. For example, cap and mittens or train times.

Difficulty sleeping

Many people with ADHD/ADD have had difficulty sleeping from a very early age. They can improve their sleep pattern if they get help with their ADHD. But separate pedagogical or medical treatment of their sleep disorder is often also necessary. Poor sleep may in itself cause symptoms similar to ADHD. Therefore, a good night’s sleep is very important.

Social interaction difficulties

Many people with ADHD/ADD may have a hard time socially. For example, this manifests itself in difficulty following conversations. They may also find it difficult to pay attention to other people’s reactions. This may result in friends getting tired of the person who has ADHD because he or she talks too much or says something that is out of context.

Distress symptoms

Many people with ADHD/ADD may experience low self-esteem, sadness or irritability and exhibit violent behaviour. This is often caused by their ADHD. It can be improved if they are met with understanding and get help with their difficulties.

There is no simple test for determining whether you have ADHD or ADD. A diagnosis can only be made by a psychiatrist. The psychiatrist will conduct several consultations and examinations.

To be diagnosed with ADHD or ADD, your difficulties must affect you so much that you are not thriving. There may be many reasons why someone is not thriving. A thorough examination of you and your surroundings is therefore required to rule out other reasons why you are not feeling well.

At the examination, you will talk about a number of matters, including your health, your family life and how you are doing at school. As ADHD is congenital, the psychiatrist will also ask you about your childhood and adolescence. Both you and your relatives will be asked about this.

The difficulties associated with ADHD/ADD may affect many different situations. The psychiatrist therefore also obtains information from the school/study programme and possibly from after-school care institutions. The final diagnosis is made on the basis of the psychiatrist’s overall assessment.

Many people with ADHD/ADD have learning problems. This may cause them problems at school. For example, they may be dyslexic or have difficulty understanding assignments with many details.

Many children and adolescents with ADHD/ADD may also have a tendency towards sadness and actual depression. This is especially the case if they do not receive treatment and relevant support for their difficulties.

Anxiety is also seen more often in children and adolescents with ADHD/ADD. This anxiety will often be reduced if the child or adolescent is given the right treatment for ADHD/ADD. However, separate treatment for anxiety may sometimes be required.

Other mental challenges such as OCD, tics and autism are seen more frequently among children and adolescents with ADHD/ADD.

Even though the symptoms of ADHD/ADD can be improved to a great extent, they often cannot be cured. Understanding is therefore very important in organising the daily life of the child/adolescent to meet his or her needs.

Several ADHD/ADD symptoms can be a nuisance to other people, for example restlessness and noisiness.  Many think that people with ADHD behave like this on purpose. This is very rarely the case.

Furthermore, people with ADHD have difficulty perceiving their effect on others. It comes as a shock to many of them that other people are bothered by their behaviour. It is therefore important that their surroundings understand and accept that people with ADHD do not have the same learning abilities as others.

You cannot tell by looking at people whether they have ADHD/ADD. But it may be crucial to a child’s development that his or her school is informed about the diagnosis, so that relevant considerations can be shown.  It is therefore a good idea to be open about the diagnosis. The right understanding and pedagogical support are very important in children’s or adolescents’ development.

If you are diagnosed with ADHD, your psychiatric contact person will decide how your treatment is to be organised.

Treatment may include:

• Psychoeducation
• Consultations/therapy
• Social and pedagogical support
• Medical treatment for ADHD and concomitant disorders.

Teaching about the disorder is called psychoeducation. Psychoeducation is an important part of ADHD/ADD therapy. It is offered to both you and your relatives. You will learn about all relevant aspects of ADHD/ADD. There will be particular focus on how to handle life with ADHD/ADD.

In addition, you will acquire knowledge about the opportunities that exist for support at home or at your place of study. Teaching can be conducted in groups or individually.

Support from the municipality will often be needed. Your psychiatric contact person will often be able to assist with contacting the municipality. For example, there may be a need for:

• Help with daily tasks at home
• A mentor scheme at your place of study or workplace
• Disability compensating state education grant if you are enrolled in a study programme

Changes to the physical environment are often also necessary at your place of study or workplace. This may, for example, be in the form of shielding you from possible distractions.

For school-aged children, there is a need for a special pedagogical approach at school. This may, for example, be shielding from distractions and the option of taking breaks as well as help with creating

If you have moderate to severe ADHD/ADD, medication is often necessary. It is the form of treatment that has the best documented effect.

The medication works by increasing the amount of neurotransmitters in the areas of your brain that are affected by the disorder. In general, medication has a good effect on attention deficit disorders.

Many people with ADHD/ADD find that medication helps them to:

• Be able to concentrate
• Become calmer
• Reflect.

There is often an improvement in symptoms when the right medication has been found. Finding the optimal treatment may take time. One reason for this is that all people react differently to medication.

Read more about different medicines, treatment start-up, etc. on our page about Medicin mod ADHD til børn og unge (ADHD medication for children and adolescents).

In the vast majority of cases, ADHD/ADD is a life-long disorder. Consequently, there will not be periods in which you are fully ‘recovered’ and completely free from symptoms. However, there may very well be times where you are doing better or worse than normally.

It will often be the case that stressful events in the life of the child/adolescent will worsen the symptoms. Fortunately, there is much that can be done to alleviate the symptoms.

Today, there are many different support options – both for students and for people who are working. The municipality is responsible for establishing support for you and your family if you need it.

In the primary and lower secondary school system, the Pedagogical Psychological Counselling Service (Pædagogisk Psykologisk Rådgivning (PPR)) is responsible for ensuring that you receive support and help. In the higher education system, you can contact your student counsellor and the State Educational Grant and Loan Scheme (Statens Uddannelsesstøtte (SU)) for special pedagogical support (SPS) and other forms of help.

Below you can find more advice on how to live with ADHD:

• Learn about your disorder
  Receive an offer of psychoeducation regarding your disorder together with your parents
  
  
• Make use of your psychiatric contact person
  Talk to your doctor, nurse or psychologist.
  
  
• Talk to those closest to you
  It is important that you talk to your relatives about the difficulties you have in connection with your ADHD.
  
  
• Avoid excessive quantities of alcohol
  Think about how much you drink at parties and on nights out. Excessive alcohol consumption can often worsen your ADHD.
  
  
• Exercise
  This can often help reduce stress, restlessness and discomfort.
  
  
• Make reasonable demands of yourself
  Many people with ADHD think that they can do much more than they actually can.
  
  
• Make sure to plan your day
  Use a weekly calendar and a structured daily schedule. Fill in your calendar with your parents or other people you trust.
  
  
• Make sure to get a good night’s sleep and eat a healthy diet
  Switch off your computer and TV at fixed times. It is important to maintain a stable daily rhythm (sleep-wake cycle). Try setting an alarm to remind you of when it is time to go to bed.
  
  
• Be open about your disorder, when appropriate
  This allows others to show consideration and help you.

As a relative, it is important to take the time to learn what it means to have an attention deficit disorder. Being a relative of a child and adolescent with ADHD can involve many challenges. You need to be accommodating while also setting clear limits for your child.

Many parents may feel ashamed and inadequate. It is important to realise that there is no perfect recipe for how to act as parents of a child with ADHD or ADD. Today, there are many courses and groups where relatives have the opportunity to receive guidance and share experiences with other families.

Participate in treatment offers

You can get a better understanding of ADHD if you participate in psychoeducation together with your child. It often alleviates the feeling of inadequacy that many have.

Seek help

You can also get help with how to handle daily challenges at home optimally. You can join an association for patients and relatives such as the Danish ADHD-Association or SIND’s (the Danish Association for Mental Health’s) advisory service for relatives. The associations hold meetings and courses and have hotlines.

Think of yourself

It is also important that you allow yourself to meet your own needs. You cannot have the energy to help and be the person responsible all the time. Perhaps your family might need extra support from the municipality? Your psychiatric contact person can usually help with this.

Pay attention to whether you are overburdened

If you develop distinct symptoms of anxiety or depression yourself, you should consult your own doctor to get help and support. In some cases, you can get a referral to a practising psychologist with health insurance reimbursement.

Pay attention to siblings

If the child/adolescent with ADHD/ADD has siblings, you must be particularly aware of their needs and reactions.

Support the treatment

• The most important thing is to have knowledge about the disorder and the treatment.
• It is a good idea to participate regularly in consultations with the psychiatric contact person.

Create a structured daily life

• Help the adolescent plan and initiate specific tasks
• Support the adolescent in opening emails and considering their content
• Support the adolescent in managing his or her finances
• Repeat important information. Write it down, if necessary
• Help your child maintain a stable daily rhythm. You can, for example, use aids such as calendars, mobile phones and weekly schedules.

Help keep up hope

• Avoid scolding. All research suggests that it will not make anyone change their behaviour.
• Praise and reward good behaviour.