ADHD in children | Aroreretini

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• ADHD stands for attention deficit hyperactivity disorder.
• The Māori word for ADHD is aroreretini – attention goes to many things.
• Some people say ADD – attention deficit disorder.

ADHD is a developmental problem. Children and young people with ADHD may have poor concentration, poor control of impulses and can be overactive. This interferes with their ability to learn and socialise and can affect family functioning.

Children with ADHD may be labelled as naughty but this is not true. Children with ADHD need support and understanding from whānau, teachers and the community.

At least 5 of every 100 children have ADHD. It's more common in boys than girls. Girls with ADHD show more inattention and are less disruptive. They are less likely to be diagnosed or may be diagnosed later.

It might seem like there are more children with ADHD now than in the past. This is probably because of better recognition of ADHD.

ADHD occurs in children and adults. ADHD symptoms usually improve with age. But a significant number of children with ADHD will continue to have symptoms as adults. They may need ongoing help.

No one knows the exact cause of ADHD but it is likely to be a combination of factors. These include genetics – children with ADHD are more likely to have a whānau member with ADHD.

ADHD can also be associated with:

• alcohol, smoking or drug exposure in pregnancy
• being born prematurely or having a low birth weight.

There is no good evidence that ADHD is caused by children eating too much sugar or food additives, although this is a commonly held view.

Children with ADHD have 3 types of main difficulties. Children with ADHD may struggle with 1 of these areas of difficulty or with all 3. As children get older, the symptoms can change.

Inattention (difficulty concentrating or focusing)

• Has difficulty focusing on just one thing.
• Is easily distracted.
• Forgets instructions
• Moves from one task to another without completing anything
• Doesn't listen when directly spoken to.
• Makes careless mistakes.
• Has difficulty organising tasks and activities.
• Daydreams a lot.
• Appears forgetful or loses things a lot.

Acting impulsively

• Talks over people
• ‘Butts in’.
• Loses control of emotions easily.
• Is accident prone.
• Has difficulty waiting for their turn.
• Acts without thinking.
• Has little or no sense of danger.

Overactivity or hyperactivity

• Is unable to sit still and constantly fidgets.
• Leaves their seat in situations where remaining seated is expected.
• Is unable to play quietly.
• Behaves ‘as though driven by a motor’.
• Talks too much.

In Aotearoa New Zealand, a diagnosis of ADHD may be made by a paediatrician, a child and adolescent psychiatrist, or a psychologist.

Gathering information

The health professional will meet with you and your child. They will gather information from you and your child's school. This might include some questionnaires for you and your child's teacher to complete.

There is no single test to diagnose ADHD. Making a diagnosis may take more than one appointment.

Making a diagnosis of ADHD

For a diagnosis of ADHD, the symptoms need to be obvious in more than one setting of a child's life (such as home and school or daycare).

The symptoms also need to be having an impact on day to day functioning. It's important to make sure the symptoms are not due to another problem like hearing difficulties, sleep problems, learning difficulties.

Yes, children with ADHD are more likely to have:

• learning difficulties
• anxiety
• depression
• disruptive behaviour.

If you're worried about other problems, talk to your healthcare provider.

If you are concerned about your child, talk to your family doctor and teacher. Sometimes teachers may be the first to raise concerns and suggest that you and your child see your family doctor.

Your family doctor may arrange a referral to a paediatrician, child psychiatrist or psychologist to make an assessment.

There is no cure for ADHD, but in most cases, symptoms can be managed.

In preschool tamariki diagnosed with ADHD behaviour and parenting strategies usually help.

In school-aged children, behavioural strategies work best in combination with medicine. Your child may also be able to get extra support at school. Talk to your child's teacher.

Behaviour strategies can help

• Positive parenting programmes – having a child with ADHD can be more challenging as a parent. It helps to learn a range of strategies so that if the first thing you try doesn't work, you have other options in your parenting toolbox.
• Counselling – sometimes your healthcare provider may suggest counselling for your child or your whānau.

Read more about strategies to help your child at home and school from the Royal Children's Hospital, Melbourne, Australia(external link). 

Medicines

Stimulants are an effective treatment

In school-aged children, medicines called ‘stimulants’ are the most effective treatment for ADHD. For some children, a combination of behaviour therapy and medicine works even better.

Parents and teachers often notice that children with ADHD have a significant improvement in their symptoms when they start taking medicine.

How stimulants can help

Stimulant medicine can help your child with ADHD to:

• concentrate better
• be less impulsive
• feel calmer
• learn and practice new skills.

Stimulants are safe

While some parents may understandably feel cautious about starting their child on this medicine, it is important to know that stimulant medicines do not affect your child's personality or brain, and are not addictive. These medicines have been used safely for many years in children with ADHD.

Methylphenidate

The most common stimulant medicine in Aotearoa New Zealand is methylphenidate. This has a number of different names such as Ritalin or Rubifen. Methylphenidate comes in different forms. Some tablets release the medicine immediately (such as Ritalin and Rubifen) and others release it into the body more slowly over the day (such as Ritalin LA and Rubifen SR).

It may take some time for your doctor and you to find the dose and timing that works best for your child.

Common side effects of methylphenidate

Some side effects can be reduced by starting on a low dose. If your child develops any side effects, talk to your doctor.

Common side effects of methylphenidate may include:

• mild tummy discomfort
• mild headache
• loss of appetite
• difficulty getting to sleep.

Some children can become sad or withdrawn on methylphenidate. It's important to talk to your doctor if this happens to your child. They may need to try another medicine.

Other medicines

There are other stimulants such as dexamfetamine. Your healthcare provider may suggest this if your child cannot take methylphenidate or if methylphenidate has not improved your child's symptoms.

Funding of dexamfetamine

In Aotearoa New Zealand dexamfetamine is funded under a Special Authority, for people who meet the criteria. A special authority means your specialist will need to make an application to Pharmac (the government medicine funding agency) for approval before the medicine can be funded for you.

• From December 2024 Pharmac has removed the special authority renewal requirements for dexamfetamine. This means that once special authority approval has been granted, it won't need to be renewed. Your doctor or nurse practitioner can continue to prescribe it.
• Previously, people needed input from a specialist every 2 years to renew their special authority. 

• Read more about the removal of the renewal criteria for stimulant treatments(external link).

Read more about methylphenidate and dexamphetamine.

If stimulant medicines don't work for your child, there are other medicines you can use. Your healthcare provider can tell you more about these.

You can watch a series of animated videos ‘Me and My ADHD’. They aim to help tamariki understand ADHD.

There is a parents' guide to the child video series(external link).

Video: That's Me, I Have ADHD!

(Centre For ADHD Awareness, Canada, 2019)

Video: When my ADHD gets me into trouble

(Centre For ADHD Awareness, Canada, 2019)

Video: My ADHD at school

(Centre For ADHD Awareness, Canada, 2019)

Clinical pathways

ADHD across the lifespan(external link) The Royal Australian and New Zealand College of Psychiatrists, 2023
Attention deficit hyperactivity disorder – diagnosis and management(external link) National Institute for Health and Care Excellence (NICE) guideline, UK, 2019
ADHD – clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children(external link) American Academy of Pediatrics, US, 2011
Recognition and assessment of common mental disorders in young people(external link) BPAC, NZ, 2010

Continuing medical education

Podcasts

ADHD management(external link) Goodfellow Unit Podcast, NZ
In this second podcast on ADD and ADHD, Dr Colette Muir talks about management in children.

Videos and seminars

Emotional and behavioral disorders, importance of the early years from PHARMAC Seminars(external link)

1. PHARMAC seminar: Emotional and behavioural disorders, importance of the early years 1a of 3
Importance of the early years for lifelong wellbeing - Dr Tanya Wright (parts 1, 2) (30 minutes + 28 minutes = 58 minutes)

(PHARMAC, NZ, 2018)

PHARMAC seminar: Emotional and behavioural disorders, importance of the early years part 1b of 3

(PHARMAC, NZ, 2018)

2. PHARMAC seminar: Attachment theory and reflective functioning 2 of 3
Attachment theory and reflective functioning - Dr Tanya Wright (28 minutes)

(PHARMAC, NZ, 2018)

3. PHARMAC seminar: ADHD in children, youth and adults 3a of 3
ADHD in children, youth and adults - Dr James Gardiner (parts 1, 2 & 3) (36 mins + 36 mins + 45 mins = 117 minutes)

(PHARMAC, NZ, 2018)

(PHARMAC, NZ, 2018)

PHARMAC seminar: ADHD in children, youth and adults, 3c of 3

(PHARMAC, NZ, 2018)