What is ADHD?

ADHD — Attention Deficit Hyperactivity Disorder — is one of the most common neurodevelopmental conditions in children and young people. It affects how the brain develops and regulates attention, impulse control and activity levels. It is not a character flaw, a parenting failure or simply "bad behaviour" — it is a genuine neurological difference that affects how children think, feel and act.

ADHD is a spectrum condition. No two children with ADHD are alike. Some are visibly hyperactive; others are quietly inattentive. Many are both. Some children also have remarkable strengths — creativity, energy, hyperfocus on topics they love, and a warmth and spontaneity that is genuinely wonderful.

5–7%
of school-age children affected worldwide
3:1
boys to girls diagnosed — though girls are often missed
70–80%
heritability — strongly runs in families

ADHD is not caused by bad parenting

Research consistently shows ADHD has strong genetic roots and is associated with differences in brain development — particularly in areas responsible for attention and impulse control. Environmental factors may influence severity but do not cause ADHD.

How does ADHD present?

ADHD presents differently at different ages and in different children. There are three main presentations, though many children have features of more than one.

⚡ Inattentive presentation

  • Difficulty sustaining attention on tasks
  • Easily distracted by external things
  • Seems to "switch off" or daydream
  • Forgetful in daily activities
  • Loses things frequently
  • Struggles to follow instructions
  • Avoids tasks requiring sustained effort

⚡ Hyperactive/impulsive presentation

  • Fidgets or squirms constantly
  • Leaves seat when expected to stay seated
  • Runs or climbs inappropriately
  • Unable to play or work quietly
  • Talks excessively
  • Interrupts or intrudes on others
  • Acts before thinking

How ADHD looks at different ages

Primary school age (5–11): Often most visible at school — difficulty sitting still, calling out in class, not completing work, falling out with peers. Teachers may notice it first. Homework can become a major flashpoint at home.

Adolescence (12–18): Hyperactivity often becomes less visible but inattention and impulsivity remain. Teenagers may struggle with organisation, time management, revision and exam preparation. Emotional regulation difficulties — frustration, low self-esteem — often become more prominent.

Girls with ADHD are frequently missed

Girls with ADHD often present predominantly with inattention rather than hyperactivity — they may appear dreamy, disorganised or "ditzy" rather than disruptive. They tend to mask their difficulties more effectively and are therefore diagnosed later, often only when academic demands increase significantly. If you have a daughter who is bright but struggling, it is always worth seeking an assessment.

What causes ADHD?

ADHD is strongly heritable — research suggests 70–80% of the risk comes from genetics. If a child has ADHD, it is very common to find that a parent, aunt, uncle or grandparent has (or had) similar traits, often undiagnosed.

Brain imaging studies show subtle differences in the ADHD brain — particularly in the frontal regions responsible for impulse control and planning, and in the basal ganglia. The brain's reward system also works differently, which explains why children with ADHD often struggle with tasks that aren't immediately rewarding — and why they can focus intensely ("hyperfocus") on things they love.

Environmental factors that can increase risk

  • Premature birth or low birth weight
  • Exposure to certain substances before birth
  • Significant early adversity or stress

None of these cause ADHD on their own — they interact with underlying genetic vulnerability.

How is ADHD diagnosed?

ADHD is a clinical diagnosis — there is no single blood test, brain scan or computer test that confirms it. A thorough assessment by an experienced clinician is essential.

A comprehensive ADHD assessment involves:

  • A detailed clinical interview with parents — covering developmental history, family history, and the child's current difficulties across settings
  • A clinical interview with the young person themselves
  • Information from school — ideally including teacher-completed rating scales
  • Standardised questionnaires from parents and teachers
  • A mental state examination
  • Physical health check including height, weight, pulse and blood pressure

Crucially, ADHD must be present in more than one setting — not just at home, and not just at school. A child who only struggles at school may have a different explanation for their difficulties.

What about computer-based tests?

You may have heard of QbTest or similar computerised attention tests. These can provide useful additional information but are not required for a diagnosis and should never be used alone. A thorough clinical assessment by an experienced consultant psychiatrist remains the gold standard.

How is ADHD treated?

ADHD is highly treatable. The best outcomes come from a combination of approaches tailored to the individual child and family.

Psychoeducation — understanding ADHD

The most important first step. When children, young people and their families truly understand ADHD — what it is, why the brain works this way, and what helps — outcomes improve dramatically. At Dr Shimrit Ziv, psychoeducation is provided as part of every assessment.

Environmental and practical strategies

Simple but highly effective changes that make a real difference:

  • Seating arrangements at school — away from distractions, near the teacher
  • Shorter focused work periods with movement breaks
  • Visual timetables and visual aids
  • Reducing background noise (headphones can help)
  • Clear, consistent routines at home
  • Breaking tasks into smaller steps

Parent support and training

ADHD-focused parent training helps parents understand their child's behaviour, respond more effectively, and build a stronger relationship. This is recommended by NICE as a first-line treatment, particularly for younger children.

Medication

For many children, medication makes a transformative difference. It does not change who your child is — it helps their brain work the way they want it to. The most commonly used medications are stimulants (methylphenidate and lisdexamfetamine) and non-stimulants (atomoxetine, guanfacine).

Before starting medication, a careful physical health check is carried out — including measuring height, weight, pulse and blood pressure. Medication is started at a low dose and increased gradually, with close monitoring.

A word from clinical practice

"When families come to me worried about medication, I understand their concern completely. What I tell them is this: medication for ADHD is one of the most well-researched and effective treatments in all of child psychiatry. When it's right for a child, the change can be remarkable — not just in academic performance, but in confidence, friendships, and family life. We always make the decision together, carefully and without pressure."

— Dr Shimrit Ziv, Dr Shimrit Ziv

What should I do if I'm concerned about my child?

If you recognise your child in what you've read here, the most important thing is to seek a proper assessment. A diagnosis — even if it feels daunting — brings clarity, understanding, and access to the right support.

You do not need to wait years on an NHS waiting list. A private assessment with a consultant child psychiatrist provides the same clinical standards, usually within a few weeks, with a comprehensive report that schools and local authorities will take seriously.

Every enquiry is reviewed personally. Get in touch and we will discuss whether an assessment is the right step for your child.