ADHD and preterm birth
Attention Deficit Hyperactivity Disorder, is a neurodevelopmental disorder, which means that the symptoms are likely to be triggered by genetic or environmental events early in development.
Children with ADHD have poor concentration, and/or are hyperactive and impulsive. ADHD tends to be more common in some families, and events at key times in development may increase the risk for ADHD such as very preterm birth or prenatal exposure to excessive levels of alcohol.
A birth prior to 37 completed weeks of pregnancy is considered preterm. This occurs in approximately 8-9% of births in Australia. Most preterm births occur between 32 and 36 weeks of gestation, and these babies have excellent survival rates and long-term outcomes.
Births prior to 32 completed weeks of gestation are referred to as very preterm, and occur in approximately 1.5% of births in Australia (5,000 babies per year). Due to advances in medical care, the majority of babies born very preterm now survive and have good outcomes, although survival and disability rates increase with decreasing gestational age at birth.
Professor Anderson says it is important for health professionals dealing with children born very preterm to know that there is a link with ADHD.
“This knowledge will hopefully encourage them to monitor the child’s behaviour closely, and organise appropriate assessments and interventions when appropriate.”
Diagnosis of ADHD
He says the diagnosis of ADHD can be made by a paediatrician, child psychiatrist or psychologist based on criteria developed by an international mental health expert group.
There are three subtypes of ADHD, predominantly inattentive, predominantly hyperactive/impulsive, or combined (both inattentive and hyperactive/impulsive).
To fulfil the criteria for the inattentive or hyperactive/impulsive subtypes, the child must exhibit at least six pre-specified symptoms that have persisted for at least six months which are inconsistent with their developmental level.
“The child must have a persistent pattern of inattention symptoms and/or hyperactivity/impulsivity symptoms that interfere with functioning or development, with several symptoms present before age 12 years and observed in two or more settings,” Professor Anderson says.
“The symptoms must be severe enough to interfere with functioning, and cannot be explained by another disorder.”
Parenting a child with ADHD
Professor Anderson says children with ADHD can behave in a way that is challenging for parents and teachers.
“Understanding the child’s abilities and limitations will assist in developing a behaviour management plan to help deal with the challenging behaviours,” he says.
“Each child is different, so there is no standardised behaviour management program, but developing routines, rules and consequences is important.
“Ensuring good sleep, a healthy diet and plenty of exercise may also help to reduce challenging behaviours.
“Some doctors also prescribe stimulant medication for children diagnosed with ADHD. While these medications can have some mild side-effects, they help some children with their attention and self-regulation.”
Professor Anderson says the challenging behaviours associated with ADHD can be difficult for families, with the potential to cause stress for parents and siblings.
“Seeking professional support is important to optimise the functioning and development of children with ADHD, but is also important to address family stressors,” he says.
Deakin University Clinical Psychologist and Murdoch Children’s Research Institute Health Services Research Team Leader, Associate Professor Emma Sciberras says it that ADHD is not caused by bad parenting. However, it can be tricky to parent children with ADHD as their behaviours can be hard to manage.
“Warm and consistent parenting strategies can help to contain the behavioural difficulties that often go along with ADHD,” she says.
“Use of positive parenting strategies may also make you feel more connected and in tune with your child.”
“Generally, having lots of structure, understanding situations that are likely to trigger difficult behaviour and giving yourself some time out can help.”
Associate Professor Sciberras says children with ADHD can have a great deal of difficulty regulating their behaviour, which is likely linked to the delay in brain maturation.
“Parents may need some extra support to implement parenting strategies to contain challenging behaviours. The nature of ADHD (e.g. impulsivity, poorer emotional regulation) can lead children to make poor decisions and exhibit challenging behaviours; children aren’t generally trying to be naughty. Seeing your child’s behaviour through this lens can help.”
Associate Professor Sciberras says children with ADHD and their families may be supported by a health professional like a paediatrician or psychologist, and that families can be referred by a GP.
“Parents should also speak to their child’s school to see what supports might be available within the school system.
“An individual learning plan may be considered, as well as regular meetings each term with school staff to monitor progress and assess whether further classroom strategies might be needed. Some families also are supported by an ADHD coach.”