It seems that Attention Deficit Hyperactivity Disorder is never out of the news. This isn't surprising, as it's a disorder than has no test, no symptoms specific only to itself and there is still no scientific basis for such a disorder.

Much of the information in the entry has been gathered by the UK parent of a child diagnosed with ADHD and so is dealing with challenging behaviour every day. Some of this behaviour is related to the diagnosis, other behaviour is not. This entry hopes to make some 'plain English' sense of the information given out by specialists in the field. The author has no medical qualifications and simply seeks to help other parents.

Diagnosis is not exact, in fact it is more a process of observation and elimination, and what's left is 'probably' ADHD, than it is of testing. There are many other reasons why a child might be displaying 'ADHD-like' behaviour - the symptoms are not unique to ADHD.

ADHD is the North American 'term' for specific criteria, and due mostly to the size of the country, this term has become widely used - taking over from Britain's own Attention Deficit Disorder (ADD) in 1997. The World Health Organisation uses the term Hyperkinetic Disorder (HKD) because often the problem with children with ADHD is not actually a deficit of attention, but rather too much attention, it's just divided between too many things, rather than being focused on one thing.

Hyper - meaning excessive, and kinetic - meaning movement - is a much better way of describing many of the children 'labelled' with ADHD. However, in the end, these are only labels, and no matter what the label is, ideally treatment and support offered would always be the same.

So, how is a diagnosis arrived at? If a child is rampaging all over the place, won't sit still, won't listen, is rude, angry, physically aggressive, then it's likely that parents may well be at the end of their tether and desperate for something (anything?) to help them. Some people think the label of ADHD will make everything better, others, that it will make things worse. Every specialist will have their own way of dealing with children such as this, and this Entry cannot cover all of them.

For the reasons above, it's easiest to first look at what isn't ADHD, but can cause the 'symptoms'.

'Forcing' Symptoms

Put ten random children in a room, on Christmas morning, with a present each and ask them to sit and wait for ten minutes. You may see fidgeting, you may see anxiety or crying, you may even see them not being able to stay in their seat.

Next ask them to do some educational worksheets before they can open their presents. You are likely to see them not being able to concentrate, perhaps excited chattering and more fidgeting - certainly they will find it very hard to finish their work.

One last thing - remove one of the presents so they know what now there isn't one for each of them - and tell them to go grab one. You're likely to see a mad rush to the presents, pushing and shoving and even perhaps hitting and fighting; the present-less child may have a tantrum, cry inconsolably, or want to steal or force one away from a child with a present, or even smash one up from jealousy.

All of these things are symptoms of ADHD.

Put all of these children in the classroom on a normal day, and most of them will show none of these symptoms at all.

What 'isn't' ADHD?

Sleep problems/deprivation - children who don't get enough sleep may exhibit extreme restlessness and be very active. Constantly not getting enough sleep can lead parents or other adults to think that the child may have ADHD. However, the children are more likely fighting sleepiness the only way they know how - with activity. Just as an adult on a monotonous drive talk to passengers (or themselves), or turn the radio up to sing along, or even jiggle about in the sleep so that they stay alert, a child will act very similarly to prevent themselves giving into sleep.

As a guide, children from age one to three need 11 to 13 hours of sleep per day, with four years old needing slightly less. Six to nine year olds need about 11 hours, with ten to 12 year olds needing around ten, with nine hours needed for teenagers. Some children differ from these hours, but they are a general guide.

So if a child regularly gets less than this, raising the amount of time they sleep could help. Results may take a few weeks. If your child has been going with less sleep than they need for a long time - months or even years, they may take a long time to settle back down, as the behaviour has begun to be 'part' of the child's personality.

Learned behaviours - as already mentioned, behaviour that has gone on for a long time becomes 'learned' behaviour. For instance the child who learns at the age of two or three that lying on the floor screaming and kicking means that she will get whatever she wants will continue to do it as long as it gets results. Fast-forward two years, or even three, and it may be that the lying on the floor has stopped, but the kicking and screaming hasn't, leading parents to wonder if their child has got 'something wrong' with them. There is nothing wrong that some parenting skills can fix, even if it takes a long time. Television programmes such asLittle Angels and Supernanny have demonstrated techniques that really work.

Grief - in the form of loss. For a child, this is A Big Thing. It could be bereavement, a relationship break-up, moving house or the death of a pet. Something, or someone, who has always been there has suddenly gone away, never to be seen again. Pet deaths can trigger worries of parental mortality which children can find so upsetting they play up to avoid thinking their sad thoughts. They will try to keep themselves busy to keep their minds off whatever it troubling them.

Socially isolated children - ie those who are not used to social settings, may appear to have ADHD as they react to a new environment - often, but not limited to, school. They will have gone from being able to choose what they did, when, how, and with whom for much of their daily lives - they have lived by their own rules. Suddenly they have to sit on the carpet and listen when told. They are not allowed to play with the toys whenever they like, and they may even have to take turns! Emotional (im)maturity also has a part to play in children adjusting. There can be a big contrast between the age that they physically are, and the stage their emotional development is at. So the child who is having an inappropriate temper tantrum in their first week of school, may be behaving in an entirely appropriate way for the emotional two year old that they really are.

Specific learning problems - children often use bad behaviour to cover up the fact that they find something very difficult, if not impossible. By throwing their books on the floor, or refusing to sit at the table, they do not have to attempt to do something they simply can't do. This could include such disorders as dyslexia, problems with logic, or even language. So learning disorders should be ruled out before attempting to diagnose ADHD.

Medical problems - these should also be ruled out, as some conditions can cause children to become 'hyperactive'. The behaviour disappears once the condition is treated.

What's Left?

Once the above criteria have been ruled out, it must be ADHD, right? Wrong. For it to be ADHD there are criteria that must be fulfilled.

Three or more settings - the behaviour must be repeated in more than two settings. Playing up for dad, but not mum, at school, but not at Brownies, these are not signs of ADHD. Normally the three settings are school (or pre-school), home, and the doctor's clinic. Children are not miraculously 'cured' at going-home time, their brains simply cannot heal themselves only to 'break' again next time they don't like the situation.

Seriously impairing a child's life - ADHD severely interferes with a child's life. They underachieve at school and find it hard to make and keep friends. School life can often make a child extremely miserable if they have ADHD.

Present for a long time - at least six months. ADHD is chronic; affected children don't suddenly become cured - the duration will be long.

If one set of criteria can be ruled out, and the other set fulfilled for a particular child, then it could be time to seek help.