Attention Deficit Hyperactivity Disorder with or without hyperactive behaviour (ADHD)

It is normal for a child not to pay attention, to act impulsively and/or to be hyperactive from time to time. This does not necessarily mean that the child has an attention deficit disorder with or without hyperactive behaviour (ADHD)! 

In Belgium, only child neurologists and child psychiatrists are qualified to make an ADHD diagnosis, based on a set of 4 criteria:

• The lack of attention and symptoms of hyperactivity/impulsiveness are excessive for the child’s level of development (age) and cannot be attributed to another cause (depression, anxiety, attachment disorder, etc.).
• The excessive nature of these symptoms is  lasting; they must have been present for more than 6 months. 
• The symptoms are observed in at least 2 environments frequented by the child (school, family, out of school activities, etc.). ADHD is not really an attention deficit but rather a marked fluctuation in attention. In a field or an activity that greatly interests them, the child with ADHD can show (very) high levels of concentration. 
• The symptoms have a negative impact on the life and overall functioning of the child:  schooling, learning, socialising, family relations, etc. 

Treatment of ADHD at the H.U.B Baby, Child, Adolescent and Young Adult Department of Psychiatry is multidisciplinary. 

1. The ADHD diagnosis begins with a consultation with a child psychiatrist. The psychiatrist puts questions to the parent(s) and child (depending on the child’s age) and observes the child’s behaviour. 
2. Further assessment(s) : to rule out other causes or to confirm or specify the type of ADHD, further examinations or opinions may be necessary (but not systematic). Notably: 

• A neuropsychological assessment to assess the profile of memory function, concentration, impulsiveness, etc.; 
• The opinion of a speech therapist  to detect any learning difficulties (dyslexia, dyscalculia, dyspraxia, etc.) that are often associated with ADHD. 

3. Treatment of ADHD conforms to international and European recommendations. It includes a multidisciplinary approach that is as personalised as possible, depending on needs and situations: 

• Individual follow-up of the child by the child psychiatrist and possibly a specialised psychologist; 
• Family therapy in the case of associated family difficulties;
• Parental coaching (educational advice to channel the child) ;
• Relational psychomotricity sessions (for children aged under 6);
• Adapted schooling for pupils with special needs (antinoise headset, extra time for doing exercises and tests, etc.) 
• School coaching (working method, etc.);
• Food supplements and/or changes to dietary habits;
• Advice on life hygiene (sleep, physical activity, etc.) 

If these approaches are insufficient and after a discussion between the child psychiatrist, the parents and the child, personalised medication can be envisaged. Minimum effective doses are always prescribed.  The dosage is evaluated regularly and adapted to the child’s needs and development.

Nutritional psychiatry - i.e. the links between diet, intestinal flora and ADHD - is the subject of a growing body of scientific research. At the Huderf, Prof Isabelle Massat is particularly interested in the potential impact of certain nutrients on ADHD symptoms.