What is ADHD?
ADHD stands for Attention Deficit Hyperactivity Disorder. It is a neurodevelopmental condition, which means it relates to how the brain develops and functions, rather than being caused by parenting or environment.
It involves difficulties in three main areas. Attention, which includes trouble focusing, being easily distracted, and struggling to complete tasks. Hyperactivity, which includes restlessness, fidgeting, and difficulty staying still. And impulsivity, which includes acting without thinking, interrupting, and finding it hard to wait.
Some children have all three. Some have mainly inattentive symptoms, which can be harder to spot, particularly in girls. And some have mainly hyperactive and impulsive symptoms.
How common is it?
NICE estimates that around five percent of school aged children have ADHD. NHS England’s most recent data suggests around 744,000 children and young people in England are living with it, many without a diagnosis.
The waiting lists for assessment are currently very long. In early 2025, over 549,000 people in England were waiting for an ADHD assessment, with most waiting over a year. That is a significant amount of time for a child and family to be without support.
Girls and ADHD
This is something I feel strongly about. ADHD in girls has historically been significantly underdiagnosed, and it still is.
Girls with ADHD are more likely to present with inattentive symptoms rather than hyperactivity, which means they are less visible and less disruptive in the classroom. They are also more likely to mask, working very hard to appear fine while struggling enormously underneath. By the time many girls receive a diagnosis, they have spent years being told they are lazy, dreamy, or not trying hard enough.
There is something else that is only recently beginning to receive the attention it deserves. The relationship between ADHD and hormones across the female lifespan. Dr Lotta Borg Skoglund, Associate Professor in Psychiatry at Uppsala University and the Karolinska Institute, has highlighted how oestrogen and progesterone play vital roles in mood, cognition, and dopamine regulation, making girls and women with ADHD especially sensitive to hormonal changes. Symptoms often worsen premenstrually, and girls with ADHD face a higher risk of PMDD and difficulties with hormonal contraception.
A girl who managed reasonably well in primary school may find everything becomes significantly harder in adolescence. Without understanding the hormonal dimension, this is often misread as anxiety or depression rather than recognised as ADHD presenting differently at a new life stage.
What you might notice
Every child with ADHD is different, but some common things parents notice include:
Difficulty paying attention or seeming not to listen, making careless mistakes, struggling to follow instructions or organise themselves, losing things frequently, and being easily distracted.
Restlessness, fidgeting, difficulty staying seated, always seeming to be on the go, talking a lot, interrupting, and finding it very hard to wait their turn.
Difficulty getting to sleep, or taking a very long time to settle at night. Sleep difficulties are very common in ADHD and often not talked about enough. You can read more about this in my free guide When Darkness Comes.
Intense focus on things they love, and complete inability to engage with things they find boring, even when they want to.
What causes ADHD?
We do not yet fully know what causes ADHD. What research does tell us is that no single risk factor explains it. It is most likely a combination of genetic and environmental factors working together.
ADHD runs in families and is heritable. Research suggests an overlap with other neurodevelopmental conditions, including autism. Additional risk factors include extreme early life adversity, prenatal exposure to certain substances, low birth weight, and prematurity.
What is clear is that it is not caused by poor parenting, too much screen time, or sugar. Parents are far too often made to feel blamed for something that is neurological in origin.
As the Association for Child and Adolescent Mental Health, of which I am a member, notes in their current clinical guidance:
No single risk factor explains ADHD. Instead it is a mix of genetic and environmental factors working together.
You can read their full clinical overview here.
It is also worth knowing that difficulties with emotional regulation and executive functioning skills are sometimes mistaken for ADHD, or can co-occur with it. Getting a thorough assessment matters.
Getting a diagnosis
It is worth knowing that the diagnosis of ADHD remains a complex one. There is no single definitive psychological or biological test. Making a diagnosis needs to be done by a specialist, drawing on information from parents, schools, and other professionals, and exploring the extent, severity, and characteristics of symptoms across different settings.
Symptoms need to be present in more than one setting for a diagnosis to be made. If your child only shows signs at home, it is less likely to be ADHD, though it is still worth exploring what might be driving the difficulties.
If you are concerned, the starting point is your GP and having a support letter from school.They can refer you to a paediatrician or CAMHS for assessment. You can find more information about the diagnostic process from the ACAMH resources on ADHD and the NICE guideline NG87.
What helps: treatment and support
The evidence supports a multimodal approach, which means combining different types of support rather than relying on any single intervention.
Parenting programmes
For younger children and those with mild to moderate ADHD, parenting programmes are recommended as a first line treatment by NICE. These help parents understand their child’s behaviour and develop strategies that work. I am a trained facilitator in the Incredible Years, one of the NICE recommended programmes, which I delivered during my time in the NHS and continue to draw on in my private practice work.
School based support
Support at school needs to be tailored to the individual child. General advice to teachers alone is not enough. What helps is targeted, specific, and consistent support that takes into account how that particular child learns and what they find hard.
Medication
Medication can be effective in reducing core symptoms, particularly stimulant medications like methylphenidate. NICE recommends medication when symptoms are severe or when other approaches have not been sufficient. It works best alongside other support rather than as a standalone treatment.
Diet
There is currently no strong evidence that omega 3 supplements, iron, or zinc are effective treatments for ADHD. What does matter is a balanced diet, good nutrition, and regular exercise. Some children do respond to certain foods or drinks, and it is worth noting any patterns you observe.
You can read the full ACAMH treatment overview here.
How I can help
I work with children and young people with ADHD and their families. My aim is to help you understand your child’s nervous system, find approaches that work for them specifically, and support you in the day to day reality of parenting a child with ADHD.
For younger children I offer play therapy and the World technique, which uses a sand tray and miniature figures to help children express and make sense of their inner world in a way that does not rely on words. This can be particularly helpful for children with ADHD who find it hard to sit and talk but communicate naturally through play.
I also work with parents individually, to think through strategies, manage the emotional impact, and navigate the systems around diagnosis and school support. And I am a trained facilitator in the Incredible Years, one of the NICE recommended parenting programmes.
Assessment and diagnosis is not something I offer, and I always direct parents to their GP as the first step. But if you would like someone who understands ADHD deeply to think alongside you, I would love to hear from you.
You can get in touch via my contact page.
Free resources
My free guides are a good starting point if you want to understand more about your child’s nervous system and what happens when big feelings take over.
Understanding Your Child’s Guard Dog Brain
When Darkness Comes includes a specific section on ADHD and sleep.
All free to download.
And if you would like occasional guidance and support straight to your inbox, you are very welcome to join my newsletter.
With warmth,
Catherine
