Attention Deficit Hyperactivity Disorder
(AD/HD)
What is it?
Attention-Deficit Hyperactivity Disorder (ADHD)
is a term used to describe a family of
neurobiological disorders that are characterized
by difficulty remaining focused on activities or
tasks, impulsiveness, and hyperactivity. In some
individuals, the hyperactivity symptom may be less
dominant, in which case the disorder has been
referred to as Attention-Deficit Disorder (ADD).
Who gets it?
The American Academy of Pediatrics (AAP)
estimates that AD/HD affects between 4% and 12% of
all school-age children. AD/HD can create problems
for these children at home, at school, or in their
relationships with friends. According to the
National Institute of Mental Health (NIMH), two to
three times more boys than girls are affected by
AD/HD, but the reason for this difference is not
clear.
What causes it?
Research has shown that children with ADHD
usually have at least one close relative, often
their father, with ADHD. So, there seems to be a
genetic connection. The disorder appears to be
caused by an abnormality in certain
neurotransmitters in the brain. Neurotransmitters
are chemicals that send messages between nerve
cells within the brain, transmitting information
that controls impulses such as movement and
emotion. It is believed that the symptoms of ADHD
can be triggered by exposure to lead or other
toxins during early childhood, a traumatic brain
injury, or other neurological disorders, such as
Tourette syndrome. It also believed that mothers
who abused chemical substances, had viral
infections, or had poor nutrition during pregnancy
are more likely to have children with ADHD. There
is no proven link between food allergies or sugar
intake and ADHD symptoms.
What are the symptoms?
Children with ADHD may begin showing symptoms
as early as age two, but symptoms become more
noticeable during school age.
The term attention deficit disorder, or ADD
was renamed AD/HD in 1994 by the American
Psychiatric Association and includes three
subtypes:
- An inattentive subtype with signs that
include:
- inability to pay attention to details or a
tendency to make careless errors in schoolwork
or other activities
- difficulty with sustained attention in tasks
or play activities
- apparent listening problems
- difficulty following instructions
- problems organizing tasks and activities
- avoidance or dislike of tasks that require
mental effort
- tendency to lose things like toys, notebooks,
or homework
- distractibility
- forgetfulness in daily activities
- Hyperactive-impulsive
subtype with signs that include:
- fidgeting or squirming
- difficulty remaining seated
- excessive running or climbing
- difficulty playing quietly
- always seeming to be "on the go"
- excessive talking
- blurting out answers before hearing the full
question
- difficulty waiting for a turn or in line
- problems with interrupting or intruding
- A combined subtype,
with behaviors that include those from both of
the other subtypes and can be seen with or
without hyperactivity.
All children have difficulty paying attention,
following directions, or being quiet from time to
time, but for children with AD/HD, these behaviors
occur more frequently and are more disturbing to
the children and those around them.
ADHD does not mean a child is not intelligent.
On the contrary, children with ADHD are often
extremely intelligent but cannot pay attention or
sit still long enough to get good grades in
school. While children with ADHD are generally not
aggressive, younger children may be quick to throw
temper tantrums. Older children may have a low
tolerance for frustration. Children with ADHD are
more likely to have behavioral, learning, mood,
and anxiety disorders. Untreated, ADHD can result
in symptoms of depression, anxiety, and
oppositional disorder during adolescence. By
adulthood, symptoms of impulsivity and
hyperactivity tend to decline, but distractibility
and inattentiveness continue. This can affect job
performance and interpersonal relationships.
How is it diagnosed?
If your child displays symptoms of ADHD, your
pediatrician or family doctor will take a complete
medical history and perform a thorough physical
exam. If no physical cause of the symptoms are
found, your doctor will refer you to a
psychologist, psychiatrist, child neurologist, or
learning specialist who will perform a complete
assessment. This includes studying your child’s
medical and school records, observing your child,
and asking questions about the frequency and
severity of the symptoms. Your observations, as
well as your child’s teachers’, also provide
important information. The healthcare professional
may use some type of diagnostic testing instrument
to gather additional data. A child will display these behaviors before age 7
and the behaviors last for at least 6 months with
ADHD. Simply having difficulty paying
attention is not enough to make a diagnosis. The
psychologist or neurologist will look for a
pattern of symptoms of inattentiveness,
impulsivity, and/or hyperactivity that have
interfered with the child’s functioning at home
and school for at least six months. The doctor may
follow the criteria listed in the latest edition
of the Diagnostic and Statistical Manual of Mental
Disorders (DSM) to make a definite diagnosis. The
DSM requires at least six of its listed symptoms
of inattention or six or more symptoms of
hyperactivity and impulsivity combined, some of
which developed before the age of seven, for a
diagnosis of ADHD. It is important to be sure that
other conditions such as depression, bipolar
disorder, autism, and anxiety disorder are not
causing symptoms that can be similar to ADHD. ADHD
sometimes is not diagnosed until adulthood after a
pattern of difficulty with relationships and work
make the symptoms difficult to ignore. It is
important to note that federal law requires public
schools to offer free testing for ADHD if you
request it.
An added difficulty in diagnosing AD/HD is that
it often coexists with other problems. Nearly half
of all children with AD/HD also have oppositional
defiant disorder, which is characterized by
stubbornness, outbursts of temper, and acts of
defiance.
Mood disorders, such as depression, are
commonly seen in children with AD/HD. Some
children may have depression as a result of having
AD/HD. They feel inept, socially isolated, and
frustrated by school failures. A little extra help
in social and academic areas can go a long way in
helping to alleviate this type of depression.
Other children may have a mood disorder that
exists independently of AD/HD, which may require
additional psychotherapy or medication.
Many children with AD/HD also have a specific
learning disability, which means that they might
have trouble mastering language or other skills,
such as math, reading, or handwriting. The most
common learning problems are with reading and
handwriting. Although AD/HD is not categorized as
a learning disability, its interference with
concentration and attention can make it even more
difficult for a child to perform well in school.
What is the treatment?
ADHD is treated with a combination of drug and
behavioral therapy. Medications called
psychostimulants are used to stimulate the
neurotransmitters in the brain that help control
hyperactivity and impulsive behavior and improve
mental focus. Commonly prescribed psychostimulants
include methylphenidate, dextroamphetamine, and
pemoline. Like most drugs, there are possible side
effects, including difficulty sleeping, loss of
appetite, nervous tics, and irregular heartbeat.
Your doctor can discuss these with you. As your
child grows, his or her dosage requirements will
change, so it is important to have regular
follow-ups with your doctor and to follow your
doctor’s recommendations for treatment.
Antidepressant drugs may also be prescribed where
the child has additional disorders.
Behavioral therapy focuses on helping the child
build self-esteem, and recognize and control
behaviors. Behavior modification therapy
reinforces good behavior with a reward that is
valued by the child. The goal is to develop a
pattern of good behavior that continues after the
rewards are stopped. Cognitive-behavioral therapy
works at a more intellectual level by helping the
child realize how his or her thoughts and behavior
are connected and to change that behavior by
changing the way the child thinks. Families often
benefit from family therapy sessions where they
work through their thoughts and feelings about
their child’s or sibling’s disorder and how they
deal with it. Your child’s school can also provide
an Individualized Education Program (IEP) that can
help the ADHD child succeed in the classroom.
While approximately half of all children with ADHD
experience a significant reduction of symptoms
between adolescence and adulthood, others need to
continue treatment as adults. With treatment,
however, children and adults with ADHD can
function fully and successfully in school, social
settings, and the workplace.
Psychostimulants often affect children
differently, and a child may respond well to one
stimulant but not another. When determining the
correct treatment for your child, doctors might
try various psychostimulants before moving on to
other types of medicines. Other medicines are
available if the stimulants are not effective for
your child or if your child's doctor is treating
AD/HD along with another disorder.
Taken in normal doses, stimulants can result in
possible side effects, such as decreased appetite,
stomachaches, irritability, and insomnia. There's
currently no evidence of any long-term side
effects. Stimulants have been used for over 50
years in the treatment of AD/HD.
Medications that can help a child with AD/HD
control impulsive behavior and attention
difficulties are more effective when combined with
behavioral therapy. Behavioral
treatments include instructing teachers and
parents about the best way to organize the child's
environment, give clear directions and commands,
and set up consistent rewards for appropriate
behaviors and negative consequences for
inappropriate ones. It also involves teaching
social skills and sports and leisure skills.
Special parenting skills are often required
because children with AD/HD may not respond as
well to typical parenting practices. Also, because
ADHD tends to run in families, parents often have
some problems with organization and consistency
themselves and need active coaching to help learn
these skills. Children who take medications and
are involved in programs to promote social
behavior do better than those who rely on
medication alone.
Self-care tips
If you or your child exhibits symptoms of ADHD,
it is important to get a diagnosis and treatment
as early as possible. If untreated, ADHD can
affect self-esteem, social development, and
educational success. If your child has been
diagnosed with ADHD, he or she will function
better within a structured, consistent routine.
Make sure your child has clearly understood
guidelines for good behavior and consistent
consequences for bad behavior. It is extremely
important that your child’s teachers are aware of
his or her disorder and are educated in its
treatment. Never change or stop medications, or
change dosages, without consulting your doctor.
Adjustments may be necessary for your child in
the classroom. He might be able to pay better
attention, for example, if he sits in the front of
the room, has an extra set of books at home, and
is given additional reminders to complete tasks.
Here are more ideas about how you can help your
child, both in the classroom and at home:
- Modify the environment in an effort to reduce
distractions. "Open" classrooms do not
work well for children with AD/HD because
sitting around tables or in groups is more
distracting that sitting in rows. Talk to your
child's teacher about decreasing noise and
clutter in the classroom.
- Provide clear instructions. Ask your child's
teachers to have your child write down his
homework assignments in a notebook, and check
that it is complete. Both you and your child's
teacher should keep oral instructions brief and
provide written instructions for tasks that
involve many steps.
- Focus on success. Provide formal feedback
(such as a star chart) to reinforce your child's
positive behaviors and reward his progress even
if it falls a little short of the goal. A daily
checklist carried home from school on which the
teacher notes behavior and academics can provide
additional structure for the child.
- Help your child organize. Encourage your
child to establish daily checklists, and remind
him to check his homework notebook as the end of
the school day to make sure that he takes the
correct supplies and textbooks home.
- Encourage your child to control impulses -
and ask your child's teacher to reward such
behavior. Rewarding a child for raising his hand
before speaking in class can go a long way to
reduce the disruption of calling out in class.
- Encourage performance in your child's areas
of strength, and provide feedback to him in
private. Do not ask your child to perform a task
in public that is too difficult.
- Consult with the school counselor or
psychologist to help design behavioral programs
to address specific problems in the classroom.
Further information on designing behavior
programs is available though the U.S. Department
of Education's Technical
Assistance Center on Positive Behavioral
Interventions and Supports (PBIS).
- Encourage active learning. Teach your child
to underline important passages as he reads and
to take notes in class. Encourage your child to
read out loud at home if fluency and
comprehension are a problem.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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