Definition
Attention deficit hyperactivity disorder (ADHD) is a disorder that affects behavior. It can cause hyperactive and impulsive behavior, and/or make it difficult to pay attention. Most people have some of these behavioral issues at some time. However with ADHD, these behavioral problems continue over a long period of time. To be considered ADHD, these behaviors must last for at least six months and be present in two environments (home, work, or school). ADHD affects children, adolescents, and adults.
There are three types of ADHD:
- Inattentive (classic “ADD”)
- Hyperactive-impulsive
- Combined—the most common type
Causes
The cause of ADHD is unknown. It most likely is caused by a chemical imbalance in the brain. There also appears to be a genetic factor since ADHD can run in families.
Risk Factors
Factors that increase your chance of developing ADHD include:
- Being a first-born boy
- Having a parent or sibling (especially an identical twin) with ADHD
- Having a mother who smoked cigarettes and/or drank alcohol during pregnancy
- Having a parent with certain conditions (such as, alcoholism, conversion disorder)
- Being born prematurely
- Other possible risk factors, such as:
- Head injury at a young age (less than two years old)
- Being born with a serious heart condition
- Having Turner syndrome (a genetic condition)
- Being exposed to certain pesticides
- Spending over two hours a day watching TV or playing video games when young
Symptoms
All children display some of the symptoms of ADHD. Children with ADHD have symptoms that are more severe and consistent. They often have difficulty in school and with their family and peers.
ADHD can last into adulthood. It can cause problems with relationships, job performance, and job retention. Symptoms can vary according to the type of ADHD:
- Inattentive (classic “ADD”)
- Easily distracted by sights and sounds
- Doesn’t pay attention to detail
- Doesn’t seem to listen when spoken to
- Makes careless mistakes
- Doesn’t follow through on instructions or tasks
- Avoids or dislikes activities that require longer periods of mental effort
- Loses or forgets items necessary for tasks
- Is forgetful in day-to-day activities
- Hyperactive-Impulsive
- Is restless, fidgets, and squirms
- Runs and climbs; not able to stay seated
- Blurts out answers before hearing the entire question
- Has difficulty playing quietly
- Talks excessively
- Interrupts others
- Has difficulty waiting in line or waiting for a turn
- Combined ADHD—Combination of the symptoms above.
People with ADHD may also have:
- Depression
- Anxiety
- Conduct disorder—difficulty following social rules
- Oppositional defiant disorder—negative, angry, and defiant behaviors
- Learning and language disorders
- Physical conditions such as sleep apnea
- Substance abuse
- Trouble sleeping
- Cigarette use
Diagnosis
There is no standard test to diagnose ADHD. It is done by a trained mental health professional. The diagnosis will also be based on feedback from family and teachers.
The American Academy of Pediatrics (AAP) recommends that the following guidelines be used for diagnosis in children 4-18 years of age:
- Evaluation should be initiated if a child shows signs of:
- Inattention
- Hyperactivity
- Impulsivity
- Poor school performance
- Behavior problems
- During diagnosis, the following information should be gathered directly from parents, caregivers, teachers, or other school professionals:
- Assessment of symptoms of ADHD in different settings (home and school)
- Age at which symptoms started
- How much the behavior affects the child’s ability to function
- The professional should examine the child for other conditions that might be causing or aggravating symptoms, such as:
- Certain health conditions
- Learning or language disorders
- Aggression
- Disruptive behavior
- Depression or anxiety
- Psychotic symptoms
- Personality disorder
- For a diagnosis of ADHD to be made, symptoms must:
- Be present in two or more of the child’s settings
- Interfere with the child’s ability to function for at least six months
- Fit a list of symptoms detailed in the most recent version of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association
Treatment
The goal is to improve the child’s ability to function. Doctors should work together with parents and school staff. Together, they can set realistic goals and evaluate the child’s response.
Treatments include:
Sleep
Children who do not sleep enough may suffer from worse behavioral problems. A key part of treatment is to ensure that children with ADHD get plenty of sleep.
Medicine
Medicines can help control behavior and increase attention span. Stimulants are the most common choice for ADHD. They increase activity in parts of the brain that appear to be less active in children with ADHD. Stimulant medications include:
- Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)
- Dextroamphetamine (Dexedrine)
- Amphetamine (Adderall)
- Lisdexamfetamine (Vyvanse)—Recently approved to treat adults with ADHD. It can also be used to treat children aged 6-12 years.
Talk to your doctor if you have any questions about ADHD medicines. There are possible risks with these medicines, including heart problems and psychiatric problems (such as, hearing voices, becoming manic).
Although the risk of serious heart problems is rare some medical organizations recommend screening before starting ADHD medication. The American Heart Association (AHA) suggests that children have an electrocardiogram (ECG) before starting stimulant medicine for ADHD. Other medical organizations like the AAP do not recommend this screening. Talk to your doctor about your child’s risk.
Other drugs include:
- Atomoxetine (Strattera)
- Antidepressants—such as imipramine (Janimine, Tofranil), venlafaxine (Effexor), and bupropion (Wellbutrin)
- Clonidine (used for Tourette’s syndrome)—to treat impulsivity
Behavior Therapy
Children who take medicine and go to therapy do better than those who just use medicine. Therapy sessions focus on practicing social and problem-solving skills. Counselors will also teach parents and teachers to help the child through positive reinforcement. This could involve changes in the classroom, as well as in parenting style. Often, daily report cards are exchanged between parents and teachers.
Other tools, like the Disc’O’Sit cushion, may be helpful in improving children’s attention in class. The Disc’O’Sit is a dome-shaped cushion filled with air that the child balances on.
ADHD coaching can also be helpful. These coaches work with individuals to help them organize and create strategies so that they can be more efficient and successful.
Prevention
There are no guidelines for preventing ADHD because the cause is unknown. Proper treatment can prevent problems later in life.
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