
- ADHD
Attention Deficit Hyperactivity Disorder (ADHD)
WHAT IS ADHD
Topic Overview
What is attention deficit hyperactivity disorder (ADHD)?
Attention deficit hyperactivity disorder (ADHD) is a condition in which a person has trouble paying attention and focusing on tasks, tends to act without thinking, and has trouble sitting still. It may begin in early childhood and can continue into adulthood. Without treatment, ADHD can cause problems at home, school, work, and with relationships. In the past, ADHD was called attention deficit disorder (ADD).
What causes ADHD?
The exact cause is not clear, but ADHD tends to run in families.
What are the symptoms?
The three types of ADHD symptoms include:
•Trouble paying attention. People with ADHD are easily distracted and have a hard time focusing on any one task.
•Trouble sitting still for even a short time. This is called hyperactivity. Children with ADHD may squirm, fidget, or run around at the wrong times. Teens and adults often feel restless and fidgety and are not able to enjoy reading or other quiet activities.
•Acting before thinking. People with ADHD may talk too loud, laugh too loud, or become angrier than the situation calls for. Children may not be able to wait for their turn or to share. This makes it hard for them to play with other children. Teens and adults seem to “leap before they look.” They may make quick decisions that have a long-term impact on their lives. They may spend too much money or change jobs often.
How is ADHD diagnosed?
ADHD is often diagnosed when a child is between 6 and 12 years old. Teachers may notice symptoms in children who are in this age group.
First, the child will have a physical exam to make sure that he or she does not have other problems such as learning disabilities, depression, or anxiety disorder. The doctor will use guidelines from the American Psychiatric Association to diagnose ADHD. The doctor may also look at written reports about the child’s behavior. Parents, teachers, and others who have regular contact with the child prepare these reports.
How is it treated?
There is no cure for ADHD, but treatment may help control the symptoms. Treatment may include medicines and behavior therapy. Parents and other adults need to closely watch children after they begin to take medicines for ADHD. The medicines may cause side effects such as loss of appetite, headaches or stomachaches, tics or twitches, and problems sleeping. Side effects usually get better after a few weeks. If they don’t, the doctor can lower the dose.
Therapy focuses on making changes in the environment to improve the child’s behavior. Often, counseling and extra support at home and at school help children succeed at school and feel better about themselves.
How does ADHD affect adults?
Many adults don’t realize that they have ADHD until their children are diagnosed. Then they begin to notice their own symptoms. Adults with ADHD may find it hard to focus, organize, and finish tasks. They often forget things. But they also often are very creative and curious. They love to ask questions and keep learning. Some adults with ADHD learn to manage their lives and find careers that let them use those strengths.
But many adults have trouble at home and work. As a group, adults with ADHD have higher divorce rates. They also are more likely to smoke and have more substance abuse problems than adults without ADHD. Fewer adults with ADHD enter college, and fewer graduate. Treatment with medicine, counseling, and behavior therapy can help adults with ADHD.
Estimates vary about how many people are affected by attention deficit hyperactivity disorder (ADHD). Part of this variation is probably due to the different sources health professionals use to diagnose it.The accepted standard for diagnosing ADHD is the DSM-IV criteria from the American Psychiatric Association.2 A child’s dominant symptoms (inattention, impulsiveness, and/or hyperactivity) are determined and categorized. The condition affects about 3% to 7% of all school-age children in the United States.
Boys are diagnosed with ADHD more often than girls, with a varying ratio of 2:1 to 9:1 depending on the specific type.
Inattention is the most common type of ADHD diagnosed in girls. This type is the least likely of the three to be noticed in the early school years. It may not be detected until late childhood. Many girls may not be diagnosed and properly treated for the disorder until later in life.
It is not clear how many adults are affected by ADHD. However, overall estimates are that about one-third of children with ADHD continue to have significant symptoms into adulthood. More research is needed in this area.
In addition, more research is needed to determine how many preschool children and adolescents are affected by ADHD.
Symptoms
The symptoms of attention deficit hyperactivity disorder (ADHD) may include:
•Inattention, which is having a short attention span and being easily distracted.
•Impulsivity, which can cause a person to do dangerous or unwise things without thinking about the consequences.
•Hyperactivity, which is inappropriate or excessive activity.
These symptoms affect people in all age groups who have ADHD. But typical behavior varies by age.
•In preschool-age children, symptoms may be hard to identify. Normal behavior in young children periodically includes all of the major symptoms. ADHD is distinguished from normal behavior by the severity and consistency of symptoms.
•Children between the ages of 6 and 12 usually show more obvious signs of ADHD than other age groups. School expectations can make symptoms more noticeable. For some children, school is the first setting where academic performance and socialization abilities are assessed. But it often is more difficult to detect ADHD when inattention is the primary symptom and the child is otherwise well-behaved. The presence of ADHD may be indicated by:
◦Low grades or test scores, including achievement tests.
◦Poor organization and study skills.
◦Socialization problems and feeling rejected by peers.
◦Dislike of school and frustration with school work.
•Teens between the ages of 13 and 18 may be in better control of disruptive behavior related to hyperactivity. Other problems that began in earlier years may continue or become worse when ADHD is not treated. Teens with inattention problems who previously managed to cope may start to fall behind in schoolwork. This is especially true when major changes occur, such as starting at a new school or going to college.
•Symptoms of ADHD in adults may not be as noticeable. Many adults with ADHD have not been diagnosed and treated. They can develop problems such as depression and difficulty maintaining a job.
There are several other conditions with symptoms similar to ADHD. For example, sometimes bipolar disorder and ADHD can be confused. It can be difficult to determine whether symptoms are caused by ADHD, another condition, or both.
Cause
The exact cause of attention deficit hyperactivity disorder (ADHD) is not known. But inherited genetic factors are likely responsible. Ongoing research is focused on identifying genes that cause a person to be susceptible to ADHD.
Using various imaging tests, researchers have been able to observe the brain at work. They have found a possible link between ADHD and:
•Brain structure.
•The function of chemicals in the brain that help regulate attention and activity (dopamine and norepinephrine).
•Differences in function of some of the areas of the brain that affect attention and impulse control.
Also, research shows that a mother’s use of cigarettes, alcohol, or other drugs during pregnancy may increase the risk for ADHD. Some studies suggest that exposure to lead may cause symptoms associated with ADHD.
Although many parents believe that foods with sugar and food additives make their children more hyperactive, these foods have not been shown to cause ADHD. In a comprehensive review of research, the U.S. National Institutes of Health (NIH) found that restricted diets seemed to help only about 5% of children with ADHD, mostly either young children or children with food allergies. Other research has shown that sugar is not related to ADHD.
A study by the National Institute of Mental Health found that certain parts of the brains of children with ADHD develop normally but about 3 years later than in children without ADHD. This may be why some children seem to grow out of the disorder.
Some people have misconceptions about ADHD, such as that children with ADHD are lazy or dumb. Talk with a doctor about questions or concerns you have about these issues.
Prevention
There is no known way to prevent attention deficit hyperactivity disorder (ADHD). Avoiding alcohol, drugs, and smoking during pregnancy may help prevent a child from developing behavior similar to ADHD as well as many other health problems.
Although you cannot prevent ADHD, you can help your child have fewer learning and attention problems by:
•Having good medical care and practicing healthy habits during pregnancy.
•Learning and applying good parenting skills, including setting consistent behavior limits.
•Maximizing preschool learning and attention skills by reading to your child and providing new learning experiences such as puzzles and board games. The development of attention skills can be increased with these types of activities rather than by watching television.
In addition, nurturing techniques that begin at birth and continue throughout childhood will help your child reach his or her potential regardless of whether ADHD is a concern.
What Increases Your Risk
So far, it appears that the greatest risk factor for developing attention deficit hyperactivity disorder (ADHD) is having an inherited tendency for the condition.
Environmental factors, such as certain parenting techniques, may influence how symptoms of ADHD are expressed, but these do not cause ADHD.
A stressful family situation may contribute to a child’s symptoms. A child may feel guilty because of his or her symptoms and the problems they cause, which can increase the risk of developing another condition, such as anxiety, along with ADHD.
When To Call a Doctor
Call a doctor if:
•You notice that you or your child has symptoms of attention deficit hyperactivity disorder (ADHD) that began before age 7.
•Your child is showing signs of ADHD, such as inattention, impulsivity, and/or hyperactivity, that are causing problems at home or school. Parents and teachers often notice this behavior during the child’s first few years in school.
•Your child shows signs of other mental health disorders, such as depression or anxiety, that last more than a few weeks or seem to be getting worse.
•Your child is having academic or behavioral problems at school.
Watchful Waiting
Preschool children
For young children who show signs of attention deficit hyperactivity disorder, watchful waiting is appropriate. It is difficult to diagnose ADHD in children younger than age 5. Young children generally have short attention spans, and their normal range of behavior includes periods of high activity and impulsivity. If you notice any ADHD symptoms in your preschooler that do not seem age-appropriate, work with your child to improve behavior. Keep a record of your child’s behavior for 6 months to see if it improves. If it continues or has consequences, such as being expelled from day care or preschool, talk with your doctor about having your child evaluated.
School-age and teen years
Watchful waiting is not appropriate for school-age children and teens with ADHD symptoms. Children need attention from a doctor if they have behavior problems that occur in more than one setting, such as poor relationships with parents and poor academic performance.
Problems caused by inattention may not become significant until the teen years, when greater self-reliance is expected. A change in school (such as advancing to junior high or high school) or a new environment (such as moving to another city) can trigger problems with inattention. If you think your child may have an inattention problem, see a doctor to find out if ADHD is the cause.
Adults
Watchful waiting may not be appropriate if you are an adult and think that you may have ADHD. Consider how long you have experienced symptoms, and think about any major changes or difficult situations that are affecting your life. Your symptoms may improve when you have addressed and worked on those issues. But talk to a doctor if your symptoms concern you. If you have other symptoms, such as depression or anxiety, a doctor can help diagnose and treat your problems.
Who To See
Health professionals who can diagnose and treat attention deficit hyperactivity disorder (ADHD) with medicine include:
•Family medicine doctors.
•Pediatricians (may specialize in developmental problems).
•Psychiatrists (may specialize in adults or children and adolescents).
•Neurologists (may specialize in child or adult nervous systems).
•Nurse practitioners who specialize in psychiatry.
Health professionals who do not prescribe medicines but can provide behavioral therapy or family counseling include:
•Psychologists. Psychologists also frequently diagnose ADHD.
•Behavioral specialists.
•Social workers.
•Psychiatric nurse specialists.
•Licensed professional counselors.
•Family therapists.
Ask your health professional about his or her training and experience related to ADHD. Diagnosing and treating ADHD requires an ability to identify and distinguish behaviors that can be subtle and complicated. In addition, make sure your health professional has enough time to evaluate you or your child. Accurate diagnosis and successful treatment of ADHD takes repeated office visits and observations. It is also necessary that your health professional be able to coordinate between other health professionals, family members, teachers, and caregivers.
Determining exactly what is causing behavioral problems can be difficult, since symptoms of attention deficit hyperactivity disorder (ADHD) may also be caused by other problems. The main symptoms of ADHD—inattention, hyperactivity, and impulsiveness—may also result from:
•Giftedness. Some gifted children will show signs of inattention in class. Often they are not challenged and are bored, so they lose interest in normal class activities. (It is also possible for a child to be both gifted and have ADHD.)
•Undernutrition. Without proper nutrients, especially in the first year of life, a child is at risk of not developing normally. This includes compromised brain development and function.
•Abuse or neglect. Emotional problems that often result from abusive conditions can cause a child to have behavior difficulties.
•Stressful home environment. Temporary or permanent family or household situations, such as divorce or a death of a loved one, may cause a child to act differently than normal. Children can become confused and frightened when there are major changes in their lives.
•Parenting skills. Sometimes parents do not know how to effectively handle challenging—but normal—behavior in a child. If parents are inconsistent or unsure of themselves, their child may develop behavior problems.
•Alcohol or drug abuse (most common in teens and adults). It is important to screen for alcohol or drug problems, especially in adults, when evaluating behavior problems.
•Other medical conditions. Some other medical conditions have symptoms similar to ADHD. These conditions can be the primary cause of symptoms, but can also occur (coexist) with ADHD. About one-third of all children with ADHD have one or more of the following conditions along with ADHD:
◦Learning disabilities. Symptoms like those of ADHD, especially inattention, are common when children are in learning environments that are too difficult for them.
◦Conduct disorder
◦Oppositional defiant disorder
◦Depression
◦Anxiety disorders
◦Tourette’s disorder
◦Developmental disorders, such as mental retardation
◦A lifelong childhood medical condition with bothersome symptoms, such as asthma
In order to best treat symptoms of ADHD, a doctor must carefully investigate these other possibilities as a contributor to or cause of behavior problems.
When symptoms are primarily a result of ADHD, they develop early in life (before the age of 7) and get worse when school demands are placed on the child. Symptoms of ADHD can be expected to continue into adulthood.
Exams and Tests
The American Psychiatric Association (APA) has established the symptoms and criteria for diagnosing attention deficit hyperactivity disorder (ADHD). These criteria divide the condition into three basic types based on major symptoms5:
•ADHD, predominantly inattentive type
•ADHD, predominantly hyperactive-impulsive type
•ADHD, combined type
In addition, some people are diagnosed with “ADHD, not otherwise specified” when symptoms of inattention, hyperactivity, and/or impulsivity are present but do not fit into one of the three types.
A doctor will use criteria for diagnosing attention deficit hyperactivity disorders to determine whether a child has ADHD. Information used to diagnose the condition includes:
•An interview with the child.
•Medical history, including asking a parent about the child’s social, emotional, educational, and behavioral history.
•Physical exam.
•Behavior rating scales or checklists for ADHD, used by parents and teachers to evaluate the child’s symptoms.
It can be difficult to determine whether a child’s behavior problems are caused by ADHD, other conditions with similar symptoms, or a combination of ADHD and another condition. Several verbal and written tests for associated disorders are used to help with this determination.
In addition, children with ADHD may have difficulty learning to read, write, or do math problems. Testing for learning disabilities will help teachers develop the best educational plan for a child with these difficulties.
Other tests may be done to identify other medical problems that might explain the child’s symptoms, such as:
•Hearing or vision impairment. This type of disability often interferes with school achievement.
•Lead exposure. Children who have even small amounts of lead in their bodies can have symptoms similar to ADHD.
•Low red blood cell counts (anemia). This condition can cause low energy and poor concentration. It can be diagnosed with results from a complete blood count (CBC).
•Thyroid disease. Blood tests can help find out if a person has too much or too little thyroid hormone, which also can affect energy and attention. This is more common in adults than children.
•Seizures. Seizures can affect brain function and result in unusual behavior. In rare cases, a person with ADHD symptoms may have an electroencephalogram (EEG) to find out if seizures are occurring.
Parents often question whether ADHD is overdiagnosed. Many doctors and researchers believe that the increase in ADHD diagnoses results from improved detection techniques, especially the standardization of assessment criteria. Current and future research should help in answering this question.
Many adults with ADHD have never been diagnosed or treated. ADHD is a lifelong condition that, left untreated, can lead to low self-esteem, frustration, school or job failure, drug abuse, and depression. To diagnose ADHD in an adult, a doctor may use the Wender Utah Rating Scale (WURS), a written test that consists of 25 questions about childhood difficulties that are often seen with the condition. The scale evaluates the presence and severity of ADHD symptoms during childhood.
Adults with untreated ADHD are at an increased risk of abusing drugs or alcohol. If an adult is suspected of having or is diagnosed with ADHD, he or she may also be screened for alcohol and drug abuse.
Early Detection
The American Academy of Pediatrics guidelines recommend that doctors ask parents about behavior and school performance during regularly scheduled well-child visits. This helps identify early signs of ADHD. If you are concerned about how your child’s temperament, learning skills, or behavior is developing, talk with your doctor during your next visit.
Before meeting with your doctor, think about at what age your child’s symptoms began. In addition, you and other caregivers should record when the behavior occurs and how long it lasts. An important component of evaluation for ADHD is considering the kinds of problems that result from the behaviors and to what extent they affect academic performance and social behavior.
Some adults do not recognize their own symptoms of ADHD until their child is diagnosed with the condition. If your child is diagnosed with ADHD or you think you have symptoms, talk with your doctor about being screened for ADHD.
Lisa’s son Jack had always been a handful. Even as a preschooler, he would tear through the house like a tornado, shouting, roughhousing, and climbing the furniture. No toy or activity ever held his interest for more than a few minutes and he would often dart off without warning, seemingly unaware of the dangers of a busy street or a crowded mall.
It was exhausting to parent Jack, but Lisa hadn’t been too concerned back then. Boys will be boys, she figured. But at age 8, he was no easier to handle. It was a struggle to get Jack to settle down long enough to complete even the simplest tasks, from chores to homework. When his teacher’s comments about his inattention and disruptive behavior in class became too frequent to ignore, Lisa took Jack to the doctor, who recommended an evaluation for attention deficit hyperactivity disorder (ADHD).
ADHD is a common behavioral disorder that affects an estimated 8% to 10% of school-age children. Boys are about three times more likely than girls to be diagnosed with it, though it’s not yet understood why.
Kids with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what’s expected of them but have trouble following through because they can’t sit still, pay attention, or attend to details.
Of course, all kids (especially younger ones) act this way at times, particularly when they’re anxious or excited. But the difference with ADHD is that symptoms are present over a longer period of time and occur in different settings. They impair a child’s ability to function socially, academically, and at home.
The good news is that with proper treatment, kids with ADHD can learn to successfully live with and manage their symptoms.