ADHD

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Introduction

What is ADHD?

ADHD stands for attention deficit hyperactivity disorder, one of the most commonly diagnosed behavioral problems in childhood and adolescence. Children with ADHD have more trouble staying focused, paying attention, and controlling their behavior and impulses than other children of the same age. ADHD seems to run in some families and can continue into adulthood. An estimated 9% of children (ages 2-17 years) are affected by ADHD, according to the Centers for Disease Control and Prevention.

Although it may be easy to label children as having ADHD, specific criteria exist for its diagnosis. The diagnosis is based on a six-month or longer persistence of multiple symptoms of inattention, hyperactivity, and impulsivity that must be more severe than those of their peers. The diagnosis is sometimes overlooked in children who predominantly have symptoms of inattention because they tend to be quiet and less disruptive than children with hyperactivity and impulsivity symptoms. It can also be missed in children with predominant symptoms of hyperactivity and impulsivity, who may be labeled instead as having emotional or disciplinary problems.

To further complicate diagnosis, other problems, such as anxiety disorders, bipolar disorder, conduct disorder, depression, learning disorders, oppositional-defiant disorder, and tic disorders, seem to occur more commonly in children who have ADHD than in other children. Furthermore, undetected seizures, hearing or vision problems, and some medical conditions, as well as stress, can cause symptoms similar to those of ADHD. ADHD may also be diagnosed in adults even if it was not identified during childhood.

Properly diagnosed and treated, symptoms of ADHD can be managed successfully, allowing children and adults who have ADHD to live productive, normal lives. Treatment often involves a combination of approaches, such as medications, behavioral therapy, lifestyle changes, and education of parents and teachers.

Since ADHD can interfere with school performance and potentially lead to lifelong problems, it is important to receive appropriate treatment if ADHD is present. Seek prompt medical care if you or your child’s teachers think your child might be affected by ADHD.

Symptoms

What are the symptoms of ADHD?

Children who have attention-deficit hyperactivity disorder (ADHD) may have symptoms mostly related to inattention, mostly related to hyperactivity and impulsivity, or a combination of symptoms related to all three. These symptoms may be present in healthy children but are more prominent in children with ADHD. In those cases, the symptoms are severe enough to cause problems at school, home or work. They may also interfere with peer relationships.

Common inattentive symptoms of ADHD

Some children mostly have symptoms of inattention, which include:

  • Appearance of not listening when spoken to directly

  • Aversion to extended mental tasks

  • Forgetfulness

  • Inability to remain attentive and undistracted

  • Lack of attention to detail

  • Lack of follow-through on instructions, chores, homework, or other duties

  • Lack of organization, resulting in misplacement of important items

  • Sloppy mistakes in homework

  • Time management problems

  • Trouble maintaining attention on age-appropriate tasks or play

Common hyperactivity and impulsivity symptoms of ADHD

Some children mostly have symptoms of hyperactivity and impulsivity, which include:

  • Difficulty waiting in line or for a turn to speak

  • Difficulty playing or doing tasks quietly

  • Inability to sit still or remain seated

  • Incessant talking

  • Tendency to interrupt others

  • Tendency toward constant motion, even when not appropriate

Symptoms that might indicate a serious condition

In some cases, ADHD may occur with other symptoms that might indicate a serious condition. Seek prompt medical care if you, or someone you are with, have symptoms of ADHD along with any of these symptoms:

  • Aggressive behaviors

  • Difficulties in school or at home

  • Difficulty controlling temper and a tendency to blame others

  • Difficulty developing and maintaining relationships with peers

  • Drug or alcohol use

  • Frequent anger and resentfulness

  • Frequent or severe injuries

  • Mood changes, such as depressed mood or anxiety

  • Repetitive involuntary movements, such as eye twitches or shoulder shrugging

  • Tendency to argue or intentionally provoke people

Causes

What causes ADHD?

The exact cause of attention-deficit hyperactivity disorder (ADHD) is not known, but genetics does seem to play a role, as ADHD does tend to run in families. A gene has been identified that seems to affect the amount of tissue formed in an area of the brain that is associated with attention; however, the area becomes more normal with time. ADHD symptoms tend to improve as the brain tissue normalizes in these children.

Exposure to smoking and alcohol during fetal development and lead poisoning may contribute to the risk of developing ADHD. Although sugar is often associated with hyperactivity, most research does not support a link between the two. Research investigating potential causes is ongoing.

What are the risk factors for ADHD?

A number of factors increase the risk of developing attention-deficit hyperactivity disorder (ADHD). Not all people with risk factors will get ADHD. Risk factors for ADHD include:

  • Brain injury
  • Exposure to alcohol as a fetus
  • Exposure to maternal smoking as a fetus
  • Family history of ADHD
  • Lead poisoning
  • Low birth weight
  • Prematurity
Treatments

How is ADHD treated?

Treatment of attention-deficit hyperactivity disorder (ADHD) begins with seeking regular medical care, which allows a health care professional the opportunity to screen for and evaluate potential symptoms of ADHD. Properly diagnosed and treated, ADHD can be managed so that it has minimal impact on your life or your child’s life. Treatment often involves a combination of approaches, such as medications, behavioral therapy, lifestyle/environmental changes, and education of parents and teachers. Behavioral interventions are preferred initially to medication as the initial intervention for preschool children with ADHD and supplement medication for school-aged children and adolescents.

Medications commonly used to treat ADHD

Although it may seem counterintuitive, stimulants are commonly used to treat ADHD. Instead of increasing energy and activity levels, they seem to have a calming effect and help to improve concentration and focus. Nonstimulants may also be used to treat ADHD, and they may have less abuse potential.

  • Amphetamine (Adderall)
  • Atomoxetine (Strattera, a nonstimulant)
  • Dexmethylphenidate (Focalin)
  • Dextroamphetamine (Dexedrine, Dextrostat)
  • Lisdexamfetamine dimesylate (Vyvanse)
  • Methamphetamine hydrochloride (Desoxyn)
  • Methylphenidate (Concerta, Metadate, Methylin, Ritalin)

What you can do to improve ADHD

In addition to medications and behavioral therapy, you can help manage your child’s ADHD symptoms by:

  • Attending parental skills education classes

  • Developing a clear system of rewards and punishments

  • Giving praise when your child is acting appropriately

  • Having your child receive social skills training

  • Joining a support group

  • Organizing your child’s environment

  • Removing distractions

  • Setting and sticking to a schedule

  • Setting clear rules

  • Sharing relaxing activities with your child

  • Using “time-outs” to remove your child from situations when behavior is inappropriate

  • Working with your child’s school to evaluate whether he or she qualifies for special education services

What are the potential complications of ADHD?

Complications of untreated or poorly controlled attention-deficit hyperactivity disorder (ADHD) can be serious. You can help minimize your child’s risk of serious complications by following the treatment plan you and your health care professional design specifically for you and your child. Complications of ADHD include:

  • Academic problems or failure
  • Co-occurrence of ADHD with behavioral problems
  • Difficulties holding a job
  • Drug and alcohol use and abuse
  • Increased risk of injury
  • Law violations and legal troubles
  • Learning disability
  • Ongoing symptoms
  • Problems developing and maintaining relationships with peers
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 14

  1. Data and Statistics About ADHD. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/data.html.

  2. What is attention deficit hyperactivity disorder? National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index....

  3. Leslie LK, Guevara JP. Attention-deficit/hyperactivity disorder. In: American Academy of Pediatrics Textbook of Pediatric Care, McInerny TK. (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2009. p.1201.

  4. Brown RT, Amler RW, Freeman WS, et al. Treatment of attention-deficit/hyperactivity disorder: overview of the evidence. Pediatrics 2005; 115:e749.

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