Attention-Deficit Hyperactivity Disorder (ADHD)

What Is It?

Attention-deficit hyperactivity disorder (ADHD) is a problem related to brain development (neurodevelopmental disorder) that causes hyperactivity (always on the move), impulsive behavior (doing things without any self control), and attention problems (not able to pay attention). ADHD is the most common problem seen in outpatient child and adolescent mental health settings. It is estimated that ADHD affects between 4 % and 12 % of school-aged children, more often boys than girls. Studies suggest that the amount of ADHD seen in the population has risen significantly in recent years. But whether more people have the disorder or whether it is just being diagnosed more often is not clear. The specific things needed to make the diagnosis of ADHD have been more clearly defined during the past 20 years. Also, people are more aware of ADHD so the disorder may be recognized more often.

Symptoms

Parents of a child who has ADHD may receive a note from school saying that their child "won't listen to the teacher," "is too active or hyper," or "causes trouble in class and is disruptive." Even though a child with ADHD often wants to be a good student, his or her impulsive behavior and inability to pay attention in class make it difficult. Teachers, parents and friends may see that the child is "misbehaving" or acting "different," but they might not be able to tell exactly what is wrong.

Over the years there have been changes in what are considered to be the essential symptoms of ADHD. In general, children with ADHD have a hard time with normal activities of everyday life because of significant problems with inattention, hyperactivity or impulsive behavior. Unlike the normally high level of activity sometimes seen in children who do not have ADHD, the hyperactivity of ADHD happens more often and is typically more haphazard, poorly organized and not goal directed (has no real purpose). Likewise, children who do not have ADHD occasionally are impulsive or inattentive. In children with ADHD, these behaviors are so frequent that they make it hard for the child to learn in school, get along with others and be safe.

Although specific symptoms of ADHD vary from child to child, a child with ADHD generally shows several of the following characteristics:

• Difficulty organizing work, often giving the impression of not having heard the teacher's instructions
• Easily distracted
• Excessively restless or fidgety behavior; unable to stay seated
• Impulsive behavior (acts without thinking)
• Carelessness
• Frequently calling out in class (without raising hand, yelling out answer before question is finished)
• Failing to follow through with teachers' or parents' requests
• Difficulty waiting for his or her turn in group settings
• Unable to stay focused on a game, project or homework assignment; often moving from one activity to the next without completing any

Many children with ADHD also show symptoms of other behavioral or psychiatric conditions. These associated conditions include learning disabilities and disorders characterized by disruptive behavior.

• Learning disabilities Studies have shown that at least 20% of children with ADHD also have learning disabilities. This is many times greater than the rate seen in the general population. The child may become angry and frustrated because of problems related to his or her learning disability.
• Oppositional defiant or conduct disorders These behavior disorders, which involve frequent outbursts of extremely negative, angry or mean behavior, affect up to one-third of all children who have ADHD. Studies have shown that children who have both ADHD and behavioral disturbances are more likely to have have a poor long-term outcome, with higher rates of school failure, antisocial behaviors and substance abuse.

Diagnosis

There is no single test to diagnose ADHD. Your doctor may make the diagnosis or may refer your child to a specialist. The doctor will ask you if your child has shown any of the characteristics of ADHD. Since many of these characteristics are more likely to be seen in a school setting, your doctor also will ask about your child's behavior in school. To help collect this information, parents, teachers and other caregivers may be asked to fill out special behavioral checklists.

Your pediatrician also will ask about your child's medical and developmental history, and will examine your child. It is important to be sure that your child does not have other conditions that may affect his or her behavior, such as trouble hearing or seeing, learning disabilities, speech problems, seizure disorders, anxiety, depression or other behavior problems. In some cases, other testing is necessary to check for one or more of these conditions. Your child may be referred to a specialist (usually a psychologist, psychiatrist or neurologist) for psychological or neuropsychological testing. These tests, which can take many hours to complete, are made up of a series of written and spoken questions and are designed to detect mental conditions (such as depression or anxiety) or learning problems.

Expected Duration

In most children with ADHD, symptoms begin before age 7 and last through adolescence. In some cases, symptoms continue into adulthood.

Prevention

Despite years of research, the exact cause of ADHD is still not fully understood. There are numerous factors that may contribute to the development of ADHD in a child. These include:

• Genetic factors
• History of head injury
• Infections of the brain and spinal cord
• Premature birth
• Exposure to tobacco, alcohol or other drugs while in the womb
• Lead poisoning

Treatment

Although there is no cure for ADHD, many treatment options are available. The goal of treatment is to help children improve social relationships, do better in school, and keep their disruptive and dangerous behaviors to a minimum. Medication alone rarely is the answer. The best results usually require a combination of medication and behavior therapy.

Several different types of medication are prescribed by doctors to treat ADHD. Stimulants, such as methylphenidate (Ritalin, Concerta and others) and forms of amphetamine (Dexedrine, Adderall and others) are safe and effective for most children, helping them to focus their thoughts and control their behavior. Despite their name, stimulants do not cause increased hyperactivity or impulsivity. In some children, these medications may cause mild side effects, such as decreased appetite, weight loss, stomachaches, sleep problems, headaches and jitteriness. Rarely, there may be more serious side effects, such as dizziness, stuttering, tics or increased blood pressure. Children who take stimulants should be monitored regularly to make sure that the medication is working properly and to check for side effects. Recently, a non-stimulant medication called atomoxetine (Strattera) was approved for treating ADHD in children and adults. Other types of medicines, such as antidepressants, also are used to treat ADHD occasionally.

Other treatment approaches, used alone or in combination, may include:

• Behavioral therapy This refers to techniques that try to improve behavior, usually by rewarding and encouraging desirable behaviors and by discouraging unwanted behaviors and pointing out the consequences.
• Cognitive therapy This is psychotherapy designed to help a child change his or her thinking so that he or she can build self-esteem, stop having negative thoughts, and improve problem-solving skills.
• Social skill training Improving social skills helps children with ADHD to make and keep friends.
• Parent education and support Training classes, support groups, and counselors can help to teach and support parents about ADHD, including strategies for dealing with ADHD-related behaviors.

Because many children with ADHD also are troubled by poor grades and school behavior problems, it is important that schools provide educational adjustments and interventions (such as an individualized educational plan) to promote the best possible learning environment for the child.

When To Call A Professional

Call your doctor if your child shows symptoms of ADHD, or if teachers notify you that your child is having academic difficulties, behavioral problems or difficulty paying attention.

Prognosis

ADHD can cause significant emotional, social and educational problems. However, when ADHD is diagnosed early and treated properly, the condition can be managed effectively, so children can grow up to have productive, successful and fulfilling lives. Although some children appear to grow out of their ADHD as they reach their adolescent years, others have lifelong symptoms.

Additional Info

American Academy of Child and Adolescent Psychiatry (AACAP)

3615 Wisconsin Ave., NW

Washington, DC 20016-3007

Phone: (202) 966-7300

Fax: (202) 966-2891

http://www.aacap.org/