Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder. It is characterized by ongoing problems with inattention and/or impulsivity and hyperactivity. It is usually first diagnosed in childhood.

Kids who have ADHD have problems staying focused, have trouble sitting still and are impulsive, which means not being able to control behaviors. These symptoms must be present in two or more settings (for example, home, school, and with friends).

The symptoms of hyperactivity and impulsivity are almost always apparent by the age of 7 and may be apparent in very young preschoolers. These symptoms often get in the way of the child's ability to interact appropriately with peers, siblings and adults.

They also affect the child’s ability to follow rules and to not engage in behaviors which may be physically dangerous.  The symptoms of inattention often not do not appear until a child faces the expectations of elementary school.

There are three types of ADHD.

ADHD, Combined Type

This is the most common type of ADHD. Children with this type of ADHD have significant and ongoing problems with inattention and distractibility as well as impulsive and hyperactive behaviors.

ADHD, Predominantly Inattentive Type

Children with this type of ADHD have significant and ongoing problems with inattention and distractibility but do not have significant problems with hyperactivity or impulsivity. While not as well studied as the combined type, recent research shows that there may be as many or more children with the predominantly inattentive type of ADHD as there are children with the combined type.

ADHD, Predominantly Hyperactive-Impulsive Type

This is the least common type of ADHD. Children with this type have significant and ongoing problems with impulsivity and hyperactivity without significant symptoms of inattention and distractibility.

The exact cause of ADHD is still unknown. Research shows a combination of genes and environmental factors likely plays a role in the development of the condition. Imaging studies suggest that the brains of children with ADHD are different from those of children without ADHD.

ADHD is the most commonly diagnosed behavior disorder of childhood. Estimates suggest that between 3 percent and 9 percent of all children have ADHD. It is more common in boys than in girls. Many parents of children with ADHD experienced symptoms of ADHD when they were younger. ADHD is sometimes found in brothers and sisters within the same family.

Most symptoms seen in children with ADHD also occur at times in children without this disorder. However, in children with ADHD, these symptoms occur more often and interfere with learning, school adjustment, and, sometimes, with the child's relationships with others.

Symptoms may persist through the teen years and into adulthood. It is estimated that 30 percent to 50 percent of children diagnosed with ADHD continue to have significant problems into adulthood.

The following are the most common symptoms of ADHD. However, each child may experience symptoms differently. The three categories of symptoms of ADHD include:

Inattention

  • Short attention span for age (difficulty sustaining attention)
  • Difficulty listening to others
  • Difficulty attending to details
  • Easily distracted
  • Forgetful
  • Poor organizational skills for age
  • Poor study skills for age

Impulsivity

  • Often interrupts others
  • Has difficulty waiting for his/her turn in school and/or social games
  • Tends to blurt out answers instead of waiting to be called upon
  • Takes frequent risks, and often without thinking before acting

Hyperactivity

  • Seems to be in constant motion; runs or climbs, at times with no apparent goal except motion
  • Has difficulty remaining in his/her seat even when it is expected
  • Fidgets with hands or squirms when in his/her seat; fidgeting excessively
  • Talks excessively
  • Has difficulty engaging in quiet activities
  • Loses or forgets things repeatedly and often
  • Inability to stay on task; shifts from one task to another without bringing any to completion

The symptoms of ADHD may resemble other medical conditions or behavior problems. Always consult your child's physician or mental health professional for a diagnosis.

A pediatrician, child psychiatrist, psychologist or a qualified mental health professional usually identifies ADHD in children.

There is no definitive test or set of tests for ADHD.  Currently, the “gold standard” for diagnosing ADHD utilizes a combination of a detailed history of the child's behavior from parents and teachers, observations of the child's behavior, and standardized assessment measures to assess for the presence of ADHD symptoms and impairments at home and school.

Other tests may be used in some cases to rule out other conditions. For example, if there is a concern about a possible learning disability, intellectual and achievement testing may be conducted. Other psychological, neurological, or physical testing may also be used to rule out other conditions that may be suspected on the basis of the initial evaluation for ADHD. Consult your child's physician for more information.

Specific treatment for ADHD will be determined by your child's physician based on:

  • Your child's age, overall health and medical history
  • Extent of your child's symptoms and resulting impairments
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Treatment for children with ADHD includes parental support and education in behavioral training, appropriate school placement and medication (typically psychostimulants).

Treatment may include:

Pharmacological Treatment

Psychostimulants (also known as stimulants) are the most commonly used ADHD medicines. Although these drugs are called stimulants, they actually have a calming effect in people with ADHD.  These medications are used for their ability to increase the level of chemicals in the brain that help the child to better maintain attention and exhibit greater self-control. They have been shown to provide the greatest improvement in the core symptoms of ADHD (inattention, impulsivity and hyperactivity). Treatment with a psychostimulant is highly effective in 75 percent to 90 percent of children with ADHD.

Psychostimulants have been used to treat childhood behavior disorders since the 1930s. They have been widely studied. Stimulants take effect in the body quickly, work for one to four hours (in their short-acting forms; extended release formulations usually last two to three times as long), and then leave the body quickly. 

Doses of stimulant medications need to be timed to match the demands of the child's schedule – for example, to help the child pay attention for a longer period of time and improve classroom performance at school, as well as to help with homework and other after-school activities which require age-appropriate attentional functioning and/or self-control. Current research suggests that the majority of children with ADHD who respond to medication benefit most from taking it daily, given its positive impact not just at school but also in behavior at home and other social settings.

There are several different ADHD medicines that may be used alone or in combination. Your healthcare provider will decide which medicine is right based on your child’s symptoms and needs.  Always follow your healthcare provider's instructions on how to take ADHD medicine.  Some ADHD medicines have side effects. If your child has side effects, contact your healthcare provider right away. Most side effects of stimulant use are mild, decrease with regular use and respond to dose changes.

Antidepressant or other psychotropic medications may also be administered for children and adolescents with ADHD (often but not always in combination with a psychostimulant or other medication) to help improve attention while decreasing aggression, anxiety and/or depression.

Psychosocial Treatments

Parenting children with ADHD may be difficult and can present challenges that create stress within the family. Classes in behavior management skills designed to address the special challenges associated with parenting a child with ADHD can help to both improve the child's functioning at home as well as help reduce stress for all family members.

Training in behavior management skills for parents usually occurs in a group setting which encourages parent-to-parent support. Behavior management skills may include:

  • Use of “time out”
  • Point systems
  • Contingent attention (responding to child with positive attention when desired behaviors occur; withholding attention when undesired behaviors occur)

Teachers may also be taught behavior management skills to use in the classroom setting. Training for teachers usually includes use of daily behavior reports that communicate in-school behaviors to parents.

Behavior management techniques tend to improve targeted behaviors (such as completing school work or keeping the child's hands to himself/herself), but are not usually helpful in reducing the child's broader difficulties with inattention, hyperactivity, or impulsivity.

Preventive measures to reduce the incidence of ADHD in children are not known at this time. 

However, early detection and intervention can reduce the severity of symptoms, decrease the interference of behavioral symptoms on school functioning, enhance the child's normal growth and developmental process and improve the quality of life for children or adolescents with ADHD.


Last Updated 08/2013