What is Attention Deficit Hyperactivity Disorder (ADHD)?
Attention-Deficit/Hyperactivity Disorder (ADHD) is a brain disorder. It is described as difficulties with focus, activity level or impulse control to the point that a person struggles at home, in school or with other people their age.
What are the Different Types of ADHD?
- Inattentive Type – having a hard time focusing, finishing the things they start or staying organized
- Hyperactive-Impulsivity Type – moving constantly, excessive talking, acting without thinking
- Combined Type – struggling with both focusing and with controlling your body, feeling restless or being impulsive
What are Signs and Symptoms of ADHD?
Difficulties focusing, finishing the things they start, being organized (inattention), feeling restless, having a hard time waiting their turn, and often interrupting or talking over others (hyperactive/impulsive) are the key behaviors of ADHD. Some people with ADHD only have problems with one of these areas. For instance, someone can still have ADHD even if all they struggle with is focusing. Others struggle with both—having a hard time focusing and finishing things, and having a hard time controlling their body or making good choices. Most children diagnosed with ADHD have the “combined” type. It is common for high levels of activity to be the first sign of ADHD when children are in preschool, although young children may also struggle with their focus and attention. It is normal to have some of these symptoms. Everyone struggles to focus sometimes! However, for people with ADHD, these symptoms:
- are more severe
- occur more often
- get in the way or lower how well they function socially, at school or in a job
Signs and Symptoms of Inattention:
- Overlooks or misses details. Makes careless mistakes in schoolwork, at work or during other activities.
- Has a hard time listening when talked to directly.
- Lacks attention to details. Easily distracted by unrelated thoughts or things.
- Has problems paying attention in tasks or play. This includes conversations, lectures or lengthy reading.
- Does not follow through on instructions. Fails to finish schoolwork, chores or other responsibilities.
- Starts tasks but quickly loses focus. Gets easily distracted.
- Has problems organizing tasks and activities.
- Has trouble with order. Work is messy and they may struggle with time management.
- Avoids or dislikes tasks that need sustained mental effort, such as schoolwork or homework.
- Loses things that are needed for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses and cell phones.
- Is forgetful in daily activities, such as chores, errands, returning calls and keeping appointments.
Signs and Symptoms of Hyperactive-Impulsivity:
- Fidgets and squirms in their seat.
- Leaves their seat in situations when staying seated is expected, such as in the classroom.
- Runs around or climbs in situations where it is inappropriate. In teens and adults, this might shift to feelings of restlessness.
- Being unable to play or engage in hobbies quietly (singing, humming, making sudden loud noises).
- Constantly in motion or “on the go,” or act as if “driven by a motor.”
- Talk nonstop.
- Blurting out an answer before a question has been completed. Finishing other people’s sentences or speaking without waiting for a turn in conversation.
- Having trouble waiting their turn (in lines, to use something, in games).
- Interrupts or intrudes on others. This may be in conversations, games or activities.
The symptoms of ADHD may look like other medical conditions or behavior problems. Always talk to your child's doctor or mental health professional to discuss symptoms.
What Causes ADHD?
The exact cause of ADHD is unknown. Research shows a combination of genes (what a child is born with) and environment (things that happen to a child) play a role in whether someone develops ADHD. Risk factors that might make ADHD more likely include:
- Cigarette smoking
- Alcohol use
- Drug use during pregnancy
- Exposure to environmental toxins during pregnancy
- Exposure to environmental toxins, such as high levels of lead, at a young age
- Low birth weight
- Brain injuries
How Common is ADHD?
ADHD is the most diagnosed behavior disorder of childhood. Estimates suggest that between 3% and 9% of all children have ADHD. It is more common in boys than in girls. Many parents of children with ADHD had symptoms of ADHD when they were younger. ADHD is sometimes found in siblings within the same family.
How is ADHD Diagnosed?
A pediatrician, child psychiatrist, psychologist or a mental health professional is usually the one to identify ADHD in children.
There is no single test for ADHD. Currently, the gold standard for diagnosing ADHD is a combination of:
- Rating forms filled out by parents and teachers
- An interview with parents to discuss the child and their history
- Observations of the child’s behavior
- Other tests may be used in some cases to rule out other conditions. For example, if there is a concern about a learning disability, intellectual (IQ) and achievement (reading, writing, math) testing may be conducted. Other psychological, neurological or physical testing may also be used to rule out other conditions.
How is ADHD Treated?
Treatment for ADHD will be determined by your child's doctor based on:
- Your child's age, overall health and medical history
- 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 how to change parent behavior or the environment to support the child’s focus and activity levels
- Medication management
Treatment may include:
Medication Treatment
Psychostimulants (also known as stimulants) are the most-used ADHD medicines. Although these drugs are called stimulants, they have a calming effect in people with ADHD. These medicines are used for their ability to increase the level of chemicals in the brain that help the child to better maintain attention and show greater self-control. They have been shown to give the greatest improvement in the core symptoms of ADHD (inattention, impulsivity and hyperactivity). Treatment with a psychostimulant is highly effective in 75% to 90% of children with ADHD.
Stimulants take effect in the body quickly. They work for four to 12 hours depending on whether the child takes a short-acting or a long-acting (“extended release”) type. Current research suggests that most children with ADHD who respond to medicine benefit most from taking it every day, as it can have a positive impact not just at school but also in their behavior at home and other social settings.
The best way to start a stimulant medication is to start at the lowest dose, then “titrate” upward, or slowly increase the dose until you see the most benefit (improved attention, focus, learning, activity level), with the least side effects. You do this with your doctor. Finding the right dose is sometimes trial and error, as the best dose is not always based on the child’s weight.
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. These include nausea, reduced appetite and headaches. If your child has side effects, contact your healthcare provider right away. Most side effects of stimulant use are mild. They may decrease with regular use and respond to dose changes.
Psychosocial Treatments
Parenting children with ADHD may be difficult. It can have 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 improve the child's functioning at home. These classes can also help reduce stress for all family members.
Training in behavior management skills for parents happens in a group setting. This encourages parent-to-parent support. Behavior management skills may include the following:
- How to catch your child being good
- How to give directions in a way that makes your child more likely to follow them
- Increasing your child’s motivation to be independent in daily routines, like getting ready for bed
- Increasing communication between home and school
- Setting up a homework routine to support success
- Providing consequences for more serious behaviors (like physical aggression)
- Teachers may also be taught behavior management skills to use in the classroom setting. Training for teachers usually includes using daily behavior reports that communicate in-school behaviors to parents.
Behavior management techniques tend to improve targeted behaviors (such as completing schoolwork or keeping the child's hands to themself.) They can also significantly improve the relationship between parents and their children.
Recent research suggests that children may experience some benefits if the family starts with behavioral training first and then introduces medication later. Benefits include a lower dose of medication needed and more improvement in functioning (academic performance, relationships with others) once the medication is started.
Can ADHD Be Prevented?
There are no known ways to prevent ADHD from developing. Knowing early whether a child has ADHD can help significantly. Partnering early on to help support our children—with teachers, doctors, and other family members— helps give our children a strong foundation to build successful relationships, learn and grow.
