Attention Deficit Hyperactivity Disorder | ADHD
Learn More:
Doctor Interview
Listen to Robert A. Kowatch, MD, PhD, Director, Pediatric Mood Disorders Center at Cincinnati Children's, explain attention deficit hyperactivity disorder (ADHD). Listen to this segment:
Radio Segment
Steve Muething, MD, associate director of clinical services in the Division of General and Community Pediatrics, can be heard weekly on Your Child's Health. On August 25, 2004, he spoke about ADHD and Hygiene. Listen to this segment:
What is ADHD? | Types | Causes | Who is affected? | Symptoms | Diagnosis | Treatment | Prevention
What is attention deficit hyperactivity disorder (ADHD)?
Attention-Deficit/Hyperactivity Disorder (ADHD) is a behavior disorder, usually first diagnosed in childhood, which is characterized by persistent problems with inattention and/or impulsivity and hyperactivity. These difficulties must be present in two or more settings (e.g., home, school, work, social), and must occur with sufficient frequency and severity as to interfere with the person's ability to function in an age-appropriate manner.
The symptoms of hyperactivity and impulsivity, when present, are almost always apparent by the age of 7 and may be apparent in very young preschoolers. These symptoms often interfere with the child's ability to interact appropriately with peers, siblings, and adults; to follow rules and instructions; and to not engage in behaviors which may be physically dangerous. In contrast, the symptoms of inattention are often not evident until a child faces the demands and expectations of elementary school.
What are the different types of ADHD?
Three major types of ADHD include the following:
ADHD, combined type
This is the most common type of ADHD and is characterized by significant and persistent problems with inattention and distractibility as well as impulsive and hyperactive behaviors.
ADHD, predominantly Inattentive Type
This type of ADHD is characterized by the presence of significant and persistent problems with inattention and distractibility in the absence of significant problems with hyperactivity or impulsivity. While not as well studied as the Combined Type, recent research suggests 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 and is characterized by significant and persistent problems with impulsivity and hyperactivity without significant symptoms of inattention and distractibility.
What causes Attention-Deficit/Hyperactivity Disorder?
ADHD is one of the most researched areas in child and adolescent mental health. However, the precise cause of the disorder is still unknown.
The available research evidence strongly suggests that ADHD is a brain-based biological disorder that is genetic. Low levels of neurotransmitters (types of brain chemicals) in certain areas of the brain are thought to be related to the presence of ADHD in children (but there is no blood test for this).
A growing body of brain imaging research is identifying differences in areas of the brain in individuals with ADHD compared to those who do not have ADHD. For example, research using brain imaging show that brain metabolism and brain activation patterns n children with ADHD are lower in the areas of the brain that are involved in attentional functioning, impulse control, and motivation/arousal. While current brain imaging technology has proved useful in identifying differences between groups of individuals with and without ADHD, it has not been found to be helpful in the diagnosis of individuals.
Who is affected by Attention-Deficit/Hyperactivity Disorder?
Estimates suggest that between 3 and 9 percent of all children have ADHD. It is more common in boys than in girls with the ratio estimated between 2:1 and 9:1, depending on the type of ADHD (e.g., lower ratios found when looking at the predominantly Inattentive Type versus Combined Type) and the type of sample (clinic versus community) used.
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 families seek help when their child's symptoms begin to interfere with learning and adjustment to the expectations of school and other age-appropriate activities (e.g., getting along with peers).
What are the symptoms of Attention-Deficit/Hyperactivity Disorder?
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 frequently and interfere with learning, school adjustment, and, sometimes, with the child's relationships with others. Symptoms may persist through adolescence and into adulthood. It is estimated that 30-50% 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 the following:
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.
How is Attention-Deficit/Hyperactivity Disorder diagnosed?
ADHD is the most commonly diagnosed behavior disorder of childhood. 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, 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 as well as to assess for the presence of other emotional or behavioral difficulties, is the "gold standard" for diagnosing ADHD.
Other tests may be used in some cases in order to rule out other conditions. For example, if there is a concern about a possible learning disability, intellectual and achievement testing may be conducted in order to assess for this. Other psychological, neurological, or physical testing may also be used in order 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.
How is Attention-Deficit/Hyperactivity Disorder treated?
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
Major components of treatment for children with ADHD include parental support and education in behavioral training, appropriate school placement and medication (typically psychostimulants).
Treatment may include:
Pharmacological Treatment
Psychostimulant medications, 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, 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 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 as their short-acting counterpart), and then leave the body quickly.
There are currently four different types of psychostimulants that are commonly used to treat ADHD:
- Methylphenidate (the active ingredient in Ritalin", Concerta" , Metadate CD", Daytrana")
- Dexmethylphenidate (the active ingredient in Focalin" and Focalin XR")
- Dextroamphetamine (the active ingredient in Dexedrine")
- A mixture of amphetamine salts (the active ingredient Adderall" and Adderall XR")
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 it's positive impact not just at school but also in their behavior at home and other social settings.
The common side effects of stimulants may include, but are not limited to, the following:
- Trouble sleeping
- Decreased appetite
- Anxiousness
- Stomachaches
- Headaches
- Stimulant rebound behavior (when the effect of the stimulant wears off, hyperactive and impulsive behviors may increase for a short period of time)
Most side effects of stimulant use are mild, decrease with regular use and respond to dose changes. Always discuss potential side effects with your child's physician.
Atomoxetine (Strattera™) is currently the only FDA-approved non-stimulant medication for the treatment of ADHD. While some children respond well to Strattera, others find it not as beneficial as the stimulants or experience side effects which prevent them from continuing on the medication. Unlike the stimulants, Atomoxetine has to build up in the system over the course of 4-6 weeks before seeing it's full benefit.
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 Atomoxetine) 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 the following:
- Use of "time out"
- Point systems
- Contingent attention (responding to child with positive attention when desired behaviors occur; withholding attention when undesired behaviors occurs)
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.
Prevention of Attention Deficit Hyperactivity Disorder
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 experienced by children or adolescents with ADHD.
Rev. 6/05, 7/07
