Types of ADHD
Signs and Symptoms of ADHD
Inattention and hyperactivity / impulsivity are the key behaviors of ADHD. Some people with ADHD have problems with only one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.
In preschool, the most common ADHD symptom is hyperactivity.
It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:
- Are more severe
- Occur more often
- Interfere with or reduce the quality of how they functions socially, at school, or in a job
Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus and is disorganized; and these problems are not due to defiance or lack of comprehension.
Signs & Symptoms of Inattention
- Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
- Difficulty listening when spoken to directly
- Difficulty attending to details
- Be easily distracted by unrelated thoughts or stimuli
- Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
- Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
- Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
- Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework
- Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
- Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
Hyperactivity means a person seems to move about constantly, including situations in which it is not appropriate when it is not appropriate, excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with their activity.
Signs & Symptoms of Hyperactive-Impulsivity
- Fidget and squirm in their seats
- Leave their seats in situations when staying seated is expected, such as in the classroom
- Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless
- Be unable to play or engage in hobbies quietly
- Be constantly in motion or “on the go,” or act as if “driven by a motor”
- Talk nonstop
- Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in conversation
- Have trouble waiting his or her turn
- Interrupt or intrude on others, for example in conversations, games, or activities
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.
Causes of ADHD
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.
Incidence of 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.
Diagnosis of ADHD
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.
Treatment of ADHD
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:
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.
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 “timeout”
- 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.