Attention-deficit/hyperactivity disorder (ADHD) is poor or short attention span and/or excessive activity and impulsiveness inappropriate for the child's age that interferes with functioning or development.
The symptoms of ADHD range from mild to severe and can become exaggerated or become a problem in certain environments, such as at home or at school. The constraints of school and organized lifestyles make ADHD a problem, whereas in prior generations, the symptoms may not have interfered significantly with children's functioning because people had different expectations about normal childhood behavior. Although some of the symptoms of ADHD can also occur in children withoutADHD, they are more frequent and severe in children with ADHD.
CausesResearch indicates that the disorder likely involves abnormalities in neurotransmitters (substances that transmit nerve impulses within the brain). ADHD has no known single specific cause, but genetic (inherited) factors are often present. Some other risk factors include low birth weight (under 3 lb [1500 g]), head injury, brain infection, and lead exposure, as well as exposure to alcohol, tobacco, and cocaine before birth.
Some people have raised concerns about whether food additives and sugar may cause ADHD. Although some children seem to become overactive or impulsive after eating foods containing sugar, studies have confirmed that ADHD is present at birth and that food and environmental factors do not cause the disorder.
SymptomsADHD is primarily a problem with sustained attention, concentration, and task persistence (ability to finish a task). Affected children may also be overactive and impulsive. Preschool children with ADHDmay have problems with communication and appear to have social interaction problems. As children reach school age, they may seem inattentive. They may fidget and squirm. They may be impulsive and talk out of turn. During later childhood, such children may move their legs restlessly, move and fidget their hands, talk impulsively, and forget easily, and they may be disorganized. They are generally not aggressive.
Signs of ADHDAll signs do not have to be present for a diagnosis of attention-deficit/hyperactivity disorder (ADHD). However, signs of inattention must always be present for a diagnosis. Signs must be present in two or more situations (for example, at home and at school) and must interfere with social or academic functioning.
Signs of inattention:
Affected children may have issues with self-esteem, depression, anxiety, or opposition to authority by the time they reach adolescence. About 60% of young children have such problems as temper tantrums, and most older children have a low tolerance for frustration.
DiagnosisThe diagnosis is based on the number, frequency, and severity of symptoms. Symptoms must be present in at least two separate environments (typically, home and school)—occurrence of symptoms just at home or just at school and nowhere else does not qualify as ADHDbecause such symptoms may be caused by the specific situation. Symptoms must also be more pronounced than would be expected for the child's developmental level. Often, diagnosis is difficult because it depends on the judgment of the observer. Also, children who are primarily inattentive may escape notice until their academic performance becomes adversely affected.
There is no laboratory test for ADHD. Questionnaires about various aspects of behavior can help doctors and psychologists make the diagnosis. Because learning disabilities are common, many children receive psychologic testing both to help determine whetherADHD exists and to detect the presence of a specific learning disability, either as a cause for inattention or as a co-existing problem.
ADHD: Epidemic or Over-Diagnosis?An increasing number of children are diagnosed with attention-deficit/hyperactivity disorder (ADHD). However, there is concern among doctors and parents that many children are misdiagnosed. A high activity level may be completely normal and simply an exaggeration of normal childhood temperament. Alternatively, it may have a variety of causes, including emotional disorders or abnormalities of brain function, such as ADHD.
Generally, 2-year-olds are active and seldom stay still. A high activity and noise level is common up until age 4. In these age groups, such behavior is normal. Active behavior can cause conflicts between parents and child and may worry parents. It also can create problems for others who supervise such children, including teachers.
Determining whether a child's activity level is abnormally high should not simply depend on how tolerant the annoyed person is. However, some children are clearly more active than average. If the high activity level is combined with short attention span and impulsivity, it may be defined as hyperactivity and considered part of ADHD.
Scolding and punishing children whose high activity level is within normal developmental limits usually backfires, increasing the child's activity level. Avoiding situations in which the child has to sit still for a long time or finding a teacher skilled in coping with such children may help. If simple measures do not help, a medical or psychologic evaluation may be useful to rule out an underlying disorder such as ADHD.
Prognosis and TreatmentChildren with ADHD generally do not outgrow their inattentiveness, although children with hyperactivity tend to become somewhat less impulsive and hyperactive with age. However, most adolescents and adults learn to adapt to their inattentiveness. Other problems that emerge or persist in adolescence and adulthood include poor academic achievement, disorganization (known as poor executive skills), low self-esteem, anxiety, depression, and difficulty in learning appropriate social behaviors. Importantly, the vast majority of children withADHD become creative and productive adults, and people who have ADHD may adjust better to work than to school situations. However, if the disorder is untreated in childhood, the risk of alcohol or substance abuse or suicide may increase.
Drug therapy:Psychostimulant drugs are the most effective drug treatment. Methylphenidate
and otheramphetamine
-like drugs are the psychostimulants most often prescribed. They are equally effective and have similar side effects. A number of slow-release (longer-acting) preparations are available in addition to the regular forms and allow for once-daily dosing. Side effects include
A number of other drugs can be used to treat inattentiveness and behavioral symptoms. These drugs include atomoxetine (a non-stimulant ADHD medicine); certain drugs typically used for high blood pressure such as clonidine
and guanfacine
; antidepressants; and antianxiety drugs. Sometimes, a combination of drugs is used.
Behavior management:To minimize the effects of ADHD, structures, routines, a school intervention plan, and modified parenting techniques are often needed. Children without significant behavior challenges may benefit from drug treatment alone. However, stimulants do not work around the clock, so adaptations may be needed to help with organizational and other skills. Behavioral therapy conducted by a child psychologist is sometimes combined with drug treatment.
- ADHD is a brain disorder that is present from birth or develops shortly after birth.
- Some children mainly have difficulty with sustained attention, concentration, and ability to complete tasks; some children are overactive and impulsive,: some are both.
- Doctors use questionnaires completed by parents and teachers as well as observations of the child to make the diagnosis.
- Psychostimulant drugs plus structured environments, routines, a school intervention plan, and modified parenting techniques are often needed.
The symptoms of ADHD range from mild to severe and can become exaggerated or become a problem in certain environments, such as at home or at school. The constraints of school and organized lifestyles make ADHD a problem, whereas in prior generations, the symptoms may not have interfered significantly with children's functioning because people had different expectations about normal childhood behavior. Although some of the symptoms of ADHD can also occur in children withoutADHD, they are more frequent and severe in children with ADHD.
CausesResearch indicates that the disorder likely involves abnormalities in neurotransmitters (substances that transmit nerve impulses within the brain). ADHD has no known single specific cause, but genetic (inherited) factors are often present. Some other risk factors include low birth weight (under 3 lb [1500 g]), head injury, brain infection, and lead exposure, as well as exposure to alcohol, tobacco, and cocaine before birth.
Some people have raised concerns about whether food additives and sugar may cause ADHD. Although some children seem to become overactive or impulsive after eating foods containing sugar, studies have confirmed that ADHD is present at birth and that food and environmental factors do not cause the disorder.
SymptomsADHD is primarily a problem with sustained attention, concentration, and task persistence (ability to finish a task). Affected children may also be overactive and impulsive. Preschool children with ADHDmay have problems with communication and appear to have social interaction problems. As children reach school age, they may seem inattentive. They may fidget and squirm. They may be impulsive and talk out of turn. During later childhood, such children may move their legs restlessly, move and fidget their hands, talk impulsively, and forget easily, and they may be disorganized. They are generally not aggressive.
Signs of ADHDAll signs do not have to be present for a diagnosis of attention-deficit/hyperactivity disorder (ADHD). However, signs of inattention must always be present for a diagnosis. Signs must be present in two or more situations (for example, at home and at school) and must interfere with social or academic functioning.
Signs of inattention:
- Often fails to pay close attention to details
- Has difficulty sustaining attention in work and play
- Does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish tasks
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
- Often loses things
- Is easily distracted by extraneous stimuli
- Is often forgetful
- Often fidgets with hands or feet or squirms
- Often leaves seat in classroom and elsewhere
- Often runs about or climbs excessively
- Has difficulty playing or engaging in leisure activities quietly
- Is often on the go or acts as if “driven by a motor”
- Often talks excessively
- Often blurts out answers before questions have been completed
- Often has difficulty waiting to take turns
- Often interrupts or intrudes on others
Affected children may have issues with self-esteem, depression, anxiety, or opposition to authority by the time they reach adolescence. About 60% of young children have such problems as temper tantrums, and most older children have a low tolerance for frustration.
DiagnosisThe diagnosis is based on the number, frequency, and severity of symptoms. Symptoms must be present in at least two separate environments (typically, home and school)—occurrence of symptoms just at home or just at school and nowhere else does not qualify as ADHDbecause such symptoms may be caused by the specific situation. Symptoms must also be more pronounced than would be expected for the child's developmental level. Often, diagnosis is difficult because it depends on the judgment of the observer. Also, children who are primarily inattentive may escape notice until their academic performance becomes adversely affected.
There is no laboratory test for ADHD. Questionnaires about various aspects of behavior can help doctors and psychologists make the diagnosis. Because learning disabilities are common, many children receive psychologic testing both to help determine whetherADHD exists and to detect the presence of a specific learning disability, either as a cause for inattention or as a co-existing problem.
ADHD: Epidemic or Over-Diagnosis?An increasing number of children are diagnosed with attention-deficit/hyperactivity disorder (ADHD). However, there is concern among doctors and parents that many children are misdiagnosed. A high activity level may be completely normal and simply an exaggeration of normal childhood temperament. Alternatively, it may have a variety of causes, including emotional disorders or abnormalities of brain function, such as ADHD.
Generally, 2-year-olds are active and seldom stay still. A high activity and noise level is common up until age 4. In these age groups, such behavior is normal. Active behavior can cause conflicts between parents and child and may worry parents. It also can create problems for others who supervise such children, including teachers.
Determining whether a child's activity level is abnormally high should not simply depend on how tolerant the annoyed person is. However, some children are clearly more active than average. If the high activity level is combined with short attention span and impulsivity, it may be defined as hyperactivity and considered part of ADHD.
Scolding and punishing children whose high activity level is within normal developmental limits usually backfires, increasing the child's activity level. Avoiding situations in which the child has to sit still for a long time or finding a teacher skilled in coping with such children may help. If simple measures do not help, a medical or psychologic evaluation may be useful to rule out an underlying disorder such as ADHD.
Prognosis and TreatmentChildren with ADHD generally do not outgrow their inattentiveness, although children with hyperactivity tend to become somewhat less impulsive and hyperactive with age. However, most adolescents and adults learn to adapt to their inattentiveness. Other problems that emerge or persist in adolescence and adulthood include poor academic achievement, disorganization (known as poor executive skills), low self-esteem, anxiety, depression, and difficulty in learning appropriate social behaviors. Importantly, the vast majority of children withADHD become creative and productive adults, and people who have ADHD may adjust better to work than to school situations. However, if the disorder is untreated in childhood, the risk of alcohol or substance abuse or suicide may increase.
Drug therapy:Psychostimulant drugs are the most effective drug treatment. Methylphenidate
and otheramphetamine
-like drugs are the psychostimulants most often prescribed. They are equally effective and have similar side effects. A number of slow-release (longer-acting) preparations are available in addition to the regular forms and allow for once-daily dosing. Side effects include
- Sleep disturbances (such as insomnia)
- Appetite suppression
- Depression, sadness, or anxiety
- Headaches
- Stomachaches
- High blood pressure
A number of other drugs can be used to treat inattentiveness and behavioral symptoms. These drugs include atomoxetine (a non-stimulant ADHD medicine); certain drugs typically used for high blood pressure such as clonidine
and guanfacine
; antidepressants; and antianxiety drugs. Sometimes, a combination of drugs is used.
Behavior management:To minimize the effects of ADHD, structures, routines, a school intervention plan, and modified parenting techniques are often needed. Children without significant behavior challenges may benefit from drug treatment alone. However, stimulants do not work around the clock, so adaptations may be needed to help with organizational and other skills. Behavioral therapy conducted by a child psychologist is sometimes combined with drug treatment.