Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a set of chronic conditions marked by an inability to pay attention, hyperactivity and impulsive acts. It begins in childhood and can affect all areas of a patient’s life. Between 3 and 5 percent of school-aged children – or about 2 million children in the United States – have ADHD, according to the National Institute of Mental Health (NIMH). Boys outnumber girls by at least a three to one ratio, according to Mental Health America.

For many years, controversy has surrounded ADHD as some experts have differed over exactly what constitutes ADHD. In recent years, the NIMH has declared definitively that ADHD is a mental health condition.

Children with ADHD may develop low self-esteem resulting from difficulties in their relationships and struggles at school associated with the condition. Although ADHD always begins in childhood, it may persist into adulthood.

In some children, ADHD symptoms will diminish over time, but others will experience symptoms well into adulthood. Medications, psychotherapy and the support of family, teachers and other adults can help children to meet the challenges presented by ADHD.

There are three major types of attention deficit hyperactivity disorder (ADHD). They include:

Some people use the term ADD to refer to attention-deficit disorder. However, this term is not used officially by the APA.

Although the causes of attention deficit hyperactivity disorder (ADHD) are not fully understood, increasing numbers of experts believe that changes in brain structure are a leading cause of the disease. Brain scans have shown alterations of neural pathways that normally carry messages transmitted by the neurotransmitter dopamine. Normally, these messages reach the brain and affect attention, movement and motivation. However, impairment to these neural pathways may prevent the messages from reaching the brain, leading to inattention, lack of planning, increased impulsivity of behavior and lack of motor control.

Other brain scans have found that patients with ADHD have lower levels of metabolic activity in the areas of the brain that dictate attention, social judgment and movement.

Additional factors that may contribute to the development of ADHD include:

Earlier theories suggested that minor head injuries or brain damage caused by infections or birthing complications might be responsible for ADHD. However, experts have not found evidence to support this hypothesis. Theories that too much or too little sugar may cause ADHD also appear to be unfounded.

Poor parenting skills do not cause a child’s ADHD. Nonetheless, problems in the home or difficulties in school or community environments can exacerbate ADHD.

Attention deficit hyperactivity disorder (ADHD) typically manifests in an inability for a child to consistently pay attention coupled with hyperactive and impulsive behavior. The first symptoms are likely to appear between the ages of 4 and 6, although in many cases it is not apparent until the child begins school. Symptoms of hyperactivity and impulsiveness typically precede inattention by up to a year or more.

Inattention may become evident in careless mistakes during schoolwork or an inability to properly listen to the conversation or direction of others. Children with ADHD frequently struggle to finish tasks and are often forgetful. Rather than appearing hyperactive, children who struggle predominantly with inattention may appear sluggish, passive and unmotivated.

Hyperactive children may fidget excessively or squirm in their seats. They may run or climb a lot and have difficulty playing quietly. Excessive talking and interrupting of others also are typical signs of hyperactivity.

A child with ADHD is unlikely to display all of the symptoms associated with the disorder. Gender may also play a role in which symptoms are exhibited. For example, boys are more likely to be hyperactive whereas girls are more likely to be inattentive. In regard to inattentiveness, girls are more likely to daydream whereas boys are more likely to play aimlessly.

Children with ADHD are often more sensitive to various sights, sounds and textures than those without the disorder. When a child with ADHD becomes overstimulated, they may lose control in a way that manifests as aggressive behavior or giddiness. Children with ADHD may have difficulty making friends and developing other meaningful relationships. This is at least partially because they have difficulty following rules and waiting their turn, and may talk excessively. These qualities may be off-putting to peers.

Children with ADHD are at much higher risk of academic difficulty than other children. Between 40 and 60 percent of children with ADHD have major learning difficulities, according to the National Mental Health Association. Hyperactivity, poor organizational skills and difficulty paying attention may all contribute to this lack of school success.

Minor trauma, such as fractures and lacerations, is also more common in children with ADHD. Teenagers with ADHD are significantly more likely to be involved in automobile accidents than those without ADHD. Troublesome behaviors such as delinquency or drug and alcohol abuse may also be associated with some people with untreated ADHD.

Parents are usually urged to contact a physician if their child is having trouble concentrating, remaining still or behaving properly. Despite the fact that symptoms of ADHD appear before age 7, many experts agree that ADHD should not be diagnosed in a child prior to age 7. This is because many of the symptoms associated with ADHD are often present in a milder form in younger children who do not have the condition. For example, children and adolescents are often noted for having higher energy levels and shorter attention spans than adults.

Diagnosing ADHD is not easy. There is no single test that reveals the presence of the disorder. A physician will perform a complete physical examination and compile a thorough medical history. The physician may use questionnaires or interviews with parents, teachers, babysitters, coaches and others who may describe behaviors typically associated with ADHD. Teachers in particular may be asked to record their observations on standard evaluation forms called behavior rating scales. These forms take advantage of a teacher’s experience working with various children by asking the teacher to compare the child’s behavior to others of the same age group. The physician will look for behaviors that have a long history, and will note when they occur.

Standardized testing also may be used to evaluate a child’s mental health status, intelligence level, learning abilities and social adjustment.

Before diagnosing ADHD, the physician will rule out other potential causes of symptoms. Sleep disorders such as sleep apnea (temporary cessation of breathing during sleep) are frequently the cause of inattention in children. Other disorders that cause symptoms similar to ADHD include hyperthyroidism (excessive production of thyroid hormone), seizure disorders, and vision or hearing problems. Sudden life changes (such as the death of a loved one) can also cause emotional disruption in children that may appear similar to ADHD.

A diagnosis of ADHD is often made in concert with other health professionals such as psychiatrists, developmental and behavioral pediatricians, and behavioral neurologists. Parents are urged to seek out the care of health professionals who have experience in diagnosing children with ADHD.

A diagnosis of ADHD is made according to certain criteria established by the American Psychiatric Association. Patients should exhibit six or more symptoms in at least one of two categories that persist for at least six months and that are maladaptive and inconsistent with developmental level.

These symptoms should be present before the age of 7, and the impairment should be present in two or more settings.

In addition, the patient must have clinically significant impairment in social, academic or occupational functioning, and symptoms cannot be due to an autistic spectrum disorder, schizophrenia, or another psychotic disorder and cannot be better accounted for by another mental disorder.

Patients are diagnosed with predominantly inattentive ADHD if they have symptoms that fit this category but not the hyperactive-impulsive type over a period of six months. They are diagnosed with hyperactive-impulsive ADHD if the opposite is true. Finally, the patient will be diagnosed with combined ADHD if the criteria from both of the two major categories are met over a period of six months.

Children who are diagnosed with ADHD are often diagnosed with another form of mental illness. Some disorders that may be diagnosed in association with ADHD include:

Alcohol abuse, cocaine abuse, or amphetamine abuse can occur (perhaps as an attempt to self-medicate for the condition).

Considerable debate remains over the best way to treat attention deficit hyperactivity disorder (ADHD). Medications called psychostimulant drugs are the most common treatment for the disorder, and are believed to boost levels of the neurotransmitter dopamine (associated with activity) and norepinephrine. This improves attention and reduces impulsiveness, hyperactivity and aggressive behavior.

Antidepressants may also be used to treat ADHD, especially in children who are depressed or who do not respond to psychostimulant therapy. However, the U.S. Food and Drug Administration (FDA) recently required that all antidepressants include a label warning that they may increase the risk of suicidal thoughts and behaviors in children.

Children who are treated with medications may consult the physician weekly until it is clear a helpful dosage level has been established. At that point, visits are likely to be scheduled every few months. Parents are urged to consult a physician about any side effects associated with medication use, including loss of appetite, problems sleeping, increased irritability, excessive weight loss and suicidal thoughts. Changes in dosage levels can usually reduce or eliminate these side effects.

Up to 90 percent of children with ADHD respond to medication, according to the National Mental Health Association (NMHA). However, the drugs do not cure ADHD, and many patients find that a combination of medications, special attention in the classroom, and family and community support remain the best treatment approach. About 80 percent of children who take medications for their ADHD continue to need the drugs during their teen years, according to the National Institute of Mental Health (NIMH).

Various forms of therapy including standard psychotherapy, behavior therapy, family therapy and social skills training, may also help relieve ADHD symptoms. Parents may benefit from taking parenting skills training that teach special techniques for addressing the unique challenges of raising a child with ADHD. For example, parents may learn to use a token or point system to reward their child for good behavior. Therapy is particularly helpful for children who are diagnosed with both ADHD and an associated condition such as depression or anxiety.

Parents can help their children to better deal with ADHD by providing structure to the child’s life and making expectations clear. Keeping children on a schedule of activities (including eating, sleeping, homework and play times) and encouraging children’s efforts and good behavior can also help. Parents are urged to communicate with their children to make sure directions are clearly understood. All of these techniques can be improved during parenting skills training.