Attention-Deficit/Hyperactivity Disorder (ADHD)

By: Tina Shahian, PhD

Last Updated: Mar 1, 2019

Overview

An estimated 4-12% of children suffer from attention-deficit/hyperactivity disorder (ADHD), a chronic neurological condition characterized by hyperactive, inattentive and/or impulsive behavior. Children with ADHD often face challenges at school and with their friends, and many suffer from other behavioral disorders as well. Signs of ADHD are usually noticeable in children by the age of 7.

There are three main types of ADHD:

• Combined type: hyperactive and impulsive behavior with inattention/distractibility. This is the most common form of ADHD.
• Impulsive/hyperactive type: hyperactive and impulsive behavior, without inattention/distractibility. This is the least common form of ADHD.
• Inattentive/distractible type: Inattention and distractibility without hyperactivity.

There is no cure for ADHD. Medication and behavior therapy are used to help patients control symptoms and lead functional lives. Although ADHD is a childhood condition, the symptoms can last into adulthood.

Causes

The exact cause of ADHD is not known but research suggests that genetics is a factor. ADHD symptoms seem to run in families and often affect siblings within the same family. Boys are also more likely to have ADHD. Physiological characteristics of ADHD have been observed in brain images from patients, which show lower metabolism in areas that control attention.

Other ADHD risk factors include:

• Family history of ADHD or mental disorder
• Exposure to environmental toxins such as lead
• Risk to fetus when mother smokes, consumes alcohol or is exposed to environmental toxins during pregnancy
• Premature birth or low birth weight
• Brain injury
• Being male.

Currently, there is not enough scientific evidence to link ADHD with excessive dietary sugar, television viewing or particular parenting styles.

Symptoms

The main symptoms of ADHD are hyperactivity, inattention and impulsiveness. Such behavior is typical of most healthy preschool-aged children. What distinguishes a normal child from one with ADHD is the frequency and severity of symptoms. In an ADHD patient, these symptoms persist for at least six months and interfere with adaptive functioning at home and at school. A child with ADHD typically displays at least 6 of the following symptoms:

Hyperactivity

• Constantly moving (e.g. running, jumping)
• Cannot remain seated
• Fidgeting and/or squirming excessively
• Inability to focus on one task
• Inability to remain quiet
• Forgetfulness.

Inattention

• Short attention span
• Poor listening skills
• Easily distracted
• Forgetfulness
• Cannot get organized
• Inability to focus on details
• Poor academics.

Impulsiveness

• Speaking or acting out of turn in class or during organized activities
• Taking risks without careful thought.

Diagnosis and Treatment

To diagnose ADHD, a physician will thoroughly evaluate a child’s family history and behavior via interviews and detailed questionnaires. Neurological and psychological testing may also be necessary for an accurate diagnosis. It is easy to mistake a normal child’s active tendencies with those of ADHD. To further complicate matters, the symptoms of ADHD share some overlap with those of other behavioral disorders, some of which may present concurrent with ADHD. A child with ADHD displays at least six symptoms of hyperactivity, inattention and impulsiveness, and is not able to function at home or at school. ADHD is generally diagnosed in children by the age of 7. Diagnosing preschool-age or younger children is difficult and often requires the expertise of other pediatric specialists.

Treatment for ADHD varies depending on the child’s age and symptoms, and involves a combination of medication and behavior therapy. Patients who suffer from depression, anxiety or other disorders may also benefit from regular counseling.

Behavior management by itself cannot correct overall hyperactive, inattentive or impulsive symptoms.  However, in conjunction with medication, it can help control specific symptoms (e.g. helping a child keep their hands to themselves). Behavior therapy is a team effort - it requires the participation of parents, other caregivers and teachers. Examples include:

• Behavior therapy. Parents, caregivers and teachers adopt a systematic approach to help the child correct his or her behavior. This can include creating a daily routine for eating/sleeping, using a reward system to reinforce positive behavior and removing privileges to discourage negative behavior. Specialized training is also available to help children develop better social skills.
• Psychotherapy. Talking about daily challenges raises self-awareness in children and helps with symptom management.
• Parental training/family therapy. Specialized training or therapy sessions help parents of children with ADHD avoid personal stress and be more effective caregivers.

The drugs routinely used to treat ADHD are called psychostimulants because they reduce symptoms by stimulating the brain to focus. Depending on the time of day, either short-acting (1-4 hours) or long-acting (8-9 hours) stimulant medication is used. For example, a long-lasting drug allows a child to focus during school hours. Psychostimulant drugs have been used to manage ADHD symptoms for over 50 years, often with great success. Most associated side effects are mild, but it is very important to use the medication as directed. The different types of medications are:

• Methylphenidate (Concerta®, Metadate®, Ritalin®)
• Dextroamphetamine (Dexedrine®, Dextrostat®)
• Lisdexamfetamine (Vyvanse®)
• Dextroamphetamine-amphetamine (Adderall XR®)
• Atomoxetine (Strattera®; a non-stimulant drug for mood swings).

Prevention

Currently there is no way to prevent ADHD. Children and pregnant women (due to the risk to fetus) should avoid exposure to smoke and environmental toxins to reduce risks. Early detection and treatment help children adapt better in school and other social environments.

Sources

• “Attention-deficit/hyperactivity disorder (ADHD)”. National Institutes of Health (NIH). Retrieved Jun 5, 2015. http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml#part_145444.
• “Attention-deficit/hyperactivity disorder (ADHD) in children”. Mayo Clinic Foundation. Retrieved Jun 5, 2015. http://www.mayoclinic.org/diseases-conditions/adhd/basics/definition/con-20023647.
• “Attention-deficit/hyperactivity disorder (ADHD)”. Centers for Disease Control and Prevention (CDC). Retrieved Jun 5, 2015. http://www.cdc.gov/ncbddd/adhd/facts.html.
• “Attention-deficit/hyperactivity disorder (ADHD) in children”. Stanford Children’s health. Retrieved Jun 5, 2015. http://www.stanfordchildrens.org/en/topic/default?id=attention-deficit-hyperactivity-disorder-adhd-in-children-90-P02552.