Attention deficit hyperactivity disorder (ADHD)
Kids with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what's expected of them but have trouble following through because they can't sit still, pay attention, or attend to details.
Of course, all kids (especially younger ones) act this way at times, particularly when they're anxious or excited. But the difference with ADHD is that symptoms are present over a longer period of time and occur in different settings. They impair a child's ability to function socially, academically, and at home.
The good news is that with proper treatment, kids with ADHD can learn to successfully live with and manage their symptoms.
What is ADHD?
ADHD used to be known as attention deficit disorder, or ADD. In 1994, it was renamed ADHD or, attention deficit hyperactivity disorder. ADHD is one of the most common childhood disorders and can continue through adolescence and adulthood.
ADHD broken down into three subtypes, each with its own pattern of behaviors:
- Inattentive – difficulty staying focused and paying attention
- Hyperactive-impulsive – difficulty controlling behavior, and hyperactivity (over-activity), meaning that your child may find it hard to sit still.
- Combined – which involves a combination of the other two types and is the most common
Although it can be challenging to raise kids with ADHD, it's important to remember they aren't "bad," "acting out," or being difficult on purpose. ADHD is a true medical condition that affects how your child thinks and processes information.
The good news is, with medication or behavioral therapy or, in some cases—both, kids with ADHD can better control their behavior.
Who gets it?
ADHD is a common behavioral disorder that affects an estimated 8% to 10% of school-age children. Boys are about three times more likely than girls to be diagnosed with it, though it's not yet understood why.
What causes it?
ADHD is not caused by poor parenting, too much sugar, or vaccines. It does have biological origins that aren't yet clearly understood. No single cause has been identified, but researchers are exploring a number of possible genetic and environmental links. In fact, studies have shown that many kids with ADHD have a close relative who also has the disorder.
Although experts are unsure whether genes are a cause of the disorder, they have found that certain areas of the brain are about 5% to 10% smaller in size and activity in kids with ADHD. Chemical changes in the brain have also been found.
In terms of environmental factors, research also links smoking during pregnancy to later ADHD in a child. Other risk factors may include premature delivery, very low birth weight, and injuries to the brain at birth.
What are the signs and symptoms of ADHD?
Your child's symptoms will be related to the type of ADHD he or she has.
Predominantly inattentive signs may include:
- Inability to pay attention to details or a tendency to make careless errors in schoolwork or other activities
- Difficulty with sustained attention in tasks or play activities
- Apparent listening problems
- Difficulty following instructions
- Problems with organization
- Avoidance or dislike of tasks that require mental effort
- Tendency to lose things like toys, notebooks, or homework
- Forgetfulness in daily activities
Predominantly hyperactive-impulsive signs may include:
- Fidgeting or squirming
- Difficulty remaining seated
- Excessive running or climbing
- Difficulty playing quietly
- Always seeming to be "on the go"
- Excessive talking
- Blurting out answers before hearing the full question
- Difficulty waiting for a turn or in line
- Problems with interrupting or intruding
- Showing emotions and acting on them without considering any consequences for themselves or others
Combined inattentive and hyperactive-impulsive
- Signs will include a combination of symptoms from the other two types of ADHD
Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children, or seems constantly "out of control." Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently "spaces out" in the classroom or on the playground.
Because there's no single test that can easily confirm that your child has ADHD, your diagnosis depends on a complete evaluation. to gather information about the child, and his or her behavior and environment. Your doctor will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD. Kids who have experienced a divorce, a move, an illness, a change in school, or other significant life event may suddenly begin to act out or become forgetful. To avoid a misdiagnosis, it's important to consider whether these factors played a role in the onset of symptoms
First, your child's doctor will perform a physical examination and take a medical history that includes questions about any concerns and symptoms, your child's past health, your family's health, any medications your child is taking, any allergies your child may have, and other issues.
Your doctor may also check hearing and vision so other medical conditions can be ruled out.
Because some emotional conditions, such as extreme stress, depression, and anxiety, can also look like ADHD, you'll likely be asked to fill out questionnaires to help rule them out.
You'll be asked many questions about your child's development and behaviors at home, school, and among friends. Other adults who see your child regularly (like teachers, who are often the first to notice ADHD symptoms) probably will be consulted, too. An evaluation, by one of our neuropsychologists may also be done.
One of the difficulties in diagnosing ADHD is that it's often found in conjunction with other problems. These are called coexisting conditions, and about two thirds of kids with ADHD have one. The most common coexisting conditions are:
- Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)
At least 35% of kids with ADHD also have oppositional defiant disorder, which is characterized by stubbornness, outbursts of temper, and acts of defiance and rule breaking. Conduct disorder is similar but features more severe hostility and aggression. Kids who have conduct disorder are more likely to get in trouble with authority figures and, later, possibly with the law. Oppositional defiant disorder and conduct disorder are seen most commonly with the hyperactive and combined subtypes of ADHD.
- Mood Disorders
About 18% of kids with ADHD, particularly the inattentive subtype, also experience depression. They may feel inadequate, isolated, frustrated by school failures and social problems, and have low self-esteem.
- Anxiety Disorders
Anxiety disorders affect about 25% of kids with ADHD. Symptoms include excessive worry, fear, or panic, which can also lead to physical symptoms such as a racing heart, sweating, stomach pains, and diarrhea. Other forms of anxiety that can accompany ADHD are obsessive-compulsive disorder and Tourette syndrome, as well as motor or vocal tics (movements or sounds that are repeated over and over). A child who has symptoms of these other conditions should be evaluated by a specialist.
- Learning Disabilities
About half of all kids with ADHD also have a specific learning disability. The most common learning problems are with reading (dyslexia) and handwriting. Although ADHD isn't categorized as a learning disability, its interference with concentration and attention can make it even more difficult for a child to perform well in school.
If your child has ADHD and a coexisting condition, the doctor will carefully consider that when developing a treatment plan. Some treatments are better than others at addressing specific combinations of symptoms.
How is ADHD treated?
ADHD can't be cured, but it can be successfully managed. Your child's doctor will work with you to develop an individualized, long-term plan. The goal is to help a child learn to control his or her own behavior and to help families create an atmosphere in which this is most likely to happen.
In most cases, ADHD is best treated with a combination of medication and behavior therapy. Any good treatment plan will require close follow-up and monitoring, and your doctor may make adjustments along the way. Because it's important for parents to actively participate in their child's treatment plan, parent education is also considered an important part of ADHD management.
Sometimes the symptoms of ADHD become less severe as a person grows older. Hyperactivity tends to get less as people grow up, although the problems with organization and attention often remain. More than half of kids who have ADHD will continue to have symptoms as young adults.
Several different types of medications may be used to treat ADHD:
- Stimulants are the best-known treatments — they've been used for more than 50 years in the treatment of ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. Possible side effects include decreased appetite, stomachache, irritability, and insomnia. There's currently no evidence of long-term side effects.
- Nonstimulants represent a good alternative to stimulants or are sometimes used along with a stimulant to treat ADHD. The first nonstimulant was approved for treating ADHD in 2003. They may have fewer side effects than stimulants and can last up to 24 hours.
- Antidepressants are sometimes a treatment option; however, in 2004 the U.S. Food and Drug Administration (FDA) issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. If an antidepressant is recommended for your child, be sure to discuss these risks with your doctor.
Medications can affect kids differently, and a child may respond well to one but not another. When determining the correct treatment, the doctor might try various medications in various doses, especially if your child is being treated for ADHD along with another disorder.
Research has shown that medications used to help curb impulsive behavior and attention difficulties are more effective when combined with behavioral therapy.
Behavioral therapy attempts to change behavior patterns by:
- Reorganizing a child's home and school environment
- Giving clear directions and commands
- Setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones
Here are examples of behavioral strategies that may help a child with ADHD:
- Create a routine.
Try to follow the same schedule every day, from wake-up time to bedtime. Post the schedule in a prominent place, so your child can see what's expected throughout the day and when it's time for homework, play, and chores.
- Get organized.
Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.
- Avoid distractions.
Turn off the TV, radio, and computer games, especially when your child is doing homework.
- Limit choices.
Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn't overwhelmed and overstimulated.
- Change your interactions with your child.
Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities.
- Use goals and rewards.
Use a chart to list goals and track positive behaviors, then reward your child's efforts. Be sure the goals are realistic (think baby steps rather than overnight success).
- Discipline effectively.
Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior. Younger kids may simply need to be distracted or ignored until they display better behavior.
- Help your child discover a talent.
All kids need to experience success to feel good about themselves. Finding out what your child does well — whether it's sports, art, or music — can boost social skills and self-esteem.
We are here to help.
If your child has been diagnosed, you probably have lots of questions. Call our offices at: 682-885-2500 to schedule an appointment, refer a patient or speak to our staff.