Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.
Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.
While treatment won’t cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome.
Symptoms
The primary features of attention-deficit/hyperactivity disorder include inattention and hyperactive-impulsive behavior. ADHD symptoms start before age 12, and in some children, they’re noticeable as early as 3 years of age. ADHD symptoms can be mild, moderate or severe, and they may continue into adulthood.
ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.
There are three subtypes of ADHD:
- Predominantly inattentive. The majority of symptoms fall under inattention.
- Predominantly hyperactive-impulsive. The majority of symptoms are hyperactive and impulsive.
- Combined. The most common type in the U.S., this is a mix of inattentive symptoms and hyperactive-impulsive symptoms.
Inattention
A child who shows a pattern of inattention may often:
- Fail to pay close attention to details or make careless mistakes in schoolwork
- Have trouble staying focused in tasks or play
- Appear not to listen, even when spoken to directly
- Have difficulty following through on instructions and fail to finish schoolwork or chores
- Have trouble organizing tasks and activities
- Avoid or dislike tasks that require focused mental effort, such as homework
- Lose items needed for tasks or activities, for example, toys, school assignments, pencils
- Be easily distracted
- Forget to do some daily activities, such as forgetting to do chores
Hyperactivity and impulsivity
A child who shows a pattern of hyperactive and impulsive symptoms may often:
- Fidget with or tap his or her hands or feet, or squirm in the seat
- Have difficulty staying seated in the classroom or in other situations
- Be on the go, in constant motion
- Run around or climb in situations when it’s not appropriate
- Have trouble playing or doing an activity quietly
- Talk too much
- Blurt out answers, interrupting the questioner
- Have difficulty waiting for his or her turn
- Interrupt or intrude on others’ conversations, games or activities
Additional issues
In addition, a child with ADHD has:
- Symptoms for at least six months
- Several symptoms that negatively affect school, home life or relationships in more than one setting, such as at home and at school
- Behaviors that aren’t normal for children the same age who don’t have ADHD
Normal behavior vs. ADHD
Most healthy children are inattentive, hyperactive or impulsive at one time or another. It’s normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest.
The same is true of hyperactivity. Young children are naturally energetic — they often are still full of energy long after they’ve worn their parents out. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they’re different from their friends or siblings.
Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.
Causes
While the exact cause of attention-deficit/hyperactivity disorder is not clear, research efforts continue. Factors that may be involved in the development of ADHD include:
- Genetics. ADHD can run in families, and studies indicate that genes may play a role.
- Environment. Certain environmental factors, such as lead exposure, may increase risk.
- Development. Problems with the central nervous system at key moments in development may play a role.
Risk factors
Risk factors for attention-deficit/hyperactivity disorder may include:
- Blood relatives, such as a parent or sibling, with ADHD or another mental health disorder
- Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings
- Maternal drug use, alcohol use or smoking during pregnancy
- Premature birth
Although sugar is a popular suspect in causing hyperactivity, there’s no reliable proof of this. Many issues in childhood can lead to difficulty sustaining attention, but that’s not the same as ADHD.
Complications
Attention-deficit/hyperactivity disorder can make life difficult for children. Children with ADHD:
- Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults
- Tend to have more accidents and injuries of all kinds than do children who don’t have ADHD
- Tend to have poor self-esteem
- Are more likely to have trouble interacting with and being accepted by peers and adults
- Are at increased risk of alcohol and drug abuse and other delinquent behavior
Coexisting conditions
ADHD doesn’t cause other psychological or developmental problems. However, children with ADHD are more likely than others to also have conditions such as:
- Learning disabilities, including problems with understanding and communicating
- Anxiety disorders, which may cause overwhelming worry, nervousness
- Depression, which frequently occurs in children with ADHD
- Disruptive mood dysregulation disorder, characterized by irritability and problems tolerating frustration
- Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant and hostile behavior toward authority figures
- Conduct disorder, marked by antisocial behavior such as stealing, fighting, destroying property, and harming people or animals
- Bipolar disorder, which includes depression as well as manic behavior
- Tourette syndrome, a neurological disorder characterized by repetitive muscle or vocal tics
Prevention
To help reduce your child’s risk of attention-deficit/hyperactivity disorder:
- During pregnancy, avoid anything that could harm fetal development. For example, don’t drink alcohol, use recreational drugs or smoke cigarettes.
- Protect your child from exposure to pollutants and toxins, including cigarette smoke and lead paint (found in some old buildings).
- Limit screen time. Although still unproved, it may be prudent for children to avoid excessive exposure to TV and video games in the first five years of life.
If your child has ADHD, to help reduce problems or complications:
- Be consistent, set limits and have clear consequences for your child’s behavior.
- Put together a daily routine for your child with clear expectations that include such things as bedtime, morning time, mealtime, simple chores and TV.
- Avoid multitasking yourself when talking with your child, make eye contact when giving instructions, and set aside a few minutes every day to praise your child.
- Work with teachers and caregivers to identify problems early, to decrease the impact of the condition on your child’s life.
Diagnosis
In general, a child shouldn’t receive a diagnosis of attention-deficit/hyperactivity disorder unless the core symptoms of ADHD start early in life — before age 12 — and create significant problems at home and at school on an ongoing basis.There’s no specific test for ADHD, but making a diagnosis will likely include:- Medical exam, to help rule out other possible causes of symptoms
- Information gathering, such as any current medical issues, personal and family medical history, and school records
- Interviews or questionnaires for family members, your child’s teachers or other people who know your child well, such as baby sitters and coaches
- ADHD criteria from the Diagnostic and Statistical Manual of Mental DisordersDSM-5, published by the American Psychiatric Association
- ADHD rating scales to help collect and evaluate information about your child
Diagnosing ADHD in young children
Although signs of ADHD can sometimes appear in preschoolers or even younger children, diagnosing the disorder in very young children is difficult. That’s because developmental problems such as language delays can be mistaken for ADHD.So children preschool age or younger suspected of having ADHD are more likely to need evaluation by a specialist, such as a psychologist or psychiatrist, speech pathologist, or developmental pediatrician.Other conditions that resemble ADHD
A number of medical conditions or their treatments may cause signs and symptoms similar to those of ADHD. Examples include:- Learning or language problems
- Mood disorders such as depression or anxiety
- Other psychiatric disorders
- Seizure disorders
- Vision or hearing problems
- Tourette syndrome
- Medical problems that affect thinking or behavior
- Sleep disorders
- Thyroid problems
- Substance abuse
- Brain injury
Treatment
Standard treatments for attention-deficit/hyperactivity disorder in children include medications, education, training and counseling. These treatments can relieve many of the symptoms of ADHD, but they don’t cure it. It may take some time to determine what works best for your child.Stimulant medications
Currently, stimulant drugs (psychostimulants) are the most commonly prescribed medications for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These medications help improve the signs and symptoms of inattention and hyperactivity — sometimes effectively in a short period of time.Examples include:- Amphetamines. These include dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall) and lisdexamfetamine (Vyvanse).
- Methylphenidates. These include methylphenidate (Concerta, Metadate, Ritalin, others) and dexmethylphenidate (Focalin)
Stimulant drugs are available in short-acting and long-acting forms. A long-acting patch of methylphenidate (Daytrana) is available that can be worn on the hip.The right dose varies from child to child, so it may take some time to find the correct dose. And the dose may need to be adjusted if significant side effects occur or as your child matures. Ask your doctor about possible side effects of stimulants.Stimulant medications and heart problems
Although rare, several heart-related deaths have occurred in children and teenagers taking stimulant medications. The possibility of increased risk of sudden death is still unproved, but if it exists, it’s believed to be in people who already have underlying heart disease or a heart defect.Your child’s doctor should make sure your child doesn’t have any signs of a heart condition and should ask about family risk factors for heart disease before prescribing a stimulant medication.Other medications
Other medications that may be effective in treating ADHD include:- Atomoxetine (Strattera)
- Antidepressants such as bupropion (Wellbutrin, others)
- Guanfacine (Intuniv, Tenex)
- Clonidine (Catapres, Kapvay)
Atomoxetine and antidepressants work slower than stimulants do and may take several weeks before they take full effect. These may be good options if your child can’t take stimulants because of health problems or if stimulants cause severe side effects.Ask your doctor about possible side effects of any medications.Suicide risk
Although it remains unproved, concerns have been raised that there may be a slightly increased risk of suicidal thinking in children and teenagers taking nonstimulant ADHD medication or antidepressants. Contact your child’s doctor if you notice any signs of suicidal thinking or other signs of depression.Giving medications safely
It’s very important to make sure your child takes the right amount of the prescribed medication. Parents may be concerned about stimulants and the risk of abuse and addiction. Dependence hasn’t been shown in children who take these drugs for appropriate reasons and at the proper dose.On the other hand, there’s concern that other people might misuse or abuse stimulant medication prescribed for children and teenagers with ADHD. To keep your child’s medications safe and to make sure your child is getting the right dose at the right time:- Give medications carefully. Children and teens shouldn’t be in charge of their own ADHD medication without proper supervision.
- At home, keep medication locked in a childproof container. An overdose of stimulant drugs is serious and potentially fatal.
- Don’t send supplies of medication to school with your child. Deliver any medicine yourself to the school nurse or health office.
ADHD behavior therapy
Children with ADHD often benefit from behavior therapy and counseling, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some children with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.Examples of therapy include:- Behavior therapy. Teachers and parents can learn behavior-changing strategies, such as token reward systems and timeouts, for dealing with difficult situations.
- Psychotherapy. This allows older children with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms.
- Parenting skills training. This can help parents develop ways to understand and guide their child’s behavior.
- Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
- Social skills training. This can help children learn appropriate social behaviors.
Ongoing treatment
The best results occur when a team approach is used, with teachers, parents, and therapists or physicians working together. Educate yourself about ADHD, and then work with your child’s teachers and refer them to reliable sources of information to support their efforts in the classroom.If your child is being treated for ADHD, he or she should see the doctor regularly until symptoms have largely improved, and then every three to four months if symptoms are stable.Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping or increased irritability, or if your child’s ADHD has not shown much improvement with initial treatment.
