What is Attention Deficit Hyperactivity Disorder (ADHD)?
Attention-Deficit/Hyperactivity Disorder (ADHD) is a brain disorder. It is described as a pattern of inattention and / or impulsivity and hyperactivity-impulsivity that gets in the way of daily activities or development.
Types of ADHD
- Inattentive
- Hyperactive-impulsivity
Signs and Symptoms of ADHD
Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD have problems with only one of the behaviors. Others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.
In preschool, the most common ADHD symptom is hyperactivity.
It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:
- Are more severe
- Occur more often
- Get in the way or lower how well they function socially, at school, or in a job
Inattention is another symptom. This means that a person cannot stay on task. They can be disorganized. They have trouble following through with things. These things are not because they don’t understand or aren’t able to do the task.
Signs and Symptoms of Inattention
- Overlooks or misses details. Makes careless mistakes in schoolwork, at work, or during other activities.
- Has a hard time listening when talked to directly
- Lacks attention to details. Easily distracted by unrelated thoughts or things.
- Has problems paying attention in tasks or play. This includes conversations, lectures, or lengthy reading.
- Does not follow through on instructions. Fails to finish schoolwork, chores, or duties in the workplace.
- Starts tasks but quickly loses focus. Gets easily distracted.
- Has problems organizing tasks and activities
- Has trouble with order. Work is messy and struggles with time management.
- Avoids or dislikes tasks that need sustained mental effort, such as schoolwork or homework
- Loses things that are needed for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
- Is forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
Hyperactivity means a person moves about constantly, including situations in which it is not appropriate. Excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with their activity.
Impulsivity means a person makes quick actions that occur in the moment without first thinking about them. They may have high potential for harm. They feel a need for instant rewards and cannot delay gratification. An impulsive person may be socially pushy and excessively interrupt others. They may make important decisions without thinking about the long-term consequences.
Signs and Symptoms of Hyperactive-Impulsivity
- Fidgets and squirms in their seats
- Leaves their seat in situations when staying seated is expected, such as in the classroom
- Runs around or climbs in situations where it is inappropriate. In teens and adults, feelings of restlessness are often felt.
- Being unable to play or engage in hobbies quietly
- Constantly in motion or “on the go,” or act as if “driven by a motor”
- Talk nonstop
- Blurting out an answer before a question has been completed. Finishing other people’s sentences or speaking without waiting for a turn in conversation.
- Having trouble waiting their turn.
- Interrupts or intrudes on others. This may be in conversations, games, or activities.
The symptoms of ADHD may look like other medical conditions or behavior problems. Always talk to your child's doctor or mental health professional for a diagnosis.
Causes of ADHD
The exact cause of ADHD is unknown. Research shows a combination of genes and environmental factors play a role in the development of the condition. They include:
- Cigarette smoking
- Alcohol use
- Drug use during pregnancy
- Exposure to environmental toxins during pregnancy
- Exposure to environmental toxins, such as high levels of lead, at a young age
- Low birth weight
- Brain injuries
Incidence of ADHD
ADHD is the most diagnosed behavior disorder of childhood. Estimates suggest that between three and nine percent of all children have ADHD. It is more common in boys than in girls. Many parents of children with ADHD had symptoms of ADHD when they were younger. ADHD is sometimes found in siblings within the same family.
Diagnosis of ADHD
A pediatrician, child psychiatrist, psychologist or a mental health professional usually identifies ADHD in children.
There is no test for ADHD. Currently, the gold standard for diagnosing ADHD is a combination of a history of the child's behavior from parents and teachers, observations of the child's behavior, and standardized assessment measures.
Other tests may be used in some cases to rule out other conditions. For example, if there is a concern about a learning disability, intellectual and achievement testing may be conducted. Other psychological, neurological, or physical testing may also be used to rule out other conditions.
Treatment of ADHD
Treatment for ADHD will be determined by your child's doctor based on:
- Your child's age, overall health and medical history
- Your child's symptoms and resulting impairments
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
Treatment for children with ADHD includes parental support and education in behavioral training, appropriate school placement and medication.
Treatment may include:
Pharmacological Treatment
Psychostimulants (also known as stimulants) are the most used ADHD medicines. Although these drugs are called stimulants, they have a calming effect in people with ADHD. These medicines are used for their ability to increase the level of chemicals in the brain that help the child to better maintain attention and show greater self-control. They have been shown to give the greatest improvement in the core symptoms of ADHD (inattention, impulsivity, and hyperactivity). Treatment with a psychostimulant is highly effective in 75 to 90 percent of children with ADHD.
Stimulants take effect in the body quickly. They work for one to four hours (in their short-acting forms; extended-release formulations usually last two to three times as long as their short-acting counterpart). Then they leave the body. Doses of stimulant medications need to be timed to match the demands of the child's schedule. Current research suggests that most children with ADHD who respond to medicine benefit most from taking it every day. it has a positive impact not just at school but also in their behavior at home and other social settings.
There are several different ADHD medicines that may be used alone or in combination. Your health care provider will decide which medicine is right based on your child’s symptoms and needs. Always follow your health care provider's instructions on how to take ADHD medicine. Some ADHD medicines have side effects. If your child has side effects, contact your health care provider right away. Most side effects of stimulant use are mild. They may decrease with regular use and respond to dose changes.
Antidepressant or other psychotropic medications may also be given for children and adolescents with ADHD to help improve attention while decreasing aggression, anxiety and/or depression.
Psychosocial Treatments
Parenting children with ADHD may be difficult. It can have challenges that create stress within the family. Classes in behavior management skills designed to address the special challenges associated with parenting a child with ADHD can help to both improve the child's functioning at home. These classes can also help reduce stress for all family members.
Training in behavior management skills for parents occurs in a group setting. This encourages parent-to-parent support. Behavior management skills may include the following:
- Use of “timeout”
- Point systems
- Contingent attention (responding to child with positive attention when desired behaviors occur. Withholding attention when undesired behaviors occur)
Teachers may also be taught behavior management skills to use in the classroom setting. Training for teachers usually includes use of daily behavior reports that communicate in-school behaviors to parents.
Behavior management techniques tend to improve targeted behaviors (such as completing schoolwork or keeping the child's hands to himself / herself). But they are not usually helpful in reducing the child's broader difficulties with inattention, hyperactivity, or impulsivity.
Preventive Action
Preventive measures to reduce the incidence of ADHD in children are not known at this time. Early detection and intervention can reduce the severity of symptoms. This can decrease the interference of behavioral symptoms on school functioning. It can also increase the child's normal growth and developmental process and improve the quality of life for children or teens with ADHD.
