Attention-Deficit / Hyperactivity Disorder
What is attention-deficit/hyperactivity disorder (ADHD)? ADHD,
also called attention-deficit disorder, is a behavior disorder,
usually first diagnosed in childhood, that is characterized by
inattention, impulsivity, and, in some cases, hyperactivity.
These symptoms usually occur together, however, one may occur
without the other(s).
The symptoms of hyperactivity, when present, are almost always
apparent by the age of 7 and may be apparent in very young
preschoolers. Inattention or attention-deficit may not be
evident until a child faces the expectations of elementary
school.
What are the different types of ADHD? Three major types of ADHD
include the following:
ADHD, combined type This, the most common type of ADHD, is
characterized by impulsive and hyperactive behaviors as well as
inattention and distractibility.
ADHD, impulsive/hyperactive type This, the least common type of
ADHD, is characterized by impulsive and hyperactive behaviors
without inattention and distractibility.
ADHD, inattentive and distractible type This type of AHD is
characterized predominately by inattention and distractibility
without hyperactivity.
What causes attention-deficit/hyperactivity disorder? ADHD is
one of the most researched areas in child and adolescent mental
health. However, the precise cause of the disorder is still
unknown. Available evidence suggests that ADHD is genetic. It is
a brain-based biological disorder. Low levels of dopamine (a
brain chemical), which is a neurotransmitter (a type of brain
chemical), are found in children with ADHD. Brain imaging
studies using PET scanners (positron emission tomography; a form
of brain imaging that makes it possible to observe the human
brain at work) show that brain metabolism in children with ADHD
is lower in the areas of the brain that control attention,
social judgment, and movement.
Who is affected by attention-deficit/hyperactivity disorder?
Estimates suggest that between 3 and 9 percent of all children
have ADHD. It is more common in boys than in girls with the
ratio estimated between 4:1 and 9:1, respectively.
Many parents of children with ADHD experienced symptoms of ADHD
when they were younger. ADHD is commonly found in brothers and
sisters within the same family. Most families seek help when
their child's symptoms begin to interfere with learning and
adjustment to the expectations of school and age-appropriate
activities.
What are the symptoms of attention-deficit/hyperactivity
disorder? Most symptoms seen in children with ADHD also occur at
times in children without this disorder. However, in children
with ADHD, these symptoms occur more frequently and interfere
with learning, school adjustment, and, sometimes, with the
child's relationships with others.
The following are the most common symptoms of ADHD. However,
each child may experience symptoms differently. The three
categories of symptoms of ADHD include the following:
inattention:
short attention span for age (difficulty sustaining attention)
difficulty listening to others
difficulty attending to details
easily distracted
forgetful
poor organizational skills for age
poor study skills for age
impulsivity:
often interrupts others
has difficulty waiting for his/her turn in school and/or social
games
tends to blurt out answers instead of waiting to be called upon
takes frequent risks, and often without thinking before acting
hyperactivity:
seems to be in constant motion; runs or climbs, at times with no
apparent goal except motion
has difficulty remaining in his/her seat even when it is expected
fidgets with hands or squirms when in his/her seat; fidgeting
excessively
talks excessively
has difficulty engaging in quiet activities
loses or forgets things repeatedly and often
inability to stay on task; shifts from one task to another
without bringing any to completion
The symptoms of ADHD may resemble other medical conditions or
behavior problems. Always consult your child's or adolescent's
physician for a diagnosis.
How is attention-deficit/hyperactivity disorder diagnosed? ADHD
is the most commonly diagnosed behavior disorder of childhood. A
pediatrician, child psychiatrist, or a qualified mental health
professional usually identifies ADHD in children. A detailed
history of the child's behavior from parents and teachers,
observations of the child's behavior, and psychoeducational
testing contribute to making the diagnosis of ADHD. Further,
because ADHD is a group of symptoms, often diagnosis depends on
evaluating results from several different types of evaluations,
including physical, neurological, and psychological. Certain
tests may be used to rule out other conditions, and some may be
used to test intelligence and certain skill sets. Always consult
your child's (adolescent's) physician for more information.
Treatment for attention-deficit/hyperactivity disorder: Specific
treatment for attention-deficit/hyperactivity disorder will be
determined by your child's (adolescent's) physician based on:
your child's (adolescent's) age, overall health, and medical
history
extent of your child's (adolescent's) symptoms
your child's (adolescent's) tolerance for specific medications,
procedures, or therapies
expectations for the course of the condition
your opinion or preference
Major components of treatment for children with ADHD include
parental support and education in behavioral training,
appropriate school placement, and medication (psychostimulants).
Treatment with a psychostimulant is highly effective in 75 to 90
percent of children with ADHD.
Treatment may include:
psychostimulant medications (stimulants) Psychostimulant
medications, used for their ability to balance chemicals in the
brain that prohibit the child from maintaining attention and
controlling impulses, may be used to reduce the major
characteristics of ADHD, which include the following:
inattention
impulsivity
hyperactivity
There are four different psychostimulant medications that are
commonly used to treat ADHD, including the following :
methylphenidate (Ritalin)
dextroamphetamine (Dexedrine)
pemoline (Cylert)
a mixture of amphetamine salts (Adderall)
Psychostimulants have been used to treat childhood behavior
disorders since the 1930s. They have been widely studied.
Stimulants take effect in the body quickly, work for one to four
hours, and then leave the body quickly. Doses of stimulant
medications need to be timed to match the child's school
schedule - to help the child pay attention for a longer period
of time and improve classroom performance. The common side
effects of stimulants may include, but are not limited to, the
following:
insomnia
decreased appetite
stomach aches
headaches
jitteriness
rebound activation (when the effect of the stimulant wears off
hyperactive and impulsive behaviors may increase for a short
period of time)
Most side effects of stimulant use are mild, decrease with
regular use, and respond to dose changes. Always discuss
potential side effects with your child's physician.
Antidepressant medications may also be administered 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 and can present challenges that create stress within
the family. Classes in behavior management skills for parents
can help reduce stress for all family members. Training in
behavior management skills for parents usually occurs in a group
setting which encourages parent-to-parent support. Behavior
management skills may include the following:
use of "time out"
point systems
contingent attention (responding to child with positive
attention when desired behaviors occur; withholding attention
when undesired behaviors occurs)
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 school work or keeping the child's
hands to himself/herself), but are not usually helpful in
reducing inattention, hyperactivity, or impulsivity.
Prevention of attention-deficit/hyperactivity disorder:
Preventive measures to reduce the incidence of ADHD in children
are not known at this time. However, early detection and
intervention can reduce the severity of symptoms, decrease the
interference of behavioral symptoms on school functioning,
enhance the child's normal growth and developmental process, and
improve the quality of life experienced by children or
adolescents with ADHD