Attention-Deficit/Hyperactivity Disorder (ADHD)
What is attention-deficit/hyperactivity disorder (ADHD)?
Attention-deficit/hyperactivity disorder (ADHD) describes individuals who have problems due to a short attention span, impulsivity, and/or hyperactivity. ADHD occurs in 5 to 8 percent of school-age children and about 2 to 4 percent of adults.
Children with ADHD often have difficulties at home, during school or with other children. For instance, children with ADHD may not complete tasks, follow rules or get along with friends.
Causes of ADHD
ADHD is complex, and there are many possible causes. However, research shows that ADHD tends to run in families. Studies indicate that there is generally a strong genetic contribution to ADHD. Other factors that may contribute to ADHD include low birth weight, smoking during pregnancy, and some severe illnesses in infancy. ADHD is not caused by poor parenting, but a child’s home environment can affect whether the ADHD behaviors get better.
Types of ADHD
There are three different types of ADHD. Each type has its own symptoms:
ADHD predominately inattentive type (ADHD-I)
Children with ADHD-I show at least six of the following symptoms:
- Don't pay close attention to details, make careless mistakes
- Have difficulty paying attention
- Do not appear to listen
- Struggle with following instructions
- Have difficulty getting organized
- Avoid or dislike tasks that require a lot of thought
- Lose things
- Are easily distracted
- Are forgetful in daily activities
ADHD predominately hyperactive-impulsive type (ADHD-HI)
Children with ADHD-HI show at least six of the following symptoms:
- Fidget with hands or feet
- Have difficulty staying seated
- Run around or climb excessively
- Have difficulty working or playing quietly
- Act “motorized”
- Talk a lot
- Have difficulty waiting or taking turns
- Interrupt or intrude upon others
ADHD combined type (ADHD-C)
Children with ADHD-C show at least six symptoms of inattention and at least six symptoms of hyperactivity/impulsivity.
Children with ADHD-C are hyperactive and impulsive and have trouble paying attention.
Testing and diagnosis of ADHD
To be diagnosed with ADHD, children must have difficulties in at least two settings, such as at home and at school. They may also have problems getting along with other children.
There is no single test to diagnose ADHD. The best way to find out whether or not your child has ADHD is to have your child evaluated by a pediatrician, psychiatrist, psychologist, neurologist or social worker familiar with ADHD. An evaluation will help to establish a diagnosis while also determining if there are other conditions present.
The evaluation should include assessment of:
- Medical history
- History of growth and development
- Review of strengths and weaknesses in school
- Review of child’s social and emotional functioning (i.e. peer relationships or expressing feelings)
- Family history of medical, developmental and psychiatric problems
- Information from both parents and teachers (including behavior rating scales)
Treatments for ADHD
Children with ADHD usually need more than one type of treatment to meet their specific needs. Medication, including stimulant or non-stimulant medication, and behavior management training for parents and teachers have been shown to be the most effective treatments.
Psychologists, counselors and social workers can help with behavior management. You can also talk to your child’s teacher, the school counselor or the school psychologist about support for your child at school.
Other treatments that may be helpful for some children include:
- Education for both parent and child about diagnosis and treatment
- School services and supports
- Organizational skills training
- Cognitive-behavior therapy for a co-occurring condition
Medications for treating ADHD
Whether your child will need to take medications depends on many things, including the severity of his symptoms. If symptoms are mild, the medical team might recommend counseling, behavior therapy or social skills training.
If symptoms are moderate to severe and causing problems at home or at school, your primary care provider may prescribe medicines. Please talk with your child's healthcare provider about the best approach based on your child's condition.
There are three types of medication used to control the symptoms of ADHD:
- Norepinephrine reuptake inhibitors
- Alpha-2 adrenergic agonists
Stimulants are the medicines used most often to treat ADHD. These drugs stimulate parts of the brain that:
- Increase attention span
- Decrease impulsiveness
- Keep you awake
- Make you feel like you have had enough to eat
There are two main categories of stimulants: amphetamine compounds and methylphenidate. In general, each category of stimulants is equally effective during the period the medication is working. Learn more about stimulants. (PDF)
Norepinephrine reuptake inhibitors (atomoxetine)
Atomoxetine (Strattera®) is the first non-stimulant medication to be approved by the FDA to treat ADHD. Norepinephrine is a chemical in the brain that is important in controlling attention and impulses. Often, children who take atomoxetine are less active and impulsive. Learn more about atomoxetine. (PDF)
Alpha-2 adrenergic agonists (clonidine and guanfacine)
Two types of long-acting alpha-2 agonists have been approved by the FDA for the treatment of ADHD in children: clonidine and guanfacine. These medications affect the level of dopamine and norepinepherine in the brain, but do this differently than stimulants and norepinepherine reuptake inhibitors. Clinical trials of these medications show improvements in ADHD symptoms.
Reviewed by Sarah Taub, MD