Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD)

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Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention | Organizations

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Definition

Attention deficit hyperactivity disorder (ADHD) is a chronic behavioral disorder. It is characterized by behavior that is hyperactive and/or inattentive. ADHD affects children, adolescents, and adults.

Causes

The cause of ADHD is unknown. It most likely is caused by a chemical imbalance in the brain. There also appears to be a genetic factor since ADHD can run in families.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Sex: male
• Parent or sibling with ADHD

Symptoms

All children display some of the symptoms of ADHD sometimes. Children with ADHD have symptoms that are noticeably more severe and consistent. Unlike normal children with lots of energy, the symptoms of children with ADHD cause them to have difficulty in school and with their family and peers relationships. They also do not outgrow their symptoms. Behaviors linked to ADHD can last into adulthood. In adulthood, ADHD symptoms can continue to cause relationship difficulties as well as problems with job performance and retention.

There are three different types of ADHD. Some children are mainly "inattentive" and don't display signs of hyperactivity. Some are "impulsive" (hyperactive). Other children exhibit a mixture of both types.

Inattentive (classic "ADD")

• Easily distracted by sights and sounds
• Doesn't pay attention to detail
• Doesn't seem to listen when spoken to
• Makes careless mistakes
• Doesn't follow through on instructions or tasks
• Avoids or dislikes activities that require longer periods of mental effort
• Loses or forgets items necessary for tasks
• Is forgetful in day-to-day activities

Hyperactive-impulsive

• Is restless, fidgets and squirms
• Runs and climbs and is not able to stay seated
• Blurts out answers before hearing the entire question
• Has difficulty playing quietly
• Talks excessively
• Interrupts others
• Has difficulty waiting in line or waiting for turn

Combined

• Has a combination of the above symptoms

Combined ADHD is the most common type.

People with ADHD also often have:

• Depression
• Anxiety
• Conduct disorder
• Antisocial behavior
• Substance abuse

Diagnosis

There is no standard test to diagnose ADHD. The diagnosis is made by a trained mental health professional. Family and teachers are involved as well.

The American Academy of Pediatrics recommends that the following guidelines be used for diagnosis in children 6-12 years of age:

• Diagnosis should be initiated if a child shows signs of difficulty in:
  • School
  • Academic achievement
  • Relationships with peers and family
• During diagnosis, the following information should be gathered directly from parents, caregivers, teachers or other school professionals:
  • Assessment of symptoms of ADHD in different settings (home and school)
  • Age at which symptoms started
  • How long symptoms last
  • How much the behavior affects the child's ability to function
• The health care professional should examine the child for:
  • Other conditions that might be causing or aggravating symptoms
  • Learning and language problems
  • Aggression
  • Disruptive behavior
  • Depression or anxiety
• For a diagnosis of ADHD to be made, symptoms must:
  • Be present in two or more of the child's settings
  • Interfere with child's ability to function for at least six months

Treatment

Therapies aim to improve the child's ability to function. Guidelines from the American Academy of Pediatrics encourage physicians to work as a team with parents and school personnel. Together they can set realistic treatment goals and evaluate the child's response.

Treatments include:

Medication

Medications can help control behavior and increase attention span. Stimulants are the most common treatment for ADHD. They increase activity in parts of the brain that appear to be underactive in children with ADHD. Stimulant medications include:

• Methylphenidate (Ritalin)
• Dextroamphetamine (Dexedrine)
• Amphetamine (Adderall)

Other drugs include:

• Antidepressants – to treat depression and anxiety
• Clonidine (used for Tourette's syndrome) – to treat impulsivity

Behavior Therapy

Children who take medication and practice behavioral techniques do better than those who just use medication. Sometimes behavioral therapy includes working one-on-one with a therapist. Together they practice social and problem-solving skills. Counselors will also teach parents and teachers to modify the child's behavior through positive reinforcement. This could involve change in the classroom as well as in parenting style. Often, daily report cards are exchanged between parents and teachers.

Prevention

There are no guidelines for preventing ADHD because the cause is unknown. Proper treatment can prevent problems later in life with school, relationships, and drug and alcohol abuse.

Organizations

National Attention Deficit Disorder Association
http://www.add.org

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
http://www.chadd.org/

SOURCES:

American Psychiatric Association

American Academy of Child & Adolescent Psychiatry

American Academy of Pediatrics

National Mental Health Association

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Last reviewed June 2001 by Medical Review Board