Attention Deficit Hyperactivity Disorder (ADHD) affects 3% to 5% of all children. These children can feel easily bored, unable to sit still, plan ahead, finish tasks, or be fully aware of what's going on around them. They often seem disorganized or frenzied. Two to three times more boys than girls are affected. ADHD often continues into adolescence and adulthood, and can cause a lifetime of frustrated dreams and emotional pain.
Although no one knows exactly what causes ADHD, scientists are finding more and more evidence that it stems from biological causes. Some research shows that attention disorders tend to run in families, so there are likely to be genetic influences. Children who have ADHD usually have at least one close relative who also has the condition. And in most cases, if one identical twin has ADHD, they both do. Knowing this can remove a huge burden of guilt from parents who might blame themselves for their child's behavior.
In recent years, as new tools and techniques for studying the brain have been developed, scientists have been able to test more theories about what does and does not cause ADHD. ADHD is NOT usually caused by home environment, too much TV, food allergies, excess sugar, poor home life or poor schools.
The family that wants a child assessed for possible ADHD can start by talking with the child's pediatrician and/or family doctor, who may do the assessment themselves or refer the family to a specialist. The specialist will first gather information to rule out other possible reasons for the child's behavior. This involves observing and talking with the child and speaking with teachers, parents, and other people who know the child well.
ADHD does not have clear physical signs that can be seen in an x-ray or a lab test. It can only be identified by looking for certain characteristic behaviors. The person's pattern of behavior is compared to a set of criteria and characteristics that appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM). According to the DSM, three patterns of behavior indicate ADHD. People with ADHD may show several signs of being consistently inattentive; they may have a pattern of being hyperactive and impulsive; or they may show all three types of behavior.
According to the DSM, signs of inattention include:
- becoming easily distracted by irrelevant sights and sounds
- failing to pay attention to details and making careless mistakes
- rarely following instructions carefully and completely
- losing or forgetting things like toys, or pencils, books, and tools needed for a task
According to the DSM, signs of hyperactivity and impulsivity include:
- feeling restless, often fidgeting with hands or feet, or squirming
- running, climbing or leaving a seat in situations where sitting or quiet behavior is expected
- blurting out answers before hearing the whole question
- having difficulty waiting in line or for a turn
To assess whether a person has ADHD, specialists consider several critical questions: Do these behaviors occur more often than in other people the same age? Are they a continuous problem, not just a response to a temporary situation? Do the behaviors occur in several settings or only in one specific place like the playground or the office?
The fact is, many things can produce these behaviors. Anything from chronic fear to mild seizures can make a child seem overactive, quarrelsome, impulsive, or inattentive. Because everyone shows some of these behaviors at times, the DSM contains very specific guidelines for determining when they indicate ADHD.
It's also important to realize that during certain stages of development, the majority of children tend to be inattentive, hyperactive, or impulsive. Preschoolers have lots of energy and run everywhere they go, but this doesn't mean they are hyperactive. And many teenagers go through a phase when they are messy, disorganized, and reject authority. It doesn't mean they will have a lifelong problem controlling their impulses.
Adults are diagnosed for ADHD based on their performance at home and at work. When possible, their parents are asked to rate the person's behavior as a child. A spouse or roommate can help rate and evaluate current behaviors. But for the most part, adults are asked to describe their own experiences. One symptom is a sense of frustration. Since people with ADHD are often bright and creative, they often report feeling frustrated that they're not living up to their potential. Many also feel restless and are easily bored, and some feel a need to seek novelty and excitement.
A correct diagnosis lets people move forward in their lives. Once the disorder is known, they can begin to receive whatever combination of educational, medical, and emotional help they need.
One of the difficulties in diagnosing ADHD is that it is often accompanied by other problems. For example, many children with ADHD also have a specific learning disability (LD). ADHD is not in itself a specific learning disability, but because it can interfere with concentration and attention, ADHD can make it doubly hard for a child with LD to do well in school.
A very small proportion of people with ADHD have a rare disorder called Tourette's syndrome. People with Tourette's have tics and other movements like eye blinks or facial twitches that they can’t control. Others may grimace, shrug, sniff, or bark out words. Fortunately, these behaviors can be controlled with medication.
Nearly half of all children with ADHD – mostly boys – have a condition called oppositional defiant disorder and may overreact, have outbursts of temper or lash out when they feel bad. Children with this combination of problems are at risk of getting in trouble at school or even with the police. They may take unsafe risks or even break laws by stealing, setting fires, destroying property or driving recklessly. It's important that they receive help before the behaviors lead to more serious problems.
Emotional disorders and attention disorders often go hand in hand, so children with ADHD should be checked for anxiety and depression. Many children with ADHD – especially younger children and boys – experience emotional disorders such as anxiety, depression, worry, tension or uneasiness. This can affect their thinking and behavior. These can be treated, and helping children handle such painful feelings will help them cope with the effects of ADHD.
Because teachers work with many children, they come to know how "average" children behave in learning situations. They are often the first to recognize that a child is hyperactive or inattentive; however, they sometimes fail to notice the needs of children who are quiet and cooperative.
In general, schools demand that children sit still, wait for a turn, pay attention, and stick with a task. It's no surprise, then, that many children with ADHD have problems in class. Their minds are fully capable of learning, but their hyperactivity and inattention make learning difficult. As a result, many students with ADHD repeat a grade or drop out of school early. Fortunately, with the right combination of educational practices, medication and counseling, these outcomes can be avoided. Although some children with ADHD may be placed in a special education class for all or part of the day, most are able to stay in the regular classroom.
Parents have the option of taking their child to a private practitioner for evaluation and educational services, but most children with ADHD qualify for free services in the public schools. An Individualized Educational Program (IEP) will outline the specific skills the child needs to develop and appropriate learning activities that build on the child's strengths. Parents play an important role in the process; they must be included in meetings and given an opportunity to review and approve their child's IEP.
For decades, three stimulant medications have been used to treat symptoms of ADHD in children and adults. These are methylphenidate (Ritalin), dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert). These medications can dramatically reduce hyperactivity and improve the ability to focus, work and learn. They may also improve physical coordination and behavior control. When used with medical supervision, stimulant drugs are usually considered quite safe. They seldom make children "high" or jittery, nor do they sedate them. They are not addictive in children, although they can be addictive to teenagers and adults if misused.
Nine out of 10 children improve on one of the three stimulants, so if one doesn't help, the others can be tried. (Parents should first make sure that the child is actually getting the prescribed daily dosage at home or at school – it’s easy to forget.) The doctor may try adjusting the dosage before switching to a different drug. Other types of medication may be used if stimulants don't work or if another disorder occurs along with ADHD. Your doctor can help decide which preparation to use and whether a child needs to take the medicine during school hours only or also in the evenings and on weekends.
Medicines don't cure ADHD, they only temporarily control the symptoms. Although the drugs help people pay better attention and complete their work, they can't increase knowledge, improve academic skills, help people feel better about themselves or cope with problems. Many experts believe that the most significant, long-lasting gains appear when medication is combined with behavioral therapy, emotional counseling and practical support.
Some doctors recommend that children be taken off a medication now and then to see if the child still needs it. They recommend temporarily stopping the drug during school breaks and summer vacations, when focused attention and calm behavior are usually not as crucial. These "drug holidays" work well if the child can still participate at camp or other activities without medication.
Children on medications should have regular checkups. Parents should also talk regularly with the child's teachers and doctor about how the child is doing. This is especially important when a medication is first started, re-started or when the dosage is changed. Parents need to know that new or exaggerated behaviors might arise when a child is under stress. The challenges that all children face, like changing schools or entering puberty, can be even more stressful for a child with ADHD.
The Medication Debate
As useful as these drugs are, Ritalin and the other stimulants have sparked controversy. While on these medications, some children may lose weight, have less appetite, grow more slowly or have problems falling asleep. Potential side effects should be carefully weighed against the benefits before prescribing the drugs. Side effects that do occur can often be handled by reducing the dosage.
Another debate is whether stimulants are prescribed for too many children. Many things, including anxiety, depression, allergies, seizures, or problems with the home or school environment can make children seem overactive, impulsive, or inattentive. Critics argue that many children who do not have a true attention disorder are medicated as a way to control their disruptive behaviors.
Even though most people don't outgrow ADHD, people do learn to adapt and live fulfilling lives by developing their personal strengths. With effective combinations of medicine, new skills, and emotional support, people with ADHD can develop ways to control their attention and minimize their disruptive behaviors.
Like all people, those with ADHD have natural talents and abilities that they can work with. In fact, many people with ADHD even feel that their patterns of behavior give them unique advantages. People with ADHD tend to be outgoing and ready for action. Many become successful in business, sports, construction, the arts and public speaking.
In the last decade, scientists have learned much about the course of the disorder and are now able to identify and treat children, adolescents and adults who have it. A variety of medications, behavior-changing therapies, and educational options are already available to help people with ADHD focus their attention, build self-esteem and function in new ways.
Although no immediate cure is in sight, a new understanding of ADHD may be just over the horizon. Using a variety of research tools and methods, scientists are beginning to uncover new information on the role of the brain in ADHD and effective treatments for the disorder. Such research will ultimately result in improving the personal fulfillment and productivity of people with ADHD.
This article was adapted from information provided by the National Institute of Mental Health, the Centers for Disease Control and Prevention and the National Institute of Neurological Disorders and Stroke.