ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for a child's age and development.
ADHD is the most commonly diagnosed behavioral disorder of childhood. It affects about 3 - 5% of school aged children. ADHD is diagnosed much more often in boys than in girls.
ADHD may run in families, but it is not clear exactly what causes it. Whatever the cause may be, it seems to be set in motion early in life as the brain is developing. Imaging studies suggest that the brains of children with ADHD are different from those of other children.
Depression, lack of sleep, learning disabilities, tic disorders, and behavior problems may be confused with, or appear with, ADHD. Every child suspected of having ADHD should be carefully examined by a doctor to rule out possible other conditions or reasons for the behavior.
Most children with ADHD also have at least one other developmental or behavioral problem. They may also have a psychiatric problem, such as depression or bipolar disorder.
The symptoms of ADHD fall into three groups:
Some children with ADHD primarily have the inattentive type. Others may have a combination of types. Those with the inattentive type are less disruptive and are more likely to not be diagnosed with ADHD.
Too often, difficult children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed. In either case, related learning disabilities or mood problems are often missed. The American Academy of Pediatrics (AAP) has issued guidelines to bring more clarity to this issue.
The diagnosis is based on very specific symptoms, which must be present in more than one setting.
In older children, ADHD is in partial remission when they still have symptoms but no longer meet the full definition of the disorder.
The child should have an evaluation by a doctor if ADHD is suspected. Evaluation may include:
Treating ADHD is a partnership between the health care provider, parents or caregivers, and the child. For therapy to succeed, it is important to:
If treatment does not appear to work, the health care provider should:
A combination of medication and behavioral treatment works best. There are several different types of ADHD medications that may be used alone or in combination.
Psychostimulants (also known as stimulants) are the most commonly used ADHD drugs. Although these drugs are called stimulants, they actually have a calming effect on people with ADHD.
These drugs include:
A nonstimulant drug called atomoxetine (Strattera) may work as well as stimulants, and may be less likely to be misused.
Some ADHD medicines have been linked to rare sudden death in children with heart problems. Talk to your doctor about which drug is best for your child.
Talk therapy for both the child and family can help everyone understand and gain control of the stressful feelings related to ADHD.
Parents should use a system of rewards and consequences to help guide their child's behavior. It is important to learn to handle disruptive behaviors. Support groups can help you connect with others who have similar problems.
Other tips to help your child with ADHD include:
Alternative treatments for ADHD have become popular, including herbs, supplements, and chiropractic treatments. However, there is little or no solid evidence that these work.
ADHD is a long-term, chronic condition. If it is not treated appropriately, ADHD may lead to:
About half of children with ADHD will continue to have troublesome symptoms of inattention or impulsivity as adults. However, adults are often more capable of controlling behavior and masking difficulties.
Although there is no proven way to prevent ADHD, early identification and treatment can prevent many of the problems associated with ADHD.
ADD; ADHD; Childhood hyperkinesis
Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):894-921.
Prince JB, Spencer TJ, Wilens TE, Biederman J. Pharmacotherapy of attention-deficit/hyperactivity disorder across the life span. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 49.
Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Fred K. Berger, MD, Addiction and Forensic Psychiatrist, Scripps Memorial Hospital, La Jolla, California.
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