Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit/hyperactivity disorder (ADHD) is a common childhood mental condition that can last into adolescence and adulthood. It affects more boys than girls. Patients with ADHD have difficulty focusing and paying attention, controlling behavior and impulsivity, and sometimes problems with learning and listening. These symptoms can make school and life at home very difficult for the patients and their families.

The hallmark symptoms of ADHD include inattention (easily distracted, daydreaming, difficulty focusing on one thing), hyperactivity (fidgeting in seats, having trouble sitting still, nonstop talking), and impulsivity (impatience, blurting out inappropriate comments, and difficulty waiting turns). It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often and interfere with daily responsibilities and relationships.

ADHD likely results from a combination of factors, including genetics, family history, and environmental factors. Previous brain injuries may also increase the risk of ADHD.

Treatment for ADHD focuses on reducing symptoms and improving daily function. Medications can improve symptoms related to inattention, impulsive behavior, and hyperactivity. These include stimulants, such as amphetamines (Adderall, Vyvanse) and methylphenidates (Ritalin, Concerta, Focalin), and non-stimulants, such as atomoxetine (Strattera) and guanfacine (Intuniv). Behavioral therapy is also an essential component of ADHD treatment.

Symptoms of ADHD include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).

A child with ADHD might:

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others

ADHD has three subtypes:

Predominantly hyperactive-impulsive

Most symptoms (six or more) are in the hyperactivity and impulsivity categories.

Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.

Predominantly inattentive

The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity and impulsivity are present, although hyperactivity and impulsivity may still be present to some degree.

Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.

Combined hyperactive-impulsive and inattentive

Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.

Most children have the combined type of ADHD.

The causes and risk factors for ADHD are unknown, but current research shows that ADHD is likely caused by a combination of factors, including:

• Genetics
• Brain injury
• Environmental exposures (e.g., lead)
• Alcohol and tobacco use during pregnancy
• Premature delivery
• Low birth weight

Parenting, or social, and certain environmental factors may or may not cause ADHD, but these factors might make symptoms worse.

Diagnosing ADHD involves several steps. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms. Often, a medical exam, including hearing and vision tests, is conducted to rule out other problems with symptoms like ADHD. Another part of the process may include a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.

Living with ADHD can difficult for the person with the disorder and his or her family, friends, and teachers. Daily tasks are challenging for people with ADHD and relationships can be negatively affected. The symptoms and severity of ADHD vary and the disorder affects everyone differently.

Treatment for ADHD focuses on reducing symptoms and improving daily function. In most cases, ADHD is best treated with a combination of behavior therapy and medication. Medications can improve symptoms related to inattention, impulsive behavior, and hyperactivity. These include stimulants, such as amphetamines (Adderall,Vyvanse) and methylphenidates (Ritalin,Concerta, Focalin), and non-stimulants, such as atomoxetine(Strattera)and guanfacine (Intuniv). Antidepressants may also be used as part of ADHD treatment. No single treatment approach is appropriate for every person with ADHD. Treatment should be individualized and continually assessed to ensure that it meets the changing needs of the person with ADHD.