Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder

(ADHD and ADD; Hyperkinetic Syndrome; Hyperkinetic Impulse Disorder)
by Julie Riley, MS, RD
Definition

Attention deficit hyperactivity disorder (ADHD) is a chronic behavioral disorder. It is behavior that is hyperactive, impulsive, and/or inattentive. These must persist for at least six months and be present in two environments (home, work, or school). 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

These risk factors may increase your chances of developing ADHD:

  • Being born prematurely
  • Having a mother who smoked cigarettes and/or drank alcohol during pregnancy
  • Having a parent with certain conditions (eg, alcoholism , conversion disorder )
  • Other possible risk factors, such as:
    • Having Turner syndrome (a genetic condition)
    • Being born with a serious heart condition
    • Being exposed to certain pesticides
    • Head injury at a young age (less than two years old)
    • Spending over two hours a day watching TV or playing video games when young
  • Being a first-born boy
  • Having a parent or sibling (especially an identical twin) with ADHD
Symptoms

All children display some of the symptoms of ADHD. Children with ADHD have symptoms that are more severe and consistent. They often have difficulty in school and with their family and peers.

ADHD can last into adulthood. It can cause problems with relationships, job performance, and job retention.

There are three types of ADHD:

  • Combined
  • Hyperactive-impulsive
  • Inattentive (classic "ADD")
Inattentive (Classic "ADD")
  • Avoids or dislikes activities that require longer periods of mental effort
  • Doesn't follow through on instructions or tasks
  • Doesn't pay attention to detail
  • Doesn't seem to listen when spoken to
  • Easily distracted by sights and sounds
  • Is forgetful in day-to-day activities
  • Loses or forgets items necessary for tasks
  • Makes careless mistakes
Hyperactive-Impulsive
  • Blurts out answers before hearing the entire question
  • Has difficulty playing quietly
  • Has difficulty waiting in line or waiting for a turn
  • Interrupts others
  • Is restless, fidgets, and squirms
  • Runs and climbs and is not able to stay seated
  • Talks excessively
Combined

Combined ADHD is the most common type.

  • Has a combination of the above symptoms

People with ADHD may also have:

Diagnosis

There is no standard test to diagnose ADHD. It is done 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 4-18 years of age:

  • During diagnosis, the following information should be gathered directly from parents, caregivers, teachers, or other school professionals:
    • Age at which symptoms started
    • Assessment of symptoms of ADHD in different settings (home and school)
    • How much the behavior affects the child's ability to function
  • Evaluation should be initiated if a child shows signs of:
    • Behavior problems
    • Hyperactivity
    • Impulsivity
    • Inattention
    • Poor school performance
  • For a diagnosis of ADHD to be made, symptoms must:
    • Fit a list of symptoms detailed in the most recent version of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association
    • Be present in two or more of the child's settings
    • Interfere with the child's ability to function for at least six months
  • The professional should examine the child for other conditions that might be causing or aggravating symptoms, such as
    • Aggression
    • Certain health conditions
    • Depression or anxiety
    • Disruptive behavior
    • Learning or language disorders
    • Personality disorder
    • Psychotic symptoms
Treatment

The goal is to improve the child's ability to function. Doctors should work together with parents and school staff. Together, they can set realistic goals and evaluate the child's response.

Treatments include:

Sleep

Children who do not sleep enough may suffer from worse behavior problems. A key part of treatment is to ensure that children with ADHD get plenty of sleep.

Medication

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

  • Amphetamine (Adderall)
  • Atomoxetine (Strattera)
  • Dextroamphetamine (Dexedrine)
  • Lisdexamfetamine (Vyvanse)—This medication was recently approved to treat adults with ADHD. It can also be used to treat children aged 6-12 years.
  • Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)

Talk to your doctor if you have any questions about ADHD medication. There are possible risks with these medications, including cardiovascular events (eg, stroke , heart attack ) and psychiatric problems (eg, hearing voices, becoming manic).

Because of the rare risk of serious heart problems, the American Heart Association suggests that children have an electrocardiogram (ECG) before starting stimulant medication for ADHD.

Other drugs include:

  • Antidepressants—such as imipramine (Janimine, Tofranil), venlafaxine (Effexor), and bupropion (Wellbutrin)
  • Clonidine (used for Tourette's syndrome )—to treat impulsivity
Behavior Therapy

Children who take medication and go to therapy do better than those who just use medication. Therapy sessions focus on practicing social and problem-solving skills. Counselors will also teach parents and teachers to help the child through positive reinforcement. This could involve changes in the classroom, as well as in parenting style. Often, daily report cards are exchanged between parents and teachers.

Other tools, like the Disc'O'Sit cushion, may be helpful in improving children's attention in class. The Disc'O'Sit is a dome-shaped cushion filled with air that the child balances on.

ADHD coaching can also be helpful. These coaches work with individuals to help them organize and create strategies so that they can be more efficient and successful.

Prevention

There are no guidelines for preventing ADHD because the cause is unknown. Proper treatment can prevent problems later in life.

Last reviewed: September 2011 by Ryan Estevez, MD, PhD, MPH.

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