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    Attention deficit hyperactivity disorder

    ADD; ADHD; Childhood hyperkinesis

    Attention deficit hyperactivity disorder (ADHD) is a problemof not being able to focus, being overactive, not being able control behavior, or a combination of these. For these problems to be diagnosed as ADHD, they must be out of the normal range for a person's age and development.

    Causes

    ADHD usually begins in childhood but may continue into the adult years.It is the most commonly diagnosed behavioral disorder in children. ADHD is diagnosed much more often in boys than in girls.

    It is not clear what causes ADHD. A combination of genes and environmental factors likely plays a role in the development of the condition. Imaging studies suggest that the brains of children with ADHD are different from those of children without ADHD.

    Symptoms

    Symptoms of ADHD fall into three groups:

    • Not being able to focus(inattentiveness)
    • Being extremely active (hyperactivity)
    • Not being able to control behavior(impulsivity)

    Some people with ADHD have mainly inattentive symptoms. Some have mainly hyperactive and impulsive symptoms. Others have a combination of different symptom types. Those with mostly inattentive symptoms are sometimes said to have attention deficit disorder (ADD). They tend to be less disruptive and are more likely not to be diagnosed with ADHD.

    Inattentive Symptoms

    • Fails to give close attention to details or makes careless mistakes in schoolwork
    • Has difficulty keeping attention during tasks or play
    • Does not seem to listen when spoken to directly
    • Does not follow through on instructions and fails to finish schoolworkorchores and tasks
    • Hasproblems organizing tasks and activities
    • Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
    • Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
    • Is easily distracted
    • Is often forgetful in daily activities

    Hyperactivity Symptoms

    • Fidgets with hands or feet or squirms in seat
    • Leaves seat when remaining seated is expected
    • Runs about or climbs in inappropriate situations
    • Hasproblemsplaying or working quietly
    • Is often "on the go," acts as if "driven by a motor"
    • Talks excessively

    Impulsivity Symptoms

    • Blurts out answers before questions have been completed
    • Has difficulty awaiting turn
    • Interrupts or intrudes on others (butts into conversations or games)

    Exams and Tests

    If ADHD is suspected, the individual should be evaluated by a health care professional. There is no test that can make or exclude a diagnosis of ADHD.The diagnosis is based on a pattern of the symptoms listed above.When the person with suspected ADHD is a child, parents and teachers are usually involved during the evaluation process.

    Most children with ADHD have at least one other developmental or mental health problem, such as a mood, anxiety or substance use disorder; a learning disability; or a tic disorder. A doctor can help determine whether these other conditions are present.

    Treatment

    Treating ADHD is a partnership between the health care provider and the patient. If the patient is a child, parents and often teachers are involved. Fortreatment to work, it is important to:

    • Set specific, appropriate goals.
    • Start medicine and/or talk therapy.
    • Follow-up regularly with the doctor to check on goals, results, and any side effects of medicines. During these visits, information should be gathered from the patient and if relevant,parents andteachers.

    If treatment does notseem to work, the health care provider will likely:

    • Confirmtheperson has ADHD
    • Check for medical conditions that can cause similar symptoms
    • Make sure the treatment plan is being followed

    Medicines

    Medicine combined withbehavioral treatment often works best. There are several different ADHD medicines that may be used alone or in combination. The health care provider will decide which medicine is right based on the person's symptoms and needs.

    Psychostimulants (also known as stimulants) are the most commonly used ADHD medicines. Although these drugs are called stimulants, they actually have a calming effect in people with ADHD.

    Follow the health care provider's instructions on how to take ADHD medicine.

    Some ADHD medicines have side effects. If the person has side effects, contact the health care provider right away. The dosage or medicine itself may need to be changed.

    Therapy

    Therapy for both thepatient and if relevant, thefamily, can help everyone understand and gain control of the stressful feelings related to ADHD.

    A common type of ADHD therapy is called behavioral therapy. It teaches children and parents healthy behaviors and how to manage disruptive behaviors. For mild cases of ADHD, behavioral therapy alone (without medicine)can sometimes be effective.

    Support groups can helpthe patient and familyconnect with others who have similar problems.

    Other tips to helpa child with ADHD include:

    • Talkregularly with the child's teacher.
    • Keep a consistent daily schedule, including regular times for homework, meals, and outdoor activities. Make changes to the schedule in advance and not at the last moment.
    • Limit distractions in the child's environment.
    • Make sure the child gets a healthy, varied diet, with plenty of fiber and basic nutrients.
    • Make sure the child gets enough sleep.
    • Praise and reward good behavior.
    • Provide clear and consistent rules for the child.

    There is little proof that alternative treatments for ADHD such as herbs, supplements, and chiropractic are helpful.

    Outlook (Prognosis)

    ADHD is a long-term, chronic condition. If it is not treated correctly, ADHD may lead to:

    • Drug and alcohol abuse
    • Not doing wellin school
    • Problems keeping a job
    • Trouble with the law

    One third to onehalf of children with ADHD continue to have symptoms of inattention or hyperactivity-impulsivity as adults. Adults with ADHDare oftenable tocontrol behavior and mask difficulties.

    When to Contact a Medical Professional

    Call the doctor if you or your child's school staff suspect ADHD. You should also tell the doctor about:

    • Problems at home, school, and with peer relationships
    • Side effects of ADHD medicine
    • Signsof depression

    References

    Bostic JQ, Prince JB. Child and adolescent psychiatric disorders. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 69.

    Knouse LE, Safren SA. Current status of cognitive behavioral therapy for adult attention-deficit hyperactivity disorder. Psychiatr Clin N Am. 2010;33:497–509.

    Pliszka S. American Academy of Child and Adolescent Psychiatry 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;46:894-921.

    Prince JB, Spencer TJ, Wilens TE, Biederman J. Pharmacotherapy of attention-deficit/hyperactivity disorder across the lifespan. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 49.

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          Tests for Attention deficit hyperactivity disorder

            Review Date: 3/23/2013

            Reviewed By: David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Blackman, Stephanie Slon, and Nissi Wang.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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