Attention deficit hyperactivity disorder (ADHD) is a condition that begins in early childhood with symptoms of inattention, impulsivity, hyperactivity and/or the inability to control one's own behavior. ADHD affects between 3 and 5 percent of children, or approximately 2 million children in the United States. Children with ADHD may have difficulty at school, at home and in social settings. Between 30 and 70 percent of children with ADHD have symptoms that persist into adulthood.
The most common characteristics of those with ADHD include:
- Poor attention; excessive distractibility
- Physical restlessness or hyperactivity
- Excessive impulsivity; saying or doing things without thinking
- Excessive and chronic procrastination
- Difficulty getting started on tasks
- Difficulty completing tasks
- Frequently losing things
- Poor organization, planning, and time management skills
- Excessive forgetfulness
Not everyone with ADHD has all of these symptoms or the same level of impairment from their symptoms.
What Causes ADHD?
The cause of ADHD is not known, and there are no clear physical markers. Because almost every child can be hyperactive, inattentive or impulsive at times, ADHD is difficult to diagnose and a sometimes controversial healthcare issue. However, most experts agree that ADHD is a real condition and that children with ADHD can be distinguished from children who are occasionally hyperactive or inattentive because those with ADHD exhibit their symptoms at an early age and to a marked and persistent degree.
What Factors Increase My Risk of Getting ADHD?
Medical experts believe ADHD has physical causes in the structure of the brain and nervous system and is not brought on by child-rearing practices or social factors. Because the physical pathology of ADHD is not known, few clear risk factors have been defined; however, studies have suggested a possible link between ADHD and:
- Genetics: ADHD runs in families, and studies have shown that 25 percent of the close relatives of children with ADHD also have ADHD, compared to about 5 percent in the general population. Research to identify the gene or genes involved in ADHD is ongoing.
- Suspected environmental agents: Some studies point to a correlation between smoking and alcohol use during pregnancy and increased risk for ADHD in the child. Other studies have found that high lead levels in the body may contribute to ADHD.
- Brain injury: Studies have shown that some children who have suffered brain injuries exhibit behavior similar to that of ADHD; however, only a small percentage of children with ADHD have documented brain injuries.
- Dietary factors: Infant malnutrition is a strong risk factor for ADHD. Even a child who gets sufficient nutrition later in life may develop ADHD as a result of malnutrition in infancy.
Is There a Laboratory Test to Diagnose ADHD?
Unfortunately, there is no lab test currently available to easily diagnose ADHD. An ADHD diagnosis is based primarily on the degree and persistence of the child’s behaviors. ADHD is suspected when those behaviors occur to a degree that is unusual and inappropriate and negatively impacts the child’s life at school, at home and in social situations.
An ADHD diagnosis is made by a trained clinician after an extensive evaluation and physical examination rules out other possible causes for the symptoms, and a thorough series of interviews with the child, parents, spouse or teachers is conducted. ADHD experts include child psychiatrists, some pediatricians, a behavioral neurologist or possibly a clinical social worker trained to recognize ADHD.
If other causes can be ruled out, the child’s behavior is evaluated in accordance with the diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which lists specific behaviors that classify the condition as ADHD. According to DSM, symptoms of ADHD must occur in at least two different settings and must impair functioning at school, home, work or in other social settings, and the behaviors must appear before age 7 and persist for at least 6 months.
Is ADHD the Same Thing As ADD?
ADD, or attention deficit disorder, is a type of ADHD. Depending on symptoms, three types of ADHD have been identified:
Predominantly Inattentive Type ADHD is also sometimes called attention deficit disorder (ADD). A child with this type of ADHD is bored easily and cannot keep his or her mind focused on anything (an exception may be made for enjoyable things). Schoolwork is especially difficult for the child with this type of ADHD. Hyperactivity and impulsivity are mild in this type. He or she is:
- Easily distracted by sounds or things happening nearby
- Unable to pay attention to or follow instructions, complete detailed tasks and prone to mistakes
- Prone to losing or forgetting things, like school assignments and books
- Unable to complete one activity before moving to another
Predominantly Hyperactive-Impulsive Type ADHD is ADHD in which a child always seems to be in high gear and can’t sit still or stay quiet. These children can usually pay attention, but cannot sit still or tone down their activity level. They may:
- Fidget and squirm in their chairs
- Leave their seats in class at inappropriate times
- Run around in the classroom, in a store or at other inappropriate times
- Talk excessively and blurt out comments
- Can’t wait their turn in line
Combined Type ADHD has elements of both behaviors. Children in this category exhibit symptoms of inattention as well as hyperactivity and impulsivity. This is the so-called “classic” form of ADHD.
How Does ADHD Progress If Left Untreated?
By definition, ADHD onset occurs in a child under 7 years of age. The symptoms tend to appear gradually over many months. The child may initially exhibit impulsive and hyperactive behavior and go on to develop inattention. These symptoms can have a severe impact on the child in an important stage of life. In some children, ADHD symptoms may wane as they mature, but the damage will have been done in the formative years of school and social development. About 80 percent of ADHD children will still need medication for ADHD as teenagers, and greater than half will need medication as adults.
Can Adults Get ADHD?
ADHD is a lifelong condition, and although some people are diagnosed with ADHD as adults, it is likely that they had undiagnosed ADHD as a child. Researchers have developed clinical criteria for the diagnosis of adult ADHD that looks at past ADHD history and current persistent behaviors. Although the symptoms of adult ADHD are not as extreme as with children, the adult’s inability to focus can be a bigger challenge in work and social situations. For adults, ADHD may be marked by an inability to get life organized, to show up for appointments or to keep a job. To diagnose ADHD in an adult, an extensive evaluation must be conducted to rule out other psychiatric conditions.
How Is ADHD Treated?
ADHD is most commonly treated with counseling and medication. In 1999, the National Institute of Mental Health (NIMH) published results of a study that found that medication alone or a combination of medication and behavioral counseling were both more effective ADHD treatments than counseling alone. The study also found that combined treatment was usually more effective in reducing anxiety, improving school performance and supporting the parent-child relationship, and also required lower medication doses than the medication-only approach.
Some treatments will work well with one child and not with another. Physicians usually try different medications and dosages until the child’s symptoms improve. Parents should be attentive to their child’s response to treatment and work with the prescribing physician to find the right medication and dosage.
What Medications Are Used to Treat ADHD?
Many medications are available to treat ADHD. They work by affecting the way the brain transmits signals, thereby improving a person''s ability to pay attention. The most common types of drugs prescribed for ADHD include:
ADHD medications include:
Stimulants: Stimulant medications are the standard first-line treatment for children with ADHD; they include amphetamine, dextroamphetamine, lisdexamfetamine, and methylphenidate. These drugs stimulate the production of the neurotransmitter dopamine, which is thought to play a role in brain functioning and self-control. The stimulants come in long-, short- and sustained-release forms that can last through the school day.
Stimulant side effects are generally considered minor and include decreased appetite, insomnia, anxiety and irritability. Side effects are usually related to the amount of medication taken, with higher doses causing more side effects.
Non-stimulants: The only non-stimulant medication currently approved for first-line ADHD treatment by the U.S. Food and Drug Administration (FDA) is Strattera, or atomoxetine. Instead of stimulating dopamine, atomoxetine increases the production of the neurotransmitter norepinephrine. Strattera is approved for use in adults, adolescents and children over age 6. It is the only FDA-approved ADHD treatment that is not controlled under the United States Controlled Substances Act.
Anti-depressants: Though not FDA-approved for ADHD, anti-depressants, including Wellbutrin (bupropion hydrochloride) and tricyclics such as Norpramin and Pertofrane (desipramine), and Tofranil (imipramine), are sometimes used as second-line treatments when multiple stimulants have not been effective, are contraindicated or cause severe side effects.
Where Can I Get Information on Living Well with ADHD?
You can find the latest news about ADHD research on Everyday Health and from non-profit and government-sponsored Web sites and research centers such as those listed here: