- What is ADHD?
ADHD is one of the most common neurobehavioral disorder affecting children. ADHD is a
condition of the brain that makes it difficult for children to control their behavior. It affects
4% to 12% of school-aged children. About 3 times more boys than girls are diagnosed with
ADHD. - What are the symptoms of ADHD?
ADHD includes 3 groups of behavior symptoms: inattention, hyperactivity, and
impulsivity.
Symptoms of attention-deficit hyperactivity disorder (ADHD)
People who have ADHD have difficulty organizing things, listening to instructions, remembering details, and/or controlling their behavior. This can make it difficult to get along with other people at home, at school, or at work.
A person with ADHD who has attention deficit/ difficulty paying attention will have 6 or more of the following symptoms:
- Difficulty following instructions
- Difficulty keeping attention on work or play activities at school, work, and home
- Losing things needed for activities at school, work, and home
- Appearing not to listen
- Doesn’t pay close attention to details
- Seems disorganized
- Trouble with tasks that require planning ahead
- Forgetting things
- Is easily distracted
A person with ADHD who is hyperactive or impulsive will have at least 6 of the following symptoms:
- Fidgety
- Runs or climbs inappropriately
- Can’t play quietly
- Blurts out answers
- Interrupts people
- Can’t stay in seat
- Talks too much
- Is always on the go
- Has trouble waiting his or her turn
- Are there different types of ADHD?
Not all children with ADHD have all the symptoms. They may have one or more of the
symptoms mentioned above. The symptoms usually are classified as the following types
of ADHD:
Inattentive only – Children with this form of ADHD are not overly active. Because they do
not disrupt the classroom or other activities, their symptoms may not be noticed. Among girls
with ADHD, this form is most common.
Hyperactive/Impulsive—Children with this type of ADHD show both hyperactive and
impulsive behavior, but can pay attention. They are the least common group and are
frequently younger.
Combined Inattentive/Hyperactive/Impulsive—Children with this type of ADHD show a
number of symptoms in all 3 dimensions. This is the most common type of ADHD. - How can I tell if my child has ADHD?
Remember, it is normal for all children to show some of these symptoms from time to time.
Your child may be reacting to stress at school or home. She may be bored or going through a
difficult stage of life. It does not mean he/she has ADHD. Sometimes a teacher is the first to
notice inattention, hyperactivity, and/or impulsivity and bring these symptoms to the parents’
attention. Perhaps questions from your pediatrician raised the issue. At routine visits,
pediatricians often ask questions such as
a) How is your child doing in school?
b) Are there any problems with learning that you or your child’s teachers have seen?
c) Is your child happy in school?
d) Is your child having problems completing class work or homework?
e) Are you concerned with any behavior problems in school, at home, or when your
child is playing with friends?
Your answers to these questions may lead to further evaluation for ADHD. If your
child has shown symptoms of ADHD on a regular basis for more than 6 months,
discuss this with your pediatrician.
Diagnosis
It is more difficult to diagnose ADHD in children 5 years of age and younger. This is because
children change very rapidly during the preschool years. It is also more difficult to diagnose
ADHD once a child becomes a teenager.
There is no single test for ADHD. The process requires several steps and involves gathering a
lot of information from multiple sources. You, your child, your child’s school, and other
caregivers should be involved in assessing your child’s behavior.
Children with ADHD show signs of inattention, hyperactivity, and/or impulsivity in specific
ways. (See the behaviors listed in Table 1.) Your pediatrician will look at how your child’s
behavior compares to that of other children his own age, based on the information reported
about your child by you, his teacher, and any other caregivers who spend time with your
child, such as coaches or child care workers.
To confirm a diagnosis of ADHD, symptoms
-Occur in more than one setting, such as home, school, and social situations and cause
some impairment
-Significantly impair your child’s ability to function in some of the activities of daily
life, such as schoolwork, relationships with you and his brothers and/or sisters, and his
relationship with friends or in his ability to function in groups such as sports teams
-Start before the child reaches 7 years of age
(However, these may not be recognized as ADHD symptoms until a child is older.)
-Have continued for more than 6 months
-In addition to looking at your child’s behavior, your pediatrician will do a physical
and neurologic examination. A full medical history will be needed to put your child’s
behavior in context and screen for other conditions that may affect his behavior. Your
pediatrician also will talk with your child about how he acts and feels. Your
pediatrician may refer your child to a pediatric subspecialist if there are concerns in
one of the following areas:
>Mental retardation
>Developmental disorder such as speech problems, motor problems, or a
learning disability
>Chronic illness being treated with a medication that may interfere with
learning
>Trouble seeing and/or hearing
>History of abuse
>Major anxiety or major depression
>Severe aggression
>Possible seizure disorder
>Possible sleep disorder
How can parents help with the diagnosis?
As a parent, you will provide crucial information about your child’s behavior and how it
affects her life at home, in school, and in other social settings. Your pediatrician will want to
know what symptoms your child is showing, how long the symptoms have occurred, and how
the behavior affects your child and your family. You may need to fill in checklists or rating
scales about your child’s behavior.
In addition, sharing your family history can offer important clues about your child’s
condition.
How will my child’s school be involved?
For an accurate diagnosis, your pediatrician will need to get information about your child
directly from your child’s classroom teacher or another school professional. Children at least
5 years of age and older spend many of their waking hours at school. Teachers provide
valuable insights. Your child’s teacher may write a report or discuss the following with your
pediatrician:
-Your child’s behavior in the classroom
-Your child’s learning patterns
-How long the symptoms have been a problem
-How the symptoms are affecting your child’s progress at school
-Ways the classroom program is being adapted to help your child
-Whether other conditions may be affecting the symptoms
In addition, your pediatrician may want to see report cards and samples of your
child’s schoolwork.
What causes ADHD?
ADHD is one of the most studied conditions of childhood, but ADHD may be caused by a
number of things. Research to date has shown
-ADHD is a biological disorder.
-A lower level of activity in the parts of the brain that control attention and activity
level may be associated with ADHD.
-ADHD frequently runs in families. Sometimes a parent is diagnosed with ADHD
In very rare cases, toxins in the environment may lead to ADHD.
Significant head injuries may cause ADHD in some cases.
Prematurity increases the risk of developing ADHD.
Prenatal exposures, such as alcohol or nicotine from smoking, increase the risk of
developing ADHD.
There is little evidence that ADHD is caused by: Eating too much sugar/ Food additives/
Allergies/ Immunizations
Treatment
Once the diagnosis is confirmed, the outlook for most children who receive treatment for
ADHD is very encouraging. There is no specific cure for ADHD, but there are many
treatment options available.
Each child’s treatment must be tailored to meet his individual needs. In most cases, treatment
for ADHD should include
A long-term management plan with
— Target outcomes for behavior — Follow-up activities
— Monitoring
Education about ADHD
Teamwork among doctors, parents, teachers, caregivers, other health care
professionals, and the child
Medication
Behavior therapy including parent training
Individual and family counseling
Treatment for ADHD uses the same principles that are used to treat other chronic conditions
like asthma or diabetes. Long-term planning is needed because these conditions are not cured.
Families must manage them on an ongoing basis. In the case of ADHD, schools and other
caregivers must also be involved in managing the condition.
Educating the people involved about ADHD is a key part of treating your child. As a parent,
you will need to learn about ADHD. Read about the condition and talk to people who
understand it. This will help you manage the ways ADHD affects your child and your family
on a day-to-day basis. It will also help your child learn to help himself.
Setting target outcomes
At the beginning of treatment, your pediatrician should help you set 3 to 6 target outcomes
(goals) for your child’s behavior. These target outcomes will guide the treatment plan. Your
child’s target outcomes should focus on helping her function as well as possible at home, at
school, and in your community. You need to identify what behaviors are most preventing
your child from success.
The following are examples of target outcomes:
• Improved relationships with parents, siblings, teachers, and friends (eg, fewer arguments
with brothers or sisters or being invited more frequently to friends’ houses or parties)
• Better schoolwork (eg, completing class work or homework assignments)
• More independence in self-care or homework (eg, getting ready for school in the morning
without supervision)
6
• Improved self-esteem (eg, increase in feeling that she can get her work done)
• Fewer disruptive behaviors
The target outcomes should be Realistic, Something your child will be able to do, and
behaviors that you can observe and count.
Medication
For most children, stimulant medications are a safe and effective way to relieve
ADHD symptoms. As glasses help people focus their eyes to see, these medications
help children with ADHD focus their thoughts better and ignore distractions. This
makes them more able to pay attention and control their behavior.
Stimulants may be used alone or combined with behavior therapy. Studies show that
about 80% of children with ADHD who are treated with stimulants improve a great
deal once the right medication and dose are determined.
Different types of stimulants are available, in short-acting (immediate- release),
intermediate-acting, and extended-release forms. (See Table 2.) Immediate-release
forms usually are taken every 4 hours, when
the medication is needed. They are the cheapest of the medications. Intermediate-acting and extended-release medications usually are taken once in the morning.
Children who use extended-release forms of stimulants can avoid taking medication at
school or after school. It is important not to chew or crush extended-release capsules
or tablets. However, extended-release capsules that are made up of beads can be
opened and sprinkled on food for children who have difficulties swallowing tablets or
capsules.
Which medication is best for my child?
It may take some time to find the best medication, dosage, and schedule for your
child.
Your child may need to try different types of stimulants or other medication. Some
children respond to one type of stimulant but not another.
The amount of medication (dosage) that your child needs also may need to be
adjusted. The dosage is not based solely on his weight. Your pediatrician will vary the
dosage over time to get the best results and control possible side effects.
The medication schedule also may be adjusted depending on the target outcome. For
example, if the goal is to get relief from symptoms mostly at school, your child may
take the medication only on school days.
It is important for your child to have regular medical check-ups to monitor how well
the medication is working and check for possible side effects.
What side effects can stimulants cause?
Side effects occur sometimes. These tend to happen early in treatment and are usually
mild and short-lived, but in rare cases can be prolonged or more severe. The most
common side effects include
Decreased appetite/weight loss Sleep problems
Social withdrawal
Some less common side effects include
Rebound effect (increased activity or a bad mood as the medication wears off)
Transient tics
Very rare side effects include
Significant increase in blood pressure or heart rate
Growth delay
Bizarre behaviors
Most side effects can be relieved by
Changing the medication dosage
Adjusting the schedule of medication
Using a different stimulant or atomoxetine
Close contact with your pediatrician is required until you find the best medication and dose
for your child. After that, periodic monitoring by your doctor is important to maintain the
best effects.
Stimulants and atomoxetine may not be an option for children who are taking certain other
medications or who have some medical conditions such as congenital heart disease.
How can my child’s school help?
Your child’s school is a key partner in providing effective behavior therapy for your child. In
fact, these principles work well in the classroom for most students.
Classroom management techniques may include
Keeping a set routine and schedule for activities
Using a system of clear rewards and consequences, such as a point system or token
economy
Sending daily or weekly report cards or behavior charts to parents to inform them
about the child’s progress
Seating the child near the teacher
Using small groups for activities
Encouraging students to pause a moment before answering questions
Keeping assignments short or breaking them into sections
Close supervision with frequent, positive cues to stay on task
Your child’s school should work with you and your pediatrician to develop strategies to assist
your child in the classroom. It is important to remember that once diagnosed and treated,
children with ADHD are more likely to achieve their goals in school.
Keeping the treatment plan on track
Ongoing monitoring of your child’s behavior and medications is required to find out if the
treatment plan is working. Office visits, phone conversations, behavior checklists, written
reports from teachers, and behavior report cards are common tools for following the child’s
progress.
Treatment plans for ADHD usually require long-term efforts on the part of families and
schools. Medication schedules may be complex. Behavior therapies require education and
patience. Sometimes it can be hard for everyone to stick with it. Your efforts play an
important part in building a healthy future for your child.
Ask your pediatrician to help you find ways to keep your child’s treatment plan on track.
Unproven treatments
You may have heard media reports or seen advertisements for “miracle cures” for ADHD.
Carefully research any such claims. Consider whether the source of the information is valid.
At this time, there is no scientifically proven cure for this condition.
The following methods have not been proven to work in scientific studies: • Megavitamins
and mineral supplements
• Anti–motion-sickness medication (to treat the inner ear)
• Treatment for candida yeast infection
• EEG biofeedback (training to increase brain-wave activity)
• Applied kinesiology (realigning bones in the skull)
• Reducing sugar consumption
• Optometric vision training (asserts that faulty eye movement and sensitivities cause the
behavior problems)
Always tell your pediatrician about any alternative therapies, supplements, or medications
that your child is using. These may interact with prescribed medications and harm your child.
Will there be a cure for ADHD soon?
While there are no signs of a cure at this time, research is ongoing to learn more about the
role of the brain in ADHD and the best ways to treat the disorder. Additional research is
looking at the long-term outcomes for people with ADHD.
Will my child outgrow ADHD?
ADHD continues into adulthood in most cases. However, by developing their strengths,
structuring their environments, and using medication when needed, adults with ADHD can
lead very productive lives. In some careers, having a high-energy behavior pattern can be an
asset.