Attention Deficit Hyperactivity Disorder

According to the National Institute of Neurological Disorders and Stroke (NINDS), attention deficit hyperactivity disorder or ADHD affects 3-5 percent of all American children. It is also now being recognized that many adults are affected. The exact cause of ADHD is still under investigation but some things are known. For example, brain damage is no longer considered a cause, but brain chemistry is. (Read about "The Brain")

ADHD is a neurobehavioral disorder. It interferes with a person's ability to focus on activities. It can also affect their ability to control their behavior in a way appropriate to their age. (Read about development stages in "Child Development") NINDS says some of the warning signs of ADHD include:

• constant fidgeting with hands and feet
• acting too impulsively
• being unable to pay attention to or follow instructions
• being easily bored as well as easily distracted
• having problems keeping things organized
• being too talkative
• being unable to complete projects, chores or homework
• being overly aggressive and defiant

Diagnosing ADHD

One of the problems with diagnosing ADHD, of course, is the fact that many of these symptoms can also be exhibited by people who don't have ADHD. And many are symptomatic of different stages a child may be going through. That's why it's essential for parents and doctors to be thorough in their evaluation before determining if a child does have a problem.

For example, the National Institute of Mental Health says specialists need to determine if a child's behavior is excessive, ongoing, long-term and pervasive, as well as if it occurs more often than in other people the same age, if it started early in life, if it isn't connected to a recent traumatic experience and if it is causing serious problems for the child. Doctors also need to rule out potential learning disabilities, as well as potential physical problems, such as chronic middle ear infection (Read about "Otitis Media"), which can cause a child to be irritable and easily distracted.

Treatment options

ADHD was once called hyperkinesis. It appears to be more common in boys, with two to three times more boys than girls being affected. Although we think of it as a childhood disorder, ADHD often continues into adolescence and adulthood, and can cause a lifetime of problems.

People with ADHD may exhibit only some of the common symptoms. For one person, for example, the overriding symptom may be an inability to focus and pay attention. For another, the main problems may stem from being overly impulsive and hyperactive. A small proportion of people with ADHD also have a rare disorder called Tourette syndrome. (Read about "Tourette Syndrome") People with Tourette have tics and other movements like eye blinks or facial twitches that they cannot control. Others may grimace, shrug, sniff or bark out words. While some of these symptoms can be controlled with medication, research continues into specific treatments for people who have both Tourette syndrome and ADHD.

Medication options for ADHD have included drugs such as methylphenidate (Ritalin), dextroamphetamine and other amphetamines. Although these are stimulants, they have been found to decrease impulsiveness and hyperactivity and increase attention. A different class of drug, known as a selective norepinephrine reuptake inhibitor, is also now being used for some cases of ADHD. Unlike stimulants, this class of drug is not considered a controlled substance. There are advantages and disadvantages to any type of medication, so it's essential that parents and children understand these issues thoroughly.

Many experts also agree that treatment for ADHD should focus on more than just medication. For example, the National Institute of Mental Health says there should be emphasis on classroom management, as well as on parental education in order to address discipline and limit-setting. There should also be tutoring and/or behavioral therapy for the child. Support groups can be extremely valuable for both the child and the family, by showing them they are not alone and by helping them learn from others who have been there before. In addition, some parents use alternative therapies such as dietary changes or biofeedback. (Read about biofeedback in "CAM Therapies")

Parenting

Parents whose children have ADHD may wonder if they did something wrong. However, ADHD isn't caused by bad parenting, although a disorganized home life and school environment can make the symptoms worse. In addition, according to the American Academy of Family Physicians (AAFP), ADHD isn't caused by a diet that contains too much sugar, too little sugar or aspartame. It isn't caused by food additives, food colorings, food allergies or other allergies or a lack of vitamins. (Read about "Vitamins & Minerals") It also isn't caused by too much TV, fluorescent lights or video games. AAFP says parents of children with ADHD have a challenge but there are things they can do at home to help.

• Keep to a schedule at home. Waking up, doing homework, chores, watching TV and going to bed should follow a consistent schedule. Write it down and post it where the child can see it. If there are changes, make sure you tell the child ahead of time.
• Make sure the child knows what the rules are. Write them down and put them next to the schedule. As part of the rules, list the results if they aren't followed and make sure the punishments happen.
• Use positive reinforcement. Whenever the child does something right on their own, praise them. Children with ADHD spend most of the day hearing don'ts and stop that's. Praise goes a long way.
• Make sure they understand what you are telling them. Remember they have trouble focusing. If you give them a long list of instructions, they're more likely to fail. Don't set them up for failure. Make sure you have their attention and then focus on them with clear careful instructions. When they finish, remember the praise.
• Don't leave your child alone. Children with ADHD are impulsive. Leaving them without adult supervision is just asking for trouble.
• Monitor your child around other children. Children with ADHD have problems with social skills. Keep play groups small. Reward good behaviors. Most important, do not allow hitting, pushing or yelling.
• Think ahead to the next day. Mornings are tough on children with ADHD. Plan and lay out clothes and school books, get them up early enough and make sure they get a good breakfast.
• Establish a homework routine, same time, same place, everyday. Cut the work into small bites and let your child have breaks. Once again, give praise for good work.
• Focus on the effort, not just the result. Rewards should follow a strong effort to get the work done.
• Stay in touch with teachers. It will let you anticipate problems and upcoming assignments that will require extra effort.

With proper support and treatment, children with ADHD can learn to channel their energies into more appropriate behaviors. As they grow up, they may also find that their drive for excitement and stimulation, as well as their creativity, can be an advantage in particular fields. Meanwhile, research continues into finding a biological basis or cause of ADHD and learning how to prevent or treat it even more effectively.

Adults with ADHD

What is much less well known about ADHD is the probability that, of children who have ADHD, many will still have it as adults. The National Institutes of Health (NIH) say several studies done in recent years estimate that between 30 percent and 70 percent of children with ADHD continue to exhibit symptoms in the adult years.

The first studies on adults who were never diagnosed as children as having ADHD, but showed symptoms as adults, were done in the late 1970s. These symptomatic adults were retrospectively diagnosed with ADHD after the researchers' interviews with their parents. The researchers developed clinical criteria for the diagnosis of adult ADHD (the Utah Criteria), which combined past history of ADHD with current evidence of ADHD behaviors. Other diagnostic assessments are now available; among them are the widely used Conners Rating Scale and the Brown Attention Deficit Disorder Scale.

Typically, adults with ADHD are unaware that they have this disorder - they often just feel that it's impossible to get organized, to stick to a job, to keep an appointment. The everyday tasks of getting up, getting dressed and ready for the day's work, getting to work on time, and being productive on the job can be major challenges for the ADHD adult, according to NIH.

Diagnosing an adult with ADHD is not easy. Many times, when a child is diagnosed with the disorder, a parent will recognize that he or she has many of the same symptoms the child has and, for the first time, will begin to understand some of the traits that have given him or her trouble for years - distractibility, impulsivity, restlessness. Other adults will seek professional help for depression or anxiety and will find out that the root cause of some of their emotional problems is ADHD. They may have a history of school failures or problems at work. They may have been involved in frequent automobile accidents.

NIH says to be diagnosed with ADHD, an adult must have childhood-onset, persistent, and current symptoms. The accuracy of the diagnosis of adult ADHD is of utmost importance and should be made by a healthcare provider with expertise in the area of attention dysfunction. For an accurate diagnosis, a history of the patient's childhood behavior, together with an interview with his life partner, a parent, close friend or other close associate, will be needed. A physical examination and psychological tests should also be given. Other conditions may also exist such as specific learning disabilities, anxiety, or affective disorders.

A correct diagnosis of ADHD can bring a sense of relief. The individual has brought into adulthood many negative perceptions of himself that may have led to low esteem. Now he can begin to understand why he has some of his problems and can begin to face them. This may mean, not only treatment for ADHD but also psychotherapy that can help him cope with the anger he feels about the failure to diagnose the disorder when he was younger.

Related Information:

    Mental Health

    Autism Spectrum Disorders