attention deficit hyperactivity disorder, sometimes called ADHD, is a chronic condition and the most commonly diagnosed behavioral disorder among children and adolescents. It affects between 3 and 5 percent of school-aged children in a 6-month period (U.S. Department of Health and Human Services, 1999).
Children and adolescents with attention deficit hyperactivity disorder have difficulty controlling their behavior in school and social settings. They also tend to be accident-prone. Although some of these young people may not earn high grades in school, most have normal or above-normal intelligence.
What are the signs of attention deficit hyperactivity disorder?
There are three different types of attention deficit hyperactivity disorder, and each has different symptoms. The types are inattentive, hyperactive-impulsive, and combined attention deficit hyperactivity disorder.
Children with the inattentive type may:
- Have short attention spans.
- Be distracted easily.
- Not pay attention to details.
- Make many mistakes.
- Fail to finish things.
- Have trouble remembering things.
- Not seem to listen.
- Not be able to stay organized.
Children with the hyperactive-impulsive type may:
- Fidget and squirm.
- Be unable to stay seated or play quietly.
- Run or climb too much or when they should not.
- Talk too much or when they should not.
- Blurt out answers before questions are completed.
- Have trouble taking turns.
- Interrupt others.
The most common type is combined attention deficit hyperactivity disorder, which, as the name implies, is a combination of the inattentive and the hyperactive-impulsive types.
A diagnosis of one of the attention deficit hyperactivity disorders is usually made when children have several of the above symptoms that begin before age 7 and last at least 6 months. Generally, symptoms have to be observed in at least two different settings, such as home and school, before a diagnosis is made.
How common is attention deficit hyperactivity disorder?
Attention-deficit/hyperactivity disorder is found in as many as one in every 20 children (U.S. Department of Health and Human Services, 1999). Boys are four 4 times more likely than girls to have the disorder (U.S. Department of Health and Human Services, 1999).
Children and adolescents with attention deficit hyperactivity disorder are at risk for many other mental disorders. About half of those with attention-deficit/hyperactivity disorder also have oppositional or conduct disorder, and about a fourth have an anxiety disorder. As many as one-third have depression, and about one-fifth have a learning disability. Sometimes children or adolescents will have two or more of these disorders in addition to attention deficit hyperactivity disorder. Children with attention-deficit/hyperactivity disorder are also at risk for developing personality and substance abuse disorders when they are adolescents or adults.
Attention deficit hyperactivity disorder is a major reason that children are referred for mental health services. Boys are more likely to be referred for treatment than girls, in part, because many boys with attention deficit hyperactivity disorder also have conduct disorder. Although mental health and special education services for children and adolescents with attention deficit hyperactivity disorder cost millions of dollars each year, in the long run, underachievement and lost productivity can be more costly for them and their families.
What causes attention deficit hyperactivity disorder?
Many causes of attention deficit hyperactivity disorder have been studied, but no one cause seems to apply to all young people with the disorder. Viruses, harmful chemicals in the environment, genetics, problems during pregnancy or delivery, or anything that impairs brain development can play a role in causing the disorder.
What help is available for families?
Many treatments, some with scientific basis and some without, have been recommended for children and adolescents with attention deficit hyperactivity disorder. Traditional approaches to treatment involve medications and/or behavior therapy.
Many types of medications have been used to treat attention deficit hyperactivity disorder. The most widely used drugs are stimulants. Stimulants increase activity in parts of the brain that appear to be underactive in children and adolescents with attention deficit hyperactivity disorder. Experts believe that this is why stimulants improve attention and reduce impulsive, hyperactive, or aggressive behavior. For some children and adolescents, certain antidepressants may also help alleviate symptoms of the disorder. Tranquilizers also have been effective for some individuals. Care must be taken when prescribing and monitoring all medications, and it is important to note that these are not the only medications that may be prescribed for this disorder.
Like most medications, those used to treat attention deficit hyperactivity disorder have side effects. These medications may cause some children to lose weight, have reduced appetites, and temporarily grow more slowly. Others may have trouble falling asleep. However, many doctors believe the benefits of these medications outweigh the possible side effects. Often, health care providers can alleviate side effects by adjusting the dosage.
Another treatment approach, called behavior therapy, involves using techniques and strategies to modify the behavior of children with the disorder. Behavior therapy may include:
- Instruction for parents and teachers on how to manage and modify children’s or adolescents’ behavior, such as rewarding good behaviors.
- Daily report cards to link efforts between home and school, where parents reward children or adolescents for good school performance and behavior.
- Summer and Saturday programs.
- Special classrooms that use intensive behavior modification.
- Specially trained classroom aides.
While a combination of stimulants and behavior therapy is believed to be helpful, it is not clear how long the benefits from this approach last. The Federal government’s National Institute of Mental Health is supporting research on the long-term benefits of various treatments, as well as research to determine if medication and behavior treatment are more effective when combined. Ongoing research efforts also are aimed at identifying new medicines and treatments.
Can attention deficit hyperactivity disorder be prevented?
Given that there are many suspected causes of attention deficit hyperactivity disorder, prevention may be difficult. However, as a precaution, it is always wise for expectant mothers to receive prenatal care and stay away from alcohol, tobacco, and other harmful chemicals during pregnancy. It also makes good sense for mothers to obtain good health care for their children. These recommendations may be particularly important when attention deficit hyperactivity disorder is suspected in other family members.
What else can parents do?
When it comes to attention deficit hyperactivity disorder, parents and other caregivers should be careful not to jump to conclusions. A high energy level alone in a child or adolescent does not mean that he or she has attention deficit hyperactivity disorder. The diagnosis depends on whether the child or adolescent can focus well enough to complete tasks that suit his or her age and intelligence. This ability is most likely to be noticed by a teacher. Since some children with attention deficit hyperactivity disorder have many different types of needs and often require special accommodations to help them function, input from teachers should be taken seriously.
If parents or caregivers suspect attention deficit hyperactivity disorder, they should:
- Make an appointment with a psychiatrist, psychologist, child neurologist, or behavioral pediatrician for an evaluation. (Ask the child’s doctor for a referral.)
- Be patient if the young person is diagnosed with attention deficit hyperactivity disorder, and recognize that progress takes time.
- Instill a sense of competence in the child or adolescent. Promote his or her strengths, talents, and feelings of self-worth.
- Remember that, in many instances, failure, frustration, discouragement, low self-esteem, and depression cause more problems than the disorder itself.
- Get accurate information from libraries, hotlines, or other sources.
- Ask questions about treatments and services.
- Talk with other families in their communities.
- Find family network organizations.
People who are not satisfied with the mental health care they are receiving should discuss their concerns with the provider, ask for information, and/or seek help from other sources. It may take time for families and providers to find the right “mix” of services and supports that work best for a child. While treatment may not fully eliminate unwanted symptoms, most children with attention deficit hyperactivity disorder do respond to medication and behavioral therapy.
Children with attention deficit hyperactivity disorder may qualify for free services within public schools. Most children with attention-deficit/hyperactivity disorder or other disabilities are eligible to receive special education services under the Individuals with Disabilities Education Act (IDEA). This act guarantees appropriate services and a public education to children ages 3 to 21 with disabilities.