Katherine Chemodurow Kelley, MD
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Katherine Chemodurow Kelley, MD
Attention Deficit Hyperactivity Disorder
What is Attention Deficit Hyperactivity Disorder (ADHD, ADD)?
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).
ADHD has three subtypes:
Most symptoms are in the hyperactivity-impulsivity categories.
Fewer symptoms of inattention are present, although inattention may still be present to some degree.
The majority of symptoms are in the inattention category and fewer symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.
children with this subtype are less likely to act out or have difficulties getting along with other children and adults. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.
Combined hyperactive-impulsive and inattentive
Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.
Most children have the combined type of ADHD.
ADHD is one of the most common childhood disorders and can continue through adolescence and into adulthood. The average age of onset is 7 years old.
ADHD affects about 4.1% American adults age 18 years and older in a given year. The disorder affects 9.0% of American children age 13 to 18 years. Boys are four times at risk than girls.
Studies show that the number of children being diagnosed with ADHD is increasing, but it is unclear why.
Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.
Genes. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder. Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments.
Environmental factors. Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children. In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, may have a higher risk of developing ADHD.
Brain injuries. children and adults who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children and adults with ADHD have suffered a traumatic brain injury.
Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it. In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute. Another study in which children were given higher than average amounts of sugar or sugar substitutes showed similar results.
Food additives. Recent British research indicates a possible link between consumption of certain food additives like artificial colors or preservatives, and an increase in activity. Research is under way to confirm the findings and to learn more about how food additives may affect hyperactivity.
Signs & Symptoms
In attention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children and adults to be inattentive, hyperactive, or impulsive sometimes, but for children and adults with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, an individual must have symptoms for 6 or more months and to a degree that is greater than others of the same age.
Children and adults who have symptoms of inattention may:
Be easily distracted, miss details, forget things, and frequently switch from one activity to another
Have difficulty focusing on one thing
Become bored with a task after only a few minutes, unless they are doing something enjoyable
Have difficulty focusing attention on organizing and completing a task or learning something new
Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
Not seem to listen when spoken to
Daydream, become easily confused, and move slowly
Have difficulty processing information as quickly and accurately as others
Struggle to follow instructions.
Children and adults who have symptoms of hyperactivity may:
Fidget and squirm in their seats
Dash around, touching or playing with anything and everything in sight
Have trouble sitting still during dinner, school, and story time
Be constantly in motion
Have difficulty doing quiet tasks or activities.
Children and adults who have symptoms of impulsivity may:
Be very impatient
Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
Have difficulty waiting for things they want or waiting their turns in games
Often interrupt conversations or others' activities.
How is ADHD diagnosed in adults?
Like children, adults who suspect they have ADHD should be evaluated by a licensed mental health professional. But the professional may need to consider a wider range of symptoms when assessing adults for ADHD because their symptoms tend to be more varied and possibly not as clear-cut as symptoms seen in children.
To be diagnosed with the condition, an adult must have ADHD symptoms that began in childhood and continued throughout adulthood. Health professionals use certain rating scales to determine if an adult meets the diagnostic criteria for ADHD. The mental health professional also will look at the person's history of childhood behavior and school experiences, and at times may interview spouses or partners, parents, close friends, and other associates. The person may also undergo various psychological tests if needed to further clarify the diagnosis.
For some adults, a diagnosis of ADHD can bring a sense of relief. Adults who have had the disorder since childhood, but who have not been diagnosed, may have developed negative feelings about themselves over the years. Receiving a diagnosis allows them to understand the reasons for their problems, and treatment will allow them to deal with their problems more effectively.
Currently available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education or training, or a combination of treatments.
Treatments can relieve many of the disorder's symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.
The most common type of medication used for treating ADHD is called a "stimulant." Although it may seem unusual to treat ADHD with a medication considered a stimulant, it actually has a calming effect on children and adults with ADHD. Many types of stimulant medications are available. A few other ADHD medications are non-stimulants and work differently than stimulants. For many children and adults, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination.
However, a one-size-fits-all approach does not apply for all children and adults with ADHD. What works for one might not work for another. One individual might have side effects with a certain medication, while another may not. Sometimes several different medications or dosages must be tried before finding one that works for a particular individual. Any person taking medications must be monitored closely and carefully by caregivers and doctors.
Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some medications also come in short-acting, long-acting, or extended release varieties. In each of these varieties, the active ingredient is the same, but it is released differently in the body. Long-acting or extended release forms often allow a person to take the medication just once a day before school or work. The patient and doctors should decide together which medication is best for the individual and whether they need medication only for school or work hours or for evenings and weekends, too.
What are the side effects of stimulant medications?
The most commonly reported side effects are decreased appetite, sleep problems, anxiety, and irritability. Some people also report mild stomachaches or headaches. Most side effects are minor and disappear over time or if the dosage level is lowered.
Are stimulant medications safe?
Under medical supervision, stimulant medications are considered safe. Stimulants do not make people with ADHD feel high, although some individuals report feeling slightly different or "funny." Although some people worry that stimulant medications may lead to substance abuse or dependence, there is little evidence of this.
Do medications cure ADHD?
Current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken. Medications can help a person pay attention and complete their work. Adding behavioral therapy, counseling, and practical support can help people with ADHD and their families to better cope with everyday problems. Research funded by the National Institute of Mental Health (NIMH) has shown that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the individual’s needs.
Different types of psychotherapy are used for ADHD. Behavioral therapy aims to help an individual change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches people how to monitor his or her own behavior. Learning to give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting, is another goal of behavioral therapy.
A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as a large calendar or date book, lists, reminder notes, and by assigning a special place for keys, bills, and paperwork. Large tasks can be broken down into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.
Psychotherapy, including cognitive behavioral therapy, also can help change one's poor self-image by examining the experiences that produced it. The therapist encourages the adult with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.