Attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder, or ADHD, is a condition that makes it unusually difficult for kids to concentrate on tasks, to pay attention, to sit still, and to control impulsive behavior. While some children exhibit mostly inattentive behaviors and others predominantly hyperactive and impulsive, the majority of those with ADHD have a combination of both. ADHD affects between 3% and 8% of school-age children in the US.

ADHD behaviors usually become apparent when a child is between 3 and 6 years of age. Hyperactive or impulsive behaviors, which are often noticed first, include fidgeting, an inability to sit still, excess energy, verbal outbursts, extreme impatience, talking incessantly, and interrupting others. The inattentive behaviors often become noticeable only when a child enters school. He might be easily distracted, have difficulty following instructions, be unusually forgetful, struggle with organizing tasks, avoid things that involve mental exertion, and appear oblivious to what’s going on around him.

Of course many forms of inattention and impulsivity are normal in early childhood. But one study found that youngsters with ADHD display those behaviors at three times the frequency of their unaffected peers. Though boys are diagnosed with ADHD much more frequently than girls, experts believe that the actual prevalence in boys and girls is just about even, though girls experience the disorder differently.

Research suggests that ADHD runs in families and has a strong genetic component; some consider it to be one of the most heritable of psychiatric disorders. In addition, some studies have found a correlation between ADHD and environmental factors such as a mother’s alcohol or tobacco use during pregnancy and exposure to lead early in life. Some children with ADHD have an abnormality in the area of the brain concerned with attention, and brain injury has also been tied to the onset of ADHD.

Because of the variety of signs and symptoms of ADHD and the different ways the disorder manifests, diagnosis is a rigorous process, and professionals must also rule out other possible reasons for your child’s behavior. Your child may be diagnosed if he exhibits a variety of inattentive or impulsive behaviors that are abnormal for children his age, over an extended period and in multiple settings—at home and at school, for instance—and the behavior interferes significantly with schoolwork or social interaction. A trained clinician will make the diagnosis only after a thorough examination of the child and collecting information from several people who have observed your child, including parents, teachers, and other adults.

Treatment for ADHD is usually a combination of behavioral therapy and medication.

Psychotherapeutic: A variety of behavioral and psychotherapeutic methods have proven successful in managing the symptoms of ADHD. Parent-child interaction therapy, which focuses on teaching parents how to cultivate desired behaviors while minimizing the impulsive or inattentive ones, is often used effectively. Parent training is another that uses the family to address the symptoms, while cognitive behavioral therapy teaches a child to control his behaviors by understanding how his thoughts and feelings influence them. Close consultation with your child’s teachers can help him succeed despite his disorder. Tools such as a daily report card that targets desired behaviors can be effective. Social skills training may help him behave more appropriately with other children, and family therapy can help parents and siblings manage the stress created by the ADHD child’s needs and behavior.

Pharmacological: The most common medications prescribed for ADHD are psychostimulants. The two most widely used are known, generically, as methylphenidate and dextroamphetamine, which go by brand names like Ritalin and Adderall. What these drugs stimulate is the brain’s production of certain neurotransmitters that seem to activate the brain’s centers of attention and impulse control. They serve to focus the attention and curb the impulsivity and hyperactivity of kids with ADHD. Stimulant medications can have significant side effects, such as headaches, loss of appetite, and trouble sleeping. Some children are prescribed other, non-stimulant drugs approved for treatment of ADHD if the side effects of stimulants are troublesome or excessive. Medicating children with ADHD is a process of trial and observation, with overwhelmingly positive results—70% to 80% of kids have an excellent response to their first medication, and 15% will respond well to a second. While 20% to 30% are not helped by medication, or experience troublesome side effects, those effects are completely reversible by ending the course of treatment.

There is no cure for ADHD. Though many children will outgrow their diagnosis, more often than not symptoms persist into adulthood, and some people will benefit from continued professional help.

Children with ADHD are often diagnosed with learning disabilities (50% to 60%); oppositional defiant disorder (40%); and anxiety (25%) or mood (34%) disorders. Tourette’s syndrome, which can cause tics and spontaneous and inappropriate utterances, also appears in conjunction with ADHD. Any course of treatment for a child with ADHD will be more effective if all of the co-occurring conditions are addressed.

Does bad parenting cause ADHD?
No. ADHD is the result of abnormalities in the brain. Still, a disorganized or unaccommodating home life can make it harder for a child to deal with the symptoms of his disorder, and contribute to more acting out.

Will my child outgrow it?
Many children will grow out of the disorder, but symptoms very often persist into adulthood, and many people will continue to need professional help to manage it.

Will medications negatively affect my child’s brain?
No. Studies have shown that medications used to treat ADHD have no affect on the structure of the brain. A child can safely be on stimulant medications for many years.

Will medication affect my child’s learning experience?
Yes, and beneficially. ADHD kids on a course of medication find that they are much more able to concentrate and get more out of their time at school than they did before.

Will diet help with the ADHD?
There is no proven link between diet and the signs and symptoms of ADHD (or lack thereof).

Are ADHD brains different than others?
Yes. Brain scans show an average difference in volume of the brain areas concerned with attention and impulse control of 3% between ADHD brains and normal ones.