What is ADHD?

Attention-deficit/hyperactivity disorder (AD/HD)is a neuro-behavioral disorder characterized by a combination of inattentiveness, distractibility, hyperactivity, and impulsive behavior.

AD/HD appears early in life. It is estimated that 3 percent to 7 percent of school-age children are diagnosed with AD/HD; boys are diagnosed more often than girls. Untreated AD/HD has been shown to have long-term adverse effects on academic performance, vocational success, and social-emotional development. AD/HD children have difficulty sitting still and paying attention in class and do not do well at school, even when they have normal or above-normal intelligence. They engage in a broad array of disruptive behaviors and experience peer rejection.

As they grow older, children with untreated AD/HD are more prone to drug abuse, antisocial behavior, and injuries of all sorts. More than half the children diagnosed with AD/HD continue to have symptoms during their adolescent years and into adulthood.

According to the most recent version of the Diagnostic and Statistical Manual-IV, AD/HD is indicated when six or more of the following symptoms have a) persisted for at least six months to a degree that is maladaptive and inconsistent with the developmental level; b) some symptoms are present before age 7;  c) symptoms cause significant impairment of functioning in two or more settings (school, work, home, after-school activities, etc.); and d) symptoms are not better accounted for by another mental disorder such as learning disorder, conduct disorder, or anxiety disorder. The symptoms of AD/HD are:

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1. Symptoms of inattention:

• Has difficulty sustaining attention, organizing tasks, or setting up tools needed for a task

• Easily distracted by irrelevant sights and sounds

• Does not pay attention to detail or follow instructions carefully

• Makes careless mistakes in schoolwork and other activities

• Fails to finish school assignments and chores

• Loses things and is forgetful

• Does not seem to listen when spoken to directly; lethargic, appears to be daydreaming

Note: Children with the "inattentive" type of AD/HD characterized by the symptoms above are less disruptive and are often not diagnosed.

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2. Symptoms of hyperactivity/impulsivity:

• May often be "on the go"

• Restless; often fidgeting with hands or feet or squirming while seated

• Unable to stay seated or play quietly

• Smaller children may run, jump, or climb about constantly

• Talks excessively at inappropriate times

• Blurts out answers before questions are completed

• Trouble taking turns or waiting in line

• Interrupts or intrudes on others; grabs things from people

The combined inattentive/hyperactivity type displays equal, predominant symptoms of the above types; this is the most common type of AD/HD type among children and adolescents.

The predominantly inattentive type displays symptoms of inattention but fewer than six hyperactivity/impulsivity symptoms.

The predominantly hyperactive-impulsive type displays criteria for hyperactivity/impulsivity symptoms but fewer than six inattentive symptoms.

Treatment: Every child suspected of having AD/HD deserves a careful evaluation both to distinguish between AD/HD and AD/HD-like symptoms commonly seen in other psychiatric and medical conditions and to determine if some situational/environmental stressors may be inciting symptoms like those of AD/HD. Psychiatrists, psychologists, pediatricians/family physicians, neurologists, and clinical social workers most often are trained in providing an evaluation and diagnosis of mental disorders and ruling out other reasons for the child's behavior.

Possible causes of AD/HD-like behavior include a sudden change in the child's life, the death of a parent or grandparent, parents' divorce, a parent's job loss, undetected seizures (such as petit mal or temporal lobe seizures), a middle-ear infection that causes intermittent hearing problems, medical disorders that may affect brain functioning, underachievement caused by learning disability, anxiety, and depression.

A thorough evaluation should include a clinical assessment of the individual's performance in academic and social settings, emotional functioning, and developmental abilities. Additional tests may include intelligence tests, measures of attention span, and parent and teacher rating scales. A medical exam by a physician is also important. A doctor may look for allergies or nutrition problems like chronic caffeine highs that might make the child seem overly active. The assessment may also include interviews with the child's teachers, parents, and other people who know the child well.

Behavior during free play or while getting individual attention is given less importance in the evaluation; in such situations, most children with AD/HD are able to control their behavior and perform well.

Every family wants to determine which treatment will be most effective for their child. This question needs to be answered by each family in consultation with a health-care professional. To help families make this important decision, the National Institute of Mental Health (NIMH) has funded many studies of treatments for AD/HD and conducted the most intensive study ever undertaken for evaluating the treatment of this disorder, the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder.

The results of the study indicated that long-term combination treatments (medication and behavioral therapy) and medication management alone were superior to intensive behavioral treatment and routine community treatment. In some areas—anxiety, academic performance, oppositionality, parent-child relations, and social skills—the combined treatment was usually superior. Another advantage of combined treatment was that children could be successfully treated with lower doses of medicine.

No single treatment is the answer for every child with AD/HD. A child may sometimes have side effects from a medication that would make that particular treatment unacceptable. And if a child with AD/HD also has anxiety or depression, a treatment combining medication and behavioral therapy might be best. Each child's needs and personal history must be carefully considered.