ADHD

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Attention Deficit Hyperactivity Disorder (ADHD) IndexGlossaryFind a Local Doctor

Attention Deficit Hyperactivity Disorder
(ADHD) (ADD)


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Medical Author: Dennis S. Phillips, MD, and John Mersch, MD, FAAP
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

What is attention deficit hyperactivity disorder (ADHD)?
What is the cause of ADHD?
What are ADHD symptoms and signs?
How is ADHD diagnosed?
How are schools involved in diagnosing, assessing, and treating ADHD?
Is ADHD inherited?
Is ADHD on the increase? If so, why?
Can ADHD be seen in brain scans of children with the disorder?
Can a preschool-aged child be diagnosed with ADHD?
What is the impact of ADHD on children and their families?
What is the role of alternative therapies in ADHD?
What are behavioral treatments?
Which educational interventions have been studied and shown to be effective in the treatment of ADHD?
What medications are currently being used to treat ADHD?
Are there standard doses for these ADHD medications?
How long are children on these ADHD medications?
Hasn't the use of stimulant medication become excessive?
Are there differences in stimulant use across racial and ethnic groups?
Why are stimulants used when the problem is overactivity?
What are the risks of the use of stimulant medication and other treatments?
Will children taking these medications for ADHD become drug addicts?
What is the relationship between ADHD and other disorders, such as learning disabilities, anxiety disorders, bipolar disorder, or depression?
What is the prognosis for individuals with ADHD?
What is the history of ADHD? How is it related to ADD?
What are the future research directions for ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) At A Glance
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Attention Deficit Hyperactivity Disorder (ADHD)
What medications are currently being used to treat ADHD?
Psychostimulant medications, including methylphenidate (Ritalin, Metadate, and Concerta), amphetamine (Dexedrine, Vyvanse, and Adderall), and atomoxetine (Strattera, marketed as a "non-stimulant," although its mechanism of action and potential side effects are essentially equivalent to the "psychostimulant" medications), a newer drug, are by far the most widely researched and commonly prescribed treatments for ADHD. Numerous short-term studies have established the safety and effectiveness of stimulants and psychosocial (behavioral therapy) treatments for not only alleviating the symptoms of ADHD but also improving the child's ability to follow rules and improve relationships with peers and parents. National Institute of Mental Health (NIMH) research has indicated that the two most effective treatment modalities for elementary-school children with ADHD are a closely monitored medication treatment or a program that combines medication with intensive behavioral interventions (behavior therapy). In the NIMH Multimodal Treatment Study for Children with ADHD (MTA), which included nearly 600 elementary-school children across multiple sites, nine out of 10 children improved substantially on one of these treatment programs.
Two types of antidepressant medications, the "tricyclic antidepressants" (TCA) (imipramine, desipramine, and nortriptyline) and bupropion (Wellbutrin), have also been shown to have a positive effect on all three of the major components of ADHD: inattention, impulsivity, and hyperactivity. They tend, though, to be considered as second options for the children who have shown inadequate response to stimulant medication or who experience unacceptable side effects from stimulant medication such as tics (uncontrolled movement disorders) or insomnia. The antidepressants, however, have a greater potential for side effects of their own, such as heart-rate and rhythm changes, dry mouth, headaches, and drowsiness, to name a few. If higher doses are required, bupropion may bring on seizures. The antidepressants, therefore, require more careful monitoring.
For the child who has a combination of ADHD and comorbid conditions such as depression, anxiety disorders, or mood disorders, stimulant medications can be combined with an antidepressant medication very successfully.
Learn more about ADHD medication »

What is attention deficit hyperactivity disorder (ADHD)?

ADHD refers to a chronic biobehavioral disorder that initially manifests in childhood and is characterized by hyperactivity, impulsivity, and/or inattention. Not all of those affected by ADHD manifest all three behavioral categories. These symptoms can lead to difficulty in academic, emotional, and social functioning. The diagnosis is established by satisfying specific criteria and may be associated with other neurological, significant behavioral, and/or developmental/learning disabilities. Therapy may consider the use of medication, behavioral therapy, and adjustments in day-to-day lifestyle activities.

Studies in the United States indicates approximately 8%-10% of children satisfy diagnostic criteria for ADHD. ADHD is, therefore, one of the most common disorders of childhood. ADHD occurs two to four times more commonly in boys than girls (male to female ratio 4:1 for the predominantly hyperactive type vs. 2:1 for the predominantly inattentive type). Three subtypes of ADHD are described: (1) predominantly inattentive, (2) predominantly hyperactive and impulsive, and (3) combined. While previously believed to be "outgrown" by adulthood, current opinion indicates that many children will continue throughout life with symptoms that may affect both occupational and social functioning. Some medical researchers note that approximately 40%-50% of ADHD-hyperactive children will have (typically non-hyperactive) symptoms persist into adulthood.


What is the cause of ADHD?

The cause of ADHD has not been fully defined. One theory springs from observations in functional brain imagining studies between those with and without symptoms. However, other authorities point out that similar variations have been shown in studies of the structure of the brain of affected and non-affected individuals. Animal studies have demonstrated differences in the chemistry of brain transmitters involved with judgment, impulse control, alertness, planning, and mental flexibility.

A genetic predisposition has been demonstrated in (identical) twin and sibling studies. If one identical twin is diagnosed with ADHD, there is at 92% probability of diagnosis with the twin sibling. When comparing nonidentical twin sibling subjects, the probability falls to 33%. (Overall population incidence is 8%-10% in the U.S., as described above.)


What are ADHD symptoms and signs?

The diagnostic criteria for ADHD are outlined in the Diagnostic and Statistical Manual of Mental Health, 4th ed. (DSM-IV). All of the symptoms of inattention, hyperactivity, and impulsivity must have persisted for at least six months to a degree that is maladaptive and inconsistent with the developmental level of the child.

Inattention:

The child often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.


The child often has difficulty sustaining attention in tasks or play activities.


The child often does not seem to listen when spoken to directly.


The child often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).


The child often has difficulty organizing tasks and activities.


The child often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).


The child often loses things necessary for tasks or activities (toys, school assignments, pencils, books, or tools).


The child is often easily distracted by extraneous stimuli.


The child is often forgetful in daily activities.
Hyperactivity:

The child often fidgets with his/her hands or feet or squirms in his/her seat
.

The child often leaves his/her seat in the classroom or in other situations in which remaining seated is expected.


The child often runs about or climbs excessively in situations in which it is inappropriate.


The child often has difficulty playing or engaging in leisure activities quietly
.

The child often talks excessively.
Impulsivity:

The child often blurts out answers before questions have been completed.


The child often has difficulty awaiting his/her turn
.

The child often interrupts or intrudes on others (for example, butts into conversations or games).
DSM-IV criteria for diagnosis of ADHD requires that some hyperactive, impulsive, or inattention symptoms that cause present difficulties were present before 7 years of age and are present in two or more settings (at school [or work] or at home). Similarly, there must be clear evidence of significant impairment in social, academic, or occupational functioning. In addition, symptoms may not entirely be caused by another severe physical disorder (for example, severe illness associated with chronic pain) or mental disorder (for example, schizophrenia, other psychotic disorders, severe disabling mood disorders, etc.).

Inattention symptoms are most likely to manifest about at 8 to 9 years of age and commonly are lifelong. The "delay" in onset of inattentive symptoms may reflect its more subtle nature (vs. hyperactivity) and/or variability in the maturation of cognitive development. Hyperactivity symptoms are usually obvious by 5 years of age and peak in severity between 7 to 8 years of age. With maturation, these behaviors progressively decline and often have been "outgrown" by adolescence. Impulsive behaviors are commonly linked to hyperactivity and also peak about 7 to 8 years of age; however, unlike their hyperactive counterpart, impulsivity issues remain well into adulthood. Impulsive adolescents are more likely to experiment with high-risk behaviors (drugs, sexual activity, driving, etc.). Impulsive adults have a higher rate of financial mismanagement (impulse buying, gambling, etc.).

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Attention Deficit Hyperactivity Disorder (ADHD) IndexGlossaryFind a Local Doctor