Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. ADHD includes some combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior. Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school.
While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions.
A diagnosis of ADHD can be scary, and symptoms can be a challenge for parents and children alike. However, treatment can make a big difference, and most children with ADHD grow up to be normal adults.
ADHD has been called attention-deficit disorder (ADD) in the past. But, ADHD is now the preferred term because it describes both primary aspects of the condition: inattention and hyperactive-impulsive behavior.
While many children who have ADHD tend more toward one category than the other, most children have some combination of inattention and hyperactive-impulsive behavior. ADHD symptoms become more apparent during activities that require focused mental effort.
In order to be diagnosed with ADHD, signs and symptoms of the disorder must appear before the age of 7. In some children, signs of ADHD are noticeable as early as 2 or 3 years of age.
Signs and symptoms of inattention may include:
Signs and symptoms of hyperactive and impulsive behavior may include:
ADHD behaviors can be different in boys and girls:
You may suspect your child's behavior is caused by ADHD if you notice consistently inattentive or hyperactive, impulsive behavior that:
Normal behavior vs. ADHD
Most healthy children are inattentive, hyperactive or impulsive at one time or another. For instance, parents may worry that a 3-year-old who can't listen to a story from beginning to end may have ADHD. But it's normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and adolescents, attention span often depends on the level of interest. Most teenagers can listen to music or talk to their friends for hours but may be a lot less focused about homework.
The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're tired. And they may become even more active when they're tired, hungry, anxious or in a new environment. In addition, some children just naturally have a higher activity level than do others. Children should never be classified as having ADHD just because they're different from their friends or siblings.
Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.
When to see a doctor
If you're concerned that your child is displaying signs of ADHD, such as trouble concentrating, difficulty sitting still, or an inability to control his or her behavior, see your pediatrician or family doctor. Your doctor may refer you to a specialist, but it's important to have a medical evaluation first to check for other causes of your child's difficulties.
If your child is already being treated for ADHD, he or she should see the doctor regularly — at least every six months if his or her symptoms are stable. Be sure to discuss how often your child should be seen for appointments with his or her doctor. Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping or increased irritability. Some children taking stimulant medications may lose their appetite and have difficulty maintaining the same height and weight growth rate. However, they will most likely reach their full growth potential by adulthood.
Parents may blame themselves when a child is diagnosed with ADHD, but the causes likely have more to do with inherited traits than parenting choices. At the same time, certain environmental factors may contribute to or worsen a child's behavior. Although there's still a lot that isn't known about ADHD, several factors may cause it:
Risk factors for ADHD include:
ADHD frequently occurs along with certain other conditions, including:
ADHD can make life difficult for children. Children with ADHD:
ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than are other children to also have conditions such as:
You're likely to start by taking your child to a family doctor or a pediatrician. Depending on the results of the initial evaluation, your doctor may refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist or pediatric neurologist.
It's a good idea to be well prepared for your child's appointment so that you can be sure you have time to cover all of the points that are important to you. Here's some information to help you get ready for your appointment, and know what to expect from your doctor.
What you can do
Your time with the doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For ADHD, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions anytime you don't understand something during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, and being ready with answers will leave you more time to spend on other issues of concern to you:
There's no specific test for ADHD. Gathering as much information as possible about your child is the best way to get an accurate diagnosis and rule out other possible causes of your child's symptoms.
An appointment to check for ADHD usually begins with a complete medical exam and a number of questions about your child's health, medical problems, difficulties, and issues that occur at school and at home.
Children diagnosed with ADHD have symptoms over a long period of time and have particular trouble in stressful, demanding situations or in activities that require sustained attention, such as reading, doing math problems or playing board games.
In general, a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD start early in life and create significant problems at home and at school on an ongoing basis.
Diagnostic criteria for attention-deficit/hyperactivity disorder
To be diagnosed with ADHD, your child must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). This manual is published by the American Psychiatric Association. For a diagnosis of ADHD, a child must have six or more signs and symptoms from one of the two categories below (or, six or more signs and symptoms from each of the two categories).
Hyperactivity and impulsivity
In addition to having at least six signs or symptoms from one of the two categories, a child with ADHD:
A child diagnosed with ADHD is often given a more specific diagnosis, such as:
Other conditions that resemble ADHD
Your child's doctor will want to check for all possible causes of your child's behavior. A number of medical conditions or their treatments may cause signs and symptoms similar to those of ADHD, including:
Not only can some of these conditions cause symptoms that mimic ADHD, but these and other coexisting conditions also are found in children with ADHD.
Diagnosing ADHD in young children
Although signs of ADHD can sometimes appear in preschoolers or children even younger, diagnosing the disorder in very young children is difficult. That's because developmental problems such as language delays can be mistaken for ADHD. For that reason, children preschool age or younger suspected of having ADHD are more likely to need evaluation by a specialist such as a psychologist or psychiatrist, speech pathologist or developmental pediatrician.
Questionnaires and interviews
Because ADHD symptoms may not be obvious in a medical office, the doctor is likely to use questionnaires and interviews to learn more about your child's behavior. Your child's doctor may want to interview or send questionnaires to your child's teachers or other people who know your child well, such as baby sitters and coaches. Your child's doctor may also use ADHD rating scales to help collect and evaluate information about your child.
Standard treatments for ADHD in children include medications and counseling. Other treatments to ease the effects of ADHD symptoms include special accommodations in the classroom, and family and community support.
Currently, stimulant drugs (psychostimulants) and the nonstimulant medication atomoxetine (Strattera) are the most commonly prescribed medications for treating ADHD.
Stimulant medications for ADHD include:
Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These ADHD medications help improve the core signs and symptoms of inattention, impulsivity and hyperactivity — sometimes dramatically. However, these medications only work for a limited time. Additionally, the right dose varies from child to child, so it may take some time in the beginning to find the correct dose.
Stimulant drugs are available in short-acting and long-acting forms.
Stimulant medication side effects
The most common side effects of stimulant medications in children include:
A few children may develop jerky muscle movements, such as grimaces or twitches (tics), but these usually disappear when the dose of medication is lowered. Stimulant medications may also be associated with a slightly reduced growth rate in children, although in most cases growth isn't permanently affected.
ADHD medications and heart problems
Although rare, several heart-related deaths occurred in children and adolescents taking stimulant medications. The increased risk of sudden death is believed to be in people who already have underlying heart disease or a heart defect. Your child's doctor will make sure your child doesn't have any signs of a heart condition, and will ask about family risk factors for heart disease before prescribing a stimulant medication.
Atomoxetine is generally given to children with ADHD when stimulant medications aren't effective or cause side effects. In addition to reducing ADHD symptoms, atomoxetine may also reduce anxiety. Given one or two times a day, atomoxetine side effects can include nausea and sedation. It can also cause reduced appetite and weight loss.
Nonstimulant medication side effects
Atomoxetine has been linked to rare side effects that include liver problems. If your child is taking atomoxetine and develops yellow skin (jaundice), dark-colored urine or unexplained flu symptoms, contact the doctor right away.
There may also be a slightly increased risk of suicidal thinking in children and adolescents taking atomoxetine. Contact your child's doctor if you notice any signs of suicidal thinking or other signs of depression.
Other medications used to treat ADHD include:
Giving medications safely
Making sure your child takes the right amount of the prescribed medication is very important. Parents may be concerned about stimulants and the risk of abuse and addiction. Dependence hasn't been shown in children who take these drugs for appropriate reasons and at the proper dose. That's because medication levels in the brain rise too slowly to produce a "high." On the other hand, there's concern that siblings and classmates of children and teenagers with ADHD might abuse stimulant medications. To keep your child's medications safe and to make sure your child is getting the right dose of medication at the right time:
ADHD counseling and therapy
Children with ADHD often benefit from behavior therapy or counseling, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some children with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.
Counseling types include:
The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. You can help by making every effort to work with your child's teachers and by referring them to reliable sources of information to support their efforts in the classroom.
Symptoms often lessen with age. However, most people never completely outgrow their ADHD symptoms.
Because ADHD is a complex disorder and each person with ADHD is unique, it's hard to make recommendations that are right for every child. But some of the following suggestions may help:
Children at home
Children in school
There's little research that indicates that alternative medicine treatments can significantly reduce ADHD symptoms. Some alternative medicine treatments that have been tried include:
Caring for a child with ADHD can be challenging for the whole family. Parents may be hurt by their child's behavior as well as by the way other people respond to it. The stress of dealing with ADHD can lead to marital stress. These problems may be compounded by the financial burden that ADHD can place on families.
Siblings of a child with ADHD also may have special difficulties. They can be affected by a brother or sister who is demanding or aggressive, and they may also receive less attention because the child with ADHD requires so much of a parent's time.
There are no easy answers for struggling families, but many resources are available that may help. Parents can get advice on raising a child with ADHD from a social worker or other mental health care professional or from a support group. Support groups don't appeal to everyone, but they often can provide excellent information about coping with ADHD from people who know. Ask your child's doctor if he or she knows of any support groups in your area.
There also are excellent books and guides for both parents and teachers, and Internet sites dealing exclusively with ADHD.
Techniques for coping
Many parents notice patterns in their child's behavior as well as in their own responses to that behavior. For instance, your child might throw a tantrum every night before dinner, and you might routinely give him or her a snack so that you can finish preparing the meal in peace. Although you don't mean to, you end up encouraging your child's behavior. Both you and your child need to act differently. But substituting new habits for old ones isn't easy — it takes real awareness and a lot of hard work. It's important to have realistic expectations and not ask more of your child than is physically or mentally possible. Set small goals for both yourself and your child and don't try to make a lot of changes all at once.
Here are a few things that can help you and your child manage ADHD:
There's no way to prevent ADHD from occurring. However, there are a few steps that could help prevent problems caused by ADHD and assure your child is as physically, mentally and emotionally healthy as possible:
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