Attention-Deficit/Hyperactivity Disorder

What is attention-deficit/hyperactivity disorder (ADHD)?

ADHD, also called attention-deficit disorder, is a behavior disorder, usually first diagnosed in childhood, that is characterized by inattention, impulsivity, and, in some cases, hyperactivity. These symptoms usually occur together; however, one may occur without the other(s).

The symptoms of hyperactivity, when present, are almost always apparent by the age of 7 and may be apparent in very young preschoolers. Inattention or attention-deficit may not be evident until a child faces the expectations of elementary school.

What are the different types of ADHD?

Three major types of ADHD include the following:

• ADHD, combined type. This, the most common type of ADHD, is characterized by impulsive and hyperactive behaviors as well as inattention and distractibility.
• ADHD, impulsive/hyperactive type. This, the least common type of ADHD, is characterized by impulsive and hyperactive behaviors without inattention and distractibility.
• ADHD, inattentive and distractible type. This type of ADHD is characterized predominately by inattention and distractibility without hyperactivity.

What causes attention-deficit/hyperactivity disorder?

ADHD is one of the most researched areas in child and adolescent mental health. However, the precise cause of the disorder is still unknown. Available evidence suggests that ADHD is genetic. It is a brain-based biological disorder. Low levels of dopamine (a brain chemical), which is a neurotransmitter (a type of brain chemical), are found in adolescents with ADHD. Brain imaging studies using PET scanners (positron emission tomography; a form of brain imaging that makes it possible to observe the human brain at work) show that brain metabolism in adolescents with ADHD is lower in the areas of the brain that control attention, social judgment, and movement.

Who is affected by attention-deficit/hyperactivity disorder?

Recent data suggests that approximately 9.5 percent (5.4 million) of children 4 to 17 years of age have ever been diagnosed with ADHD, as of 2007. Boys are two to three times more likely to have ADHD than girls.

Many parents of adolescents with ADHD experienced symptoms of ADHD when they were younger. ADHD is commonly found in brothers and sisters within the same family. Most families seek help when their adolescent's symptoms begin to interfere with learning and adjustment to the expectations of school and age-appropriate activities.

What are the symptoms of attention-deficit/hyperactivity disorder?

The symptoms of ADHD vary with age. In general, hyperactive behavior in children is less conspicuous, as, at this age, children are less likely to be required to sit still, pay attention for long periods of time, etc. As children mature, though, symptoms become more conspicuous. In early school-aged children, symptoms present differently, and involve more gross motor activity, climbing, running, fidgeting, inability to sit still, trouble remaining seated, tapping, etc.). These symptoms often affect class work. During late childhood and early adolescence, these types of symptoms are less common, and more restlessness sets in. In adolescence, there is often more impulsive behavior, breaking of rules, and problems with relationships.

The following are the most common general symptoms of ADHD. However, each individual may experience symptoms differently. The three categories of symptoms of ADHD, regardless of age, include the following:

• Inattention:
  • Short attention span for age (difficulty sustaining attention)
  • Difficulty listening to others
  • Difficulty attending to details
  • Easily distracted
  • Forgetfulness
  • Poor organizational skills for age
  • Poor study skills for age
• Impulsivity:
  • Often interrupts others
  • Has difficulty waiting for his or her turn in school and/or social games
  • Tends to blurt out answers instead of waiting to be called on
  • Takes frequent risks, and often without thinking before acting
• Hyperactivity:
  • Seems to be in constant motion; runs or climbs, at times with no apparent goal except motion
  • Has difficulty remaining in his or her seat even when it is expected
  • Fidgets with hands or squirms when in his or her seat; fidgeting excessively
  • Talks excessively
  • Has difficulty engaging in quiet activities
  • Loses or forgets things repeatedly and often
  • Inability to stay on task; shifts from one task to another without bringing any to completion

The symptoms of ADHD may resemble other medical conditions or behavior problems. Furthermore, many of these symptoms may occur in children and teens who do not have ADHD. A key element in diagnosis is that the symptoms must significantly impair adaptive functioning in both home and school environments. Always consult your adolescent's health care provider for a diagnosis.

How is attention-deficit/hyperactivity disorder diagnosed?

ADHD is the most commonly diagnosed behavior disorder of childhood. A pediatrician, child psychiatrist, or a qualified mental health professional usually identifies ADHD in adolescents. A detailed history of the adolescent's behavior from parents and teachers, observations of the adolescent's behavior, and psychoeducational testing contribute to making the diagnosis of ADHD. Further, because ADHD is a group of symptoms, often diagnosis depends on evaluating results from several different types of evaluations, including physical, neurological, and psychological. Certain tests may be used to rule out other conditions, and some may be used to test intelligence and certain skill sets. Consult your adolescent's health care provider for more information.

Treatment for attention-deficit/hyperactivity disorder

Specific treatment for attention-deficit/hyperactivity disorder will be determined by your adolescent's health care provider based on:

• Your adolescent's age, overall health, and medical history
• Extent of your adolescent's symptoms
• Your adolescent's tolerance for specific medications or therapies
• Expectations for the course of the condition
• Your opinion or preference

Major components of treatment for adolescents with ADHD include parental support and education in behavioral training, appropriate school placement, and medication. Treatment with a psychostimulant is highly effective in most children and teens with ADHD.

Treatment may include:

• Psychostimulant medications. Psychostimulant medications are used for their ability to balance chemicals in the brain that prohibit the adolescent from maintaining attention and controlling impulses. They help "stimulate" or help the brain to focus and may be used to reduce the major characteristics of ADHD, which include the following:
  • Inattention
  • Impulsivity
  • Hyperactivity

  Different psychostimulant medications that are commonly used to treat ADHD include the following:

  • Methylphenidate (Ritalin, Metadate, Concerta, Methylin)
  • Dextroamphetamine (Dexedrine, Dextrostat))
  • A mixture of amphetamine salts (Adderall)
  • Atomoxetine (Strattera), which is a newer, nonstimulant medication for ADHD
  • Lisdexamfetamine dimesylate (Vyvanse)

  Psychostimulants have been used to treat childhood behavior disorders since the 1930s. They have been widely studied. Stimulants take effect in the body quickly, work for one to four hours, and then leave the body quickly. Recently many long acting stimulant medications have come on the market, lasting eight to nine hours, requiring one daily dosing. Doses of stimulant medications need to be timed to match the adolescent's school schedule to help the adolescent pay attention for a longer period of time and improve classroom performance. The common side effects of stimulants may include, but are not limited to, the following:

  • Insomnia
  • Decreased appetite
  • Stomach aches
  • Headaches
  • Jitteriness
  • Rebound activation (when the effect of the stimulant wears off, hyperactive and impulsive behaviors may increase for a short period of time)

  Most side effects of stimulant use are mild, decrease with regular use, and respond to dose changes. Always discuss potential side effects with your adolescent's health care provider.

  Antidepressant medications may also be administered for children and adolescents with ADHD to help improve attention while decreasing aggression, anxiety, and/or depression.

• Psychosocial treatments. Parenting adolescents with ADHD may be difficult and can present challenges that create stress within the family. Classes in behavior management skills for parents can help reduce stress for all family members. Training in behavior management skills for parents usually occurs in a group setting which encourages parent-to-parent support. Behavior management skills may include the following:
  • Use of "time out"
  • Point systems
  • Contingent attention (responding to the adolescent with positive attention when desired behaviors occur; withholding attention when undesired behaviors occur)

  Teachers may also be taught behavior management skills to use in the classroom setting. Training for teachers usually includes use of daily behavior reports that communicate in-school behaviors to parents.

  Behavior management techniques tend to improve targeted behaviors (such as completing school work or keeping the adolescent's hands to himself or herself), but are not usually helpful in reducing overall inattention, hyperactivity, or impulsivity.

Prevention of attention-deficit/hyperactivity disorder

Preventive measures to reduce the incidence of ADHD in adolescents are not known at this time. However, early detection and intervention can reduce the severity of symptoms, decrease the interference of behavioral symptoms on school functioning, enhance the adolescent's normal growth and development, and improve the quality of life experienced by children or adolescents with ADHD.

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