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Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder

(ADHD and ADD; Hyperkinetic Syndrome; Hyperkinetic Impulse Disorder)

 

Definition

Attention deficit hyperactivity disorder (ADHD) is a condition of the brain that can affect how you behave. It can make you hyperactive, impulsive, and/or make it hard to pay attention. These problems happen anywhere you go including home, school, or work. ADHD is often first noticed when you are a child. If you have mild symptoms you may not know you have ADHD until you are an adult.

There are 3 types of ADHD:

  • Inattentive (classic "ADD")
  • Hyperactive-impulsive
  • Combined inattentive and hyperactive—the most common type
 

Causes    TOP

The exact cause of ADHD is not known. It is most likely caused by a chemical imbalance in the brain when it is growing. Your genes and factors in the environment may both have a role in these changes.

Child's Brain

Child Brain

A chemical imbalance in the brain may be responsible for ADHD.

Copyright © Nucleus Medical Media, Inc.

 

Risk Factors    TOP

Factors that may increase your chances of developing ADHD include:

  • Premature birth
  • Having a parent or sibling (especially an identical twin) with ADHD
  • Having a mother who has one or more of the following factors:
    • Smoked cigarettes and/or drank alcohol during pregnancy with you
    • Took antidepressant medication before pregnancy or during the first 3 months of pregnancy
    • Has a mental health condition
    • Had preterm labor during pregnancy
  • Head injury

Parenting styles may affect the symptoms but do not cause ADHD.

 

Symptoms    TOP

Symptoms can vary according to the type of ADHD:

  • Inattentive (classic "ADD")
    • Easily distracted by sights and sounds
    • Does not pay attention to detail
    • Does not seem to listen when spoken to
    • Makes careless mistakes
    • Does not follow through on instructions or tasks
    • Avoids or dislikes activities that require longer periods of mental effort
    • Loses or forgets items necessary for tasks
    • Is forgetful in day-to-day activities
  • Hyperactive-Impulsive
    • Is restless, fidgets, and squirms
    • Runs and climbs, and is not able to stay seated
    • Blurts out answers before hearing the entire question
    • Has difficulty playing quietly
    • Talks excessively
    • Interrupts others
    • Has difficulty waiting in line or waiting for a turn
  • Combined ADHD—Combination of the symptoms above.

These symptoms are common in all children at some point. Children with ADHD have more severe symptoms that occur more often.

In adults, these symptoms can cause problems with relationships and work. They can make it difficult to do your job well or keep a job.

Certain mental health or behavior problems are more common in those with ADHD. Common issues include:

 

Diagnosis    TOP

There is no standard test to determine if ADHD is present. A trained health professional will observe you or your child and collect information from the family, caregivers, and teachers.

The following information will also be helpful:

  • Behavior and symptoms of ADHD in different settings—home, recreation/sports, and school
  • Age at which symptoms started
  • How much the behavior affects the child's ability to function

The doctor will also rule out any other conditions or problems that may be causing the symptoms.

 

Treatment    TOP

ADHD is a lifelong condition but its effect can be managed with treatment. The goal of treatment is to improve the child's ability to grow, learn, and have relationships. Doctors should work together with parents, school staff, and other health professionals. Together, they can set realistic goals and keep an eye on the child's response. Proper treatment can prevent problems later in life.

Treatments include:

Sleep

Children who do not sleep enough may suffer from worse behavioral problems. A key part of treatment is to ensure that children with ADHD get plenty of sleep. Below are the recommended hours of sleep from the American Academy of Pediatrics:

  • Children
    • 3-5 years old should sleep 10-13 hours each day including naps
    • 6-12 years old should sleep 9-12 hours each day
  • Teenagers 13-18 years old should sleep 8-10 hours each day

Medication

For children over 6 years of age, medications may be used alone or may be combined with therapy. They can help to control behavior and increase focus.

Stimulants are the most common type of medication used to treat ADHD. They increase activity in parts of the brain that seem to be less active in those with ADHD. Stimulant medications:

  • May be short-acting or long-acting
  • May be given as a pill, liquid, or as a patch that is applied to the skin
  • May have increased risk of psychiatric problems (some medications)
  • May decrease appetite

The doctor will work to find medication with the most benefit and least risk for each child.

Other medications that may be considered include:

  • Selective norepinephrine reuptake inhibitors—to promote attention and decrease impulsiveness and hyperactivity
  • Antidepressants—to manage depression symptoms
  • Antipsychotics—to treat aggressive behavior
  • Certain blood pressure lowering medication—to treat impulsivity

Medication may not be the first choice to treat preschool children. Treatment may start with behavior therapy alone. Medication may be added if the first treatment plan is not working.

Behavior Therapy    TOP

Therapy may be all that is needed for younger children. In children that need medication, therapy can help them do better.

Therapy will help by teaching new social and problem solving skills. Parents and teachers will also be shown ways to help their children adapt. This may include changes in the classroom, as well as changes to how they parent. For example, an air cushion on a child's seat at school allows the child to move their body without distracting other students. Moving their body may help them increase their attention span.

ADHD coaching can also be helpful for older children and adults. Coaches work with people to help them organize and be more successful.

Neurofeedback is a treatment that has shown some promise but is still being studied. This treatment shows brain wave patterns on a screen and gives a cue when attention starts to wander. The goal is to re-train the brain to avoid patterns that lead to distraction.

 

Prevention    TOP

There are no current guidelines to prevent ADHD because the cause is unclear.

RESOURCES:

Attention Deficit Disorder Association
https://www.add.org

Children and Adults with Attention-Deficit/Hyperactivity Disorder
http://www.chadd.org

CANADIAN RESOURCES:

About Kids Health—The Hospital for Sick Children
http://www.aboutkidshealth.ca

Canadian Psychiatric Association
http://www.cpa-apc.org

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Last reviewed February 2018 by EBSCO Medical Review Board Adrian Preda, MD
Last Updated: 2/19/2018

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