Attention-deficit/hyperactivity disorder (ADHD

Overview

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.

 

Children with ADHD may also struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.

 

While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcomes.

 

Symptoms

The primary features of ADHD include inattention and hyperactive-impulsive behavior. ADHD symptoms start before age 12, and in some children, they're noticeable as early as 3 years of age. ADHD symptoms can be mild, moderate or severe, and they may continue into adulthood.

 

ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.

 

There are three subtypes of ADHD:

 

Predominantly inattentive. The majority of symptoms fall under inattention.

Predominantly hyperactive/impulsive. The majority of symptoms are hyperactive and impulsive.

Combined. This is a mix of inattentive symptoms and hyperactive/impulsive symptoms.

Inattention

A child who shows a pattern of inattention may often:

 

Fail to pay close attention to details or make careless mistakes in schoolwork

Have trouble staying focused in tasks or play

Appear not to listen, even when spoken to directly

Have difficulty following through on instructions and fail to finish schoolwork or chores

Have trouble organizing tasks and activities

Avoid or dislike tasks that require focused mental effort, such as homework

Lose items needed for tasks or activities, for example, toys, school assignments, pencils

Be easily distracted

Forget to do some daily activities, such as forgetting to do chores

Hyperactivity and impulsivity

A child who shows a pattern of hyperactive and impulsive symptoms may often:

 

Fidget with or tap his or her hands or feet, or squirm in the seat

Have difficulty staying seated in the classroom or in other situations

Be on the go, in constant motion

Run around or climb in situations when it's not appropriate

Have trouble playing or doing an activity quietly

Talk too much

Blurt out answers, interrupting the questioner

Have difficulty waiting for his or her turn

Interrupt or intrude on others' conversations, games or activities

Typical developmental behavior vs. ADHD

Most healthy children are inattentive, hyperactive or impulsive at one time or another. It's typical for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest.

 

The same is true of hyperactivity. Young children are naturally energetic — they often are still full of energy long after they've worn their parents out. In addition, some children just naturally have a higher activity level than others do. 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 shows signs of ADHD, see your pediatrician or family doctor. Your doctor may refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist or pediatric neurologist, but it's important to have a medical evaluation first to check for other possible causes of your child's difficulties.

 

Causes

While the exact cause of ADHD is not clear, research efforts continue. Factors that may be involved in the development of ADHD include genetics, the environment or problems with the central nervous system at key moments in development.

Risk factors

Risk factors for ADHD may include:

 

Blood relatives, such as a parent or sibling, with ADHD or another mental health disorder

Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings

Maternal drug use, alcohol use or smoking during pregnancy

Premature birth

Although sugar is a popular suspect in causing hyperactivity, there's no reliable proof of this. Many issues in childhood can lead to difficulty sustaining attention, but that's not the same as ADHD.

 

Complications

ADHD can make life difficult for children. Children with ADHD:

 

Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults

Tend to have more accidents and injuries of all kinds than do children who don't have ADHD

Tend to have poor self-esteem

Are more likely to have trouble interacting with and being accepted by peers and adults

Are at increased risk of alcohol and drug abuse and other delinquent behavior

Coexisting conditions

ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than others to also have conditions such as:

 

Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant and hostile behavior toward authority figures

Conduct disorder, marked by antisocial behavior such as stealing, fighting, destroying property, and harming people or animals

Disruptive mood dysregulation disorder, characterized by irritability and problems tolerating frustration

Learning disabilities, including problems with reading, writing, understanding and communicating

Substance use disorders, including drugs, alcohol and smoking

Anxiety disorders, which may cause overwhelming worry and nervousness, and include obsessive compulsive disorder (OCD)

Mood disorders, including depression and bipolar disorder, which includes depression as well as manic behavior

Autism spectrum disorder, a condition related to brain development that impacts how a person perceives and socializes with others

Tic disorder or Tourette syndrome, disorders that involve repetitive movements or unwanted sounds (tics) that can't be easily controlled

 

Prevention

Here are a few tips to help reduce your child's risk of ADHD: During pregnancy, avoid anything that could harm fetal development. For example, don't drink alcohol, use recreational drugs or smoke cigarettes.

Protect your child from exposure to pollutants and toxins, including cigarette smoke and lead paint.

Limit screen time. Although no link to ADHD has been proven, it may be prudent for children to avoid excessive exposure to TV and video games in the first five years of life.

Jan Ricks Jennings, MHA, LFACHE

Senior Consultant

Senior Management Resources, LLC

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Marcy 13, 2022