Attention-deficit/hyperactivity disorder (ADHD) is an illness characterized by inattention, hyperactivity and impulsivity. The most commonly diagnosed behavior disorder in young persons, ADHD affects an estimated three percent to five percent of school-age children.
Although ADHD is usually diagnosed in childhood, it is not a disorder limited to children—ADHD often persists into adolescence and adulthood and is frequently not diagnosed until later years.
There are actually three different types of ADHD, each with different symptoms: predominantly inattentive, predominantly hyperactive/impulsive and combined.
Those with the combined type, the most common type of ADHD, have a combination of the inattentive and hyperactive/impulsive symptoms.
A diagnosis of ADHD is made when an individual displays at least six symptoms from either of the above lists, with some symptoms having started before age seven. Clear impairment in at least two settings, such as home and school or work, must also exist. Additionally, there must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
ADHD affects an estimated two million American children, an average of at least one child in every U.S. classroom. In general, boys with ADHD have been shown to outnumber girls with the disorder by a rate of about three to one. The combined type of ADHD is the most common in elementary school-aged boys; the predominantly inattentive type is found more often in adolescent girls.
While there is no specific data on the rates of ADHD in adults, the disorder is sometimes not diagnosed until adolescence or adulthood. Half of the children with ADHD retain symptoms of the disorder throughout their adult lives. (It is generally believed that older individuals diagnosed with ADHD have had elements of the disorder since childhood.)
This is a question that has become increasingly difficult to answer simply. ADHD, or attention-deficit/hyperactivity disorder, is the only clinical term for disorders characterized by inattention, hyperactivity and impulsivity used in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, the diagnostic "bible" of psychiatry. However (and this is where things get tricky), ADD, or attention-deficit disorder, is a term that has become increasingly popular among laypersons, the media and even some professionals. Some use the term ADD as an umbrella term—after all, ADHD is an attention-deficit disorder. Others use the term ADD to refer to the predominantly inattentive type of ADHD, since that type does not feature hyperactive symptoms. Lastly, some simply use the terms ADD and ADHD interchangeably. The bottom line is that when people speak of ADD or ADHD, they generally mean the same thing. However, only ADHD is the "official" term.
Yes. In fact, symptoms like those of ADHD are often mistaken for or found occurring with other neurological, biological and behavioral disorders.
First of all, it is important to realize that ADHD is not caused by dysfunctional parenting, nor is it due to a lack of intelligence or discipline.
While early theories suggested that ADHD may be caused by minor head injuries or brain damage resulting from infections or complications at birth, research found this hypothesis to lack substantial supportive evidence. Furthermore, scientific studies have not verified dietary factors, another widely discussed possible influence for the development of ADHD, as a main cause of the disorder.
Many treatments—some with good scientific basis, some without—have been recommended for individuals with ADHD. The most proven treatments are medication and behavioral therapy.
Stimulants are the most widely used drugs for treating attention deficit/hyperactivity disorder. Examples of the most commonly used stimulants are methylphenidate (Ritalin), dextroamphetamine (Dexedrine, Desoxyn), amphetamine and dextroamphetamine (Adderall). Some of the stimulant class of medications come in longer acting preparations and can be given once a day. These drugs increase activity in parts of the brain that are underactive in those with ADHD, improving attention and reducing impulsiveness, hyperactivity and/or aggressive behavior. Stimulants have been shown to have the potential for abuse and are classified as controlled substances. The FDA has also approved a non-stimulant medication, Atomoxetine (Straterra), which does not appear to have the same risk of abuse as the stimulants. However, this medication carries a warning that in a small percentage of cases, suicidal thinking can be activated by this medication.
Other medications can be prescribed for ADHD but are done so “off label” which means the FDA has not approved the medication for this particular use in children and adolescents. If the doctor is making that recommendation, ask him or her why and what research and clinical experience inform that recommendation. You may get a second opinion from another doctor if you are not satisfied with the answers.
Every person reacts to treatment differently, so it is important to work closely and communicate openly with your physician. Some common side effects of stimulant medications include weight loss, decreased appetite, trouble sleeping and, in children, a temporary slowness in growth; however, these reactions can often be controlled by dosage adjustments. There is controversy about a serious possible heart complication that can occur in a small percent of people who take stimulants. Tics, or involuntary movement problems, are not common but can be uncomfortable side effects.
It is important to weigh the risks and benefits of these treatments with your doctor and youth.
Medication has proven effective in the short-term treatment of about three quarters of individuals with ADHD.
Treatment strategies such as rewarding positive behavior changes and communicating clear expectations of those with ADHD have also proven effective. Additionally, it is extremely important for family members and teachers or employers to remain patient and understanding.
Children with ADHD can additionally benefit from caregivers paying close attention to their progress, adapting classroom environments to accommodate their needs and using positive reinforcers. There is some evidence that behavioral treatment can lower the dose of the medications a child requires.
Where appropriate, parents should work with the school district to plan an individualized education program (IEP).
The child and adolescent clinical and research literature is always evolving. The National Institute of Mental Health and the American Association of Child and Adolescent Psychiatry are two excellent sources of current information on available treatment options and their potential risks and benefits.
There are a variety of other treatment options offered (some rather dubious) for those with ADHD. Those treatments not scientifically proven to work include biofeedback, special diets, allergy treatment, megavitamins, chiropractic adjustment and special-colored glasses.
Many children with ADHD also have co-occurring learning disabilities. Evaluation of a child’s learning style and strengths may be advisable to better match classroom and other supports with their learning style.
Reviewed by Ken Duckworth, M.D., July 2010