Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder

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

En Español (Spanish Version)More InDepth Information on This Condition

Definition

Attention deficit hyperactivity disorder (ADHD) is a disorder that affects behavior. It can cause hyperactive and impulsive behavior, and/or make it difficult to pay attention. Most people have some of these behavioral issues at some time. However with ADHD, these behavioral problems continue over a long period of time. To be considered ADHD, these behaviors must last for at least six months and be present in two environments (home, work, or school). ADHD affects children, adolescents, and adults.

There are three types of ADHD:

Inattentive (classic "ADD")
Hyperactive-impulsive
Combined—the most common type

Causes

The cause of ADHD is unknown. It most likely is caused by a chemical imbalance in the brain. There also appears to be a genetic factor since ADHD can run in families.

Child's Brain

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

Risk Factors

Factors that increase your chance of developing ADHD include:

Being a first-born boy
Having a parent or sibling (especially an identical twin) with ADHD
Having a mother who smoked cigarettes and/or drank alcohol during pregnancy
Having a parent with certain conditions (such as, alcoholism, conversion disorder)
Being born prematurely
Other possible risk factors, such as:
- Head injury at a young age (less than two years old)
- Being born with a serious heart condition
- Having Turner syndrome (a genetic condition)
- Being exposed to certain pesticides
- Spending over two hours a day watching TV or playing video games when young

Symptoms

All children display some of the symptoms of ADHD. Children with ADHD have symptoms that are more severe and consistent. They often have difficulty in school and with their family and peers.

ADHD can last into adulthood. It can cause problems with relationships, job performance, and job retention. Symptoms can vary according to the type of ADHD:

Inattentive (classic "ADD")
- Easily distracted by sights and sounds
- Doesn't pay attention to detail
- Doesn't seem to listen when spoken to
- Makes careless mistakes
- Doesn't 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; 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.

People with ADHD may also have:

Depression
Anxiety
Conduct disorder—difficulty following social rules
Oppositional defiant disorder—negative, angry, and defiant behaviors
Learning and language disorders
Physical conditions such as sleep apnea
Substance abuse
Trouble sleeping
Cigarette use

Diagnosis

There is no standard test to diagnose ADHD. It is done by a trained mental health professional. The diagnosis will also be based on feedback from family and teachers.

The American Academy of Pediatrics (AAP) recommends that the following guidelines be used for diagnosis in children 4-18 years of age:

Evaluation should be initiated if a child shows signs of:
- Inattention
- Hyperactivity
- Impulsivity
- Poor school performance
- Behavior problems
During diagnosis, the following information should be gathered directly from parents, caregivers, teachers, or other school professionals:
- Assessment of symptoms of ADHD in different settings (home and school)
- Age at which symptoms started
- How much the behavior affects the child's ability to function
The professional should examine the child for other conditions that might be causing or aggravating symptoms, such as:
- Certain health conditions
- Learning or language disorders
- Aggression
- Disruptive behavior
- Depression or anxiety
- Psychotic symptoms
- Personality disorder
For a diagnosis of ADHD to be made, symptoms must:
- Be present in two or more of the child's settings
- Interfere with the child's ability to function for at least six months
- Fit a list of symptoms detailed in the most recent version of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association

Treatment

The goal is to improve the child's ability to function. Doctors should work together with parents and school staff. Together, they can set realistic goals and evaluate the child's response.

Treatments include:

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.

Medicines can help control behavior and increase attention span. Stimulants are the most common choice for ADHD. They increase activity in parts of the brain that appear to be less active in children with ADHD. Stimulant medications include:

Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)
Dextroamphetamine (Dexedrine)
Amphetamine (Adderall)
Lisdexamfetamine (Vyvanse)—Recently approved to treat adults with ADHD. It can also be used to treat children aged 6-12 years.

Talk to your doctor if you have any questions about ADHD medicines. There are possible risks with these medicines, including heart problems and psychiatric problems (such as, hearing voices, becoming manic).

Although the risk of serious heart problems is rare some medical organizations recommend screening before starting ADHD medication. The American Heart Association (AHA) suggests that children have an electrocardiogram (ECG) before starting stimulant medicine for ADHD. Other medical organizations like the AAP do not recommend this screening. Talk to your doctor about your child's risk.

Other drugs include:

Atomoxetine (Strattera)
Antidepressants—such as imipramine (Janimine, Tofranil), venlafaxine (Effexor), and bupropion (Wellbutrin)
Clonidine (used for Tourette's syndrome)—to treat impulsivity

Children who take medicine and go to therapy do better than those who just use medicine. Therapy sessions focus on practicing social and problem-solving skills. Counselors will also teach parents and teachers to help the child through positive reinforcement. This could involve changes in the classroom, as well as in parenting style. Often, daily report cards are exchanged between parents and teachers.

Other tools, like the Disc'O'Sit cushion, may be helpful in improving children's attention in class. The Disc'O'Sit is a dome-shaped cushion filled with air that the child balances on.

ADHD coaching can also be helpful. These coaches work with individuals to help them organize and create strategies so that they can be more efficient and successful.

Prevention

There are no guidelines for preventing ADHD because the cause is unknown. Proper treatment can prevent problems later in life.

Resources:

Attention Deficit Disorder Association

http://www.add.org/

Attention Deficit Disorder Resources

http://www.addresources.org/

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

http://www.chadd.org/

Canadian resources:

About Kids Health

http://www.aboutkidshealth.ca/

Canadian Psychiatric Association

http://www.cpa-apc.org/

References:

Attention-Deficit/Hyperactivity Disorder: Management. American Family Physician. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/attention-deficit-hyperactivity...sorder-adhd.html. Accessed August 14, 2012.

ADHD. The Nemours Foundation website. Available at: http://kidshealth.org/parent/medical/learning/adhd.html. Accessed August 14, 2012.

Attention deficit hyperactivity disorder (ADHD). National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/what-is-attention-deficit-hyperacti...y-disorder.shtml. Accessed August 14, 2012.

ADHD basics. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/health-issues/conditions/adhd/Pag...ADHD-Basics.aspx. Accessed August 14, 2012.

Attention-deficit hyperactivity disorder (ADHD) in children. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated April 11, 2012. Accessed August 14, 2012.

Attention-deficit hyperactivity disorder (ADHD) in adults. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated April 25, 2012. Accessed August 14, 2012.

Fact sheet ADHD. The National Mental Health Association website. Available at: http://www.nmha.org/go/information/get-info/a...d/ad/hd-and-kids. Accessed August 14, 2012.

FDA directs ADHD drug manufacturers to notify patients about cardiovascular adverse events and psychiatric adverse events. US Food and Drug Administration website. Available at: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01568.html. Accessed August 14, 2012.

Methylphenidate and clonidine help children with ADHD and tics. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/news_and_events/news_articles/ne...article_adhd.htm. Accessed August 14, 2012.

Rappley M. Attention deficit-hyperactivity disorder. NEJM. 2005;352:165-173.

Risks for ADHD drugs outlined in patient guides. US Food and Drug Administration website. Available at: http://www.fda.gov/ForConsumers/ConsumerUp...es/ucm107863.htm. Updated April 2007. Accessed August 14, 2012.

ADHD. American Psychiatric Association website. Available at: http://www.apa.org/topics/adhd/index.aspx. Accessed August 14, 2012.

4/30/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Vetter V, Elia J, Erickson C, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs. Circulation. American Heart Association website. Available at: http://circ.ahajournals.org/content/117/18/2407.full.pdf. Accessed April 30, 2008.

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10/16/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Wilens TE, Vitulano M, Upadhyaya H, et al. Cigarette smoking associated with attention deficit hyperactivity disorder. J Pediatr. 2008;153:414-419.

1/8/2010 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Froehlich TE, Lanphear BP, Auinger P, et al. Association of tobacco and lead exposures with attention-deficit/hyperactivity disorder. Pediatrics. 2009;124:1054-1063.

2/4/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Froehlich TE, Lanphear BP, Auinger P, et al. Association of tobacco and lead exposures with attention-deficit/hyperactivity disorder. Pediatrics. 2009;124(6):e1054-1063.

11/19/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Swing EL, Gentile DA, Anderson CA, Walsh DA. Television and video game exposure and the development of attention problems. Pediatrics. 2010;126(2):214-221.

10/28/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Subcommittee on Attention-deficit/hyperactivity Disorder, Steering Committe on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011 Oct 16.

AAP Recommendations and Diagnostic Guidelines for ADHD. American Academy of Pediatrics, Healthy Children website. Available at: http://www.healthychildren.org/English/health-issues/conditions/adhd/pages/AAP-Recommendations-Diagnostic-Guide...es-for-ADHD.aspx. Updated October 24, 2011. Accessed October 28, 2011.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.