Attention Deficit / Hyperactivity Disorder
Basics
Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder that begins in childhood, and is characterized by a persistent pattern of inattention, impulsivity, and hyperactivity. ADHD is one of the most commonly diagnosed psychiatric disorders in children and adolescents. ADHD is thought to affect about 9.2% of boys and 2.9% of girls who are of school age. While it is estimated that about 2% of adults also suffer from ADHD, the condition often goes unrecognized in adults.
People with ADHD have many symptoms, including extreme inattentiveness and/or impulsiveness and hyperactivity. Many people with ADHD continue to have symptoms throughout life.
Causes
ADHD runs in families, and seems to have a strong genetic component.
Scientists are not sure what happens in the brain to cause ADHD. One study found that children with ADHD have symptoms similar to those seen in adults with damage to the part of the brain largely responsible for emotions and personality (frontal lobes). Therefore, it is thought that the frontal lobes or related structures may be involved with ADHD Figure 01. Other studies evaluating blood flow or energy use in the brain have also found evidence of brain dysfunction among people with ADHD.
Figure 01. Frontal lobes of the brain
Symptoms
ADHD is characterized by inattentive, hyperactive, or impulsive behavior that begins during childhood. ADHD is characteristically diagnosed in children under the age of seven, although the disorder can be present in adolescents and adults as well. Individuals with ADHD often seem to be disorganized or preoccupied. They may be poor listeners, and frequently change the subject or become distracted by unimportant interruptions. Individuals with ADHD may appear to be impatient, interrupting others frequently, or blurting out tactless comments. Some impulsive people engage in high-risk sports or other activities. While similar symptoms can occur in normal children and adults, people with ADHD show a persistent pattern that is more frequent and more severe than that of others in the same age group.
Some people with ADHD have mostly inattentive symptoms, while others exhibit mostly hyperactive and impulsive behavior. Most people with ADHD have features of both subtypes Table 01. Inattention may manifest itself as carelessness at work or at home, or difficulty completing projects. Individuals with ADHD often seem to be disorganized or preoccupied.
Hyperactivity can manifest as fidgetiness or an inability to engage in tasks or leisure activities that require a person to sit still. People with these symptoms often seem to be “on the go.” Hyperactive people sometimes describe having accelerated or multiple thoughts at the same time.
Table 1. Symptoms of ADHD by Subtype
| Inattentive | Hyperactive/impulsive |
|---|---|
| Fails to pay close attention to details or makes careless mistakes | Fidgets with hands or feet or squirms in seat |
| Has difficulty sustaining attention | Leaves seat in situations where remaining seated is expected |
| Does not seem to listen | Runs about or climbs excessively (in adults, may be limited to feelings of restlessness) |
| Does not follow through on instructions and fails to finish tasks | Has difficulty paying attention or engaging in leisure activities quietly |
| Has difficulty organizing tasks and activities | "On the go" or acts as if "driven by a motor" |
| Avoids or dislikes tasks that require sustained mental effort | Talks excessively |
| Loses things necessary for tasks or activities | Blurts out answers before questions completed (impulsivity) |
| Easily distracted by extraneous stimuli | Has problems waiting turns (impulsivity) |
| Forgetful in daily activities | Interrupts or intrudes on others (impulsivity) |
Other troubling features are commonly seen in individuals with ADHD Table 02. Possibly as a result of frequently being “in trouble” or regarded as lazy, many people with ADHD have low self-esteem. They may have a low tolerance for frustration, and have frequent temper outbursts and mood changes. Some very impulsive people become “class clowns.” More troubling consequences of ADHD include possible drug abuse and conduct disorder, often involving anti-social behavior and skirmishes with the law.
Table 2. Learning/Behavior Problems In Children or Adolescents with ADHD
| Possible problems identified by parents/family members | Possible problems identified by school personnel | Possible problems identified by patients |
|---|---|---|
| Noncompliance | Fidgety, restless behavior | Dislike of school |
| Aggression | Hyperactivity | Lack of close or long-term friendships |
| Anger management problems | Fidgety, restless behavior | Frustration with certain teachers or subjects |
| Impulsivity | Inattention, off-task behavior, distractibility | Excessive conflict with parents |
| Engaging in physically dangerous activity | Social interaction problems (impulsivity, intrusiveness) | Low self-esteem |
| Task completion difficulty | Underachievement, school failure | - |
| Disorganized, messy | Disruptive classroom behavior | |
| Appearing "spaced out" or "zoned out" | Excessive talking, blurting out answers | |
| Changeable moods | Poor listening | |
| Absent-mindedness | Incomplete, missing homework | |
| Social/emotional "immaturity" | Messy, disorganized work | |
| "Hyper," "in constant motion" |
Risk Factors
ADHD is more common in boys than in girls.
ADHD tends to run in families
Diagnosis
Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder that begins in childhood, and is characterized by a persistent pattern of inattention, impulsivity, and hyperactivity. ADHD is one of the most commonly diagnosed psychiatric disorders in children and adolescents. ADHD is thought to affect about 9.2% of boys and 2.9% of girls who are of school age. While it is estimated that about 2% of adults also suffer from ADHD, the condition often goes unrecognized in adults.
People with ADHD have many symptoms, including extreme inattentiveness and/or impulsiveness and hyperactivity. Many people with ADHD continue to have symptoms throughout life.
ADHD runs in families, and seems to have a strong genetic component.
Scientists are not sure what happens in the brain to cause ADHD. One study found that children with ADHD have symptoms similar to those seen in adults with damage to the part of the brain largely responsible for emotions and personality (frontal lobes). Therefore, it is thought that the frontal lobes or related structures may be involved with ADHD Figure 01. Other studies evaluating blood flow or energy use in the brain have also found evidence of brain dysfunction among people with ADHD.Figure 01. Frontal lobes of the brain
ADHD is characterized by inattentive, hyperactive, or impulsive behavior that begins during childhood. ADHD is characteristically diagnosed in children under the age of seven, although the disorder can be present in adolescents and adults as well. Individuals with ADHD often seem to be disorganized or preoccupied. They may be poor listeners, and frequently change the subject or become distracted by unimportant interruptions. Individuals with ADHD may appear to be impatient, interrupting others frequently, or blurting out tactless comments. Some impulsive people engage in high-risk sports or other activities. While similar symptoms can occur in normal children and adults, people with ADHD show a persistent pattern that is more frequent and more severe than that of others in the same age group.
Some people with ADHD have mostly inattentive symptoms, while others exhibit mostly hyperactive and impulsive behavior. Most people with ADHD have features of both subtypes Table 01. Inattention may manifest itself as carelessness at work or at home, or difficulty completing projects. Individuals with ADHD often seem to be disorganized or preoccupied.
Hyperactivity can manifest as fidgetiness or an inability to engage in tasks or leisure activities that require a person to sit still. People with these symptoms often seem to be “on the go.” Hyperactive people sometimes describe having accelerated or multiple thoughts at the same time.
Table 1. Symptoms of ADHD by Subtype
| Inattentive | Hyperactive/impulsive |
|---|---|
| Fails to pay close attention to details or makes careless mistakes | Fidgets with hands or feet or squirms in seat |
| Has difficulty sustaining attention | Leaves seat in situations where remaining seated is expected |
| Does not seem to listen | Runs about or climbs excessively (in adults, may be limited to feelings of restlessness) |
| Does not follow through on instructions and fails to finish tasks | Has difficulty paying attention or engaging in leisure activities quietly |
| Has difficulty organizing tasks and activities | "On the go" or acts as if "driven by a motor" |
| Avoids or dislikes tasks that require sustained mental effort | Talks excessively |
| Loses things necessary for tasks or activities | Blurts out answers before questions completed (impulsivity) |
| Easily distracted by extraneous stimuli | Has problems waiting turns (impulsivity) |
| Forgetful in daily activities | Interrupts or intrudes on others (impulsivity) |
Other troubling features are commonly seen in individuals with ADHD Table 02. Possibly as a result of frequently being “in trouble” or regarded as lazy, many people with ADHD have low self-esteem. They may have a low tolerance for frustration, and have frequent temper outbursts and mood changes. Some very impulsive people become “class clowns.” More troubling consequences of ADHD include possible drug abuse and conduct disorder, often involving anti-social behavior and skirmishes with the law.
Table 2. Learning/Behavior Problems In Children or Adolescents with ADHD
| Possible problems identified by parents/family members | Possible problems identified by school personnel | Possible problems identified by patients |
|---|---|---|
| Noncompliance | Fidgety, restless behavior | Dislike of school |
| Aggression | Hyperactivity | Lack of close or long-term friendships |
| Anger management problems | Fidgety, restless behavior | Frustration with certain teachers or subjects |
| Impulsivity | Inattention, off-task behavior, distractibility | Excessive conflict with parents |
| Engaging in physically dangerous activity | Social interaction problems (impulsivity, intrusiveness) | Low self-esteem |
| Task completion difficulty | Underachievement, school failure | - |
| Disorganized, messy | Disruptive classroom behavior | |
| Appearing "spaced out" or "zoned out" | Excessive talking, blurting out answers | |
| Changeable moods | Poor listening | |
| Absent-mindedness | Incomplete, missing homework | |
| Social/emotional "immaturity" | Messy, disorganized work | |
| "Hyper," "in constant motion" |
ADHD is more common in boys than in girls.
ADHD tends to run in families
A doctor will ask the patient and family members or teachers about noticeable symptoms of ADHD, including information about trouble at work or school. As children or teenagers with ADHD often fail to report their symptoms completely or accurately, it is important for the doctor to gather information from family members and teachers as well. The doctor will ask about personal relationships both inside and outside the home, and work or study habits.
Adults often lack insight about their own symptoms, and should also bring along their spouse, significant other, or other family members to provide additional information.
To be diagnosed as such, ADHD must be severe enough to adversely affect the person in at least two settings, such as at school, at home, in social groups, or in the workplace.
Because psychiatrists define ADHD as a disorder that must have been present since before the age of seven, it is difficult for doctors to diagnose ADHD in adults.
A diagnosis in adults is based on a recollection of symptoms from childhood and current symptoms. Old school records and reports from other family members may help confirm the childhood diagnosis.
Prevention and Screening
Treatment
For treatment to be effective, patients with ADHD must be highly motivated to follow their treatment plan closely. Drug treatment for ADHD can work when patients take medications and adhere to the medication schedule. Young patients may benefit from parent management training, structured school settings, and social skills training.
Students with ADHD often receive special accommodations for school testing. Arrangements can be made to take exams in private areas, to be given increased time on tests, and to have the ability to take breaks during exams. Parents interested in these options should contact their child's school.
Your doctor is the best source of information on the drug treatment choices available to you.
Behavioral therapy and family counseling are effective when used along with medication. Individuals with ADHD may benefit from strategies that help to improve organizational skills, relationships, and anger management. If an individual's ADHD disrupts family life, other members of the family may also benefit from counseling.
Some patients for whom it is affordable may benefit from a “coach”, who is someone trained to provide daily encouragement and assistance in reaching goals. This person does not necessarily have to be a clinician. However, there is no scientific proof that this therapy works for adults.
Joining an association of other adults with ADHD may also be helpful in gaining insight into problems and keeping abreast of new developments. One such organization is the Association for Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD):
CHADD8181 Professional Place, Suite 201Landover, MD 20785(800) 233-4050301-306-7070FAX 301-306-7090http://www.chadd.org/
Students with ADHD are eligible for assistance under federal legislation section 504, the Americans with Disabilities Act. Section 504 is intended to protect the rights of people with disabilities. Your doctor can help you access school services associated with this legislation by preparing a statement about how ADHD interferes with schoolwork, or by preparing a medication plan to be used by the school.
Some people believe that changing the diet or taking nutritional supplements will help the symptoms of ADHD; however, there is no scientific evidence to support that such approaches are effective.
Adolescents with ADHD frequently have learning disabilities. Teenagers with speech and language difficulties can develop inattentive and hyperactive behaviors similar to those of ADHD. Those with difficulties processing sound often also have attention and memory difficulties.
Treatment for ADHD will not be successful if a patient with ADHD also has a learning disability that has not been dealt with.
Adolescents or adults with ADHD who are not performing well at school or work often become depressed or anxious. About one-quarter of children with ADHD also have anxiety disorder. The failing grades, refusal to do schoolwork, poor performance at work, and lack of concentration characteristic of ADHD are also common signs of depression.
A woman of childbearing age with ADHD who is thinking of becoming pregnant should talk to her doctor about whether or not to continue medication.
People with ADHD are at high risk for other psychiatric disorders and substance abuse. Rates of antisocial personality disorder, substance abuse, and learning disorders are especially high in people with ADHD. It is unclear whether people with ADHD have genetic tendencies towards such problems, or if the other disorders result from their inability to cope with the problems of ADHD.
ADHD is a lifelong disorder. While some children grow out of ADHD, most continue to have problems into adolescence and adulthood. Adults with ADHD usually need treatment throughout life.
Problems associated with the symptoms of ADHD may become more significant after childhood. The consequences of impulsive behavior may be more severe in adolescence than during childhood and adulthood. For example, teenage boys with ADHD receive more driving tickets and have more car crashes than their peers. Poor academic performance during the high school years may also carry more significance than in earlier years. Conflicts at school and at home may seem less manageable than in childhood.
In adulthood, frequent boredom, inattentiveness, and impulsivity can also have serious repercussions in relationships and on the job.
People with ADHD may require lifetime therapy. Family members can help evaluate the effectiveness of medications and counseling, as improvements or continued problems may be more apparent to them than to the actual patient.