In recent years, attention deficit hyperactivity disorder (ADHD) has been a subject of great public attention and concern. It is one of the most common psychiatric disorders that appears in childhood. Children with the condition can't stay focused on a task or sit still, and often act without thinking. In general, they find it difficult to finish any project or activity they begin.
If left untreated, ADHD can have long-term effects on a child's ability to make friends or do well at school or work. Over time, children with the condition may develop
depression (
see ADHD and Depression), poor self-esteem, and other emotional problems.
A child with ADHD faces a difficult but not insurmountable task ahead. In order to achieve his or her full potential, the child should receive help, guidance, and understanding from:
- Parents
- Guidance counselors
- The public education system.
ADHD used to be known as attention deficit disorder, or
ADD. In 1994, it was renamed ADHD.
Some of the warning signs of ADHD include:
- Failure to listen to instructions
- Inability to organize oneself and school work
- Fidgeting with hands and feet
- Talking too much
- Leaving projects, chores, and homework unfinished
- Having trouble paying attention to and responding to details.
There are several types of ADHD, such as:
- ADHD, Predominantly Inattentive Type
- ADHD, Predominantly Hyperactive-Impulsive Type
- ADHD, Combined Type.
Effective treatment depends on an appropriate diagnosis. A comprehensive medical evaluation of the child must be conducted to establish a correct diagnosis of ADHD and to rule out other potential causes of the symptoms. This condition can be reliably diagnosed when appropriate guidelines are used. Ideally, a healthcare provider making an ADHD diagnosis should include input from both parents and teachers. However, some healthcare providers make a diagnosis without all this information and tend to either overdiagnose ADHD or underdiagnose it.
The condition is usually diagnosed in childhood, although it can continue into the adult years
(see Adult ADHD).
Research has shown that certain medications (stimulants, in most cases) and behavioral therapies that help children with ADHD control their activity level and impulsiveness, pay attention, and focus on tasks are the most beneficial treatments. Stimulants commonly prescribed for the condition include:
Despite data showing that stimulant medications are safe, there are widespread misunderstandings about the safety and use of these drugs, and some healthcare providers are reluctant to prescribe them. Like all medications, those used to treat ADHD do have side effects and need to be closely monitored.
Most experts agree that treatment for ADHD should address multiple aspects of the individual's functioning and should not be limited to the use of medications alone. Effective treatment should include:
- Structured classroom management
- Parent education (to address discipline and setting limits)
- Tutoring and/or behavioral therapy for the child.
Problems Families May Face
Parents need to carefully evaluate treatment choices when their child receives a diagnosis of ADHD. When they pursue treatment for their children, families face high out-of-pocket expenses because treatment for ADHD and other mental illnesses is often not covered by insurance policies. In schools, treatment plans are often poorly integrated. In addition, there are few special education funds directed specifically for ADHD. All of these factors lead to children who do not receive proper and adequate treatment.
To overcome these barriers, parents may want to look for school-based programs that have a team approach involving:
- Parents
- Teachers
- School psychologists
- Other mental health specialists
- Physicians.
There is no "cure" for ADHD. Children with the disorder seldom outgrow it; however, some may find adaptive ways to accommodate the condition as they mature.
Brain-imaging research using a technique called magnetic resonance imaging (MRI) has shown that differences exist between the brains of children with and those without ADHD. In addition, there appears to be a link between a person's ability to pay continued attention and the use of glucose (the body's major fuel) in the brain. In adults with ADHD, the brain areas that control attention use less glucose and appear to be less active, suggesting that a lower level of activity in some parts of the brain may cause inattention.
Research shows that the disorder tends to run in families, so there are likely to be genetic influences. Children who have ADHD usually have at least one close relative who also has it. At least one-third of all fathers who had the condition in their youth also have children with it. Even more convincing of a possible genetic link is that when one twin of an identical pair has the disorder, the other is likely to have it, too.
ADHD research has also shown that the use of stimulants alone is more effective than behavioral therapies in controlling the core symptoms -- inattention, hyperactivity/impulsiveness, and aggression. In other areas of functioning, such as
anxiety symptoms, academic performance, and social skills, the combination of stimulant use with intensive behavioral therapies was consistently more effective. Researchers continue to track these children into adolescence to evaluate the long-term outcomes of these treatments, and ongoing reports will be published.
ADHD was first described by Dr. Heinrich Hoffman in 1845. As a physician who wrote books on medicine and psychiatry, Dr. Hoffman was also a poet who became interested in writing for children when he couldn't find suitable materials to read to his three-year-old son. The result was a book of poems, complete with illustrations, about children and their characteristics. "The Story of Fidgety Philip" was an accurate description of a little boy who had attention deficit hyperactivity disorder.
Yet it was not until 1902 that Sir George F. Still published a series of lectures to the Royal College of Physicians in England. In these lectures, he described a group of impulsive children with significant behavioral problems caused by a genetic dysfunction and not by poor child rearing -- children who today would be easily recognized as having ADHD. Since then, several thousand scientific papers on the disorder have been published, providing information on its nature, course, causes, impairments, and treatments.
ADHD, which is the most commonly diagnosed behavioral disorder of childhood, occurs in 3 to 5 percent of school-age children in a six-month period.
Pediatricians report that approximately 4 percent of their patients have ADHD, but in practice, the diagnosis is often made in children who meet some, but not all, of the criteria.
Boys are two to three times more likely to have it than girls are.
ADHD is found in all cultures, although its prevalence differs. This difference is thought to stem more from differences in diagnostic criteria than from differences in symptoms.
Key information about ADHD includes the following:
- ADHD often co-occurs with other problems, such as depressive and anxiety disorders, conduct disorder, drug abuse, or antisocial behavior.
- Symptoms usually become evident in preschool or early elementary years. The disorder frequently persists into adolescence and occasionally into adulthood.
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