Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children. ADHD also affects many adults. Symptoms of ADHD include inattention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting), and impulsivity (hasty acts that occur at the moment without thought).
An estimated 8.4% of children and 2.5% of adults have ADHD. ADHD is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork. It is more common among boys than girls.
Signs and Symptoms
It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, are severe, and cause difficulty at school, at home, or with friends.
A child with ADHD might:
- daydream a lot
- forget or lose things a lot
- squirm or fidget
- talk too much
- make careless mistakes or take unnecessary risks
- have a hard time resisting temptation
- have trouble taking turns
- have difficulty getting along with others
How is ADHD diagnosed?
Healthcare providers use the guidelines in the American Psychiatric Association’s Diagnostic and Statistical Manual, fifth edition (DSM-5), to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities can also help determine how many children have ADHD, and how public health is impacted by this condition.
Types
There are three different types of ADHD, depending on which types of symptoms are strongest in the individual:
Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
Combined Presentation: Symptoms of the above two types are equally present in the person.
Causes of ADHD
Scientists are studying cause(s) and risk factors to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies link genetic factors with ADHD.
In addition to genetics, scientists are studying other possible causes and risk factors including:
Brain injury
Exposure to environmental risks (e.g., lead) during pregnancy or at a young age
Alcohol and tobacco use during pregnancy
Premature delivery
Low birth weight
Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.
Treatments
In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly training for parents, is recommended as the first line of treatment before medication is tried. What works best can depend on the child and family. Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.
Treatment recommendations for ADHD
ADHD is sometimes diagnosed during childhood, typically in school settings where symptoms of the condition, such as problems with behavioral control, anger issues, distractibility, and inattention, are most evident.
Several treatment options can manage symptoms successfully.
For children with ADHD younger than 6 years of age, the American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment, before medication is tried. For children 6 years of age and older, the recommendations include medication and behavior therapy together — parent training in behavior management for children up to age 12 and other types of behavior therapy and training for adolescents. Schools can be part of the treatment as well. AAP recommendations also include adding behavioral classroom intervention and school support.
Good treatment plans will include close monitoring of whether and how much the treatment helps the child’s behavior, as well as making changes as needed along the way. To learn more about AAP recommendations for the treatment of children with ADHD
Behavior Therapy
ADHD affects not only a child’s ability to pay attention or sit still at school, but it also affects relationships with family and other children. Children with ADHD often show behaviors that can be very disruptive to others. Behavior therapy is a treatment option that can help reduce these behaviors; it is often helpful to start behavior therapy as soon as a diagnosis is made.
The goals of behavior therapy are to learn or strengthen positive behaviors and eliminate unwanted or problem behaviors. Behavior therapy for ADHD can include:
Parent training in behavior management;
Behavior therapy with children; and
Behavioral interventions in the classroom external icon.
These approaches can also be used together. For children who attend early childhood programs, it is usually most effective if parents and educators work together to help the children.
Children younger than 6 years of age
For young children with ADHD, behavior therapy is an important first step before trying medication because:
Parent training in behavior management gives parents the skills and strategies to help their children.
Parent training in behavior management has been shown to work as well as medication for ADHD in young children.
Young children have more side effects from ADHD medications than older children.
The long-term effects of ADHD medications on young children have not been well-studied.
School-age children and adolescents
For children ages 6 years and older, AAP recommends combining medication treatment with behavior therapy. Several types of behavioral therapies are effective, including:
Parent training in behavior management;
Behavioral interventions in the classroom;
Peer interventions that focus on behavior; and
Organizational skills training.
These approaches are often most effective if they are used together, depending on the needs of the individual child and the family.
Medication
There are two main types of medication for ADHD: stimulants and non-stimulants.
Stimulant medications are highly effective treatments that have been safely used for decades. They include methylphenidate and amphetamines. As with all medicines, children taking these drugs must be carefully monitored by their parents and doctors. Two non-stimulant medications, atomoxetine, and guanfacine have also been shown to be effective in treating ADHD symptoms. These medications are alternatives for those who do not respond well to stimulants or if a non-stimulant is preferred.
Some children experience dramatic relief of symptoms with medication and this relief continues with ongoing treatment. Other children may experience only partial relief or the medication may seem to stop working. A change in medication or adjustment in dose may improve the response. Other children and families may benefit from additional therapy specific to problem behaviors.
The national organization Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) notes that many adults report that medication helps them gain more control and organization in their lives.
