Attention-deficit/hyperactivity disorder (ADHD) in children
Definition:
Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. ADHD includes some combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior. Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school.
While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions.
A diagnosis of ADHD can be scary, and symptoms can be a challenge for parents and children alike. However, treatment can make a big difference, and most children with ADHD grow up to be normal adults.
Symptoms:
ADHD has been called attention-deficit disorder (ADD) in the past. But, ADHD is now the preferred term because it describes both primary aspects of the condition: inattention and hyperactive-impulsive behavior.
While many children who have ADHD tend more toward one category than the other, most children have some combination of inattention and hyperactive-impulsive behavior. ADHD symptoms become more apparent during activities that require focused mental effort.
In order to be diagnosed with ADHD, signs and symptoms of the disorder must appear before the age of 7. In some children, signs of ADHD are noticeable as early as 2 or 3 years of age.
Signs and symptoms of inattention may include:
Most healthy children are inattentive, hyperactive or impulsive at one time or another. For instance, parents may worry that a 3-year-old who can't listen to a story from beginning to end may have ADHD. But it's normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and adolescents, attention span often depends on the level of interest. Most teenagers can listen to music or talk to their friends for hours but may be a lot less focused about homework.
The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're tired. And they may become even more active when they're tired, hungry, anxious or in a new environment. In addition, some children just naturally have a higher activity level than do others. Children should never be classified as having ADHD just because they're different from their friends or siblings.
Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.
When to see a doctor
If you're concerned that your child is displaying signs of ADHD, such as trouble concentrating, difficulty sitting still, or an inability to control his or her behavior, see your pediatrician or family doctor. Your doctor may refer you to a specialist, but it's important to have a medical evaluation first to check for other causes of your child's difficulties.
If your child is already being treated for ADHD, he or she should see the doctor regularly — at least every six months if his or her symptoms are stable. Be sure to discuss how often your child should be seen for appointments with his or her doctor.
Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping or increased irritability. Some children taking stimulant medications may lose their appetite and have difficulty maintaining the same height and weight growth rate. However, they will most likely reach their full growth potential by adulthood.
Causes:
Parents may blame themselves when a child is diagnosed with ADHD, but the causes likely have more to do with inherited traits than parenting choices. At the same time, certain environmental factors may contribute to or worsen a child's behavior. Although there's still a lot that isn't known about ADHD, several factors may cause it:
ADHD can make life difficult for children. Children with ADHD:
ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than are other children to also have conditions such as:
Standard treatments for ADHD in children include medications and counseling. Other treatments to ease the effects of ADHD symptoms include special accommodations in the classroom, and family and community support.
Medications
Currently, stimulant drugs (psychostimulants) and the nonstimulant medication atomoxetine (Strattera) are the most commonly prescribed medications for treating ADHD.
Stimulant medications for ADHD include:
Stimulant drugs are available in short-acting and long-acting forms.
The most common side effects of stimulant medications in children include:
ADHD medications and heart problems
Although rare, several heart-related deaths occurred in children and adolescents taking stimulant medications. The increased risk of sudden death is believed to be in people who already have underlying heart disease or a heart defect. Your child's doctor will make sure your child doesn't have any signs of a heart condition, and will ask about family risk factors for heart disease before prescribing a stimulant medication.
Nonstimulant medication
Atomoxetine is generally given to children with ADHD when stimulant medications aren't effective or cause side effects. In addition to reducing ADHD symptoms, atomoxetine may also reduce anxiety. Given one or two times a day, atomoxetine side effects can include nausea and sedation. It can also cause reduced appetite and weight loss.
Nonstimulant medication side effects
Atomoxetine has been linked to rare side effects that include liver problems. If your child is taking atomoxetine and develops yellow skin (jaundice), dark-colored urine or unexplained flu symptoms, contact the doctor right away.
There may also be a slightly increased risk of suicidal thinking in children and adolescents taking atomoxetine. Contact your child's doctor if you notice any signs of suicidal thinking or other signs of depression.
Other medications used to treat ADHD include:
Making sure your child takes the right amount of the prescribed medication is very important. Parents may be concerned about stimulants and the risk of abuse and addiction. Dependence hasn't been shown in children who take these drugs for appropriate reasons and at the proper dose. That's because medication levels in the brain rise too slowly to produce a "high." On the other hand, there's concern that siblings and classmates of children and teenagers with ADHD might abuse stimulant medications. To keep your child's medications safe and to make sure your child is getting the right dose of medication at the right time:
Children with ADHD often benefit from behavior therapy or counseling, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some children with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.
Counseling types include:
Symptoms often lessen with age. However, most people never completely outgrow their ADHD symptoms.
Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. ADHD includes some combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior. Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school.
While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions.
A diagnosis of ADHD can be scary, and symptoms can be a challenge for parents and children alike. However, treatment can make a big difference, and most children with ADHD grow up to be normal adults.
Symptoms:
ADHD has been called attention-deficit disorder (ADD) in the past. But, ADHD is now the preferred term because it describes both primary aspects of the condition: inattention and hyperactive-impulsive behavior.
While many children who have ADHD tend more toward one category than the other, most children have some combination of inattention and hyperactive-impulsive behavior. ADHD symptoms become more apparent during activities that require focused mental effort.
In order to be diagnosed with ADHD, signs and symptoms of the disorder must appear before the age of 7. In some children, signs of ADHD are noticeable as early as 2 or 3 years of age.
Signs and symptoms of inattention may include:
- Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
- Often has trouble sustaining attention during tasks or play
- Seems not to listen even when spoken to directly
- Has difficulty following through on instructions and often fails to finish schoolwork, chores or other tasks
- Often has problems organizing tasks or activities
- Avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
- Frequently loses needed items, such as books, pencils, toys or tools
- Can be easily distracted
- Often forgetful
- Fidgets or squirms frequently
- Often leaves his or her seat in the classroom or in other situations when remaining seated is expected
- Often runs or climbs excessively when it's not appropriate or, if an adolescent, might constantly feel restless
- Frequently has difficulty playing quietly
- Always seems on the go
- Talks excessively
- Blurts out the answers before questions have been completely asked
- Frequently has difficulty waiting for his or her turn
- Often interrupts or intrudes on others' conversations or games
- Boys are more likely to be primarily hyperactive, whereas girls are more frequently undiagnosed as they tend to be quietly inattentive.
- Girls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle aimlessly.
- Boys tend to be less compliant with teachers and other adults, so their behavior is often more conspicuous.
- Lasts more than six months
- Occurs in more than just one setting (typically at home and at school)
- Regularly disrupts school, play and other daily activities
- Causes problems in relationships with adults and other children
Most healthy children are inattentive, hyperactive or impulsive at one time or another. For instance, parents may worry that a 3-year-old who can't listen to a story from beginning to end may have ADHD. But it's normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and adolescents, attention span often depends on the level of interest. Most teenagers can listen to music or talk to their friends for hours but may be a lot less focused about homework.
The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're tired. And they may become even more active when they're tired, hungry, anxious or in a new environment. In addition, some children just naturally have a higher activity level than do others. Children should never be classified as having ADHD just because they're different from their friends or siblings.
Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.
When to see a doctor
If you're concerned that your child is displaying signs of ADHD, such as trouble concentrating, difficulty sitting still, or an inability to control his or her behavior, see your pediatrician or family doctor. Your doctor may refer you to a specialist, but it's important to have a medical evaluation first to check for other causes of your child's difficulties.
If your child is already being treated for ADHD, he or she should see the doctor regularly — at least every six months if his or her symptoms are stable. Be sure to discuss how often your child should be seen for appointments with his or her doctor.
Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping or increased irritability. Some children taking stimulant medications may lose their appetite and have difficulty maintaining the same height and weight growth rate. However, they will most likely reach their full growth potential by adulthood.
Causes:
Parents may blame themselves when a child is diagnosed with ADHD, but the causes likely have more to do with inherited traits than parenting choices. At the same time, certain environmental factors may contribute to or worsen a child's behavior. Although there's still a lot that isn't known about ADHD, several factors may cause it:
- Altered brain function and anatomy. While the exact cause of ADHD remains a mystery, brain scans have revealed important differences in the structure and brain activity of people with ADHD. For example, there appears to be less activity in the areas of the brain that control activity levels and attention.
- Heredity. ADHD tends to run in families. Several genes that may be associated with ADHD are currently being studied.
- Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke are at increased risk of having children with ADHD. Alcohol or drug abuse during pregnancy may reduce activity of the nerve cells (neurons) that produce neurotransmitters. Pregnant women who are exposed to environmental poisons also may be more likely to have children with symptoms of ADHD.
- Childhood exposure to environmental toxins. Preschool children exposed to certain toxins are at increased risk of developmental and behavioral problems. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span.
- Food additives. Substances added to food, such as artificial coloring or food preservatives, may contribute to hyperactive behavior. Although sugar is a popular suspect in causing hyperactivity, there's no reliable proof of this.
ADHD can make life difficult for children. Children with ADHD:
- Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults
- Tend to have more accidents and injuries of all kinds than do children who don't have the disorder
- Are more likely to have trouble interacting with peers and adults
- Are at increased risk of alcohol and drug abuse and other delinquent behavior
ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than are other children to also have conditions such as:
- Oppositional defiant disorder (ODD). This condition is generally defined as a pattern of negative, defiant and hostile behavior toward authority figures.
- Conduct disorder. A more serious condition than ODD, conduct disorder is marked by antisocial behavior such as stealing, fighting, destroying property and harming people or animals.
- Depression and bipolar disorder. Depression frequently occurs in children with ADHD. Some children may have bipolar disorder, which includes depression as well as manic behavior.
- Anxiety disorders. Anxiety disorders tend to occur fairly often in children with ADHD and may cause overwhelming worry, nervousness and worsening of ADHD symptoms. Once anxiety is treated and under control, children are better able to deal with the symptoms of ADHD.
- Learning disabilities. Learning disabilities are common in children with ADHD. However, gifted learners also may have ADHD. Children with both ADHD and learning disabilities may need extra attention in the classroom or special education services.
- Tourette syndrome. Many children with ADHD also have Tourette syndrome, a neurological disorder characterized by compulsive muscle or vocal tics.
Standard treatments for ADHD in children include medications and counseling. Other treatments to ease the effects of ADHD symptoms include special accommodations in the classroom, and family and community support.
Medications
Currently, stimulant drugs (psychostimulants) and the nonstimulant medication atomoxetine (Strattera) are the most commonly prescribed medications for treating ADHD.
Stimulant medications for ADHD include:
- Methylphenidate (Ritalin, Concerta, Daytrana)
- Dextroamphetamine-amphetamine (Adderall)
- Dextroamphetamine (Dexedrine, Dextrostat)
Stimulant drugs are available in short-acting and long-acting forms.
- The short-acting forms last about four hours, while the long-acting preparations usually last between six and 12 hours.
- Methylphenidate is available in a long-acting patch that can be worn on the hip (Daytrana). It delivers medication for about nine hours. While the long-lasting effects mean your child won't need to take medication as often, it can take up to three hours to start working. For it to work in the morning, the patch may need to be put in place early while your child is still asleep.
The most common side effects of stimulant medications in children include:
- Decreased appetite
- Weight loss
- Problems sleeping
- Irritability as the effect of the medication tapers off
ADHD medications and heart problems
Although rare, several heart-related deaths occurred in children and adolescents taking stimulant medications. The increased risk of sudden death is believed to be in people who already have underlying heart disease or a heart defect. Your child's doctor will make sure your child doesn't have any signs of a heart condition, and will ask about family risk factors for heart disease before prescribing a stimulant medication.
Nonstimulant medication
Atomoxetine is generally given to children with ADHD when stimulant medications aren't effective or cause side effects. In addition to reducing ADHD symptoms, atomoxetine may also reduce anxiety. Given one or two times a day, atomoxetine side effects can include nausea and sedation. It can also cause reduced appetite and weight loss.
Nonstimulant medication side effects
Atomoxetine has been linked to rare side effects that include liver problems. If your child is taking atomoxetine and develops yellow skin (jaundice), dark-colored urine or unexplained flu symptoms, contact the doctor right away.
There may also be a slightly increased risk of suicidal thinking in children and adolescents taking atomoxetine. Contact your child's doctor if you notice any signs of suicidal thinking or other signs of depression.
Other medications used to treat ADHD include:
- Antidepressants. These medications are generally used in children who don't respond to stimulants or atomoxetine, or who have a mood disorder as well as ADHD.
- Clonidine (Catapres) and guanfacine (Intuniv, Tenex). These are high blood pressure medications shown to help with ADHD symptoms. They may be prescribed to reduce tics or insomnia caused by other ADHD medications, or to treat aggression caused by ADHD.
Making sure your child takes the right amount of the prescribed medication is very important. Parents may be concerned about stimulants and the risk of abuse and addiction. Dependence hasn't been shown in children who take these drugs for appropriate reasons and at the proper dose. That's because medication levels in the brain rise too slowly to produce a "high." On the other hand, there's concern that siblings and classmates of children and teenagers with ADHD might abuse stimulant medications. To keep your child's medications safe and to make sure your child is getting the right dose of medication at the right time:
- Administer medications carefully. Children and teens shouldn't be in charge of their own ADHD medication.
- At home, keep medication locked in a childproof container. An overdose of stimulant drugs is serious and potentially fatal.
- Don't send supplies of medication to school with your child. Deliver any medicine yourself to the school nurse or health office.
Children with ADHD often benefit from behavior therapy or counseling, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some children with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.
Counseling types include:
- Behavior therapy. Teachers and parents can learn behavior-changing strategies for dealing with difficult situations. These strategies may include token reward systems and timeouts.
- Psychotherapy. This allows older children with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms.
- Parenting skills training. This can help parents develop ways to understand and guide their child's behavior
- Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
- Social skills training. This can help children learn appropriate social behaviors.
- Support groups. Support groups can offer children with ADHD and their parents a network of social support, information and education.
Symptoms often lessen with age. However, most people never completely outgrow their ADHD symptoms.
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