Attention Deficit Hyperactivity Disorder/ADHD
Attention Deficit Hyperactivity Disorder/ADHD
My child has problems with paying attention…
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).
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 and can 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
This section has been adapted from the Learning Disabilities Association of America; http://ldaamerica.org. See more also here
- Difficulty staying focused, paying attention, controlling behavior and hyperactivity
- Becomes apparent in some children in preschool and early school years
- Principle characteristics are: inattention, hyperactivity, and impulsivity
- Three subtypes of ADHD:
- Predominantly hyperactive/impulsive: does not show significant inattention
- Predominantly inattentive/ADD: does not show significant hyperactive-impulsive behavior
- Combined: displays both inattentive and hyperactive-impulsive symptoms
- Executive function deficits. These are typically part of the ADHD syndrome in part or whole. Such deficits can co-occur with other disorders as well. See here
Behaviors that may indicate an executive function deficit are:
- Planning, organization, strategizing, attention to details, and managing time and space
- An inefficiency in the cognitive management systems of the brain that affects a variety of neuropsychological processes such as planning, organization, strategizing, paying attention to and remembering details, and managing time and space.
Scientists are studying cause(s) and risk factors in an effort 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 of twins link genes with ADHD.1
In addition to genetics, scientists are studying other possible causes and risk factors including:
- Brain injury
- Environmental exposures (e.g., lead)
- 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.
Deciding if a child has ADHD is a several step process. There is no single test to diagnose ADHD, and many other organization problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms. One step of the diagnosis process involves having a medical exam done, including hearing and vision tests, to rule out other problems that have symptoms symptoms similar to ADHD. Another part of the process may include a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.
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 is recommended as the first line of treatment. No single treatment is the answer for every child and good treatment plans will include close monitoring, follow-ups and any changes needed along the way.
Following are treatment options for ADHD:
- Behavioral intervention strategies
- Parent training
- School accommodations and interventions
To go to the American Academy of Pediatrics (AAP) policy statement on the treatment of school-aged children with ADHD, visit the Recommendations page.
Types of ADHD
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 who is 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.
Because symptoms can change over time, the presentation may change over time as well.
Research shows that behavioral therapy is an important part of treatment for children with ADHD. ADHD affects not only a child’s ability to pay attention or sit still at school, but it also affects their relationships with their family and how well they do in their classes. Behavioral therapy is a treatment option that can help reduce these problems for children and should be started as soon as a diagnosis is made. Read about effective therapies here »
Following are examples that might help with your child’s behavioral therapy:
- Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime.
- Get organized. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.
- Avoid distractions. Turn off the TV, radio, and computer, especially when your child is doing homework.
- Limit choices. Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn’t overwhelmed and overstimulated.
- Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities.
- Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child’s efforts. Be sure the goals are realistic—baby steps are important!
- Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior.
- Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well — whether it’s sports, art, or music — can boost social skills and self-esteem.
Behavior Treatment for Preschoolers
The 2011 clinical practice guidelines from the American Academy of Pediatrics recommend that doctors prescribe behavior interventions that are evidence-based as the first line of treatment for preschool-aged children (4–5 years of age) with ADHD. It is possible that parents or teachers can provide this first line of treatment.
The Agency for Health Care Research and Quality (AHRQ) conducted a review in 2010 of all existing studies on treatment options for preschoolers. The review found enough evidence to recommend parent behavioral interventions as a good treatment option for preschoolers with disruptive behavior in general and as helpful for those with ADHD symptoms.
The AHRQ review found that effective parenting programs help parents develop a positive relationship with their child, teach them about how children develop, and help them manage negative behavior with positive discipline. The review also found four programs for parents of preschoolers that include these key components:
Medication can help a child with ADHD in their everyday life and may be a valuable part of a child’s treatment. Medication is an option that may help control some of the behavior problems that have led to trouble in the past with family, friends and at school.
Several different types of medications may be used to treat ADHD:
- Stimulants are the best-known and most widely used treatments. Between 70-80 percent of children with ADHD respond positively to these medications.
- Nonstimulants were approved for treating ADHD in 2003. This medication seems to have fewer side effects than stimulants and can last up to 24 hours.
Medications can affect children differently, where one child may respond well to one medication, but not another. When determining the best treatment, the doctor might try different medications and doses, so it is important to work with your child’s doctor to find the medication that works best for your child.
Getting Help & Sharing Your Concerns
If you or your doctor has concerns about ADHD, you can take your child to a specialist such as a child psychologist or developmental pediatrician, or you can contact your local early intervention agency (for children under 3) or public school (for children 3 and older). You can fill out a symptoms checklist and take it to the child’s doctor.
For tips on sharing concerns about a child’s development, click on one of the following:
The Centers for Disease Control and Prevention (CDC) sponsors the National Resource Center, a program of CHADD – Children and Adults with Attention-Deficit/Hyperactivity Disorder. Their website has links to information for people with ADHD and their families. The National Resource Center operates a call center with trained staff to answer questions about ADHD. The number is 1-800-233-4050 FREE.
In order to make sure your child reaches his or her full potential, it is very important to get help for ADHD as early as possible.
If your discussion item concerns different specific conditions, you may want to place those remarks under our General Discussion page.
If your comment is better directed to us in the form of a nonpublic email, please see our “Contact Us” page.
Note: All H4MC blogs are public forums for a diverse readership. We hope that these blogs will open-up community discussion and build community support. The blogs are not monitored for content, although staff of the H4MC may occasionally participate. H4MC retains the right to remove comments deemed inappropriate. H4MC does not necessarily support the views expressed. Please respect the authors and readers and avoid posting comments directed at persons or that are culturally insensitive.