What is attention-deficit/hyperactivity disorder (ADHD)?
ADHD is a common developmental and behavioral disorder that
affects 8 percent to 12 percent of all school-age children. ADHD is
characterized by inattention, distractibility, hyperactivity, and impulsivity
that are inappropriate for the child's age. Children with ADHD are easily
distracted by sights and sounds in their environment, cannot concentrate for
long periods of time, are restless and impulsive, or have a tendency to daydream
and be slow to complete tasks.
There are sub-types of ADHD, including the most common sub-type,
combined ADHD, which includes all the symptoms mentioned above. Inattentive ADHD
primarily includes the symptoms of impaired attention and concentration.
Individuals with inattentive-type ADHD might often make careless mistakes,
appear "daydreamy," fail to complete tasks, are easily distracted, and avoid
activities that require sustained mental effort and close concentration.
The diagnosis of ADHD is applied to children and adults after
they consistently display some or all of these behaviors over a period of time
in at least two settings, such as at home and in school or work.
What causes ADHD?
There is no known cause for ADHD. Research has shown that ADHD
has a neurological basis and is not caused by home or school surroundings. ADHD
is not caused by poor parenting. Studies suggest that ADHD results from a
chemical imbalance or deficiency in certain neurotransmitters (chemicals in the
brain that regulate behavior). A 1990 study conducted by the National Institute
of Mental Health indicates a link between a person's ability to pay continued
attention and the level of activity in the brain. This study found that the rate
at which the brain uses glucose (its main source of energy) is lower in people
with ADHD.
ADHD might be hereditary. If one or both parents have ADHD, their children might show signs of it as well.
Some conditions might mimic ADHD, such as elevated lead levels, trauma, or emotional distress due to loss, such as divorce.
How is ADHD treated?
Assessment methods used to create an individualized treatment
plan should include a thorough developmental and medical history, individual
interview of the child, and behavior rating scales completed by parents and
teachers. Psychoeducational tests often determine if a specific learning
disability is also present.
The appropriate treatment plan for ADHD is a multi-modality plan
that might include medication, educational assistance, parent guidance, and a
behavioral plan.
What medicines are used to treat ADHD?
If mild to moderate symptoms are present, stimulant medicines
such as methylphenidate (Ritalin®) or dextroamphetamine (Dexedrine®)
are often initially recommended as part of the treatment plan. These drugs
stimulate the parts of the brain responsible for organization and management
(which have been shown to be less active in individuals with ADHD) to better
regulate attention, impulse and motor behavior. Stimulant medicines are
effective in 70 percent to 80 percent of patients. In 2003, a new medicine
atomoxetine (Strattera®) was introduced that offers a non-stimulant
alternative.
What other medicines are used to treat ADHD?
When the stimulants and Strattera are not effective or are not
well-tolerated, several other medicines are available to treat ADHD. These
medicines might include:
- Nortriptyline (Pamelor®) or other tricyclic antidepressants
- Clonidine (Catapres®) or guanfacine (Tenex®)
- Bupropion (Wellbutrin®)
- Venlafaxine (Effexor®)
Alternate medicines for ADHD might need to be monitored with
EKGs (tests that measure the heart's electrical activity) or blood tests to
measure the levels of certain substances in the blood. Medicines are selected by
determining:
- The presence of accompanying conditions (such as depression, anxiety,
severe impulsivity)
- Side effects experienced during stimulant use (such as rebound of ADHD
symptoms at the end of a stimulant dose)
- The presence of motor or vocal tics
Selection of medicine for ADHD should be discussed completely
with parents and the older child or adolescent. The pros and cons of medicine
choices should be reviewed, including the identification of the most impairing
symptoms that are the target of treatment.
Are the sub-types of ADHD treated differently?
Both combined ADHD and inattentive ADHD are treated effectively
with stimulants in 70 percent to 80 percent of patients. Stimulants are the most
beneficial type of ADHD medicines for assisting the patient's focus. Combined
ADHD has the most predictable response to stimulants. Atomoxetine might offer
benefits, especially to older inattentive teens.
At times, combinations of medicines are necessary, especially
when the patient has more than one diagnosis or severe symptoms. Periodically
readjusting medicine doses is necessary as the child gains weight. Inadequate
dosing or missed doses might explain many cases of "treatment failure."
Clinical research continues to expand the medicines available for the effective treatment of ADHD.
Myths about ADHD treatment
Media sources frequently exaggerate the controversies over ADHD
treatment. Contrary to media coverage, there is not widespread over-prescribing
of stimulants for ADHD or abuse of these medicines. A thorough assessment by a
physician+ prior to initiating treatment and careful monitoring of any drug
treatment plan guards against such concerns.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 10/11/2008…#5210
