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Diseases & Conditions

What is Attention Deficit Hyperactivity Disorder?

ADHD is a developmental problem characterized by inattention, hyperactivity, and impulsivity. Children with ADHD are easily distracted by sights and sounds in their environment. They cannot concentrate for long periods of time, are restless and impulsive, and/or have a tendency to daydream and be slow to complete tasks.

ADHD, predominantly the inattentive type, is diagnosed when the essential features displayed are not those of hyperactivity or impulsivity, but rather those of inattention. These individuals 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.

How prevalent is ADHD?

ADHD is one of the most common developmental problems among children, affecting 8% to 12% of all school-age children. ADHD is more common among boys than girls; two to three times more boys have ADHD than girls. On average, at least one child in every classroom in the United States needs help for ADHD. It is important to remember that girls and gifted children with ADHD are an under-identified population.

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. 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.

How can you tell if a child is hyperactive or just misbehaving?

Not every child who is overly active can be diagnosed as hyperactive. The hyperactive child remains at a “high energy” level and is almost in constant motion regardless of the activity or situation. Children who are misbehaving can behave within acceptable boundaries when they choose to do so, modifying their behavior to the situations they are in. Hyperactive children have much more difficulty controlling their activity level and behavior, and some are incapable of being still.

Do children outgrow this condition?

As a hyperactive child gets older, his or her activity level might decrease, or the over-activity might appear as restless, fidgety behavior. Even though most people don’t outgrow ADHD, people do learn to adapt. Most children improve as they enter adolescence, although they might continue to be very active and have trouble concentrating.

If the difficulties associated with ADHD are managed appropriately throughout their lives, people with ADHD learn to focus their attention, develop their personal strengths, and become quite productive and successful.

How is school performance affected by ADHD?

Children with ADHD have difficulty following directions, concentrating, organizing tasks, and completing school work within time limits. Completing homework in a consistent and timely manner is also a problem for children with ADHD.

What should a parent or child's teacher do if ADHD is suspected?

If it is suspected that a child has an attention or hyperactivity problem, and it appears that his or her school performance is being affected, the parents should first request that the child’s school evaluate him or her. When making this request, the parents must be as specific as possible about the type of educational difficulties their child is experiencing.

Schools are required to evaluate a child (age 3 to 21) if he or she is suspected of having a disability that is affecting his or her learning/educational performance. This evaluation is provided free of charge to families and must, by law, involve more than one standardized test or procedure.

After this evaluation, the parents should make an appointment with their child's doctor. It is particularly helpful to provide the doctor some background information about the concerns of school personnel. The doctor might refer the child to a specialist, if necessary.

If the child is not in school yet, but the parents suspect that he or she has an attention or hyperactivity problem, they should make an appointment with their family doctor to discuss the possibility of ADHD. The doctor can refer the child to a specialist, if necessary.

It is important that school personnel, families, and the family doctor work closely together to establish the diagnosis and treatment plan for a child with ADHD. Sometimes the child is referred to a child neurologist or child psychiatrist for the diagnosis and treatment of ADHD, which might also be appropriate.

How is ADHD diagnosed?

A proper ADHD diagnosis includes:

  • A thorough medical and family history
  • A physical examination
  • Interviews with the parents and the child
  • Behavior rating scales completed by parents and teachers
  • Observation of the child
  • A variety of psychological tests to measure I.Q. and social and emotional adjustment, as well as to indicate the presence of specific learning disabilities

Specialists consider the following when diagnosing ADHD:

  • Are the behaviors more frequent or excessive than in others of the same age?
  • Did the behaviors begin early in life (before age 7)? Have the behaviors been present for more than six months?
  • Are the behaviors a continuous problem and not just a response to a temporary situation?
  • Do the behaviors occur in several settings or only in one specific place?
  • Do the behaviors impair at least two areas of a person’s life (such as home, school, work, or social settings)?

After asking a series of questions, specialists will compare the person’s pattern of behavior to a set of criteria and characteristics of the disorder.

One of the difficulties in diagnosing ADHD is that it often is accompanied by other problems, such as a learning disability (difficulty mastering a certain academic skill). ADHD is not in itself a learning disability, but it can make it more difficult for the child with a learning disability to do well in school.

What are the treatment options?

Behavior-changing therapies, educational assistance, and a variety of medicines are available to help people with ADHD focus their attention, function in new ways, and build their self-esteem.

  • Behavior-changing therapies — There are many ways parents and teachers can help a child manage his or her difficulties associated with ADHD. The main goal of behavior management is to increase the child’s appropriate behavior and decrease the inappropriate behavior. Children with ADHD respond best in an environment (both home and school) that is structured and predictable, with clear and consistent rules and expectations. Consequences need to be established ahead of time and delivered immediately.
  • Educational help — In the school arena, ADHD might negatively affect academic performance. Children might miss important blocks of information, exhibit inconsistent skill development, and lack organizational skills.

    Many children with ADHD benefit from educational accommodations provided under a 504 plan. These might include preferential seating, extended time on tests, and note-taking support.

    Some ADHD children might qualify for special education services under the category of Other Health Impaired (OHI). The type of educational help or special services children receive will depend on the nature and severity of their difficulties. Also, parents might want to pursue tutorial support in addition to any school support to assist with study and organizational skills.
  • Medicine – Medicine is a proven treatment for many people with ADHD, but not all children with ADHD need to take medicine. Children with milder forms of ADHD might be helped with a structured environment and firm, but fair types of discipline and rewards.

    The parents’ decision to place a child on medicine is a personal one, and should only be made after a thorough evaluation of the child has taken place and after careful consideration by the parents and the doctor.

    It is now known that some people with ADHD will continue to benefit from medicine throughout adolescence and adulthood.
    Ritalin, Metadate, Dexedrine, Concerta, Adderall, and Strattera are the most widely prescribed medicines for ADHD. These drugs are believed to stimulate the action of neurotransmitters in the brain, which enables the brain to better regulate attention, impulsiveness, and motor behavior. Medicines have been used to treat ADHD for more than 60 years.

Is psychological treatment helpful?

Psychological counseling will not eliminate ADHD, but might be helpful to families. Therapy can help parents learn to provide an appropriate, stress-free environment for homework completion. Psychological counseling might also help children and their families deal more effectively with the social and emotional aspects of ADHD. Counseling can be an important part of treatment and should not be overlooked.

Are there controversial therapies for ADHD?

Controversial treatments for ADHD include restricted diets, anti-motion sickness medication, allergy treatment, treatment for yeast infections, megavitamins, biofeedback, chiropractic adjustment, and eye training. At the current time, there is no strong scientific evidence supporting the efficacy of these treatments for ADHD. As their child’s primary caregivers, parents need to become informed consumers and be cautious when considering such treatments.

Where can I get more information?

Children and Adults With Attention Deficit Disorders (CHADD)
National Office: 800.233.4050 or 301.306.7090
www.chadd.org

Attention Deficit Disorder Association (ADDA)
856.439.9099
www.add.org

Learning Disabilities Association of America
412.341.1515
www.ldanatl.org

National Center for Learning Disabilities
888.575.7373 or 212.545.7510
www.ncld.org

Family Resource Center on Disabilities
800.952.4199 or 312.939.3513
www.frcd.org

Council for Exceptional Children
800.224.6830 or 888.CEC.SPED (232.7733)
www.cec.sped.org

Please note: While every effort has been made to keep the contact information as current as possible, the information may change on occasion.

© Copyright 1995-2009 The Cleveland Clinic Foundation. All rights reserved.

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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: 3/4/2011…#4784