Attention-Deficit/Hyperactivity Disorder (ADHD)
What is Attention-Deficit/Hyperactivity Disorder (ADHD)?
Does your child fail to sustain attention, behave within appropriate limits at home and in public, or sit quietly when they’re expected to do so? Not being able to stay within limits or sit quietly is normal childhood behavior if it happens at different ages and from time to time, but if this behavior occurs frequently and interferes with your child’s daily life, they may have ADHD.
ADHD is a neurodevelopmental condition that can affect family life. The word “neurodevelopmental” refers to the nervous system which includes the brain as it develops across the lifespan. ADHD behavior usually appears by age seven though difficult behavior may show up before this, and ADHD is treatable. With ADHD, children can have trouble with impulsivity, hyperactivity, distractedness, following instructions and completing tasks.
When symptoms of Attention-Deficit Hyperactivity Disorder occur in childhood, they tend to persist into adulthood in about 49.9% of the cases (about half). Adults with ADHD often find it difficult to follow directions, to remember information and to concentrate on or organize tasks. Without proper acknowledgement and management of these behaviors, ADHD can result in behavioral, emotional, academic, vocational and social problems that decrease the quality of life.
What is the difference between ADHD and ADD (Attention-Deficit Disorder)?
ADHD is the only term assigned to this diagnosis but there are different presentations of ADHD — ADHD Inattentive Presentation, ADHD Hyperactive/Impulsive Presentation, ADHD Combined Presentation (both inattention and H/I behavior) and a fourth type called Unspecified ADHD, a diagnosis used when symptoms are unclear.
How common is ADHD?
About 11% of children between the ages of four and 17 have ADHD. Symptoms of ADHD typically first appear between the ages of three and six years old. The average age of ADHD diagnosis is seven years old. In children, it’s three times more common in young boys than girls. Males are almost three times more likely to be diagnosed with ADHD than females.
ADHD isn’t just a childhood disorder. About 4% of American adults over the age of 18 contend with ADHD behaviors on a daily basis. In adulthood, it’s diagnosed equally between males and females. During their lifetimes, 13% of men will be diagnosed with ADHD while just 4.2% of women will be diagnosed.
Is ADHD a mental illness?
By definition, ADHD is better referred to as a neurodevelopmental disorder, not a “mental illness.” The term “mental illness” is a very broad term for any type of condition that affects mood, behavior or thinking. ADHD is better described as a pattern of behavior — something different in the way a person does things — rather than describing it as something “wrong” with people. Evidence indicates that ADHD is associated with neural pathways in brain functioning (the default mode and the task positive mode). This functioning yields problematic behavioral at certain ages (stages of development) — thus the term neurodevelopmental disorder is a better broad category name for the problem of ADHD.
Is ADHD a form of autism?
No, although they are both neurodevelopmental disorders. Except, many children with autism have ADHD. But the two conditions are by expression and definition quite different.
Is ADHD a learning disability?
ADHD is not a learning disability, though it certainly can impair learning. About 30% to 40% of children with ADHD also have a learning disability. Like those with a learning disability, children with ADHD are eligible to receive special education services.
What are the symptoms of ADHD?
Children, teenagers and adults with ADHD have an ongoing pattern of three types of core behaviors:
- Inattentiveness: Difficulty sustaining attention to tasks.
- Impulsivity: Doing things on sudden urges, without thinking such as talking out in class, throwing a toy, or interrupting someone in conversation. In adults, the impulses may be irresponsible such as spending too much money.
- Hyperactivity: Restlessness such as fidgeting, inability to stay seated when sitting is expected such as in church or school, moving or climbing when it’s inappropriate to do so.
Children, teens and adults with ADHD are diagnosed by the behavior pattern that is most actively present. The three most common ADHD presentations are Predominantly Inattentive, Predominantly Hyperactive/Impulsive and the combination of these types.
ADHD Predominantly Inattentive Presentation is defined by the following nine behaviors:
- Fails to pay close attention to details or makes careless mistakes in schoolwork, at work or during other activities.
- Has trouble paying attention during tasks or play.
- Appears to not listen even when spoken to directly.
- Has difficulty following through on instructions (for example, often fails to finish schoolwork, chores or other duties in the workplace).
- Often has difficulty organizing tasks or activities.
- Avoids or dislikes tasks that require continuous mental effort, such as schoolwork, homework or preparing reports, completing forms and reviewing lengthy papers.
- Frequently loses needed items, such as books, pencils, tools, wallets/purses, keys, paperwork, phone and eyeglasses.
- Can be easily distracted by actions or thoughts unrelated to the current task.
- Is often forgetful in daily activities (such as doing chores, running errands, returning phone calls, paying bills and keeping appointments).
Behaviors of the ADHD Predominantly Hyperactivity/Impulsive type include:
- Fidgets with or taps hands or feet or squirms frequently.
- Leaves seat in the classroom or in the workplace when remaining seated is expected.
- Runs or climbs excessively when it's not appropriate; constantly feels restless (if an adolescent or adult).
- Has trouble playing or engaging in leisure activities quietly.
- Always seems “on the go” or “driven by a motor.”
- Talks too much.
- Blurts out the answers before questions have been completely asked; older children may often finish sentences for others who are talking.
- Frequently has trouble waiting for his or her turn.
- Often interrupts or intrudes on others' conversations or games.
What are the risk factors of ADHD?
ADHD is largely a hereditary condition. If one or both parents have been diagnosed with ADHD, their children are more likely to have it as well. Although the exact etiology (i.e., origins) of ADHD are ill-defined, healthcare providers report other associated risk factors:
- Biological: ADHD is associated with the way certain neurotransmitters (chemicals in the brain that help control behavior) work, especially dopamine and norepinephrine, and this difference causes changes in two different attentional networks of the brain — the default network, associated with automatic attention and the task positive network, associated with directed or effortful attention.
- Environment: Exposure to toxins (poisons) in the environment (lead, for example) has been linked to ADHD in children.
- Prenatal substance exposure (during pregnancy): Smoking and/or drug and alcohol use during pregnancy is associated with ADHD in children.
What makes ADHD symptoms worse?
Certain behaviors are expected depending on the age of a person. Because the brain doesn’t develop at the same rate in everyone, cognitive functions may be poor in some people and not in others. A child 10 years old, for example, might only have the abilities of a younger child 8 years old rather than his or her same age peers. Therefore, as you or your child get older, the problem is not that ADHD gets worse, it’s that the child’s abilities are not developing synchronized with age.
Although ADHD doesn’t get “worse,” the tasks expected of the person become more complicated with age and circumstances, such as increased demands in school, therefore, the problematic behaviors (such as completing things on time) become more problematic. For example, as the child may get a lower grade for turning in late work. Examples of other complications include:
- Undertaking new challenges without sufficient support: New and more complex challenges frequently arise in school. As a child advances in grade level, academic tasks become more complex, such as having to write lengthy reports or studying numerous chapters of a history book. Task complexity in reading, spelling, math and interacting with classmates pose problems to the child who has limited ability to meet demand. The student with ADHD may struggle even more without additional collateral support from parents and teachers.
- Often, children are punished for actions they cannot control: Children with ADHD may be criticized and punished by parents and teachers, they may be looked down on by peers because of their inability to finish tasks or remember their schoolwork, and some may not know how to play appropriately with their friends. Adults can be penalized by supervisors at their jobs for forgetting to do work and, at times, even by family members for failing to stay organized, or stay focused on tasks to completion.
- Additional problems with thinking, emotions and behaviors: Psychiatric disorders like depression and anxiety are common in people with ADHD. Children are 62% more likely to have at least one disorder. Adults with ADHD are six times more likely to have a disorder. People with ADHD are also more likely to abuse drugs and alcohol.
- Stress: So many things can cause additional stress in the life of someone with ADHD. Examples include serious medical illnesses, domestic violence, divorce, loss of employment or the death of a friend or family member.
- No treatment: According to recent data, 17.5% of children ages four to 17 in the United States received no treatment — behavioral or pharmacological — for ADHD Treatment is vital for managing ADHD symptoms.