Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder
(ADHD and ADD, Hyperkinetic Syndrome, Hyperkinetic Impulse Disorder)
Definition
Attention deficit hyperactivity disorder (ADHD) is a chronic behavioral disorder. It is characterized by behavior that is hyperactive, impulsive, and/or inattentive. These behaviors must persist for at least six months and be present in two environments (home, work, or school). ADHD affects children, adolescents, and adults.
Causes
The cause of ADHD is unknown. It most likely is caused by a chemical imbalance in the brain. There also appears to be a genetic factor since ADHD can run in families.
Child's Brain A chemical imbalance in the brain may be responsible for ADHD. © 2008 Nucleus Medical Art, Inc.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for ADHD are:
- Sex: male
- Parent or sibling with ADHD
Symptoms
All children display some of the symptoms of ADHD sometimes. Children with ADHD have symptoms that are more severe and consistent. They often have difficulty in school and with their family and peers.
Behaviors linked to ADHD can last into adulthood. ADHD symptoms can continue to cause relationship difficulties. It can also cause problems with job performance and retention.
There are three types of ADHD:
- Inattentive (classic "ADD")
- Hyperactive-impulsive
- Combined
Inattentive (Classic "ADD")
- Easily distracted by sights and sounds
- Doesn't pay attention to detail
- Doesn't seem to listen when spoken to
- Makes careless mistakes
- Doesn't follow through on instructions or tasks
- Avoids or dislikes activities that require longer periods of mental effort
- Loses or forgets items necessary for tasks
- Is forgetful in day-to-day activities
Hyperactive-Impulsive
- Is restless, fidgets, and squirms
- Runs and climbs and is not able to stay seated
- Blurts out answers before hearing the entire question
- Has difficulty playing quietly
- Talks excessively
- Interrupts others
- Has difficulty waiting in line or waiting for a turn
Combined
- Has a combination of the above symptoms
Combined ADHD is the most common type.
Many people with ADHD also often have:
- Depression
- Anxiety
- Conduct disorder
- Oppositional defiant disorder
- Learning disorders
- Substance abuse
Diagnosis
There is no standard test to diagnose ADHD. It is done by a trained mental health professional. Family and teachers are involved as well.
The American Academy of Pediatrics recommends that the following guidelines be used for diagnosis in children 6-12 years of age:
-
Diagnosis should be initiated if a child shows signs of difficulty in:
- School
- Academic achievement
- Relationships with peers and family
-
During diagnosis, the following information should be gathered directly from parents, caregivers, teachers, or other school professionals:
- Assessment of symptoms of ADHD in different settings (home and school)
- Age at which symptoms started
- How much the behavior affects the child's ability to function
-
The professional should examine the child for:
- Other conditions that might be causing or aggravating symptoms
- Learning and language problems
- Aggression
- Disruptive behavior
- Depression or anxiety
- Psychotic symptoms
- Personality disorder
-
For a diagnosis of ADHD to be made, symptoms must:
- Be present in two or more of the child's settings
- Interfere with the child's ability to function for at least six months
- Fit a list of symptoms detailed in the most recent version of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association
Treatment
Therapies aim to improve the child's ability to function. American Academy of Pediatrics guidelines encourage physicians to work as a team with parents and school personnel. Together, they can set realistic treatment goals and evaluate the child's response.
Treatments include:
Medication
Medications can help control behavior and increase attention span. Stimulants are the most common treatment for ADHD. They increase activity in parts of the brain that appear to be underactive in children with ADHD. Stimulant medications include:
- Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)
- Dextroamphetamine (Dexedrine)
- Amphetamine (Adderall)
- Atomoxetine (Strattera)
- Lisdexamfetamine dimesylate (Vyvanse)—This medication was recently approved to treat adults with ADHD. It can also be used to treat children aged 6-12 years.*²
In February 2007, the US Food and Drug Administration (FDA) directed the makers of all drugs approved for the treatment of ADHD to develop Patient Medication Guides. These guides should alert patients to possible cardiovascular risks and adverse psychiatric symptoms associated with the medicines. There have been reports of sudden death in patients with underlying serious heart problems or defects. There are also reports of stroke or heart attack in adults with certain risk factors. Another FDA review revealed a slight increased risk (about 1 per 1,000) for drug-related psychiatric adverse events, such as hearing voices, becoming suspicious for no reason, or becoming manic. This occurred even in patients who did not have previous psychiatric problems. If you have any questions about possible adverse effects of ADHD medications, speak with your doctor.
Because of the rare risk of serious heart problems, the American Heart Association suggests that children have an electrocardiogram (ECG) before starting stimulant medication for ADHD.*¹
Other drugs include:
- Antidepressants—such as imipramine (Janimine, Tofranil), venlafaxine (Effexor), and bupropion (Wellbutrin)
- Clonidine (used for Tourette's syndrome)—to treat impulsivity
Behavior Therapy
Children who take medication and practice behavioral techniques do better than those who just use medication. Therapy sessions focus on practicing social and problem-solving skills. Counselors will also teach parents and teachers to modify the child's behavior through positive reinforcement. This could involve change in the classroom as well as in parenting style. Often, daily report cards are exchanged between parents and teachers.
RESOURCES:
Attention Deficit Disorder Association
http://www.add.org/
Attention Deficit Disorder Resources
http://www.addresources.org/
Children and Adults With Attention-Deficit/Hyperactivity Disorder (CHADD)
http://www.chadd.org/
CANADIAN RESOURCES:
About Kids Health
http://www.aboutkidshealth.ca/
Canadian Psychiatric Association
http://www.cpa-apc.org/
References:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association;2000.
Attention deficit hyperactivity disorder. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/publicat/adhd.cfm#treat. Accessed February 9, 2008.
Children's Health Topics. American Academy of Pediatrics website. Available at: http://www.aap.org/. Accessed June 24, 2008.
Factshhet ADHD. The National Mental Health Association website. Available at: http://www.nmha.org/. Accessed June24, 2088.
FDA directs ADHD drug manufacturers to notify patients about cardiovascular adverse events and psychiatric adverse events. US Food and Drug Administration website. Available at: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01568.html. Accessed on February 13, 2008.
Methylphenidate and clonidine help children with ADHD and tics. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/news_and_events/news_articles/news_article_adhd.htm. Accessed February 13, 2008.
Rappley M. Attention deficit-hyperactivity disorder. NEJM. 2005;352:165-173.
The Truth About Diagnosing and Treating ADHD. American Psychiatric Association website. Available at: http://www.psych.org/. Accessed June 24, 2008.
Yourchild-ADHD. American Academy of Child and Adolescent Psychiatry website. Available at: http://www.aacap.org/. Accessed June 24, 2008.
*¹ 4/30/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Vetter V, Elia J, Erickson C, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs. Circulation. American Heart Association website. Available at: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189473. Accessed April 30, 2008.
*² 4/30/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: FDA approval letter. US Food and Drug Administration website. Available at: http://www.fda.gov/cder/foi/appletter/2008/021977s001ltr.pdf. Accessed April 30, 2008.
Last reviewed February 2008 by Rosalyn Carson-DeWitt, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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