Attention-deficit/hyperactivity disorder (ADHD)

What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that begins in childhood, continues through adolescence, and often persists into adulthood. About 5 to 7% of children in the United States have ADHD, and similar rates have been found in countries all over the world. ADHD can look different depending on the person. While the condition is often characterized by inattention, disorganization, hyperactivity and impulsiveness, all of which can interfere with daily functioning, not all people with ADHD will have all of these symptoms.

Research suggests that ADHD is caused by a combination of genetic and environmental factors. Scientists are working to uncover more details about the specific genes involved and the contributing environmental factors, but they have established that genetics play a powerful role – in fact, some studies suggest ADHD is as heritable as height.

Environmental factors that increase the likelihood of developing ADHD include prenatal exposure to nicotine or alcohol, premature birth or low birth weight, and exposure to lead or other toxins. While the ways a child has been parented and taught didn't cause their ADHD, both can impact the severity of their symptoms.

Signs & symptoms of ADHD

ADHD symptoms are related to inattention, hyperactivity and impulsiveness. Pretty much everyone struggles with these things at certain times during their lives, but the problems are more frequent, severe and troublesome for people with ADHD. Not everyone with ADHD has all symptoms of the disorder. Some people may only have symptoms related to attention, while others – usually young children – may only have symptoms related to hyperactivity and impulsiveness. Hence there are three presentations of ADHD (categorized by the type and number of symptoms the person has): the predominantly inattentive presentation, predominantly hyperactive-impulsive presentation and combined presentation.

 

Symptoms of inattentive ADHD

• Makes careless-seeming mistakes or struggles with details
• Has difficulty sustaining attention
• Doesn't seem to listen when directly spoken to
• Has difficulty following instructions or starts tasks but doesn't finish them
• Has difficulty staying organized
• Avoids tasks that require sustained mental effort, such as homework
• Loses things often Is easily distracted
• Is forgetful

Symptoms of hyperactive-impulsive ADHD

• Fidgets or squirms
• Leaves seat when staying in place is expected (for example, during dinner or class)
• Runs or climbs on things
• Unable to play quietly
• Typically "on the go" – almost as if driven by a motor
• Talks excessively
• Blurts out answers before questions are completed
• Has difficulty waiting their turn
• Frequently interrupts others or intrudes on their space

Diagnosis of ADHD

Diagnosing ADHD requires a comprehensive evaluation by a psychologist or psychiatrist, pediatrician, or another care provider with specialized mental health training.

As part of the diagnostic process, the doctor will rule out other causes of the symptoms, such as anxiety, depression, learning differences or a physical health condition. Hyperactive and impulsive ADHD symptoms can appear as early as age 3, while symptoms of inattention tend to emerge later in childhood. Children who struggle solely with inattention may not display bothersome symptoms until around fourth grade – or even middle school. In general, for this diagnosis to be considered, some symptoms of ADHD should be evident by age 12, including for adults being evaluated.

Treatment of ADHD

Effective ADHD treatments are available, including medication and certain behavioral interventions that have been established as effective, such as:

• Behavioral parent training
• Social skills training for children
• Classroom interventions
• Organizational skills training
• Cognitive behavioral therapy

Many children with ADHD experience significant improvement in their symptoms from psychotherapy (talk therapy) alone or medication alone. However, both medication and psychotherapy may be needed to maximize improvement.

At our Hyperactivity, Attention and Learning Problems (HALP) Clinic, we offer comprehensive care for children from preschool to college age. When there is concern for ADHD, our approach starts with a complete diagnostic workup examining problems and disorders that can affect a child's ability to thrive at school or home. We offer family education opportunities, including classes to equip parents with techniques for helping their children with behavioral, learning or emotional problems as well as fun kids' classes that develop their social and life skills for making and keeping friends, handling disappointments, setting up routines and staying organized. The HALP Clinic can also provide school consultations in which one of our providers visits the child's school for classroom observation, teacher training or individualized education plan (IEP) staffing issues. Or a HALP provider can help a teacher design a behavioral program to improve academic performance. In addition, we can give technical advice on appropriate educational accommodations under the Individuals with Disabilities Education Act (IDEA) or Section 504 (which protects kids from disability-based discrimination).