Attention Deficit Hyperactivity Disorder

ADHD symptoms start before age 12. In some children, they're noticeable as early as three years of age. 

Overview

It’s not unusual for children to have short attention spans or behavior that’s out of control. It’s how they find out what’s allowed. And what’s appropriate.

However, for some children, these types of behaviors are more common than occasional. And they don’t seem to outgrow them when their age suggests they should. It’s as if these children don’t seem to have control of themselves. And their ability to concentrate and focus fails to develop the way you would expect.

For children with Attention Deficit Hyperactivity Disorder (ADHD,) their problems with attention and hyperactivity are frequent and severe. It’s not that they’re trying to be “bad,” though their behavior can be seen that way by others. Something is keeping them from staying on track with their peers, both at home and at school.  

What is ADHD?

ADHD is a common neurodevelopmental disorder, meaning it begins to reveal itself and cause problems as the brain develops during childhood. It affects about six percent of school-age children. Boys are more likely than girls to be diagnosed with it. And doctors don’t fully understand why.

ADHD stands for attention deficit hyperactivity disorder. Young people with ADHD have a tendency to act without thinking. They tend to have a high energy level, and have trouble focusing on the task before them, particularly if the task is not naturally interesting, fun, or engaging for them such as schoolwork or household chores.  They usually understand what’s expected of them. But because it’s hard for them to sit still, pay attention or focus on details, they have trouble following through.

What Symptoms Should Parents Look for?

ADHD symptoms start before age 12. In some children, they're noticeable as early as three years of age.

Children with ADHD may have trouble getting along with their siblings. Completing tasks and learning are especially challenging for them.

They have an impulsive nature that is difficult for them to control. That impulsive behavior can put them in danger of physical harm.

ADHD symptoms can be mild, moderate or severe. They often continue into adulthood. Left untreated, ADHD can lead to serious, lifelong problems. ADHD in teens and adults can result in poor grades, run-ins with the law, failed relationships, and the inability to hold a job.

There are three types of ADHD.

  1. Predominantly inattentive. The majority of symptoms fall under inattention, distraction and disorganization. Signs of this type include:
    • Trouble paying attention to details.
    • A tendency to make careless mistakes in schoolwork or other activities.
    • Difficulty staying focused on tasks or play activities.
    • Apparent problems with listening.
    • Difficulty following instructions.
    • Problems with organizing tasks or activities.
    • Avoidance or dislike of tasks that require mental effort.
    • A tendency to lose things like toys, notebooks, or homework.
    • Easily distracted.
    • Forgetfulness in daily activities, such as forgetting to do chores.

    Because children with this form of ADHD are less likely to disrupt the classroom or other activities, their symptoms may not be noticed as quickly.

  2. Predominantly hyperactive-impulsive. The majority of symptoms are related to hyperactivity and impulsiveness. Signs of this type include:
    • Fidgeting or squirming.
    • Difficulty remaining seated.
    • Excessive running or climbing.
    • Difficulty playing quietly.
    • Always seeming to be "on the go."
    • Excessive talking.
    • Blurting out answers, interrupting the questioner.
    • Difficulty waiting for a turn or in line.
    • Problems with interrupting or intruding on others' conversations, games or activities.

    This is the least common form of ADHD.

  3. Combined. This is the most common type in the U.S. It is a mix of many inattentive symptoms and hyperactive-impulsive symptoms.

    ADHD does not show physical signs that can be detected by a lab test. Typical ADHD symptoms may overlap with those of other physical and psychological disorders.

    ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than others to also have conditions such as:

    • Learning disabilities, including problems with reading, writing, and math skills.
    • Anxiety disorders, which may cause overwhelming worry and nervousness.
    • Depression, which frequently occurs in children with ADHD.
    • Disruptive mood dysregulation disorder, which is characterized by irritability and problems tolerating frustration.
    • Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant and hostile behavior toward authority figures.
    • Conduct disorder, which is characterized by antisocial behavior such as stealing, fighting, destroying property, and harming people or animals.
    • Bipolar disorder, which includes depression as well as manic behavior.
    • Tourette syndrome, which is a neurological disorder characterized by repetitive muscle and vocal tics.

    Children with ADHD typically display problems in multiple areas, such as school, at home, and with peers. However, impairment may be more noticeable in some areas than others. Children with ADHD usually have problems in many areas, not just one.

What Causes ADHD?

No single cause of ADHD has been identified. We do know ADHD is not caused by vaccines, watching television, poor parenting or too much sugar.

Current research leans toward biological origins for ADHD. Doctors are exploring a number of possible genetic and environmental links. There is strong evidence to suggest that many children with ADHD have close relatives with the disorder.

Researchers have also found brain differences in children with ADHD. Chemical changes in the brain also have been found.

How is ADHD Diagnosed?

Because there is no test for ADHD, a diagnosis depends on a complete evaluation. To be diagnosed with ADHD, a child must have a specified number of symptoms for at least 6 months.

Initially, parents should talk with their child’s primary care provider about their concerns.  In many cases ADHD can be evaluated and treated by primary care.

For young children and children with more severe symptoms, it can be helpful to have a specialist involved like a psychiatrist, psychologist or developmental behavioral pediatrician. They can confirm the diagnosis and identify any other concerns, such as Tourette syndrome, a learning disability, anxiety or depression.  Psychologists and counselors often play a big role in helping with the non-medication treatment options.

How is ADHD Treated?

ADHD can't be cured. But it can be successfully managed.

In most cases, ADHD is best treated with a combination of medications and counseling. Effective treatment of childhood ADHD involves four different treatment strategies:

  • Behavioral Parent Training.
  • Behavioral School Intervention.
  • Medication.

Parents shouldn’t expect instant changes. Improvement and behavioral change is a gradual, ongoing process.

Any good treatment plan will include close follow-up and monitoring. Sometimes the symptoms of ADHD become less severe or change as a person grows older, particularly as self-regulation improves with development and adults get the opportunity to 'self-select' their environments (e.g., pick jobs they are interested in and good at).

Hyperactivity tends to ease as kids become young adults, although the problems with organization, attention, and impulsivity often remain. More than half of kids who have ADHD will continue to have symptoms as young adults.

When Should You Seek Help for Children with ADHD?

An early diagnosis is important so that your child can get the needed help. Don’t wait to see if the problems “will get better on their own.” Most often, they don’t. Then everyone – including your child – suffers more than they should have to.

If you're concerned that your child shows signs of ADHD, talk with your child’s primary care provider.