Attention deficit hyperactivity disorder

Definition

Attention deficit hyperactivity disorder (ADHD) is a problem caused by the presence of 1 or more of these findings: not being able to focus, being overactive, or not being able control behavior.

Alternative Names

ADD; ADHD; Childhood hyperkinesis

Causes

ADHD often begins in childhood. But it may continue into the adult years. ADHD is diagnosed more often in boys than in girls.

It is not clear what causes ADHD. It may be linked to genes and home or social factors. Experts have found that the brains of children with ADHD are different from those of children without ADHD. Brain chemicals are also different.

Symptoms

ADHD symptoms fall into three groups:

Some people with ADHD have mainly inattentive symptoms. Some have mainly hyperactive and impulsive symptoms. Others have a combination of these behaviors.

INATTENTIVE SYMPTOMS

HYPERACTIVITY SYMPTOMS

IMPULSIVITY SYMPTOMS

Many of the above findings are present in children as they grow. For these problems to be diagnosed as ADHD, they must be out of the normal range for a person's age and development.

Exams and Tests

There is no test that can diagnose ADHD. Diagnosis is based on a pattern of the symptoms listed above. When a child is suspected to have ADHD, parents and teachers are often involved during the evaluation.

Most children with ADHD have at least one other developmental or mental health problem. This may be a mood, anxiety, or substance use disorder. Or it may be a learning problem or a tic disorder.

Treatment

Treating ADHD is a partnership between the health care provider and the person with ADHD. If it's a child, parents and often teachers are involved. For treatment to work, it is important to:

If treatment does not seem to work, the health care provider will likely:

MEDICINES

Medicine combined with behavioral treatment often works best. Different ADHD medicines can be used alone or combined with each other. The doctor will decide which medicine is right, based on the person's symptoms and needs.

Psychostimulants (also known as stimulants) are the most commonly used medicines. Although these drugs are called stimulants, they actually have a calming effect in people with ADHD.

Follow the health care provider's instructions about how to take ADHD medicine. The provider needs to monitor if the medicine is working and if there are any problems with it. So, be sure to keep all appointments with the provider.

Some ADHD medicines have side effects. If the person has side effects, contact the doctor right away. The dosage or medicine itself may need to be changed.

THERAPY

A common type of ADHD therapy is called behavioral therapy. It teaches children and parents healthy behaviors and how to manage disruptive behaviors. For mild ADHD, behavioral therapy alone (without medicine) may be effective.

Other tips to help a child with ADHD include:

There is little proof that alternative treatments for ADHD such as herbs, supplements, and chiropractic are helpful.

Support Groups

Resources for more information on ADHD include:

Outlook (Prognosis)

ADHD is a long-term condition. ADHD may lead to:

One third to one half of children with ADHD have symptoms of inattention or hyperactivity-impulsivity as adults. Adults with ADHD are often able to control behavior and mask problems.

When to Contact a Medical Professional

Call the doctor if you or your child's teachers suspect ADHD. You should also tell the doctor about:

References

American Academy of Pediatrics, Subcommittee on Attention-Deficity/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128:1007-1022. PMID: 22003063 www.ncbi.nlm.nih.gov/pubmed/22003063.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013.

Prince JB, Wilens TE, Spencer TJ, Biederman J. Pharmacotherapy of attention-deficit/hyperactivity disorder across the lifespan. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 49.

Sprich SE, Safren SA, Finkelstein D, Remmert JE, Hammerness P. A randomized controlled trial of cognitive behavioral therapy for ADHD in medication-treated adolescents. J Child Psychol Psychiatry. 2016. PMID: 26990084 www.ncbi.nlm.nih.gov/pubmed/26990084.

Urion DK. Attention-deficity/hyperactivity disorder. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 33.