ADHD Disorders

Could You or Your Child Have ADHD?
Attention-deficit hyperactivity disorder (ADHD) affects both children and adults. Learn about ADHD symptoms, treatments, and why it’s especially important for children to have an accurate diagnosis.
What is Attention-Deficit Hyperactivity Disorder (ADHD)?

ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development as characterized by symptoms of inattention and/or hyperactivity and impulsivity. Distinguishing features of ADHD are short attention span and high levels of distractibility for chronological age and developmental level. This condition is also referred to as ADD (Attention Deficit Disorder), which is old terminology.

A diagnosis of ADHD is given based on symptoms of “inattention” or based on symptoms of “hyperactivity and impulsivity.” In addition, “other specified ADHD disorder” or “unspecified ADHD disorder” may be given as a diagnosis when a patient does not meet the full criteria for ADHD but the symptoms still causes significant distress or impairment in social, occupational, or other important areas of functioning.

Inattention Symptoms

A diagnosis of ADHD based on inattentive symptoms requires that six or more of the following symptoms have persisted for at least 6 months, negatively impacting directly on social and occupational activities. For older adolescents and adults, at least five symptoms are required.

  • Often fails to give close attention to details or makes carless mistakes in schoolwork, at work, or during other activities.
  • Often has difficulty sustaining attention in tasks or play activities, including remaining focused during lectures, conversations, or lengthy reading.
  • Often does not seem to listen when spoken to directly (mind seems elsewhere, even in the absence of any obvious distraction).
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace.
  • Often has difficulty organizing tasks and activities; has poor time management; fails to meet deadlines.
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework).
  • Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, eyeglasses, paperwork, mobile phones).
  • Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
  • Is often forgetful in daily activities (doing chores, running errands, returning calls, paying bills, keeping appointments).

Hyperactivity and Impulsivity

A diagnosis of ADHD based on hyperactive-impulsive symptoms requires that six or more of the following symptoms have persisted for at least 6 months, negatively impacting directly on social and occupational activities. For older adolescents and adults, at least five symptoms are required.

  • Often fidgets with or taps hands or feet, or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected.
  • Children often run about in situations where it is inappropriate. In adolescents or adults, this may be limited to feeling restless.
  • Often unable to play or engage in leisure activities quietly.
  • Is often “on the go,” acting as if “driven by a motor,” is uncomfortable being still for extended time, as in restaurants or meetings).
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed, completed people’s sentences, cannot wait for turn in conversation.
  • Often has difficulty waiting his or her turn.
  • Often interrupts or intrudes on others, such as butting into conversations, games, or activities. May start using other people’s things without asking or receiving permission.

A diagnosis of ADHD based on either inattentive or hyperactive-impulsive symptoms requires that several of the symptoms were present prior to age 12. Moreover, there is clear evidence that the symptoms interfere with social, academic, or occupational functioning. Also, the symptoms are not better explained by another mental health disorder, substance intoxication or withdrawal.

What is the rate of ADHD among children and adults?

Evidence suggests that ADHD occurs in about 5 percent of youth including children and adolescents, and in up to 4 percent of adults. ADHD is at least twice as prevalent in boys than in girls. Symptoms of ADHD are often present by age 3, but the diagnosis is often not made until kindergarten or elementary school.

Does ADHD ever go away as a child grows into adulthood?

The course of ADHD varies. Symptoms have been shown to persist into adolescence in 60 to 85 percent of cases, and into adult life in about 60 percent of cases. The remaining 40 percent of cases may remit at puberty or early adulthood. In some cases, the hyperactivity may disappear, but the decreased attention span and impulse-control problems persist. Most individuals with the disorder undergo partial remission and are vulnerable to antisocial behavior, substance use disorders, and mood disorders. Learning problems often continue throughout life.

Do children with ADHD have other mental health problems?

Most children with ADHD have some social difficulties. Socially dysfunctional children with ADHD have significantly higher rates of other psychiatric disorders, and have more problems with behavior in school as well as with family members and peers. Overall, the outcome of ADHD in childhood seems to be related to the degree of other mental health issues, including conduct disorder, social disability, and chaotic family factors. 

Are there other conditions in children that resemble ADHD?

Yes. A number of medical conditions or their treatments may cause symptoms similar to those of ADHD. Examples include:

  • Autism spectrum disorder
  • Brain injury
  • Learning or language problems
  • Medical problems or medications that affect thinking or behavior
  • Mood disorders such as depression or anxiety
  • Vision or hearing problems
  • Seizure disorders
  • Sleep disorders
Is ADHD a genetic condition?

Yes, data suggest that ADHD is largely genetic, with a heritability factor of approximately 7 percent. The rate of ADHD in parents and siblings of children with ADHD is 2 to 8 times greater than in the general population. First-degree biological relatives are at high risk for developing ADHD as well as other psychiatric disorders, including disruptive behavior disorders, anxiety disorders, and depressive disorders. Siblings of children with ADHD are also at higher risk for learning disorders and academic difficulties.

Can issues during pregnancy cause ADHD?

Yes. Higher rates of ADHD occur in children born prematurely and in children whose mothers have had maternal infections during pregnancy.

What is the treatment for ADHD?

Pharmaceutical medications are considered the first line of treatment for ADHD. Central nervous system stimulants are the first choice since they have the greatest effect with generally mild side effects. Excellent safety records are documented for short- and sustained-release preparations of methylphenidate (Ritalin, Ritalin-SR, Concerta, Metadate CD, Metadate ER), dextroamphetamine (Dexedrine, Dexedrine Spansule, Vyvanse), and dextroamphetamine and amphetamine salt combinations (Adderall, Adderall XR).

Newer preparations of methylphenidate include Methylin, a chewable form; Daytrana, a methylphenidate path; and dexmethylphenidate, the D-enantiomer (Focalin), and its longer acting from Focalin XR. These newer preparations aim to maximize effects and minimize adverse effects. Vyvanse, approved by the FDA for children 6 years and older, is less likely to have risks of abuse or overdose.

Stimulants are contraindicated in children, adolescents, and adults with known cardiac risks and abnormalities.

Nonstimulant medications approved by the FDA for the treatment of ADHD include atomoxetine (Strattera), a norepinephrine uptake inhibitor that requires monitoring for potential increases in suicidal thoughts or behaviors. A-agonist including clonidine (Catapres) and guanfacine (Tenex) have also been found effective in treating ADHD. Antidepressants, such as bupropion (Wellbutrin, Wellbutrin SR) have been used with mixed success in the treatment of ADHD.

Psychotherapy and Counseling

Children with ADHD often benefit from behavior therapy, psychotherapy, social skills training, and parent skills training and counseling. These types of therapy may be provided by a psychiatrist, psychologist, social worker or other mental health professional. Some children with ADHD may also have other conditions such as an anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.

Counseling for adult ADHD generally includes psychotherapy, education about the disorder and learning skills to help one be successful. Cognitive behavioral therapy teaches specific skills to manage one’s behavior and change negative thinking patterns into positive ones.It can also an individual deal with life challenges, such as school, work or relationship problems, and help address other mental health conditions, such as depression or substance misuse.

Marital counseling and family therapy can help loved ones cope with the stress of living with someone who has ADHD and learn what they can do to help.

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Mental Health Library Sources:
Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.
Disclaimer:
Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.
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