• What is attention deficit hyperactivity disorder?
• What are the symptoms?
• Could other problems be causing this behavior?
• How common is ADHD?
• What causes ADHD?
• Will my child outgrow it?
• Isn't there controversy about ADHD?
• How will my child be evaluated?
• What is the treatment?
• What can I do at home to help my child?
What is attention deficit hyperactivity disorder?
Attention deficit hyperactivity disorder (ADHD) is a condition that makes it hard for a child to control her activity level and reactions to what's going on around her. A child with ADHD also finds it tough to keep her attention on what she wants to do. ADHD shows up in early childhood and often lasts through adolescence and adulthood.
What are the symptoms?
They can vary depending on the child. Health professionals have identified three main types of ADHD: inattentive ADHD (previously called ADD); hyperactive-impulsive ADHD; and combined ADHD, in which a child has both inattentive and hyperactive symptoms.
In diagnosing ADHD, a doctor will assess whether a child has often behaved in some of the following ways, in more than one setting, for longer than six months. The behavior also has to be negatively affecting the child's life — at home, at school, and in social situations:
Signs of inattention:
• Has a hard time paying close attention to details
• Makes careless mistakes in schoolwork or other activities
• Daydreams, has trouble focusing her attention
• Has difficulty listening to what's being said to her
• Is easily distracted from tasks and play
• Doesn't follow through on obeying instructions and fails to finish schoolwork or chores (but not out of rebellion or failure to understand)
• Forgets things
• Has trouble organizing tasks and other activities
• Loses important things or items needed for tasks and activities, such as toys, school assignments, pencils, books
• Avoids or strongly dislikes tasks (such as homework or games) that require sustained mental effort
Signs of hyperactivity:
• Often fidgets or squirms, seems to be in constant motion
• Leaves her seat in the classroom or in other situations where she's expected to stay put
• Talks too much
• Has trouble playing quietly
• Often runs about or climbs in situations where it's inappropriate
Signs of impulsivity:
• Blurts out answers before the whole question has been asked
• Has trouble waiting her turn or standing in line
• Acts and speaks without thinking
• Runs into the street without looking
• Interrupts or intrudes on others' conversations or games
Of course, all children are occasionally "hyper" or inattentive. That's why experts say it's tricky to diagnose this condition — it's sometimes hard to tell a child with ADHD from one who's simply energetic. But a child with ADHD is more easily distracted and more impulsive than most kids her age, and her activity can border on the frenetic. If you think your child behaves that way a lot — more so than other kids her age — and you can see it's giving her problems, talk to her doctor.
Could other problems be causing this behavior?
Yes, a hearing or vision problem, a learning disability, or an emotional situation such as a death or divorce in the family could be challenging your child's ability to concentrate. Or she could just need more outlets for physical activity. But if you're concerned, talk to her doctor.
How common is ADHD?
According to the American Academy of Pediatrics (AAP), ADHD affects 4 to 12 percent of U.S. schoolchildren. Signs usually appear before age 7. Studies show ADHD affects three times as many boys as girls, and there is often a family history of the condition.
What causes ADHD?
This is the subject of an enormous amount of research, and there's still plenty we don't know. Most researchers say ADHD is at least partly genetic: Some studies show that if one child has it, the chances of a sibling having it are 20 to 25 percent, or five times as high as in the general population.
There may be a neurological aspect, too: People with ADHD are thought to have inherited a physical inability to regulate levels of brain chemicals like dopamine and norepinephrine. And research has shown that children with ADHD have 3 to 4 percent less volume in all areas of the brain than children without ADHD. They also have less white matter — the fibers that make connections between areas of the brain. Still, experts don't yet know if these differences are directly related to ADHD or just a variation of what's normal.
For a time, researchers theorized that attention disorders were caused by minor head injuries or damage to the brain. In fact, for many years ADHD was called "minimal brain damage" or "minimal brain dysfunction." But while people with severe brain injury often have ADHD-like symptoms, the vast majority of people with ADHD have no history of head injury or brain damage.
Cigarette and alcohol use during the mother's pregnancy may also be contributing factors. But contrary to what you may have heard, the most recent studies don't substantiate any link between ADHD and refined sugar, food additives, or immunizations. And ADHD is not caused by poor parenting, family problems, bad teachers or schools, or too much TV. Environment can influence the severity of ADHD and how well the child copes and functions with the condition, but it's not a cause.
Will my child outgrow it?
Probably not — ADHD usually continues into adulthood. In fact, 80 percent of the children who are prescribed medication for ADHD still take it as teens, and over half still take it as adults. Many learn to manage the disorder, though.
Isn't there controversy about ADHD?
Yes, in part because researchers aren't sure precisely what causes it, and also because it's difficult to diagnose, since so many of the symptoms overlap with common childhood behavior.
Medication is a topic of debate, too: Doctors, other medical experts, and parents all tend to have strong opinions about whether it's okay to use drugs to treat the condition in children, especially before age 6. (The AAP's diagnostic guidelines for ADHD are specified only for ages 6 to 12.)
For 3 to 4 out of 100 children who take them, Ritalin and other stimulant drugs prescribed for ADHD have side effects such as stomachaches, headaches, weight loss, and trouble sleeping. Raised blood pressure and delayed growth are potential problems, too. If your child is prescribed medication for ADHD, her doctor will want to see her regularly.
How will my child be evaluated?
The doctor will examine your child and review her medical and social history. She may ask you about your pregnancy, other family members who've been diagnosed with ADHD, and any emotional troubles your child has gone through. She may also order tests to rule out vision and hearing problems.
The doctor might refer you to a child psychologist or psychiatrist, a developmental pediatrician, or another mental health professional, who'll probably give your child various tests to evaluate such things as her memory and her problem-solving and listening skills. This practitioner will ask you or your child's daycare provider to fill out a form that asks questions like, "How often does the child seem to be restless?" with possible responses ranging from "never" to "always."
The expert will look at whether your child displays the behaviors associated with ADHD. She may ask the daycare provider to write a letter describing your child's typical behavior, since even a child who's running in circles much of the time may act calmer or more focused during a doctor visit. Together your child's doctor and the other practitioners will make a diagnosis.
What is the treatment?
There are three options: family therapy, behavioral therapy, and medication.
Family therapy, sometimes called parent training, is one of the best ways to deal with ADHD. It will help you learn how to handle your own frustration with your child's behavior, how to parent consistently and positively, and how to adjust your expectations of her.
Behavioral therapy can teach you how to structure situations at home and school so that your child doesn't become unnecessarily stimulated or distracted. It might also help your child develop coping strategies for particular skills and situations.
ADHD medications aren't usually prescribed for children under 6, though some are approved for ages 3 and up. The medications most often prescribed are stimulants, including methylphenidate (better known by its brand name, Ritalin) and dextroamphetamine (Dexedrine). Researchers believe these medications help regulate levels of neurotransmitters in the brain. Both medications come in short-acting (two to four hours) and longer-lasting (six to ten hours) form.
Keep in mind that ADHD is a relatively new term and the condition has received a lot of media attention in recent years. Researchers are still trying to decide on the best ways to treat it, and as new studies are publicized, your friends and family may give you an earful about what you should do. The best solution to any confusion and anxiety you feel is to work closely with your child's doctor and therapist, focusing on the solutions that seem most helpful and effective for your child.
What can I do at home to help my child?
The first step is to accept that your child has a behavioral disorder and adjust your expectations of what she's capable of just now. Many kids with ADHD are terrifically bright and creative — your child may well grow up to be an eminent scientist or film director. But you'll need to rethink the way you parent her as well as the type of environment you establish for her. Here's where to begin:
• Sign everybody up. If you do get a definitive diagnosis, notify family members (at least those who spend a lot of time with your child), close friends, teachers, and anybody else who can offer support. Some parents of children with ADHD used to keep quiet for fear their child would be stigmatized, but it can be comforting and grounding to be able to give the condition a name. And it's important to build your support network so your child can get all the help she needs in the months and years ahead.
• Change the scene. Eliminate sources of overstimulation and distraction in your child's environment. At home, make sure her room is tidy, stashing extra toys or books where they won't catch her eye. At school, ask the teacher to place your child where she can keep an eye on her or to move her away from kids and objects that tend to divert her attention.
• Structure your day. All children do well with routines, but kids with ADHD need them more than others do. A regular schedule prevents the anxiety and tension of not knowing what's going to happen next. You don't have to be rigid — just make sure your child knows when and where she'll have her meals, snacks, homework time, baths, and so on.
• Reward instead of punish. You've probably already discovered how useless it is to try to punish your child when she's running around or tuning you out. But you may not know how well kids with ADHD respond to simple rewards. Praise good behavior immediately ("You brushed your teeth, just like I asked you to! Thanks so much!"), and give your child some little token that pleases her — a gold star, a funny rubber stamp, or an extra bedtime story. The reward should be something she can enjoy right away, since kids with ADHD don't like to wait.Getting a tangible show of appreciation will make your child feel good, and she'll be inclined to repeat the behavior that made her feel that way. Over time, the good feeling will start to come from inside and there'll be less need to provide those external rewards.
