ADHD (attention deficit hyperactivity disorder) is one of the most frequently occurring childhood psychiatric disorders. Symptoms include not staying focused on a task, having trouble sitting still, and acting without thinking. These symptoms usually become evident in preschool or early elementary years, and can continue into adolescence and even adulthood. In many cases, the most effective treatments for ADHD include medications and behavioral therapies. ADHD used to be known as attention deficit disorder, or ADD. In 1994, it was renamed ADHD.
Attention Deficit Hyperactivity Disorder (ADHD or ADD) is a diagnostic term given to children and adults who have problems in four major areas of their lives. These four areas are impulsivity, hyperactivity, boredom and inattention. ADHD is a neurologically-based disorder.
The lower portion of the brain houses an area known as the reticular activating system. This system in the brain keeps the higher brain centers alert and ready for input. With ADHD, there is some evidence that this particular area is not working correctly and that the brain seems to be going to sleep. The hyperactivity is the brain's attempt to stimulate activity and maintain alertness.
Other areas of the brain may also be affected. These include the inhibitory mechanisms of the cortex and the frontal lobes. Each of these particular areas of the brain is associated with a variety of various functions.
There has been some controversy over the diagnosis of ADHD as a neurological condition. Many experts say that there is no evidence whatsoever that ADHD is neurological, as there have been no medical tests to diagnose the deficiency. Also, the criteria encapsulated are too broad to make a specific diagnosis.
There are number of factors that are fairly common in ADHD sufferers. The condition seems to run in families, and there are connections with families who have a history of depression and/or alcoholism. Asthma may be more prevalent in sufferers of ADHD, and affected children often show considerable artistic ability, but may also show difficulty in writing or drawing.
ADHD is five to seven times more common in boys than girls, and it occurs at every level of intelligence. The condition is more commonly diagnosed in the United States than in Europe. Stimulant medication is used more commonly in America as an intervention strategy.
About 35% of all children who are referred to mental health clinics are referred with ADHD. The condition effects about 3% of adults and 5% of children. It is thought that 50 to 60% of children will outgrow ADHD by the time they reach their twenties.
In many cases, ADHD symptoms appear over the course of several months, often with symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more. Specific symptoms include having trouble organizing activities, fidgeting, and excessive talking. Many normal children can have symptoms of this condition, but at lower levels, so it is important to get an accurate diagnosis by a qualified professional.
As explained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the principal symptoms of ADHD are:
Inattention
Hyperactivity
Impulsivity.
It is not fully understood whether these problems are an extreme form of normal behavior, or part of a separate range of behavior.
A person with ADHD usually has symptoms characteristic of one of the three subtypes of the condition. The subtypes are:
ADHD mainly inattentive
ADHD mainly hyperactive-impulsive
ADHD combined
If your child has symptoms of all three behavioral problems – inattentiveness, hyperactivity and impulsiveness – they may have ADHD combined, which is the most common subtype of ADHD.
Alternatively, if your child has symptoms of inattentiveness but not hyperactivity or impulsiveness, they may have ADHD mainly inattentive. This form of ADHD is also known as attention deficit disorder (ADD).
Childhood ADHD is more commonly diagnosed in boys than in girls, but this may be because disruptive behavior, which the diagnosis may be partly based on, tends to be more common in boys than girls.
Girls with ADHD often have the mainly inattentive form of the condition, which may make them quiet and dreamy and can sometimes go unnoticed. It is therefore possible that ADHD could be underdiagnosed in girls, and could be more common than previously thought.
The main symptoms of inattentiveness include:
Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities
Often has trouble keeping attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
Often has trouble organizing activities
Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework)
Often loses things needed for tasks and activities (for example, toys, school assignments, pencils, books, or tools)
Is often easily distracted
Is often forgetful in daily activities.
Children with symptoms of inattention have a hard time keeping their minds on any one thing and may get bored with a task after only a few minutes. If they are doing something they really enjoy, they have no trouble paying attention. However, focusing deliberate, conscious attention on organizing and completing a task or learning something new is difficult.
Homework is particularly difficult for children with symptoms of inattention. They will forget to write down an assignment or leave it at school. They will forget to bring a book home or will bring the wrong one. The homework, if finally finished, is full of errors and erasures. Homework is often accompanied by frustration for both parent and child.
The main symptoms of hyperactivity include:
Often fidgets with hands or feet or squirms in seat
Often gets up from seat when remaining in seat is expected
Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless)
Often has trouble playing or enjoying leisure activities quietly
Is often "on the go" or often acts as if "driven by a motor"
Often talks excessively.
Children with symptoms of hyperactivity always seem to be "on the go" or constantly in motion. They dash around touching or playing with whatever is in sight, or talk incessantly. Sitting still at dinner or during a school lesson or story can be a difficult task. They squirm and fidget in their seats or roam around the room. They may wiggle their feet, touch everything, or noisily tap their pencil.
Teenagers or adults with ADHD symptoms of hyperactivity may feel internally restless. They often report needing to stay busy and may try to do several things at once.
The main symptoms of impulsiveness include:
Often blurts out answers before questions have been finished
Often has trouble waiting one's turn
Often interrupts or intrudes on others (for example, butts in to conversations or games)
Some symptoms that cause impairment were present before the age of seven
Some impairment from the symptoms is present in two or more settings (for example at school/work and at home)
There must be clear evidence of significant impairment in social, school, or work functioning
The symptoms do not happen only during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder; the symptoms are not better accounted for by another mental disorder (for example, mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).
Children with ADHD symptoms of impulsivity seem unable to curb their immediate reactions or think before they act. They will often blurt out inappropriate comments, display their emotions without restraint, and act without regard for the later consequences of their conduct. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they're upset.
Teenagers or adults with ADHD symptoms of impulsivity may choose to do things that have an immediate but small payoff rather than engage in activities that may take more effort yet provide much greater but delayed rewards.
The exact causes of ADHD are unclear, although many people mistakenly believe that the disorder arises from social factors or child-rearing methods. Through research, scientists are refining their theories about the possible causes, some of which include environmental agents and genetics. Brain injury, food additives, and sugar are no longer thought to cause ADHD.
When a child is diagnosed with ADHD (attention deficit hyperactivity disorder), many parents wonder "Why? What went wrong?" or "Did I do something to cause this?" The fact is, ADHD research scientists do not currently know the exact cause or causes of ADHD. However, over the last few decades, scientists have come up with several theories about what causes the condition. Some of these have led to dead ends, while others have led to exciting new avenues of investigation.
A few plausible theories regarding the causes of ADHD include:
Environmental factors
Genetics.
Other factors that have not shown to cause the condition include:
Brain injury
Food additives and sugar.
There is little compelling evidence at this time that ADHD can arise purely from social factors or child-rearing methods. Most of the possible causes of ADHD appear to be related to neurobiology and genetics. This is not to say that environmental factors cannot influence the severity of ADHD, and especially the degree of impairment and suffering the child may experience, but that such factors do not seem to cause the condition by themselves. Knowing this can remove a huge burden of guilt from parents, who might blame themselves for their child's behavior.
Preschool children exposed to certain toxins are at increased risk of developmental and behavioral problems. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels of lead is not as prevalent as it once was. Children who live in old buildings where lead still exists in the plumbing or in lead paint that has been painted over may be at risk.
Pregnant women who smoke are at increased risk of having children with ADHD. It is always best to refrain from both cigarette and alcohol use during pregnancy.
Alcohol or drug abuse during pregnancy may reduce activity of the nerve cells (neurons) that produce neurotransmitters. Pregnant women who are exposed to environmental poisons also may be more likely to have children with symptoms of ADHD.
Attention disorders often run in families, so there are likely to be genetic influences. Studies indicate that 25 percent of the close relatives of children with ADHD also have it, whereas the rate is about 5 percent in the general population. Many studies of twins now show that the disorder has a strong genetic influence.
One early theory believed that attention disorders were caused by brain injury. While some children who have suffered accidents leading to brain injury may show signs of behavior similar to that of ADHD, only a small percentage of children with the condition have suffered a traumatic brain injury.
It has been suggested that refined sugar or food additives may be possible causes of ADHD, or that the symptoms of ADHD are made worse by these products. However, research has not proven this to be true. In 1982, the National Institutes of Health held a scientific consensus conference to discuss this issue. It was found that dietary restrictions helped about 5 percent of children with ADHD, mostly young children who had food allergies.
A more recent study on the effect of sugar on children, using sugar one day and a sugar substitute on alternate days (without parents, staff, or children knowing which substance was being used) showed no significant effects of sugar on behavior or learning.
In another study, half of the the children were given sugar, half that their children were given aspartame. The mothers who thought their children had received sugar rated them as more hyperactive than the other children and were more critical of their behavior.
Effective treatment depends on an appropriate diagnosis. A comprehensive medical evaluation of the child must be conducted to establish a correct diagnosis of ADHD and to rule out other potential causes of the symptoms. This condition can be reliably diagnosed when appropriate guidelines are used. Ideally, a healthcare provider making an ADHD diagnosis should include input from both parents and teachers. However, some healthcare providers make a diagnosis without all this information and tend to either overdiagnose ADHD or underdiagnose it.
The condition is usually diagnosed in childhood, although it can continue into the adult years.
An appointment to check for ADHD usually begins with a complete medical exam and a number of questions about your child's health, medical problems, difficulties, and issues that occur at school and at home.
Children diagnosed with ADHD have symptoms over a long period of time and have particular trouble in stressful, demanding situations or in activities that require sustained attention, such as reading, doing math problems or playing board games.
In general, a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD start early in life and create significant problems at home and at school on an ongoing basis.
As soon as a thorough, accurate diagnosis is made, ADHD treatment can begin. No single treatment is the answer for every child. Several factors are involved in determining which option is best, such as the child's needs, personal and medical history, and research findings. In many cases, a plan to treat ADHD consists of a combination of medications and behavior therapy. Other treatments to ease the effects of ADHD symptoms include special accommodations in the classroom, and family and community support.
Currently, stimulant drugs (psychostimulants) and the nonstimulant medication atomoxetine (Strattera) are the most commonly prescribed medications for treating ADHD.
Stimulant medications for ADHD include:
Methylphenidate (Ritalin, Concerta, Daytrana)
Dextroamphetamine-amphetamine (Adderall)
Dextroamphetamine (Dexedrine, Dextrostat)
Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These ADHD medications help improve the core signs and symptoms of inattention, impulsivity and hyperactivity — sometimes dramatically. However, these medications only work for a limited time. Additionally, the right dose varies from child to child, so it may take some time in the beginning to find the correct dose.
Stimulant drugs are available in short-acting and long-acting forms.
The short-acting forms last about four hours, while the long-acting preparations usually last between six and 12 hours.
Methylphenidate is available in a long-acting patch that can be worn on the hip (Daytrana). It delivers medication for about nine hours. While the long-lasting effects mean your child won't need to take medication as often, it can take up to three hours to start working. For it to work in the morning, the patch may need to be put in place early while your child is still asleep.
Stimulant
medication side effects
The
most common side effects of stimulant medications in children
include:
Decreased appetite
Weight loss
Problems sleeping
Irritability as the effect of the medication tapers off
A few children may develop jerky muscle movements, such as grimaces or twitches (tics), but these usually disappear when the dose of medication is lowered. Stimulant medications may also be associated with a slightly reduced growth rate in children, although in most cases growth isn't permanently affected.
ADHD
medications and heart problems
Although
rare, several heart-related deaths occurred in children and
adolescents taking stimulant medications. The increased risk of
sudden death is believed to be in people who already have underlying
heart disease or a heart defect. Your child's doctor will make sure
your child doesn't have any signs of a heart condition, and will ask
about family risk factors for heart disease before prescribing a
stimulant medication.
Nonstimulant
medication
Atomoxetine is
generally given to children with ADHD when stimulant medications
aren't effective or cause side effects. In addition to reducing ADHD
symptoms, atomoxetine may also reduce anxiety. Given one or two times
a day, atomoxetine side effects can include nausea and sedation. It
can also cause reduced appetite and weight loss.
Nonstimulant
medication side effects
Atomoxetine
has been linked to rare side effects that include liver problems. If
your child is taking atomoxetine and develops yellow skin (jaundice),
dark-colored urine or unexplained flu symptoms, contact the doctor
right away.
There may also be a slightly increased risk of suicidal thinking in children and adolescents taking atomoxetine. Contact your child's doctor if you notice any signs of suicidal thinking or other signs of depression.
Other medications used to treat ADHD include:
Antidepressants. These medications are generally used in children who don't respond to stimulants or atomoxetine, or who have a mood disorder as well as ADHD.
Clonidine (Catapres) and guanfacine (Intuniv, Tenex). These are high blood pressure medications shown to help with ADHD symptoms. They may be prescribed to reduce tics or insomnia caused by other ADHD medications, or to treat aggression caused by ADHD.
Giving
medications safely
Making sure
your child takes the right amount of the prescribed medication is
very important. Parents may be concerned about stimulants and the
risk of abuse and addiction. Dependence hasn't been shown in children
who take these drugs for appropriate reasons and at the proper dose.
That's because medication levels in the brain rise too slowly to
produce a "high." On the other hand, there's concern that
siblings and classmates of children and teenagers with ADHD might
abuse stimulant medications. To keep your child's medications safe
and to make sure your child is getting the right dose of medication
at the right time:
Administer medications carefully. Children and teens shouldn't be in charge of their own ADHD medication.
At home, keep medication locked in a childproof container. An overdose of stimulant drugs is serious and potentially fatal.
Don't send supplies of medication to school with your child. Deliver any medicine yourself to the school nurse or health office.
Children with ADHD often benefit from behavior therapy or counseling, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some children with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.
Counseling types include:
Behavior therapy. Teachers and parents can learn behavior-changing strategies for dealing with difficult situations. These strategies may include token reward systems and timeouts.
Psychotherapy. This allows older children with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms.
Parenting skills training. This can help parents develop ways to understand and guide their child's behavior.
Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
Social skills training. This can help children learn appropriate social behaviors.
Support groups. Support groups can offer children with ADHD and their parents a network of social support, information and education.
The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. You can help by making every effort to work with your child's teachers and by referring them to reliable sources of information to support their efforts in the classroom.
Symptoms often lessen with age. However, most people never completely outgrow their ADHD symptoms.
Dietary factors contribute a lot in treating ADHD. ADHD diet with vitamins and essential nutrients is recommended for children with ADHD. Omega-3 is a type of polyunsaturated fat. It is an essential fatty acid found in vegetables like walnuts, hemp and flax and certain kind of fish like salmon, sardine and tuna. ADHD diet should be rich in Omega-3 fatty acids as it plays a major role in proper brain functioning. ADHD diet should also contain high amount of proteins and low carbohydrate foods. High protein diet including cheese, nuts, beans, meat and eggs can improve mental concentration. Children with ADHD should eat lots of fresh fruits and vegetables, as they are rich sources of essential vitamins and minerals.
Dietary factors like caffeine and sugar and other common allergens like milk, wheat and eggs are responsible to increase hyperactivity. Caffeine is a stimulant and it is not recommended for a child with ADHD to consume caffeine-containing drinks. Foods with additives and chemicals such as synthetic coloring, artificial flavoring, artificial preservatives, salicylates, artificial sweeteners and other food additives like sodium benzoate, sulfites are recommended to exclude from children's diet. Foods rich in sugar like fruit juice and chocolates should also be excluded.
Here are some helpful dietary tips, which can be useful in treating the kids with ADHD:
Organic foods: Organic foods, which are free from additives, pesticides and toxins, are beneficial for children with ADHD. These factors can negatively affect concentration and increase hyperactivity.
Avoid high-mercury fish: Almost all fish and shellfish consist of traces of mercury, which affect child's ability to think and concentrate. Hence, it is recommended that children with ADHD should avoid high mercury fish such as swordfish, shark, tilefish and mackerel.
Gluten sensitivity: Children with ADHD may be sensitive to gluten. Child's gluten sensitivity is detected through a blood test. If the child is sensitive to gluten, then you may exclude gluten-containing foods such as wheat and barley from the diet.
Add multivitamins: Multivitamins are important for children with ADHD. Intracellular vitamin analysis can be done to get an idea about which vitamins and minerals should be added to the diet.
ADHD is a serious behavioral problem in children. Adding some essential nutrients and food supplements to the diet is thus, an effective way to treat ADHS. Besides, such supplements in the diet are also good for the healthy growth.