Attention-deficit/hyperactivity disorder (ADHD) in children
Attention-deficit/hyperactivity disorder (ADHD) in children
Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. ADHD includes a combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.
Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.
While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome.
Attention-deficit/hyperactivity disorder (ADHD) has been called attention-deficit disorder (ADD) in the past. But ADHD is now the preferred term because it describes both of the primary features of this condition: inattention and hyperactive-impulsive behavior. In some children, signs of ADHD are noticeable as early as 2 or 3 years of age.
Signs and symptoms of ADHD may include:
ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.
Normal behavior vs. ADHD
The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're tired. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they're different from their friends or siblings.
Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.
When to see a doctor
If your child is already being treated for ADHD, he or she should see the doctor regularly until symptoms have largely improved, and then every three to four months if symptoms are stable. Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping, increased irritability, or if your child's ADHD has not shown much improvement with initial treatment.
While the exact cause of ADHD is not clear, research efforts continue.
Multiple factors have been implicated in the development of ADHD. It can run in families, and studies indicate that genes may play a role. Certain environmental factors also may increase risk, as can problems with the central nervous system at key moments in development.
Risk factors for ADHD may include:
Although sugar is a popular suspect in causing hyperactivity, there's no reliable proof of this. Many things in childhood can lead to difficulty sustaining attention, but that is not the same as ADHD.
ADHD can make life difficult for children. Children with ADHD:
Preparing for your appointment
You're likely to start by taking your child to a family doctor or pediatrician. Depending on the results of the initial evaluation, your doctor may refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist or pediatric neurologist.
What you can do
Some basic questions to ask your doctor include:
Don't hesitate to ask questions anytime you don't understand something.
What to expect from your doctor
Tests and diagnosis
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.
There's no specific test for ADHD, but making a diagnosis will likely include:
Diagnostic criteria for ADHD
Hyperactivity and impulsivity
In addition to having at least six signs or symptoms from these two categories, a child with ADHD:
A child diagnosed with ADHD is often given a more specific diagnosis (a subtype), such as:
Other conditions that resemble ADHD
Diagnosing ADHD in young children
Treatments and drugs
Standard treatments for ADHD in children include medications, education, training and counseling. These treatments can relieve many of the symptoms of ADHD, but they don't cure it. It may take some time to determine what works best for your child.
Examples include methylphenidate (Concerta, Metadate, Ritalin, others), dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall XR) and lisdexamfetamine (Vyvanse).
Stimulant drugs are available in short-acting and long-acting forms. A long-acting patch is available that can be worn on the hip.
The right dose varies from child to child, so it may take some time to find the correct dose. And the dose may need to be adjusted if significant side effects occur or as your child matures. Ask your doctor about possible side effects of stimulants.
Stimulant medications and heart problems
Ask your doctor about possible side effects of any medications.
Giving medications safely
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 at the right time:
ADHD behavior therapy and counseling
Examples of therapy include:
The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. Educate yourself about ADHD, and then work with your child's teachers and refer them to reliable sources of information to support their efforts in the classroom.
Lifestyle and home remedies
Because ADHD is complex and each person with ADHD is unique, it's hard to make recommendations that work for every child. But some of the following suggestions may help create an environment in which your child can succeed.
Children at home
Children in school
There's little research that indicates that alternative medicine treatments can reduce ADHD symptoms. Before considering any alternative interventions, talk with your doctor to determine if the therapy will be safe. Some alternative medicine treatments that have been tried, but are not yet fully proved scientifically, include:
Coping and support
Caring for a child with ADHD can be challenging for the whole family. Parents may be hurt by their child's behavior as well as by the way other people respond to it. The stress of dealing with ADHD can lead to marital conflict. These problems may be compounded by the financial burden that ADHD can place on families.
Siblings of a child with ADHD also may have special difficulties. They can be affected by a brother or sister who is demanding or aggressive, and they may also receive less attention because the child with ADHD requires so much of a parent's time.
There also are excellent books and guides for both parents and teachers, and Internet sites dealing exclusively with ADHD. But be careful of websites or other resources that focus on risky or unproved remedies or those that conflict with your health care team's recommendations.
Techniques for coping
To help manage ADHD:
To help reduce your child's risk of ADHD:
If your child has ADHD, to help reduce problems or complications:
Last Updated: 2013-03-05
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