Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent 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.
The primary features of attention-deficit/hyperactivity disorder include inattention and hyperactive-impulsive behavior. ADHD symptoms start before age 12, and in some children, they’re noticeable as early as 3 years of age. ADHD symptoms can be mild, moderate or severe, and they may continue into adulthood.
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.
There are three subtypes of ADHD:
• Predominantly inattentive. The majority of symptoms fall under inattention.
• Predominantly hyperactive-impulsive. The majority of symptoms are hyperactive and impulsive.
• Combined. The most common type in the U.S., this is a mix of inattentive symptoms and hyperactive-impulsive symptoms.
A child who shows a pattern of inattention may often:
•Fail to pay close attention to details or make careless mistakes in schoolwork
•Have trouble staying focused in tasks or play
•Appear not to listen, even when spoken to directly
•Have difficulty following through on instructions and fail to finish schoolwork or chores
•Have trouble organizing tasks and activities
•Avoid or dislike tasks that require focused mental effort, such as homework
•Lose items needed for tasks or activities, for example, toys, school assignments, pencils
•Be easily distracted
•Forget to do some daily activities, such as forgetting to do chores
Hyperactivity and impulsivity
A child who shows a pattern of hyperactive and impulsive symptoms may often:
•Fidget with or tap his or her hands or feet, or squirm in the seat
•Have difficulty staying seated in the classroom or in other situations
•Be on the go, in constant motion
•Run around or climb in situations when it’s not appropriate
•Have trouble playing or doing an activity quietly
•Talk too much
•Blurt out answers, interrupting the questioner
•Have difficulty waiting for his or her turn
•Interrupt or intrude on others’ conversations, games or activities
In addition, a child with ADHD has:
•Symptoms for at least six months
•Several symptoms that negatively affect school, home life or relationships in more than one setting, such as at home and at school
•Behaviors that aren’t normal for children the same age who don’t have ADHD
Normal behavior vs. ADHD
Most healthy children are inattentive, hyperactive or impulsive at one time or another. It’s normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest.
The same is true of hyperactivity. Young children are naturally energetic — they often are still full of energy long after they’ve worn their parents out. 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.
Standard treatments for attention-deficit/hyperactivity disorder 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.
Currently, stimulant drugs (psychostimulants) are the most commonly prescribed medications for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These medications help improve the signs and symptoms of inattention and hyperactivity — sometimes effectively in a short period of time.
• Amphetamines. These include dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall) and lisdexamfetamine (Vyvanse).
• Methylphenidates. These include methylphenidate (Concerta, Metadate, Ritalin, others) and dexmethylphenidate (Focalin)
Stimulant drugs are available in short-acting and long-acting forms. A long-acting patch of methylphenidate (Daytrana) 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
Although rare, several heart-related deaths have occurred in children and teenagers taking stimulant medications. The possibility of increased risk of sudden death is still unproved, but if it exists, it’s believed to be in people who already have underlying heart disease or a heart defect.
Your child’s doctor should make sure your child doesn’t have any signs of a heart condition and should ask about family risk factors for heart disease before prescribing a stimulant medication.
Other medications that may be effective in treating ADHD include:
•Antidepressants such as bupropion (Wellbutrin, others)
•Guanfacine (Intuniv, Tenex)
•Clonidine (Catapres, Kapvay)
Atomoxetine and antidepressants work slower than stimulants do and may take several weeks before they take full effect. These may be good options if your child can’t take stimulants because of health problems or if stimulants cause severe side effects.
Ask your doctor about possible side effects of any medications.
Although it remains unproved, concerns have been raised that there may be a slightly increased risk of suicidal thinking in children and teenagers taking nonstimulant ADHD medication or antidepressants. Contact your child’s doctor if you notice any signs of suicidal thinking or other signs of depression.
Giving medications safely
It’s very important to make sure your child takes the right amount of the prescribed medication. 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.
On the other hand, there’s concern that other people might misuse or abuse stimulant medication prescribed for children and teenagers with ADHD. To keep your child’s medications safe and to make sure your child is getting the right dose at the right time:
• Give medications carefully. Children and teens shouldn’t be in charge of their own ADHD medication without proper supervision.
• 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.
ADHD behavior therapy
Children with ADHD often benefit from behavior therapy and 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.
Examples of therapy include:
• Behavior therapy. Teachers and parents can learn behavior-changing strategies, such as token reward systems and timeouts, for dealing with difficult situations.
• 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.
The best results 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.
If your child is 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 or increased irritability, or if your child’s ADHD has not shown much improvement with initial treatment.
There’s little research that indicates that alternative medicine treatments can reduce attention-deficit/hyperactivity disorder symptoms. Before considering any alternative interventions, talk with your doctor to determine if the therapy is safe. Some alternative medicine treatments that have been tried, but are not yet fully proved scientifically, include:
• Yoga or meditation. Doing regular yoga routines or meditation and relaxation techniques may help children relax and learn discipline, which may help them manage their symptoms of ADHD.
• Special diets. Most diets promoted for ADHD involve eliminating foods thought to increase hyperactivity, such as sugar, and common allergens such as wheat, milk and eggs. Some diets recommend avoiding artificial food colorings and additives. So far, studies haven’t found a consistent link between diet and improved symptoms of ADHD, though some anecdotal evidence suggests diet changes might make a difference. Caffeine use as a stimulant for children with ADHD can have risky effects and is not recommended.
• Vitamin or mineral supplements. While certain vitamins and minerals from foods are necessary for good health, there’s no evidence that supplemental vitamins or minerals can reduce symptoms of ADHD. “Megadoses” of vitamins — doses that far exceed the Recommended Dietary Allowance (RDA) — can be harmful.
• Herbal supplements. There is no evidence to suggest that herbal remedies help with ADHD, and some may be harmful.
• Proprietary formulations. These are products made from vitamins, micronutrients and other ingredients that are sold as possible treatment supplements for children with ADHD. These products have had little or no research and are exempt from Food and Drug Administration oversight, making them possibly ineffective or potentially harmful.
• Essential fatty acids. These fats, which include omega-3 oils, are necessary for the brain to function properly. Researchers are still investigating whether these may improve ADHD symptoms.
• Neurofeedback training. Also called electroencephalographic (EEG) biofeedback, in these sessions a child focuses on certain tasks while using a machine that shows brain wave patterns. The goal is to learn to keep brain wave patterns active in the front of the brain, improving symptoms of ADHD. More research is needed to see if this works.
• Exercise. In addition to its health benefits, regular exercise may have a positive effect on behavior in children with ADHD when added to treatment.