What is Attention Deficit (Hyperactivity) Disorder or ADHD?
Attention-deficit Hyperactivity Disorder is "a condition of the brain that makes it hard for children to control their behavior." (1) All kids have problems with their behavior from time to time, but kids with ADHD have behavior problems that interfere with regular life and are continual. ADHD usually lasts the whole life.
Kids with Attention-Deficit Hyperactivity Disorder (ADHD or AD/HD) can have different kinds of symptoms:
- Inattention: These kids have trouble with paying attention, are disorganized or daydream too much.
- Hyperactivity: These kids are always moving, talk too much, and can't sit still.
- Impulsivity: These kids act and talk without thinking, interrupt a lot or show poor judgment.
- Combination: The above symptoms can occur in different combinations.
Is ADHD a learning disability?
ADHD and learning disabilities are two different kinds of challenges, but they do often occur together. Your may hear these called by the medical term co-morbidities.
How common is ADHD?
Attention-Deficit Hyperactivity Disorder is the most common behavior disorder in school-aged kids. About 8-12% of kids have it.
What causes ADHD?
The exact causes of ADHD are not yet known. Experts think that ADHD is caused by differences in the way messages are sent in the brain. ADHD seems to run in families, so it may be inherited.
How is ADHD diagnosed?
ADHD is usually diagnosed in school-aged kids (ages 6-12), because it is hard to make a diagnosis in younger children. The diagnostic process has many steps. You, the parent, your child's school, and other caregivers will all need to provide information about your child's behavior to the health care provider. To find out about diagnosis, read the American Academy of Pediatrics clinical practice guideline:
How is ADHD treated?
The best treatment for ADHD is usually medication, combined with behavior therapy (including training parents in behavior therapy) and setting things up for your child at home and at school to make it easier to pay attention. Because ADHD is a chronic (on-going) condition, treatment must also be on going. Usually, you will have a long-term plan that includes goals for your child. When all the parts of the treatment plan are in place, and everyone (child, parents, teachers, doctors, caregivers, etc.) works together, treatment will be most effective.
To find out more about what to expect in the treatment process, read the American Academy of Pediatrics clinical practice guideline:
What if I think my child might have ADHD?
If you think your child may have ADHD, you should have him or her checked by his/her primary care provider or a psychiatrist. Sometimes a sight or hearing problem, family stress, worry, a learning disability, or communication problem can affect a child's attention and behavior. You should also get help from your school system.
What can the school system do for my child?
If your child is struggling in school, ask your school system in writing for an evaluation of your child. They are required to provide it, at no cost to you. The purpose of an evaluation is to find out why your child is not doing well in school. A team of professionals will work with you to evaluate your child. If they do not find a problem, you can ask the school system to pay for an Independent Educational Evaluation (IEE). There are strict rules about this, so you may not get it. You can also have your child tested again privately, and pay for it yourself. But check with your school district first to make sure they will accept the private test results. By law, the school system must consider the results of the second evaluation when deciding if your child can get special services.
If testing shows your child has ADHD, the school system may start your child in a special education program.
What is special education?
Special education means "educational programming designed specifically for the individual." It can really help your child do better in school. If your school-aged child qualifies for special education, they will have an Individualized Education Plan (IEP) designed just for him or her.
- Here is a helpful overview of the special education process.
What about medication?
There is a lot of news lately about ADHD medications and kids. Some people think medications are prescribed too much. Others see them working and think they are a great idea. Whatever your feelings, be sure you know the basic facts about ADHD medications.
Stimulant medications, such as Ritalin, Dexedrine, and Adderall have been used for a long time and have a good track record. A newer medication that is not a stimulant, called Strattera, may help some kids who haven't done well on the stimulants.
The National Institute of Mental Health has great general information for parents on what you need to know when your child is taking a medication.
Recent studies indicate that stimulant medications do not contribute to risk for later substance use, dependence or abuse. In fact, treatment with stimulants may reduce those risks.
- The National Institute of Mental Health and Columbia University conducted a study in 1999 of ADHD treatments. The findings of this study of multi-modal treatments (a combination of medication and behavioral treatments) indicate that:
- Medication alone is as effective for ADHD symptoms as multi-modal therapy
- Medication is more effective than behavioral alone
- Multi-modal treatment is better for ADHD associated with co-morbidities (coexisting conditions). Co-existing conditions include anxiety, oppositional-defiant disorder (ODD), conduct disorders, etc.
There are also other kinds of medicine that your child's doctor may try if the stimulants don't work. Sometimes, your child's doctor may need to try a few different medicines at a few different doses to find the one that works best for your child. You could think of the brain as a black box that we can't see inside. The doctor doesn't know how a medicine will affect the brain until he or she tries it.
Nine out of ten kids improve on stimulant medication.
If your child's doctor prescribes a medication for your child, make sure you ask about the benefits and risks of taking the drug.
Remember: if your child takes a medication and his or her behavior improves, it is really your child's own strengths coming out from behind the ADHD. Give the credit for improvement to the child, not to the drug.
What about alternative and complementary treatments?
You may feel desperate for a "silver bullet" that will cure your child's problem. Some of the alternative treatments may sound reasonable, and may even be developed by doctors or specialists. But if they are not scientifically proven, you risk spending time, money, and hope on false promises. On the other hand, you and your child's doctor might decide it's worth it to try a low-risk alternative treatment.
Some treatments that the National Institute of Mental Health and the American Academy of Pediatrics warns have not been proven to work in scientific studies are:
- Restricted diets
- Allergy treatments
- Medications for motion sickness to correct inner ear problems
- Mega-vitamin and mineral supplements
- Chiropractic adjustment, bone realignment, applied kinesiology and realigning bones in the skull
- Treatment for candida (yeast infection)
- Eye or vision training
- Special colored glasses
- EEG biofeedback
Some alternative treatments, such as mega-vitamins and special supplements, may actually be dangerous to your child. Use caution, and talk with your child's doctor if you are considering alternative and complementary treatments. Your child's doctor needs to know all treatments being used, as some may interact with prescribed treatments.
Biofeedback could be a useful treatment for ADHD. Biofeedback has the added benefit of getting kids actively involved in developing their own coping strategies. This can be empowering. However, biofeedback treatment can be expensive, especially if your insurance doesn't cover it. For more on biofeedback:
A look at biofeedback from UM's Dr. Felt.
NASA's work on using biofeedback for extended attention span training.
What about girls with ADHD?
ADHD seems to be more easily recognized in boys than in girls. Girls with ADHD tend to draw less attention to themselves than boys do, and the "squeaky wheel gets the grease." Some experts believe that girls with ADHD may act very differently from the typical picture we have of the kid with ADHD.
It's possible that girls with primarily hyperactive-type ADHD act like tomboys. They may be active, messy and disorganized. Girls who have trouble paying attention may act more like daydreamers, and may go unnoticed at school because they are so quiet. Finally, girls with a combination of the two may be hyper-talkative, rather than hyperactive, and also be silly and excitable.
When girls with ADHD fall through the cracks and go undiagnosed, they pay a high price. They may not do well in school and their self-esteem may suffer. They may come to think of themselves as not very bright, quitters, or low achievers. If you suspect your daughter may have ADHD, you should find a professional who has experience in diagnosing ADHD in girls, and have your daughter evaluated.
Reprinted with permission from: http://www.med.umich.edu/yourchild/topics/adhd.htm
Reviewed by John O'Brien, M.D.
