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by Riley J

Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder

(ADHD and ADD; Hyperkinetic Syndrome; Hyperkinetic Impulse Disorder)

Definition

Attention deficit hyperactivity disorder (ADHD) is a disorder that affects behavior. It can cause hyperactive, impulsive behavior, and/or make it difficult to pay attention. These behavioral problems continue over a long period of time. ADHD can affect people of all ages. Though ADHD is present throughout the lifetime, it may not be diagnosed until adulthood.
There are 3 types of ADHD:
  • Inattentive (classic "ADD")
  • Hyperactive-impulsive
  • Combined inattentive and hyperactive—the most common type

Causes

The cause of ADHD is unknown. It most likely is caused by a chemical imbalance in the brain. The change may happen while the brain is developing. Genes and environmental factors may both play a role.
Child's Brain
Child Brain
A chemical imbalance in the brain may be responsible for ADHD.
Copyright © Nucleus Medical Media, Inc.

Risk Factors

Factors that may increase your chances of ADHD:
Parenting styles may influence the symptoms of ADHD but do not cause it.

Symptoms

These symptoms are common in all children at some point in childhood. Children with ADHD have symptoms that are more severe and occur more often. These children also often have difficulty in school and connecting with their family and peers.
ADHD can in adults can cause problems with relationships, job performance, and job retention. Symptoms can vary according to the type of ADHD:
  • Inattentive (classic "ADD")
    • Easily distracted by sights and sounds
    • Does not pay attention to detail
    • Does not seem to listen when spoken to
    • Makes careless mistakes
    • Does not follow through on instructions or tasks
    • Avoids or dislikes activities that require longer periods of mental effort
    • Loses or forgets items necessary for tasks
    • Is forgetful in day-to-day activities
  • Hyperactive-Impulsive
    • Is restless, fidgets, and squirms
    • Runs and climbs, and is not able to stay seated
    • Blurts out answers before hearing the entire question
    • Has difficulty playing quietly
    • Talks excessively
    • Interrupts others
    • Has difficulty waiting in line or waiting for a turn
  • Combined ADHD—Combination of the symptoms above.
Certain mental health or behavior challenges are more common in those with ADHD. This may be because of changes in the brain or challenges because of ADHD symptoms. Common issues include:

Diagnosis

There is no standard test to diagnose ADHD. It is done by a trained health professional who observes the patient and collects information from the patient, family, caregivers, and teachers.
During diagnosis, the following information may be gathered:
  • Behavior and symptoms of ADHD in different settings—home, recreation/sports, and school
  • Age at which symptoms started
  • How much the behavior affects the child's ability to function

Treatment

The goal is to improve the child's ability to grow, learn, and develop relationships. Doctors should work together with parents and school staff. Together, they can set realistic goals and keep an eye on the child's response. Proper treatment can prevent problems later in life.
Treatments include:

Sleep

Children who do not sleep enough may suffer from worse behavioral problems. A key part of treatment is to ensure that children with ADHD get plenty of sleep.

Medication

Medications can help control behavior and increase attention span. They are generally the first line of treatment for children aged 6 years and older, and adolescents. For preschool children who do not respond to behavior therapy, medications may be added to their treatment plan. Stimulants are the most common choice for ADHD. They increase activity in parts of the brain that appear to be less active in children with ADHD. Some of these medications have an increased risk of heart or psychiatric problems. The medical team will work to find medication with the most benefit and least risk for each child.
Other medications include:
  • Selective norepinephrine reuptake inhibitors—to promote attention and decrease impulsiveness and hyperactivity
  • Antidepressants—to manage depression symptoms
  • Antipsychotics—to treat aggressive behavior
  • Alpha-agonist hypotensive agents—to treat impulsivity

Behavior Therapy

Children who take medication and go to therapy do better than those who just use medication. Young children may respond to therapy alone. Therapy sessions focus on practicing social and problem-solving skills. Counselors will also teach parents and teachers techniques that may help help. This could involve changes in the classroom, as well as in parenting style. For example, an inflated cushion on a child's seat at school may help their attention span.
ADHD coaching can also be helpful. These coaches work with individuals to help them organize and create strategies for efficiency and success.
Neurofeedback is a treatment that has shown some promise but is still being studied. This treatment shows brain wave patterns with images on a screen. It gives people a visual cue when their attention starts to wander. Over several sessions, people can retrain their brain to use the good brain patterns and avoid patterns that result in inattention.

Prevention

There are no current guidelines to prevent ADHD because the cause is unknown.

RESOURCES

Attention Deficit Disorder Association
https://www.add.org
Children and Adults with Attention-Deficit/Hyperactivity Disorder
http://www.chadd.org

CANADIAN RESOURCES

About Kids Health—The Hospital for Sick Children
http://www.aboutkidshealth.ca
Canadian Psychiatric Association
http://www.cpa-apc.org

References

ADHD. American Psychiatric Association website. Available at: http://www.apa.org/topics/adhd/index.aspx. Accessed October 3, 2017.
AD/HD and kids. Mental Health America website. Available at: http://www.mentalhealthamerica.net/conditions/adhd-and-kids. Accessed October 3, 2017.
Alternative treatments for ADHD in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T908158/Alternative-treatments-for-ADHD-in-children. Updated September 15, 2016. Accessed October 3, 2017.
Attention-deficit hyperactivity disorder (ADHD). Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/attention-deficit-hyperactivity-disorder-adhd. Updated June 2017. Accessed October 3, 2017.
Attention deficit hyperactivity disorder (ADHD) in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T231898/Attention-deficit-hyperactivity-disorder-ADHD-in-adults. Updated December 27, 2016. Accessed October 3, 2017.
Attention-deficit hyperactivity disorder (ADHD) in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113926/Attention-deficit-hyperactivity-disorder-ADHD-in-children-and-adolescents. Updated May 23, 2017. Accessed October 3, 2017.
Diagnosing ADHD in children: Guidelines & information for parents. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Diagnosing-ADHD-in-Children-Guidelines-Information-for-Parents.aspx. Updated January 9, 2017. Accessed October 3, 2017.
Rappley M. Attention deficit-hyperactivity disorder. NEJM. 2005;352(2):165-173.
Medications for attention deficit hyperactivity disorder (ADHD) in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T901218/Medications-for-attention-deficit-hyperactivity-disorder-ADHD-in-children. Updated June 21, 2016. Accessed October 3, 2017.
Seida JC, Schouten JR, Mousavi SS, et al. First- and Second-Generation Antipsychotics for Children and Young Adults [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Feb. (Comparative Effectiveness Reviews, No. 39.) Available from: http://www.ncbi.nlm.nih.gov/books/NBK84643. Accessed January 27, 2014.
Understanding ADHD: Information for parents. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Understanding-ADHD.aspx. Updated January 9, 2017. Accessed October 3, 2017.
What is ADHD? Kids Health—Nemours Foundation website. Available at:http://kidshealth.org/en/parents/adhd.html. Updated July 2014. Accessed October 3, 2017.
4/30/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113926/Attention-deficit-hyperactivity-disorder-ADHD-in-children-and-adolescents: Vetter V, Elia J, Erickson C, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs. Circulation. 2008;117(18):2407-2423.
4/30/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T908158/Alternative-treatments-for-ADHD-in-children: Pfeiffer B, Henry A, Miller S, Witherell S. Effectiveness of Disc 'O' Sit cushions on attention to task in second-grade students with attention difficulties. Am J Occup Ther. 2008;62(3):274-281.
7/6/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113926/Attention-deficit-hyperactivity-disorder-ADHD-in-children-and-adolescents: Paavonen EJ, Räikkönen K, Lahti J, et al. Short sleep duration and behavioral symptoms of attention-deficit/hyperactivity disorder in healthy 7- to 8-year-old children. Pediatrics. 2009;123(5):e857-e864.
10/12/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113926/Attention-deficit-hyperactivity-disorder-ADHD-in-children-and-adolescents: Cortese S, Faraone SV, Konofal E, Lecendreux M. Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry. 2009;48(9):894-908.
2/4/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113926/Attention-deficit-hyperactivity-disorder-ADHD-in-children-and-adolescents: Froehlich TE, Lanphear BP, Auinger P, et al. Association of tobacco and lead exposures with attention-deficit/hyperactivity disorder. Pediatrics. 2009;124(6):e1054-e1063.
10/28/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113926/Attention-deficit-hyperactivity-disorder-ADHD-in-children-and-adolescents: Subcommittee on Attention-deficit/hyperactivity Disorder, Steering Committe on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007-1022.
1/13/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113926/Attention-deficit-hyperactivity-disorder-ADHD-in-children-and-adolescents: Silva D, Colvin L, Hagemann E, Bower C. Environmental risk factors by gender associated with attention-deficit/hyperactivity disorder. Pediatrics. 2014;133(1):e14-e22.
8/19/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T900174/Epilepsy-in-children: Reilly C, Atkinson P, Das KB, et al. Neurobehavioral comorbidities in children with active epilepsy: a population-based study. Pediatrics. 2014;133(6):e1586-e1593.
7/13/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T908158/Alternative-treatments-for-ADHD-in-children: Micouland-Franchi JA, Geoffroy PA, et al. EEG neurofeedback treatments in children with ADHD: an updated meta-analysis of randomized controlled trials. Front Hum Neurosci. 2014.13;8:906.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrian Preda, MD
  • Review Date: 09/2017
  • Update Date: 10/03/2017