The Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in children. Although the diagnosis is usually made in childhood, symptoms may persist as the child gets older and reaches adulthood. The core symptoms of ADHD are difficulty paying attention, difficulty controlling impulses, and being very active.
How frequent is the Attention Deficit Hyperactivity Disorder? According to the U.S. Centers for Disease Control and Prevention (CDC) update from October 2016, the prevalence of ADHD is about 11% in children 4-17 years of age as of 2011 and 5% of all children. Furthermore, ADHD is about more common among boys (13.2%) than in girls (5.6%). The average age of ADHD diagnosis was 7 years of age, but children with more severe ADHD were diagnosed earlier. Furthermore, across 10 countries, it was projected that adult ADHD was associated with 143.8 million lost days of productivity each year (deGraaf et al, 2008). Click here for the abstract-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2665789/. Causes: Genetics plays an important role in the causation of ADHD. Other causes may include postnatal prefrontal brain injury, exposure to environmental (e.g., lead) during pregnancy or at a young age, alcohol and tobacco use during pregnancy, and premature delivery. Research does not however support commonly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social issues. There is some evidence in controlled double-blind studies that sensitivity to food or additives such as colorings and preservatives might be important for a minority of children with ADHD. According to the National Resource Center on ADHD, structural and functional imaging research on the neurochemistry of ADHD implicate the catecholamine-rich frontal-subcortical systems in the pathophysiology of ADHD. The effectiveness of stimulant medication, along with animal models of hyperactivity, also point to catecholamine disruption as at least one source of ADHD brain dysfunction.
The types of ADHD: There are three different types of ADHD, depending on which types of symptoms are strongest in the individual: Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines. Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others. The person behaves "as if driven by a motor." Combined Presentation: Symptoms of the above two types are equally present in the person. Because symptoms can change over time, the presentation may change over time as well.
Symptoms and signs: Commonly seen symptoms include a child who may daydream a lot, forget or lose things a lot, squirm or fidget, talk too much, make careless mistakes or take unnecessary risks, have a hard time resisting temptation, have trouble taking turns, and have difficulty getting along with others.
The specific diagnostic criteria according to the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition (DSM-5) are as follows: People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:
Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level: Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities. Often has trouble holding attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked). Often has trouble organizing tasks and activities. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework). Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). Is often easily distracted Is often forgetful in daily activities.
Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level: Often fidgets with or taps hands or feet, or squirms in seat. Often leaves seat in situations when remaining seated is expected. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless). Often unable to play or take part in leisure activities quietly. Is often "on the go" acting as if "driven by a motor". Often talks excessively. Often blurts out an answer before a question has been completed. Often has trouble waiting his/her turn. Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met: Several inattentive or hyperactive-impulsive symptoms were present before age 12 years. Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities). There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
Diagnosis and differential diagnoses: The diagnostic process: There is no single diagnostic test for ADHD though the following process is usually followed. The process involves a detailed history and physical examination by the child's physician, developmental assessment, and hearing and vision tests. Other professionals such as psychologists, neurologists, and psychiatrists may also make the diagnosis. There are several checklists to evaluate ADHD symptoms available. The one we offer on our site: the Conners 3 for children is one of the most widely accepted and used tests. Many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms. and should be considered, too in the differential diagnosis. Obtaining a history or having a questionnaire filled out by the child's teacher may also be part of the diagnostic process. The Conners 3 Teacher questionnaire is also available in online format from our website. When evaluating a child for ADHD, the primary care clinician should assess whether other conditions are present that might coexist with ADHD, including emotional or behavioral (such as anxiety, depressive, oppositional defiant, and conduct disorders), developmental (such as learning and language disorders or other neurodevelopmental disorders), and physical (such as tics, sleep apnea) conditions.
Treatment: The 2011 Clinical Practice guideline of the American Academy of Pediatrics is available here in .pdf form (http://pediatrics.aappublications.org/content/pediatrics/early/2011/10/14/peds.2011-2654.full.pdf). According to this recommendation, the child's treating clinician should recommend the following: 1. For preschool-aged children(4–5 years of age), the primary care clinician should prescribe evidence-based parent- and/or teacher-administered behavior therapy as the first line of treatment and may prescribe methylphenidate if the behavior interventions do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child’s function. 2. For elementary school–aged children (6–11 years of age), the primary care clinician should prescribe US Food and Drug Administration–approved medications for ADHD and/or evidence-based parent and/or teacher-administered behavior therapy as treatment for ADHD, preferably both. The evidence is particularly strong for stimulant medications and sufficient but less strong for atomoxetine, extended-release guanfacine, and extended-release clonidine (in that order). The school environment, program, or placement is a part of any treatment plan. 3. For adolescents (12–18 years of age), the primary care clinician should prescribe Food and Drug Administration–approved medications for ADHD with the assent of the adolescent and may prescribe behavior therapy as treatment for ADHD preferably both.
Medication: The use of medication is not without risk and families should seek the advice of the physician managing their child in the process of deciding about medication use. Several different types of medications are FDA-approved to treat ADHD in children: Stimulants are the best-known and most widely used ADHD medications. Between 70-80 percent of children with ADHD have fewer ADHD symptoms when they take these fast-acting medications. Nonstimulants were approved for treating ADHD in 2003. Nonstimulants do not work as quickly as stimulants, but they can last up to 24 hours. Medications can affect children differently. One child may respond well to one medication, but not another. The doctor may need to try different medications and doses, so it is important for parents to work with their child’s doctor to find the medication that works best for their child.
Behavior Therapy: Research shows that behavior therapy is an important part of treatment for children with ADHD. ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and other children. Children with ADHD often show behaviors that can be very disruptive to others. Behavior therapy is a treatment option that can help reduce these behaviors. It is often helpful to start behavior therapy as soon as a diagnosis is made. The goals of behavior therapy are to learn or strengthen positive behaviors and eliminate unwanted or problem behaviors. Behavior therapy can include behavior therapy training for parents, behavior therapy with children, or a combination. Teachers can also use behavior therapy to help reduce problem behaviors in the classroom. In parent training in behavior therapy, parents learn new skills or strengthen their existing skills to teach and guide their children and to manage their behavior. In behavior therapy with children, the therapist works with the child to learn new behaviors to replace behaviors that don’t work or cause problems.
ADHD and the Classroom: The symptoms of ADHD, inability to pay attention, difficulty sitting still, difficulty controlling impulses, can make it particularly hard for children with ADHD to do well in school. It is important for teachers to have the needed skills to help children manage their ADHD. However, since the majority of children with ADHD are not enrolled in special education classes, their teachers will most likely be regular education teachers who might know very little about ADHD and could benefit from assistance and guidance. These are some tips to share with teachers for classroom success: Make assignments clear – check with the student to see if they understood what they need to do Give positive reinforcement and attention to positive behavior Make sure assignments are not long and repetitive. Shorter assignments that provide a little challenge without being too hard are best. Allow time for movement and exercise Communicate with parents on a regular basis Use a homework folder to limit the number of things the child has to track Be sensitive to self-esteem issues Minimize distractions in the classroom Involve the school counselor or psychologist Further information about Behavior therapy and ADHD in the Classroom is available here: https://www.cdc.gov/ncbddd/adhd/treatment.html
Disclaimer: The Autism Telemedicine Company does not endorse or recommend the use of any medication or therapy on this website, nor does it dispense medical or other professional advice, nor does it prescribe medication. The content on this site is informational only and does not, nor is it intended to replace the professional advice or guidance of the child's or adult's treating provider, nor does it constitute medical or professional advice. See also Disclaimer and Terms of Service pages. Updated: March 1, 2017.