Psychiatric Associates

Attention-Deficit/Hyperactivity Disorder (ADHD)

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What is Attention-Deficit/Hyperactivity Disorder?

       Attention-Deficit/Hyperactivity Disorder, commonly referred to as ADHD or ADD (Attention-Deficit Disorder), is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). Treatments can relieve many of the disorder's symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions and using new tools such as brain imaging to better understand ADHD and to find more effective ways to prevent, diagnose, and treat it.

       Many adults who have the disorder don't know that they do. Like children and teens with ADHD, adults with ADHD lead challenging lives. For some adults with ADHD, finding out that they have it can provide a sense of relief. Being able to connect ADHD to long-standing problems helps adults with ADHD understand why their lives have been so troubled and getting treatment often improves their lives tremendously.

What types of Attention-Deficit/Hyperactivity Disorder (ADHD) are there?

       There are four types of ADHD:

  • Predominantly Inattentive Type, in which the majority of symptoms are in the Inattention category, although some symptoms in the Hyperactivity-Impulsivity category may be present;
  • Predominantly Hyperactive/Impulsive Type, in which the majority of symptoms are in the Hyperactivity-Impulsivity category, although some symptoms in the Inattention category may be present;
  • Combined Type, in which symptoms of both Inattention and Hyperactivity-Impulsivity are present;
  • Not Otherwise Specified, in which symptoms from both categories are present but the criteria for the above types aren't met.
What are the symptoms of ADHD?

       Inattention, Hyperactivity, and Impulsivity are the key symptoms of ADHD. It's normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD these symptoms are more severe and more frequent. To be diagnosed with ADHD a child must have symptoms for six or more months and to a degree that is greater than that typical of other children of the same age. Children with symptoms of Inattention may:
  • often fail to give close attention to details or make careless mistakes in schoolwork, work, or other activities (such as rushing through problems or quizzes or not checking their work);
  • often have difficulty sustaining attention in tasks or play activities (although they can sustain attention if they like what they're doing or if they're alone);
  • often not seem to listen even when spoken to directly (because they're lost in their own thoughts or distracted by something);
  • often not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace (but not because they don't want to or because they don't understand the instructions);
  • often have difficulty organizing tasks and activities (both mentally and physically);
  • often avoid, dislike, or be reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework—often because they've failed in the past and don't want to fail again);
  • often lose things necessary for tasks or activities (such as toys, school assignments, pencils, books, or tools);
  • often be easily distracted by extraneous stimuli (irrelevant things going on around them, or even their own thoughts); and
  • may often be forgetful in daily activities (leaving for school without a coat, homework, lunch, backpack, etc.).
       Children with symptoms of Hyperactivity may:
  • often fidget with their hand or feet or squirm in their seats;
  • often leave their seats in classrooms or in other situations in which remaining seated is expected (such as church services or school assemblies);
  • often run about or climb excessively in situations in which this is inappropriate—sometimes touching or picking up everything in sight (in adolescents or adults, this may be limited to subjective feelings of restlessness);
  • often have difficulty playing or engaging in leisure activities quietly (be loud and boisterous);
  • often be "on the go" or often act as if they're "driven by a motor" (the Energizer Bunny phenomenon); and
  • may often talk excessively (talking when they shouldn't, talking at length, or talking rapidly or nonstop).

       Children with symptoms of Impulsivity may:

  • often blurt out answers before the questions have even been completed;
  • often have difficulty awaiting their turns (in games or waiting in lines); and
  • may often interrupt or intrude on others (such as butting into conversations or jumping into the middle of games that are already in play).

       Adults with ADHD show many of the same symptoms that children and adolescents show. In addition, however, they may:

  • find it difficult or impossible to organize important aspects of their lives, such as finances (checking accounts or bill paying);
  • have difficulty keeping a job (often being fired for chronic lateness or absenteeism);
  • have difficulty remembering and keeping appointments;
  • be challenged by daily tasks such as getting up in the morning, preparing to go to work, getting to work on time, and being productive at work;
  • have a history of failed relationships, including in some cases multiple failed marriages;
  • have had multiple traffic accidents;
  • often feel restless, keyed up, or on edge;
  • try to do several things at once, most or all of them unsuccessfully; and
  • may tend to prefer "quick fixes" rather than making the changes needed to achieve long-term success.

What disorders often accompany ADHD?

       Some children with ADHD also have other illnesses or conditions, including one or more of the following:

  • Learning Disabilities, such as Reading Disorder, Mathematics Disorder, or Disorder of Written Expression, in which a child can have difficulty understanding certain sounds or words, performing mathematical operations, and/or expressing himself in words;
  • Oppositional Defiant Disorder, in which a child often loses his temper, argues with adults, actively defies or refuses to comply with requests or rules, deliberately annoys people, blames others for his mistakes or misbehavior, is touchy or easily annoyed by others, is angry and resentful, and/or is spiteful or vindictive;
  • Conduct Disorder, in which a child bullies, starts fights, uses a weapon, is physically cruel, steals, forces sex on someone, sets fires, destroys property, commits breaking and entering, lies, disobeys curfew, runs away, and/or is truant;
  • Anxiety Disorders or Depressive Disorders, in which a child experiences symptoms of anxiety/panic, depression, and/or both;
  • Bipolar Disorder, in which a child experiences episodes of mania/hypomania, depression, and/or mood swings from one to the other;
  • Tourette's Syndrome, in which a child experiences multiple motor tics and one or more verbal tics, such as eye blinking, facial twitching or grimacing, throat clearing, snorting, sniffing, or barking out words inappropriately;
  • Sleep Disorders, such as Sleep Apnea, in which a child stops breathing periodically through the night, is excessively sleepy and fatigued during the day, and may fall asleep even in the midst of doing things;
  • Eneuresis, or bed wetting;
  • and/or Substance Abuse, including alcohol abuse, recreational drug abuse, prescription drug abuse, and/or sniffing or huffing volatiles.

What causes ADHD?

       No one is sure what causes ADHD, although many studies suggest that genes play a role. Like many other disorders, ADHD probably results from a combination of factors. In addition to genetics, certain environmental factors, brain injuries, nutrition, and the social environment may contribute to ADHD.

  • Genetics: Inherited from our parents, genes are the "blueprints" for who we are. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop ADHD. Knowing the genes involved may one day help researchers prevent ADHD before symptoms develop. Learning about specific genes could also lead to better treatments. Children with ADHD who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This National Institute of Mental Health (NIMH) research showed that the difference wasn't permanent, however, and as children with this gene grew up the brain developed to a normal level of thickness and their ADHD symptoms improved.
  • Environmental factors: Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children. In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, may have a higher risk of developing ADHD.
  • Brain injuries: Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD are known to have suffered a traumatic brain injury (TBI).
  • Nutrition: The idea that refined sugar causes ADHD or makes symptoms worse is popular, but research discounts rather than supports this theory. In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute. Another study in which children were given higher-than-average amounts of sugar or sugar substitute showed similar results. In another study, children who were considered sugar-sensitive by their mothers were given the sugar substitute aspartame, also known as Nutrasweet. Although ALL of the children got aspartame, half of their mothers were told that their children were given sugar and the other half were told that their children were given aspartame. The mothers who THOUGHT their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to mothers who thought their children were given aspartame. Recent British research indicates a possible link between consumption of certain food additives like artificial colorings or preservatives and an increase in activity in children. Research is underway to confirm the findings and to learn more about how food additives may affect hyperactivity.

How is ADHD diagnosed?

       Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these nermal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of three and six, and because symptoms vary from person to person, the disorder can be hard to diagnose. A parent may first notice that his child loses interest in things sooner than other children, or seems constantly "out of control." Often, teachers notice the symptoms first, when a child has trouble following rules or frequently "spaces out" in the classroom or on the playground.

       No single test can diagnose a child as having ADHD. Instead, a licensed medical or mental health professional needs to gather information about the child and his behavior and environment. A family may want to first talk with the child's Primary Care Provider (PCP), usually a Pediatrician or Family Practitioner. Some PCPs can assess the child themselves, but many will refer the family to a mental health professional with experience in childhood mental disorders such as ADHD. The PCP or mental health professional will first try to rule out other possible causes for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that resemble ADHD. Between them, the PCP and the mental health professional will determine if the child:

  • is experiencing undetected seizures that could be associated with other medical conditions;
  • has a middle ear infection that is causing hearing problems;
  • has any undetected hearing or vision problems;
  • has any medical problems that affect thinking and behavior;
  • has any learning disabilities;
  • has anxiety or depression or other psychiatric problems that might cause ADHD-like symptoms; and/or
  • has been affected by a significant and sudden change, such as the death of a family member, a divorce, or a parent's job loss. 

       The PCP or mental health professional will also check school and medical records for clues to determine if the child's home or school environments appear unusually stressful or disrupted and gather information from the child's parents, teachers, coaches, daycare providers, and others who know the child well. The PCP or mental health professional will consider:

  • Are the behaviors excessive and long-term, and do they affect all aspects of the child's life?
  • Do the behaviors happen more often in this child than in the child's peers?
  • Are the behaviors a continuous problem or a response to a temporary situation?
  • Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?  

       The PCP or mental health professional will pay close attention to the child's behavior in different situations. Some situations are highly structured and some aren't; some require the child to keep paying attention and some don't. Most children with ADHD are better able to control their behaviors in situations in which they are getting individual attention or are free to focus on enjoyable activities, so these types of situations are less relevant to the assessment. A child also may be evaluated to determine how he acts in social situations. He may be given tests of intellectual ability and academic achievement to determine whether or not he has a learning disability. Finally, after gathering all of this information the PCP or mental health professional determines whether or not the child meets the diagnostic criteria for ADHD.

How is ADHD treated?

       ADHD cannot be cured, so current treatments focus on reducing the symtoms and improving the individual's functioning. Treatments include medication, various types of psychotherapy, education or training, and combinations of these.  

       Medications: The most common type of medication used for treating ADHD is the stimulant class. Although it may seem unusual to treat a hyperactive child with a stimulant, such medications actually have a calming effect on children, in that they greatly improve the child's ability to focus and concentrate. Many different stimulants are avaliable. A few other non-stimulant ADHD medications are also available. For many children, ADHD medications reduce hyperactivity and impulsivity and improve ability to focus, work, and learn. Medication also may improve physical coordination.

       Choice of medication is important. What works for one child might not work for another. One child might have side effects with a certain medication, while another child might not. Sometimes several different medications or dosages have to be tried before a combination that works is found. Any child taking medications must be monitored closely and carefully by parents and prescribers.

       Stimulant medications come in different forms, such as pills, tablets, capsules, liquids, and, in some cases, patches. Some medications also come in short-acting, long-acting, and extended-release forms. The active ingredient is the same in each of these, but is released into the body differently. Long-acting or extended-release forms often allow a child to take a medication just once a day in the morning before school, so the child doesn't have to make a trip to the school nurse every day for a second dose. Parents and prescribers should decide together which medication is best for any given child and whether or not the child needs medication just during school hours or for evenings and weekends, too.

       Below is a list of medications approved by the Food and Drug Administration (FDA) for use in treating ADHD:

Trade Name
Generic Name
Approved Age
Adderall 
amphetamine
3 and older
Adderall XR
amphetamine (extended-release)
6 and older
Concerta
methylphenidate (long-acting)
6 and older
Daytrana
methylphenidate patch
6 and older
Desoxyn
methamphetamine hydrochloride
6 and older
Dexedrine
dextroamphetamine
3 and older
Dextrostat
dextroamphetamine
3 and older
Focalin
dexmethylphenidate
6 and older
Focalin XR
dexmethylphenidate (extended-release)
6 and older
Metadate ER
methylphenidate (extended-release)
6 and older
Metadate CD
methylphenidate (extended-release)
6 and older
Methylin
methylphenidate (oral solution & chewable tablets)
6 and older
Ritalin
methylphenidate
6 and older
Ritalin SR
methylphenidate (extended-release)
6 and older
Ritalin LA
methylphenidate (long-acting)
6 and older
Strattera
atomoxetine
6 and older
Vyvanse
lisdexamfetamine dimesylate
6 and older

Psychiatric Associates / 4084 Okemos Rd. / Suite A / Okemos, MI 48864
Phone: (517) 347-4848 / Fax: (517) 347-4844