Attention Deficit Hyperactivity Disorder (ADHD)

What is Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder is a mental health disorder that starts during childhood. For many people with ADHD, the disorder continues into adult years.

There are many things that you and your health care provider or therapist (mental health professional) can do to manage your symptoms.

What are the causes?

The exact cause of ADHD is not known.

What increases the risk?

You are more likely to develop this condition if:

  • You have a family history of ADHD.
  • You are male.
  • You were born to a mother who smoked or drank alcohol during pregnancy.
  • You were exposed to lead poisoning or other toxins in the womb or in early life.
  • You were born before 37 weeks of pregnancy (prematurely) or you had a low birth weight.
  • You have experienced a brain injury.

What are the signs or symptoms?

Symptoms of this condition depend on the type of ADHD. The two main types are inattentive and hyperactive-impulsive. Some people may have symptoms of both types.

Symptoms of the inattentive type include:

  • Difficulty watching, listening, or thinking with focused effort (paying attention).
  • Making careless mistakes.
  • Not listening.
  • Not following instructions.
  • Being disorganized.
  • Avoiding tasks that require time and attention.
  • Losing things.
  • Forgetting things.
  • Being easily distracted.

Symptoms of the hyperactive-impulsive type include:

  • Restlessness.
  • Talking too much.
  • Interrupting.
  • Difficulty with:
    • Sitting still.
    • Staying quiet.
    • Feeling motivated.
    • Relaxing.
    • Waiting in line or waiting for a turn.

How is this diagnosed?

This condition is diagnosed based on your current symptoms and your history of symptoms. The diagnosis can be made by a provider such as a primary care provider, psychiatrist, psychologist, or clinical social worker. The provider may use a symptom checklist or a standardized behavior rating scale to evaluate your symptoms. He or she may want to talk with family members who have known you for a long time and have observed your behaviors.

There are no lab tests or brain imaging tests that can diagnose ADHD.

How is this treated?

This condition can be treated with medicines and behavior therapy. Medicines may be the best option to reduce impulsive behaviors and improve attention. Your health care provider may recommend:

  • Stimulant medicines. These are the most common medicines used for adult ADHD. They affect certain chemicals in the brain (neurotransmitters). These medicines may be long-acting or short-acting. This will determine how often you need to take the medicine.
  • A non-stimulant medicine for adult ADHD (atomoxetine). This medicine increases a neurotransmitter called norepinephrine. It may take weeks to months to see effects from this medicine.

Psychotherapy and behavioral management are also important for treating ADHD. Psychotherapy is often used along with medicine. Your health care provider may suggest:

  • Cognitive behavioral therapy (CBT). This type of therapy teaches you to replace negative thoughts and actions with positive thoughts and actions. When used as part of ADHD treatment, this therapy may also include:
    • Coping strategies for organization, time management, impulse control, and stress reduction.
    • Mindfulness and meditation training.
  • Behavioral management. This may include strategies for organization and time management. You may work with an ADHD coach who is specially trained to help people with ADHD to manage and organize activities and to function more effectively.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.

Talk with your health care provider about the possible side effects of your medicine to watch for.

General instructions

  • Learn as much as you can about adult ADHD, and work closely with your health care providers to find the treatments that work best for you.
  • Do not use drugs or abuse alcohol. Limit alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
  • Follow the same schedule each day. Make sure your schedule includes enough time for you to get plenty of sleep.
  • Use reminder devices like notes, calendars, and phone apps to stay on-time and organized.
  • Eat a healthy diet. Do notskip meals.
  • Exercise regularly. Exercise can help to reduce stress and anxiety.

Keep all follow-up visits as told by your health care provider and therapist. This is important.

Where to find more information

  • A health care provider may be able to recommend resources that are available online or over the phone. You could start with:

Contact a health care provider if:

  • Your symptoms are changing, getting worse, or not improving.
  • You have side effects from your medicine, such as:
    • Repeated muscle twitches, coughing, or speech outbursts.
    • Sleep problems.
    • Loss of appetite.
    • Depression.
    • New or worsening behavior problems.
    • Dizziness.
    • Unusually fast heartbeat.
    • Stomach pains.
    • Headaches.
  • You are struggling with anxiety, depression, or substance abuse.

Get help right away if:

  • You have a severe reaction to a medicine.
  • You have thoughts of hurting yourself or others.

If you ever feel like you may hurt yourself or others, or have thoughts about taking your own life, get help right away. You can go to the nearest emergency department or call:

Summary

  • ADHD is a mental health disorder that starts during childhood and often continues into adult years.
  • The exact cause of ADHD is not known.
  • There is no cure for ADHD, but treatment with medicine, therapy, or behavioral training can help you manage your condition.

Attention Deficit Hyperactivity Disorder, Pediatric

Attention deficit hyperactivity disorder (ADHD) is a condition that can make it hard for a child to pay attention and concentrate or to control his or her behavior. The child may also have a lot of energy. ADHD is a disorder of the brain (neurodevelopmental disorder), and symptoms are typically first seen in early childhood. It is a common reason for behavioral and academic problems in school.

There are three main types of ADHD:

  • Inattentive. With this type, children have difficulty paying attention.
  • Hyperactive-impulsive. With this type, children have a lot of energy and have difficulty controlling their behavior.
  • Combination. This type involves having symptoms of both of the other types.

ADHD is a lifelong condition. If it is not treated, the disorder can affect a child’s future academic achievement, employment, and relationships.

What are the causes?

The exact cause of this condition is not known.

What increases the risk?

This condition is more likely to develop in:

  • Children who have a first-degree relative, such as a parent or brother or sister, with the condition.
  • Children who had a low birth weight.
  • Children whose mothers had problems during pregnancy or used alcohol or tobacco during pregnancy.
  • Children who have had a brain infection or a head injury.
  • Children who have been exposed to lead.

What are the signs or symptoms?

Symptoms of this condition depend on the type of ADHD. Symptoms are listed here for each type:

Inattentive

  • Problems with organization.
  • Difficulty staying focused.
  • Problems completing assignments at school.
  • Often making simple mistakes.
  • Problems sustaining mental effort.
  • Not listening to instructions.
  • Losing things often.
  • Forgetting things often.
  • Being easily distracted.

Hyperactive-impulsive

  • Fidgeting often.
  • Difficulty sitting still in one’s seat.
  • Talking a lot.
  • Talking out of turn.
  • Interrupting others.
  • Difficulty relaxing or doing quiet activities.
  • High energy levels and constant movement.
  • Difficulty waiting.
  • Always “on the go.”

Combination

  • Having symptoms of both of the other types.

Children with ADHD may feel frustrated with themselves and may find school to be particularly discouraging. They often perform below their abilities in school.

As children get older, the excess movement can lessen, but the problems with paying attention and staying organized often continue. Most children do not outgrow ADHD, but with good treatment, they can learn to cope with the symptoms.

How is this diagnosed?

This condition is diagnosed based on a child’s symptoms and academic history. The child’s health care provider will do a complete assessment. As part of the assessment, the health care provider will ask the child questions and will ask the parents and teachers for their observations of the child. The health care provider looks for specific symptoms of ADHD.

Diagnosis will include:

  • Ruling out other reasons for the child’s behavior.
  • Reviewing behavior rating scales that have been filled out about the child by people who deal with the child on a daily basis.

A diagnosis is made only after all information from multiple people has been considered.

How is this treated?

Treatment for this condition may include:

  • Behavior therapy.
  • Medicines to decrease impulsivity and hyperactivity and to increase attention. Behavior therapy is preferred for children younger than 6 years old. The combination of medicine and behavior therapy is most effective for children older than 6 years of age.
  • Tutoring or extra support at school.
  • Techniques for parents to use at home to help manage their child’s symptoms and behavior.

Follow these instructions at home:

Eating and drinking

  • Offer your child a well-balanced diet. Breakfast that includes a balance of whole grains, protein, and fruits or vegetables is especially important for school performance.
  • If your child has trouble with hyperactivity, have your child avoid drinks that contain caffeine. These include:
    • Soft drinks.
    • Coffee.
    • Tea.
  • If your child is older and finds that caffeinated drinks help to improve his or her attention, talk with your child’s health care provider about what amount of caffeine intake is a safe for your child.

Lifestyle

  • Make sure your child gets a full night of sleep and regular daily exercise.
  • Help manage your child’s behavior by following the techniques learned in therapy. These may include:
    • Looking for good behavior and rewarding it.
    • Making rules for behavior that your child can understand and follow.
    • Giving clear instructions.
    • Responding consistently to your child’s challenging behaviors.
    • Setting realistic goals.
    • Looking for activities that can lead to success and self-esteem.
    • Making time for pleasant activities with your child.
    • Giving lots of affection.
  • Help your child learn to be organized. Some ways to do this include:
    • Keeping daily schedules the same. Have a regular wake-up time and bedtime for your child. Schedule all activities, including time for homework and time for play. Post the schedule in a place where your child will see it. Mark schedule changes in advance.
    • Having a regular place for your child to store items such as clothing, backpacks, and school supplies.
    • Encouraging your child to write down school assignments and to bring home needed books. Work with your child’s teachers for assistance in organizing school work.

General instructions

  • Learn as much as you can about ADHD. This will improve your ability to help your child and to make sure he or she gets the support needed. It will also help you educate your child’s teachers and instructors if they do not feel that they have adequate knowledge or experience in these areas.
  • Work with your child’s teachers to make sure your child gets the support and extra help that is needed. This may include:
    • Tutoring.
    • Teacher cues to help your child remain on task.
    • Seating changes so your child is working at a desk that is free from distractions.
  • Give over-the-counter and prescription medicines only as told by your child’s health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • Your child has repeated muscle twitches (tics), coughs, or speech outbursts.
  • Your child has sleep problems.
  • Your child has a marked loss of appetite.
  • Your child develops depression.
  • Your child has new or worsening behavioral problems.
  • Your child has dizziness.
  • Your child has a racing heart.
  • Your child has stomach pains.
  • Your child develops headaches.

Get help right away if:

  • Your child talks about or threatens suicide.
  • You are worried that your child is having a bad reaction to a medicine that he or she is taking for ADHD.
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