Attention deficit hyperactivity disorder (ADHD) is a chronic behavioral disorder. It is behavior that is hyperactive, impulsive, and/or inattentive. These must persist for at least six months and be present in two environments (home, work, or school). ADHD affects children, adolescents, and adults.

The cause of ADHD is unknown. It most likely is caused by a chemical imbalance in the brain. There also appears to be a genetic factor since ADHD can run in families.

Risk factors for ADHD are:

• Sex: male
• Parent or sibling with ADHD

All children display some of the symptoms of ADHD. Children with ADHD have symptoms that are more severe and consistent. They often have difficulty in school and with their family and peers.

ADHD can last into adulthood. It can cause problems with relationships, job performance, and job retention.

There are three types of ADHD:

• Inattentive (classic "ADD")
• Hyperactive-impulsive
• Combined

• Easily distracted by sights and sounds
• Doesn't pay attention to detail
• Doesn't seem to listen when spoken to
• Makes careless mistakes
• Doesn't 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

• 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 is the most common type.

• Has a combination of the above symptoms

People with ADHD can also have:

• Depression
• Anxiety
• Conduct disorder
• Oppositional defiant disorder
• Learning disorders
• Substance abuse
• Trouble sleeping
• Cigarette use

There is no standard test to diagnose ADHD. It is done by a trained mental health professional. Family and teachers are involved, as well.

The American Academy of Pediatrics recommends that the following guidelines be used for diagnosis in children 6-12 years of age:

• Diagnosis should be initiated if a child shows signs of difficulty in:
  • School
  • Academic achievement
  • Relationships with peers and family
• During diagnosis, the following information should be gathered directly from parents, caregivers, teachers, or other school professionals:
  • Assessment of symptoms of ADHD in different settings (home and school)
  • Age at which symptoms started
  • How much the behavior affects the child's ability to function
• The professional should examine the child for:
  • Other conditions that might be causing or aggravating symptoms
  • Learning and language problems
  • Aggression
  • Disruptive behavior
  • Depression or anxiety
  • Psychotic symptoms
  • Personality disorder
• For a diagnosis of ADHD to be made, symptoms must:
  • Be present in two or more of the child's settings
  • Interfere with the child's ability to function for at least six months
  • Fit a list of symptoms detailed in the most recent version of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association

The goal is to improve the child's ability to function. Doctors should work together with parents and school staff. Together, they can set realistic goals and evaluate the child's response.

Treatments include:

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

Medications can help control behavior and increase attention span. 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. Stimulant medications include:

• Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)
• Dextroamphetamine (Dexedrine)
• Amphetamine (Adderall)
• Atomoxetine (Strattera)
• Lisdexamfetamine (Vyvanse)—This medication was recently approved to treat adults with ADHD. It can also be used to treat children aged 6-12 years.

Talk to your doctor if you have any questions about ADHD medication. There are possible risks with these medications, including cardiovascular events (eg, stroke , heart attack ) and psychiatric problems (eg, hearing voices, becoming manic).

Because of the rare risk of serious heart problems, the American Heart Association suggests that children have an electrocardiogram (ECG) before starting stimulant medication for ADHD.

Other drugs include:

• Antidepressants—such as imipramine (Janimine, Tofranil), venlafaxine (Effexor), and bupropion (Wellbutrin)
• Clonidine (used for Tourette's syndrome )—to treat impulsivity

Children who take medication and go to therapy do better than those who just use medication. Therapy sessions focus on practicing social and problem-solving skills. Counselors will also teach parents and teachers to help the child through positive reinforcement. This could involve changes in the classroom, as well as in parenting style. Often, daily report cards are exchanged between parents and teachers.

Other tools, like the Disc'O'Sit cushion, may be helpful in improving children's attention in class. The Disc'O'Sit is a dome-shaped cushion filled with air that the child balances on.

ADHD coaching can also be helpful. These coaches work with individuals to help them organize and strategize so that they can be more efficient and successful.