Attention Deficit Hyperactivity Disorder
(ADHD and ADD; Hyperkinetic Syndrome; Hyperkinetic Impulse Disorder)
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 affects children, adolescents, and adults.
There are three types of ADHD:
- Inattentive (classic "ADD")
- Combined—the most common type
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.
This condition is more common in first-born males.
Factors that increase your chance of developing ADHD include:
- Premature birth
- Having a parent or sibling (especially an identical twin) with ADHD
- Having a mother who smoked cigarettes and/or drank alcohol, had a urinary tract infection, or had preterm labor during pregnancy
- Having a parent with certain conditions such as alcoholism and conversion disorder
- Other possible risk factors include:
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. Symptoms can vary according to the type of ADHD:
Inattentive (classic "ADD")
- 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; 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.
People with ADHD may also have:
There is no standard test to diagnose ADHD. It is done by a trained health professional using information from the patient, family, caregivers, and teachers or other school professionals and patient observation.
During diagnosis, the following information may be gathered:
- Assessment of 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
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.
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.
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.
Talk to your doctor if you have any questions about ADHD medications. There are possible risks with these medications, including heart problems and psychiatric problems.
Other medications include:
- Selective norepinephrine reuptake inhibitors—to promote attention and decrease impulsiveness and hyperactivity
- Antipsychotics—to treat aggressive behavior
- Alpha-agonist hypotensive agents—to treat impulsivity
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 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 create strategies so that they can be more efficient and successful.
Neurofeedback, also called EEG feedback, is the retraining of brainwave patterns. It has shown some promise in the treatment of ADHD in children. In a neurofeedback training session, several sensors that measure the brain's electrical activity are attached to the scalp. You relax and play a video game, which is controlled just by brain waves and responds favorably to brain waves of the desired pattern.
There are no guidelines for preventing ADHD because the cause is unknown. Proper treatment can prevent problems later in life.
Attention Deficit Disorder Association
Children and Adults with Attention-Deficit/Hyperactivity Disorder
About Kids Health—The Hospital for Sick Children
Canadian Psychiatric Association
AAP Recommendations and Diagnostic Guidelines for ADHD. American Academy of Pediatrics, Healthy Children website. Available at: http://www.healthychildren.org/English/health-issues/conditions/adhd/pages/AAP-Recommendations-Diagnostic-Guidelines-for-ADHD.aspx. Updated October 24, 2011. Accessed October 28, 2011.
ADHD. American Psychiatric Association website. Available at: http://www.apa.org/topics/adhd/index.aspx. Accessed August 14, 2012.
ADHD. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/parent/medical/learning/adhd.html. Accessed August 14, 2012.
ADHD basics. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/ADHD-Basics.aspx. Accessed August 14, 2012.
Attention-Deficit/Hyperactivity Disorder: Management. American Family Physician. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/attention-deficit-hyperactivity-disorder-adhd.html. Accessed August 14, 2012.
Attention deficit hyperactivity disorder (ADHD). National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/what-is-attention-deficit-hyperactivity-disorder.shtml. Accessed August 14, 2012.
Attention-deficit hyperactivity disorder (ADHD) in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 25, 2012. Accessed August 14, 2012.
Attention-deficit hyperactivity disorder (ADHD) in children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 11, 2012. Accessed August 14, 2012.
Fact sheet ADHD. The National Mental Health Association website. Available at: http://www.nmha.org/go/information/get-info/ad/hd/ad/hd-and-kids. Accessed August 14, 2012.
FDA directs ADHD drug manufacturers to notify patients about cardiovascular adverse events and psychiatric adverse events. US Food and Drug Administration website. Available at: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01568.html. Accessed August 14, 2012.
Methylphenidate and clonidine help children with ADHD and tics. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/news_and_events/news_articles/news_article_adhd.htm. Accessed August 14, 2012.
Rappley M. Attention deficit-hyperactivity disorder. NEJM. 2005;352:165-173.
Risks for ADHD drugs outlined in patient guides. US Food and Drug Administration website. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107863.htm. Updated April 2007. Accessed August 14, 2012.
4/30/2008 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Vetter V, Elia J, Erickson C, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs. Circulation. American Heart Association website. Available at: http://circ.ahajournals.org/content/117/18/2407.full.pdf. Accessed April 30, 2008.
4/30/2008 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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;62:274-281.
7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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:e857-864.
10/12/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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;48:894-908.
10/16/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Wilens TE, Vitulano M, Upadhyaya H, et al. Cigarette smoking associated with attention deficit hyperactivity disorder. J Pediatr. 2008;153:414-419.
1/8/2010 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Froehlich TE, Lanphear BP, Auinger P, et al. Association of tobacco and lead exposures with attention-deficit/hyperactivity disorder. Pediatrics. 2009;124:1054-1063.
2/4/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Froehlich TE, Lanphear BP, Auinger P, et al. Association of tobacco and lead exposures with attention-deficit/hyperactivity disorder. Pediatrics. 2009;124(6):e1054-1063.
11/19/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Swing EL, Gentile DA, Anderson CA, Walsh DA. Television and video game exposure and the development of attention problems. Pediatrics. 2010;126(2):214-221.
10/28/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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 Oct 16.
1/13/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Silva D, Colvin L, et al. Environmental risk factors by gender associated with attention-deficit/hyperactivity disorder. ““.
1/28/2014 DynaMed's Systematic Literature Surveillance http://www/ebscohost.com/dynamed: 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.
8/19/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Reilly C, Atkinson P, et al. Neurobehavioral comorbidities in children with active epilepsy: a population-based study. Pediatrics. 2014;133(6):e1586-1593.
7/13/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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 Nov 13;8:906.
Last reviewed July 2015 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.