ADHD

Two smiling parents, their daughter's arms wrapped around her mother's neck and shouldersAttention Deficit Hyperactivity Disorder (ADHD) is a condition that
becomes apparent in some children in the preschool and early school years. It is
hard for these children to control their behavior and/or pay attention. It is
estimated that between 3 and 5 percent of children have ADHD, or approximately 2
million children in the United States. This means that in a classroom of 25 to
30 children, it is likely that at least one will have ADHD.

ADHD was first described by Dr. Heinrich Hoffman in 1845. A physician who
wrote books on medicine and psychiatry, Dr. Hoffman was also a poet who became
interested in writing for children when he couldn’t find suitable materials to
read to his 3-year-old son. The result was a book of poems, complete with
illustrations, about children and their characteristics. “The Story of Fidgety
Philip” was an accurate description of a little boy who had attention deficit
hyperactivity disorder. Yet it was not until 1902 that Sir George F. Still
published a series of lectures to the Royal College of Physicians in England in
which he described a group of impulsive children with significant behavioral
problems, caused by a genetic dysfunction and not by poor child rearing—children
who today would be easily recognized as having ADHD.1 Since then,
several thousand scientific papers on the disorder have been published,
providing information on its nature, course, causes, impairments, and
treatments.

A child with ADHD faces a difficult but not insurmountable task ahead. In
order to achieve his or her full potential, he or she should receive help,
guidance, and understanding from parents, guidance counselors, and the public
education system. This document offers information on ADHD and its management,
including research on medications and behavioral interventions, as well as
helpful resources on educational options.

Because ADHD often continues into adulthood, this document contains a section
on the diagnosis and treatment of ADHD in adults.


Symptoms

The principal characteristics of ADHD are inattention,
hyperactivity, and impulsivity. These symptoms
appear early in a child’s life. Because many normal children may have these
symptoms, but at a low level, or the symptoms may be caused by another disorder,
it is important that the child receive a thorough examination and appropriate
diagnosis by a well-qualified professional.

Symptoms of ADHD will appear over the course of many months, often with the
symptoms of impulsiveness and hyperactivity preceding those of inattention,
which may not emerge for a year or more. Different symptoms may appear in
different settings, depending on the demands the situation may pose for the
child’s self-control. A child who “can’t sit still” or is otherwise disruptive
will be noticeable in school, but the inattentive daydreamer may be overlooked.
The impulsive child who acts before thinking may be considered just a
“discipline problem,” while the child who is passive or sluggish may be viewed
as merely unmotivated. Yet both may have different types of ADHD. All children
are sometimes restless, sometimes act without thinking, sometimes daydream the
time away. When the child’s hyperactivity, distractibility, poor concentration,
or impulsivity begin to affect performance in school, social relationships with
other children, or behavior at home, ADHD may be suspected. But because the
symptoms vary so much across settings, ADHD is not easy to diagnose. This is
especially true when inattentiveness is the primary symptom.

According to the most recent version of the Diagnostic and Statistical
Manual of Mental Disorders
2 (DSM-IV-TR), there are three
patterns of behavior that indicate ADHD. People with ADHD may show several signs
of being consistently inattentive. They may have a pattern of being hyperactive
and impulsive far more than others of their age. Or they may show all three
types of behavior. This means that there are three subtypes of ADHD recognized
by professionals. These are the predominantly hyperactive-impulsive
type
(that does not show significant inattention); the
predominantly inattentive type (that does not show significant
hyperactive-impulsive behavior) sometimes called ADD—an outdated term for this
entire disorder; and the combined type (that displays both
inattentive and hyperactive-impulsive symptoms).

Hyperactivity-Impulsivity

Hyperactive children always seem to be “on the go” or
constantly in motion. They dash around touching or playing with whatever is in
sight, or talk incessantly. Sitting still at dinner or during a school lesson or
story can be a difficult task. They squirm and fidget in their seats or roam
around the room. Or they may wiggle their feet, touch everything, or noisily tap
their pencil. Hyperactive teenagers or adults may feel internally restless. They
often report needing to stay busy and may try to do several things at once.

Impulsive children seem unable to curb their immediate
reactions or think before they act. They will often blurt out inappropriate
comments, display their emotions without restraint, and act without regard for
the later consequences of their conduct. Their impulsivity may make it hard for
them to wait for things they want or to take their turn in games. They may grab
a toy from another child or hit when they’re upset. Even as teenagers or adults,
they may impulsively choose to do things that have an immediate but small payoff
rather than engage in activities that may take more effort yet provide much
greater but delayed rewards.

Some signs of hyperactivity-impulsivity are:

  • Feeling restless, often fidgeting with hands or feet, or squirming while
    seated
  • Running, climbing, or leaving a seat in situations where sitting or quiet
    behavior is expected
  • Blurting out answers before hearing the whole question
  • Having difficulty waiting in line or taking turns.

Inattention

Children who are inattentive have a hard time keeping their minds on any one
thing and may get bored with a task after only a few minutes. If they are doing
something they really enjoy, they have no trouble paying attention. But focusing
deliberate, conscious attention to organizing and completing a task or learning
something new is difficult.

Homework is particularly hard for these children. They will forget to write
down an assignment, or leave it at school. They will forget to bring a book
home, or bring the wrong one. The homework, if finally finished, is full of
errors and erasures. Homework is often accompanied by frustration for both
parent and child.

The DSM-IV-TR gives these signs of inattention:

  • Often becoming easily distracted by irrelevant sights and sounds
  • Often failing to pay attention to details and making careless mistakes
  • Rarely following instructions carefully and completely losing or forgetting
    things like toys, or pencils, books, and tools needed for a task

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