Attention-Deficit Hyperactivity Disorder

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Attention-Deficit Hyperactivity Disorder

Mental Health
8271
Behavior and Development
Attention-Deficit Hyperactivity Disorder
Attention-Deficit Hyperactivity Disorder
htmADHD_Middle
Learn how to identify and deal with attention-deficit hyperactivity disorder.
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InteliHealth
2011-05-29
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InteliHealth Medical Content
2013-03-11
Reviewed by the Faculty of Harvard Medical School

Attention-Deficit Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition (problem related to brain development). Children with this disorder may have problems paying attention. They may also be hyperactive (always on the move) or impulsive (showing limited, if any, self-control). At times, nearly every child will have some of these problems. Most children occasionally daydream, fail to finish tasks, and have times when they play recklessly, become very active, or generate  noise and mess. However, these behaviors seem to happen more often in children with ADHD, making it harder for the child to get along with others or to learn in school. These behaviors may also put the child at risk of injury.

ADHD is one of the most common behavior problems, affecting about one of every 10 to 20 school-aged children. Most children with ADHD have some degree of inattention, hyperactivity and impulsivity. However, some children with ADHD only have problems with inattention, while others may only have problems with hyperactivity and impulsivity. ADHD, by definition, starts before age 12. But symptoms of ADHD often start before age 7. These signs and symptoms tend to occur or at least be noticed more at school, but a child can also have difficulties at home or other places. ADHD has typically been seen only as a problem of childhood, but it's now clear that for many people with the disorder, ADHD problems persist into adulthood.

How to tell if a child has ADHD

Carefully watch (observe) your child's behavior both at home and in other social settings. Look for signs of inattention, hyperactivity and impulsivity. Also, speak with your child's teachers to find out if your child exhibits these behaviors in the classroom as well. In many cases, it's the teacher who first raises the concern that a child may have ADHD. Some things to look for are listed in the table below.

Symptom

Behavioral Clues

Inattention
  • Does not pay attention to details or makes careless mistakes
  • Has difficulty paying attention during activities
  • Does not seem to listen when spoken to directly
  • Does not follow through on instructions or fails to finish tasks
  • Is disorganized
  • Avoids or dislikes tasks that require concentration
  • Loses important things
  • Is easily distracted
  • Forgets things
Hyperactivity
  • Fidgets or squirms
  • Cannot remain seated
  • Runs around, jumps or climbs when not appropriate
  • Has difficulty playing quietly
  • Acts as if "driven by a motor," continually "on the go"
  • Talks too much
Impulsivity
  • Acts without thinking
  • Yells (blurts) out answers before questions have been completed
  • Has difficulty waiting turn
  • Interrupts others

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What to do if you suspect your child has ADHD

If you suspect that your child has ADHD, first discuss your concerns with your pediatrician. The pediatrician may make the diagnosis and manage the problem alone or refer you to a specialist, if necessary. There is no single test for ADHD. To make the diagnosis, information about your child's behavior will be needed from you and your child, your child's school, and other frequent caregivers. Your pediatrician will also obtain a medical history and perform a physical exam to make sure that your child does not have other conditions that may affect your child's behavior, such as trouble hearing or seeing, learning disabilities, speech problems, seizure disorders, anxiety, depression, or other behavior problems.

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How ADHD is treated

If your child is diagnosed with ADHD, your pediatrician (or the specialist to whom you were referred) will work with you to make a treatment plan just for your child. Medication alone rarely is the answer. Although there is no cure for ADHD, a combination of medication and behavior therapy can help your child focus his thoughts and control his behavior. In the youngest children, a behavioral program is often tried before medication is offered. But medication can help, if behavior therapy doesn't lead to enough progress. The goal of treatment is to help your child to improve social relationships, perform better in school, and decrease disruptive and dangerous behaviors.

Medication:

Several types of medication are used to treat ADHD. Stimulants, such as methylphenidate (for example, Ritalin, Concerta) and dextroamphetamine (for example, Dexedrine, Adderall), are safe and effective for most children with ADHD, helping them to better focus and concentrate on what they are doing. Despite their name, these medications do not cause increased hyperactivity or impulsivity. In some children, stimulants may cause mild side effects such as decreased appetite, weight loss, stomachaches, sleep problems, headaches and jitteriness. Rarely, more serious side effects may occur, such as dizziness, stuttering, tics or increased blood pressure. In general, children taking these medications are not at greater risk for having heart side effects. But tell the doctor if there is any history of heart problems, either in your child or other family members. Your pediatrician will monitor your child to make sure that the medication is working properly and to check for side effects.

Behavior therapy:

Behavior therapy involves changing your child's environment to make it easier for him to improve his behavior. There are many different types of behavior therapy, but most follow the same general principles:

  • Set specific goals. Instead of setting large, long-term goals that are usually overwhelming for your child, together set small, reasonable goals, such as staying focused on homework for a certain amount of time, or completing a book report.
  • Provide rewards and consequences. Praise your child (positive reinforcement) when he accomplishes one of his goals, or behaves the way you expect. Give negative consequences, such as time-out or taking away privileges, when he fails to meet a goal, or shows an unacceptable behavior.
  • Be consistent. To be successful, all caregivers must be involved, with no changes in rules from person to person, day to day, or place to place. Everyone needs to be "on the same page" so your child will not get confused.

Some specific suggestions for helping your child change his behavior include:

  • Organize your home, especially your child’s room, play area and work space, so that your child has clear places to keep his schoolwork, toys and clothes.
  • Take away all distractions, such as music, video games and television during mealtime and when your child is doing homework.
  • Arrange your child's day with a specific schedule and be sure to stick to it. Try to keep the times for waking, eating, leaving for school, bathing and going to sleep the same from day to day. Use timers and alarm clocks to keep your child on track during the day.
  • Help your child complete homework and household chores using charts and checklists kept in places where your child sees them all the time. Keep instructions simple and brief. Offer frequent, friendly reminders.
  • Pay close attention to your child’s safety, especially around traffic, firearms, swimming pools, power tools, dangerous chemicals or medications in the home. Constantly remind your child about the importance of safety.

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How your child's school can help

Your child's classroom also can be changed to make it easier for him to improve his behavior. Talk with your child's teacher about some of these suggestions, many of which will reflect changes you should already have made at home:

  • Keep a set routine and schedule for activities.
  • Provide rewards for desired behavior and negative consequences for unacceptable behavior.
  • Send home frequent behavior reports so you can monitor your child’s progress there.
  • Seat your child near the teacher at the front of the room.
  • Place your child in smaller groups for activities.
  • Encourage students to pause a moment before answering questions.
  • Keep assignments short or break them into small sections.
  • Provide close supervision with frequent, positive cues to stay on task.

If your child has ADHD that remains severe enough to interfere with his ability to learn despite a combination of medication and behavior therapy, he may need a special evaluation. This means making an individualized education plan (IEP), which may include additional special services such as a classroom aide, private tutoring or special classroom settings. Federal laws require public schools to cover the costs of evaluating for special educational needs and to provide the necessary services to meet these needs.

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Outgrowing ADHD

Although some children appear to outgrow their ADHD symptoms during their adolescent years, others may continue to have lifelong symptoms. However, by building on their strengths, arranging their environments in special ways, and continuing medications if necessary, most adults with ADHD lead productive, successful and very fulfilling lives. In fact, many adults with ADHD do extraordinarily well in those careers that call for an energetic, always-on-the-go personality.

The symptoms of some conditions are similar to those of ADHD. To learn about them, visit ADHD Imitators.

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hyperactivity,behavior therapy,medication,pediatrician
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Last updated July 31, 2014


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