DefinitionSymptomsCausesRisk factorsComplicationsTreatments and drugs Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. ADHD includes a combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior. Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful. While treatment won’t cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome. Attention-deficit/hyperactivity disorder (ADHD) has been called attention-deficit disorder (ADD) in the past. But ADHD is now the preferred term because it describes both of the primary features of this condition: inattention and hyperactive-impulsive behavior. In some children, signs of ADHD are noticeable as early as 2 or 3 years of age. Signs and symptoms of ADHD may include: Difficulty paying attention Frequently daydreaming Difficulty following through on instructions and apparently not listening Frequently has problems organizing tasks or activities Frequently forgetful and loses needed items, such as books, pencils or toys Frequently fails to finish schoolwork, chores or other tasks Easily distracted Frequently fidgets or squirms Difficulty remaining seated and seemly in constant motion Excessively talkative Frequently interrupts or intrudes on others’ conversations or games Frequently has trouble waiting for his or her turn ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive. Normal behavior vs. ADHD Most healthy children are inattentive, hyperactive or impulsive at one time or another. It’s normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest. The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they’re tired. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they’re different from their friends or siblings. Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected. When to see a doctor If you’re concerned that your child shows signs of ADHD, see your pediatrician or family doctor. Your doctor may refer you to a specialist, but it’s important to have a medical evaluation first to check for other possible causes of your child’s difficulties. If your child is already being treated for ADHD, he or she should see the doctor regularly until symptoms have largely improved, and then every three to four months if symptoms are stable. Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping, increased irritability, or if your child’s ADHD has not shown much improvement with initial treatment. While the exact cause of ADHD is not clear, research efforts continue. Multiple factors have been implicated in the development of ADHD. It can run in families, and studies indicate that genes may play a role. Certain environmental factors also may increase risk, as can problems with the central nervous system at key moments in development. Risk factors for ADHD may include: Blood relatives (such as a parent or sibling) with ADHD or another mental health disorder Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings Maternal drug use, alcohol use or smoking during pregnancy Maternal exposure to environmental poisons — such as polychlorinated biphenyls (PCBs) — during pregnancy Premature birth Although sugar is a popular suspect in causing hyperactivity, there’s no reliable proof of this. Many things in childhood can lead to difficulty sustaining attention, but that is not the same as ADHD. ADHD can make life difficult for children. Children with ADHD: Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults Tend to have more accidents and injuries of all kinds than children who don’t have the disorder Have poor self-esteem Are more likely to have trouble interacting with and being accepted by peers and adults Are at increased risk of alcohol and drug abuse and other delinquent behavior Coexisting conditions ADHD doesn’t cause other psychological or developmental problems. However, children with ADHD are more likely than are other children to also have conditions such as: Learning disabilities, including problems with understanding and communicating Anxiety disorders, which may cause overwhelming worry, nervousness and worsening of ADHD symptoms until the anxiety is treated and under control Depression, which frequently occurs in children with ADHD Bipolar disorder, which includes depression as well as manic behavior Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant and hostile behavior toward authority figures Conduct disorder, marked by antisocial behavior such as stealing, fighting, destroying property, and harming people or animals Tourette syndrome, a neurological disorder characterized by repetitive muscle or vocal tics Standard treatments for ADHD in children include medications, education, training and counseling. These treatments can relieve many of the symptoms of ADHD, but they don’t cure it. It may take some time to determine what works best for your child. Stimulant medications Currently, stimulant drugs (psychostimulants) are the most commonly prescribed medications for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These medications help improve the signs and symptoms of inattention and hyperactivity — sometimes dramatically. Examples include methylphenidate (Concerta, Metadate, Ritalin, others), dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall XR) and lisdexamfetamine (Vyvanse). Stimulant drugs are available in short-acting and long-acting forms. A long-acting patch is available that can be worn on the hip. The right dose varies from child to child, so it may take some time to find the correct dose. And the dose may need to be adjusted if significant side effects occur or as your child matures. Ask your doctor about possible side effects of stimulants. Stimulant medications and heart problems Although rare, several heart-related deaths occurred in children and teenagers taking stimulant medications. The possibility of increased risk of sudden death is still unproved, but if it exists, it’s believed to be in people who already have underlying heart disease or a heart defect. Your child’s doctor should make sure your child doesn’t have any signs of a heart condition and should ask about family risk factors for heart disease before prescribing a stimulant medication. Other medications Other medications used to treat ADHD include atomoxetine (Strattera) and antidepressants such as bupropion (Wellbutrin, others) and desipramine (Norpramin). Clonidine (Catapres) and guanfacine (Intuniv, Tenex) have also been shown to be effective. Atomoxetine and antidepressants work slower than stimulants and may take several weeks before they take full effect. These may be good options if your child can’t take stimulants because of health problems or if stimulants cause severe side effects. Ask your doctor about possible side effects of any medications. Suicide risk Although it remains unproved, concerns have been raised that there may be a slightly increased risk of suicidal thinking in children and teenagers taking nonstimulant ADHD medication or antidepressants. Contact your child’s doctor if you notice any signs of suicidal thinking or other signs of depression. Giving medications safely Making sure your child takes the right amount of the prescribed medication is very important. Parents may be concerned about stimulants and the risk of abuse and addiction. Dependence hasn’t been shown in children who take these drugs for appropriate reasons and at the proper dose. On the other hand, there’s concern that siblings and classmates of children and teenagers with ADHD might abuse stimulant medications. To keep your child’s medications safe and to make sure your child is getting the right dose at the right time: Administer medications carefully. Children and teens shouldn’t be in charge of their own ADHD medication without proper supervision. At home, keep medication locked in a childproof container. An overdose of stimulant drugs is serious and potentially fatal. Don’t send supplies of medication to school with your child. Deliver any medicine yourself to the school nurse or health office. ADHD behavior therapy and counseling Children with ADHD often benefit from behavior therapy and counseling, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some children with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem. Examples of therapy include: Behavior therapy. Teachers and parents can learn behavior-changing strategies for dealing with difficult situations. These strategies may include token reward systems and timeouts. Psychotherapy. This allows older children with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms. Parenting skills training. This can help parents develop ways to understand and guide their child’s behavior. Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD. Social skills training. This can help children learn appropriate social behaviors. The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. Educate yourself about ADHD, and then work with your child’s teachers and refer them to reliable sources of information to support their efforts in the classroom.