ADHD in Children and Adolescents

ATTENTION DEFICIT HYPERACTIVITY DISORDER IN CHILDREN AND ADOLESCENTS.

Introduction

Parents are distressed when they receive a note from school saying that their child won’t listen to the teacher or causes trouble in class. One possible reason for this kind of behavior is Attention Deficit/Hyperactivity Disorder (ADHD). Even though the child with ADHD often wants to be a good student, the impulsive behavior and difficulty paying attention in class frequently interferes and causes problems. Teachers, parents, and friends know that the child is misbehaving or different but they may not be able to tell exactly what is wrong.
Any child may show inattention, distractibility, impulsivity, or hyperactivity some of the time, but the child with ADHD shows these symptoms and behaviors more frequently and se¬verely than other children of the same age or developmental level. ADHD occurs in around 5% of all school age children according to many studies done in several countries conducted all over the world. ADHD symptoms are usually evident before the age of 12 years and often continue into adulthood. ADHD runs in families with about 25% of biological parents also having this medical condition.

Overview and Facts

There are three main types of ADHD. One type is characterized by inattentiveness (without hyperactivity), one type is characterized by hyperactive or impulsive behavior, and the third (and most com¬mon) type is combined- when children exhibit signs of both inattention as well as hyperac¬tive/impulsive behavior. Symptoms are often unnoticed until a child enters school. To be diagnosed with ADHD, a child must show symptoms in at least two settings, such as home and school, and the symptoms must interfere with the child’s ability to function at home or school for at least six months. Specialists have agreed that at least six symptoms from the following lists must be present for an accurate diagnosis (see section below).

Symptoms

Signs of inattention:

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted
Is often forgetful in daily activities.

Signs of impulsivity and hyperactivity behavior:

Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often "on the go" acting as if "driven by a motor".
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting his/her turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)

The presence of some symptoms, however, does not confirm a diagnosis of ADHD. Just because a child has a lot of energy or difficulty paying attention in school does not mean the child has ADHD. An accurate diagnosis relies on the presence of a range of symptoms and difficulties that prevent the child from performing at an appropriate level for his or her age and intelligence level. Teachers often first observe these issues, and their input should be considered seriously.

Causes and Risk Factors

Studies have shown that ADHD has a high level of heritability (i.e. it is genetic in most cases). Non-genetic causes of ADHD include smoking during pregnancy, hypoxia at birth, brain injuries, or certain neurological or medical conditions.

Tests and Diagnosis

In general, a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD start early in life and create significant problems at home and at school on an ongoing basis.
There's no specific test for ADHD, but making a diagnosis will likely include:

Information gathering, such as any current medical issues, personal and family medical history and school records
Interviews or questionnaires for family members, your child's teachers or other people who know your child well, such as baby sitters and coaches
ADHD rating scales and tests to help collect and evaluate information about your child such as: DePaul questionnaire, Conner’s questionnaire
Computerized tests of attention and impulsivity such as the visual or auditory versions of the Test of Variability of Attention (TOVA)
Full cognitive or intelligence tests may be needed when learning problems other than ADHD are suspected. Learning problems involving reading, writing, language expression or maths often coexist with ADHD (see section on Learning Disorders in our website for more details).

Treatment

Research clearly demonstrates that medication can help improve attention, focus, goal directed behavior, and organizational skills. Medications most likely to be helpful include the stimulants (various methylphenidate and amphetamine preparations) and the non-stimulant, atomoxetine. Other medications such as guanfacine, clonidine, and some antidepressants may also be helpful.
Other treatment approaches may include cognitive-behavioral therapy, social skills training, parent education, and modifications to the child’s education program. Behavioral therapy can help a child control aggression, modulate social behavior, and be more productive. Cognitive therapy can help child build self-esteem, reduce negative thoughts, and improve problem-solving skills. Parents can learn management skills such as issuing instructions one-step at a time rather than issuing multiple requests at once. Education modifications can address ADHD symptoms along with any coexisting learning disabilities.