ADHD

What is Attention-Deficit Hyperactivity Disorder (ADHD)?

Image Click Here to watch Dr. Pelham's video on ADHD in children

Attention-deficit hyperactivity disorder (ADHD) is defined as a pattern of behaviors in which a child shows, usually before the age of 7, developmentally inappropriate levels of inattention, impulsivity, or hyperactivity. It is the most common mental health problem of childhood, affecting 3% to 5% of the population, and is considerably more common in boys than in girls. The behavior of children with ADHD often results in serious disturbances in their relationships with parents, teachers, peers, and siblings, as well as academic problems. The symptoms and criteria for a diagnosis of ADHD from the Diagnostic and Statistical Manual of The American Psychiatric Association are described below. A child must show symptoms that cause problems and are present to a greater degree than other same age children.

To learn more about recognizing and treating inattention and hyperactivity/impulsivity in children, please follow these links to watch brief interviews with experts on behavioral therapy and on medication treatment.

Symptoms of Inattention:

• fails to give close attention to details or makes careless mistakes

• does not seem to listen when spoken to directly remaining seated is expected

• does not follow through on instructions and fails to finish tasks

• has difficulty sustaining attention in tasks or play activities

• has difficulties organizing tasks and activities

• loses things necessary for tasks or activities (e.g., toys, books)

• is easily distracted

• is forgetful in daily activities

Symptoms of Hyperactivity:

• leaves seat in classroom or in other situations in which

• fidgets with hands or feet or squirms in seat

• runs or climbs excessively when it is inappropriate (not due to oppositional behavior or failure to understand instructions) (in adolescents, may be feelings of restlessness)

• has difficulty playing or engaging in leisure activities

• avoids or dislikes tasks that require sustained mental effort quietly (such as schoolwork or homework)

• is always "on the go" or acts as if "driven by a motor"

• often talks excessively

Symptoms of Impulsivity:

• blurts out answers before questions have been completed

• has difficulty awaiting turn

• interrupts or intrudes on others (e.g., butts into conversations or games)

To receive a diagnosis of ADHD, a person must:

• Have six or more symptoms of either inattention (listed above on the left or hyperactivity/impulsivity

• Symptoms must have persisted for at least six months and must be present to a degree that creates problems and is inconsistent with developmental level

• At least some symptoms that caused impairment (that is, problems at home or school) were present before the age of seven

• Some symptoms be present in at least two different settings (e.g., home, school), and there must be clinically significant impairment in social or academic functioning at home or school

There are three different subtypes of ADHD, these are:

  • Combined Type: 6 symptoms present from each of the lists above
  • Predominantly Inattentive: 6 inattentive symptoms present that are listed above
  • Predominantly Hyperactive-Impulsive: 6 symptoms present that are listed above

Children do not have to have all of these symptoms, nor do they have to show symptoms in all settings for a diagnosis to be made. For example, most children with ADHD can pay attention in situations in which they are very interested (e.g., a favorite television show), or in a one-to-one setting such as a testing session with a psychologist. Since all children sometimes show some of these behaviors some of the time, it is important that the behaviors be present to an extreme degree compared to other children of the same age and that they be causing significant disruption to the child, his or her family, peers, or classroom before the child is diagnosed as ADHD. Diagnosis is a complex process that cannot be based on a single visit to the doctor. Instead, information must be gathered from parents and teachers, and from observations of the child in natural settings. When information from parents and teachers conflicts, more weight is usually given to teachers because they are usually more familiar with normal behavior for an age group.

In addition to the defining characteristics listed above, children with ADHD often exhibit other problems including defiant and noncompliant behavior toward adults, verbal and physical aggression towards peers and siblings, low self esteem (particularly in adolescents), and learning disabilities. Also, family problems often accompany ADHD, including marital problems, alcohol problems (especially in fathers) and stress and depression (especially in mothers). Therefore, these parental problems need to be assessed and treated along with the children's problems.