Have you noticed that your child is easily distracted, has trouble following directions, and can’t seem to finish tasks? Perhaps he or she doesn’t listen to others, can’t focus on schoolwork, and can’t sit still. Are these behaviors just part of growing up, or could your child have an attention deficit disorder?
Attention-deficit/hyperactivity disorder (AD/HD) is a chronic condition affecting children and adults that is characterized by problems with attention, impulsivity, and over-activity. It affects 2 to 5 percent of school-age children and 2 to 4 percent of adults. (Up to half of those with AD/HD as children continue to have some problems as adults.)
AD/HD is the most commonly diagnosed mental disorder of children in this country. The disorder is most often is discovered during the early school years, when a child begins to have problems paying attention. AD/HD (includes hyperactivity/impulsivity) is more common in boys, while ADD (without hyperactivity) is more common in girls.
Types of AD/HD
AD/HD is grouped into three types: inattentive, hyperactive-impulsive, and combined (children exhibit signs of both inattentiveness and hyperactive-impulsive behavior). A diagnosis the type depends on the specific symptoms the person has. It is a complex condition, and symptoms may look different with different people.
The symptoms tend to change over time and vary across age groups, with hyperactivity-impulsivity more common in children, and more inattentive symptoms during adulthood. The cause of AD/HD is not known, but it’s believed that many factors contribute to the condition, including heredity (AD/HD tends to run in families), a chemical imbalance in the brain, a prenatal infection, brain trauma, and lead toxicity.
Problems Faced for Those with AD/HD
AD/HD can lead to significant behavioral, emotional, social, and academic problems for both children and adults. It can interfere with a child’s performance in school and with his or her ability to make and keep friends. Both of these can negatively impact a child's self-esteem. Children with AD/HD also are at risk for developing conduct disorder, depression, or an anxiety disorder. They are also more likely to have a learning disability.
For adults, AD/HD can affect all parts their lives, including their work and their relationships. A person may be disorganized and have trouble keeping up at work. Adults with this disorder also have higher incidences of substance abuse as well as legal issues related to speeding tickets and motor vehicle accidents.
Just because a child or adult doesn’t pay attention doesn’t mean he or she has AD/HD. It’s important to explore all of the possibilities that could explain someone’s behavior.
A medical history and physical exam should be done first to rule out conditions like lead toxicity, vision problems, or hearing deficits. If a physical disorder isn’t found, a child should be seen by a specialist in childhood development disorders, such as a child and adolescent psychiatrist or psychologist or other health professional trained to diagnose and treat AD/HD. Adults also should be seen by a trained professional.
A diagnosis of AD/HD is a clinical diagnosis based on a child’s history and behaviors that prevent the child from performing at an appropriate level for his or her age and intelligence.
When I evaluate a child, I gather information (rating scales, report cards) from the child’s teachers who often first observe the signs of AD/HD. I also talk to the child’s parents and other adults who know the child. I learn about the family structure and any special conditions or problems the child may have. It’s also important to determine if there are other problems such as learning disabilities, conduct disorders, depression, or anxiety.
While AD/HD can’t be cured, it can be managed with professional counseling, special education, support from families and schools, and medication.
Special education—A child with AD/HD may require special education designed to his or her unique needs. It’s important to look at how the school supports the child with an individual education plan (IEP) that focuses on the child’s special needs.
Individual therapy—Psychotherapy can help a child cope with the frustrations of AD/HD and improve self-esteem and social skills. Therapy also focuses on the child’s behavioral and school problems. Counseling also may help parents and other family members better understand the child’s disorder. And groups such as CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) provide support to parents and others affected by AD/HD (www.chadd.org).
Medication—Medication can help children and adults with AD/HD control hyperactivity and impulsive behavior, and increase attention span. Once a child takes medication for AD/HD, he or she usually stays continues taking it as an adult. Medication usually works best in combination with therapy. It’s important to take medications for AD/HD as prescribed, and not to “double up” if symptoms appear worse. It may take several months to find the right medication without major side effects.
Left untreated, AD/HD can have a significant impact on many aspects of a person’s life. Most people with AD/HD learn to adapt with proper management and can experience some relief of their symptoms.