Attention Deficit and Hyperactivity Disorder: An Overview
It is natural for young children to be easily distracted, have trouble listening, and be unable to sit still. We expect these behaviors to improve gradually as children get older, but some children seem to have more trouble developing age-appropriate attention skills and behavior control. You may have heard of Attention Deficit and Hyperactivity Disorder, or ADHD, as it is commonly known, and wondered if your child has it.
The name ADHD also includes attention disorders that are not associated with much hyperactivity (about 1/3 of children with ADHD are not hyperactive). Some people refer to this as ADD, but the term ADHD now includes all types of attention issues. According to the American Academy of Pediatrics, ADHD is one of the most common developmental issues and is estimated to affect from 4% to 12% of children and adolescents. Boys are about 3 times more likely to be diagnosed with ADHD than girls. ADHD is a chronic condition that usually lasts through adolescence, and is often a lifelong condition. If your child is diagnosed with ADHD, the good news is that there are very effective treatments and many ways that you can help your child to function at her better while living with ADHD.
ADHD and your child
Things to look out for. The three main characteristics of ADHD are inattention, impulsivity, and often (but not always) hyperactivity. All three are not necessarily evident every child with ADHD. Some children with ADHD are inattentive, disorganized, and impulsive but are not hyperactive. If your child has a hard time paying attention, is easily distracted, is disorganized, puts things off, interrupts, talks a lot, has trouble being patient, is fidgety, or cannot stay still or seated, and these signs have been evident and distracting your child in at least two settings (at home, in school, during sports or other activities, for example) and if the child symptoms has been evident for at least six months, you may want to have her evaluated.
Things you should know. ADHD is a medical disorder and does not just appear because your child is lazy, unmotivated, or not trying hard enough. In fact, many studies have shown that the brains of children and adults with ADHD are different from other brains. They show less activity in the parts of the brain that control attention, judgment, organization, impulse control, and activity level. This makes it difficult for your child to control his attention and behavior, and may interfere with his social and educational functioning. A diagnosis of ADHD does not mean that your child is of below-average intelligence. Very bright children can have ADHD. While there is no cure at this time for ADHD, there are excellent treatments available, and there are also many ways for parents to help children with ADHD at home. Approximately 2/3 of children with ADHD also have a learning disability, excessive worrying or fearfulness, moodiness, irritability or mood swings, oppositional behavior, or muscle twitches. If your child has both ADHD and another condition, it is important that both conditions are identified and that you learn about the options for treating each appropriately.
Getting a diagnosis. There are many reasons why a child may have trouble paying attention or doing well in school. If you suspect your child has ADHD, you should have her evaluated by a pediatrician, developmental specialist, or child psychologist or psychiatrist. While there is no blood test or x-ray that can be used to diagnose ADHD, there are specific behavioral criteria that must be met for a diagnosis to be made. Whichever professional is diagnosing your child will ask for information from you and your child’s school regarding his behavior, will examine your child, and may have you or the school fill out a behavioral questionnaire. At the end of the evaluation, he or she will tell you whether your child has ADHD, and whether there may also be a co-existing condition that needs further diagnosis.
Making a treatment plan. After the diagnosis has been made, you and the professional who has evaluated your child should discuss the best options for treating your child’s ADHD. The professional will generally develop a treatment plan based on input from you, the school and from observing your child. Components of treatment vary depending on the severity of the disorder but can include several of the following options: medication, behavior management, tutoring to improve study skills, organization and/or test preparation, individual counseling, parent training, or family counseling. ADHD requires ongoing follow-up and management, and so you should maintain regular contact with your child’s school and pediatrician. All children with ADHD, whether or not they take medication, require regular monitoring and follow-up. Children on medication require dosage adjustments to find the optimal dose of medicine, and the dosage should be adjusted many times as your child grows and her schedule changes. Most children taking medication for ADHD should see their doctor at least 2 or 3 times per year to monitor height, weight, and vital signs and to discuss what is going well and what areas need improvement. Some children do not require treatment with medication at first, but may a year or two later. Some children do not have a second diagnosis initially, but as one may develop over time. As the demands on your child change over time, some treatments may be discontinued while others may be introduced.
Medicines for treating ADHD. We used to think that medications for ADHD should only be used as a last resort. However, recent research has shown that stimulant medications are the most effective treatment for ADHD, and non-medical treatments work best when children also take medication to control their ADHD, and often a combination of stimulant medication and behavioral treatment is most effective. Several different medications are available, so if one type does not work or if it causes side effects, a different medication should be tried. Over 90% of children with ADHD respond positively to some kind of medication. The right medication and the right dose will not change your child’s personality, except that he can choose to focus and control his behavior when he needs to. If you see any negative personality changes, you should consider these a side effect and tell your child’s doctor immediately. Doctors generally prescribe low doses of medication at first with gradual increases until the right dose is reached. They will probably have you and your child’s teacher fill out a follow-up behavioral questionnaire. Some mild side effects are common at first, especially related to appetite and sleep, but should lessen. Talk to your child’s doctor about the pros and cons of medication on weekends and vacations, because some children do best with taking their medication every day. Do not be afraid to ask a lot questions – the idea of using medications can be scary but can also cause life-changing improvements.
Managing ADHD at school. In addition to any treatment your child’s pediatrician recommends, your child may need some classroom accommodations, such as repetition of instructions, extra time on tests, and/or help organizing books and papers needed for homework. In many cases ADHD is considered a disability that requires special education services at school under the “Other Health Impairment” category of the Individuals with Disabilities Act. Depending on the severity of your child’s issues, these services can include extra help, sessions with a school counselor, or more specialized services like a classroom aide. Even with a formal diagnosis from an outside professional, the school may want to conduct its own evaluation of your child. If your child is deemed eligible for special education services, you and the school will develop an Individualized Education Plan for her. If she is deemed ineligible, she still may receive certain accommodations and assistance. You have the right to appeal any decision made about your child. For more information on the special education process, see OneToughJob’s fact sheet on Special Education. It might be that your child only requires a little bit of extra attention in the classroom. If this is the case, it is important that you communicate this to her teachers. Make sure they know the nature of her difficulties, how she is being treated, strategies that work and do not work in managing her behavior, and whether she needs certain accommodations such as specific instructions or a seat in the front. For more information, see the WebMD fact sheet on Back to School with ADHD.
Managing ADHD at home. Parents of children with ADHD often find themselves saying “no” often, or interacting in negative ways with. You can learn to use incentives, positive feedback, and modest consequences effectively since these work far better than constant yelling, nagging, and criticizing. Learning to stay calm and in control, using a positive tone of voice, finding small behaviors to praise, and using more incentives and less punishment can improve both your child’s self esteem and yours. For incentives, special time doing something like baking together, going on an outing, or reading an extra story at bedtime can be satisfying for both you and your child. Other helpful things you can do at home include setting a predictable daily routine and schedule, allowing your child to take frequent breaks from homework and chores, and giving instructions simply, with few words. Break down complicated instructions into small parts and let your child do the first part of the task before giving instructions for the next step so there’s less to forget. Some children do well with checklists, timers, and other reminders that will also allow you to nag less. In general, children with ADHD do require more supervision and assistance in getting things done. Encourage your child to participate in activities that allow her to burn energy.
For more information, look at the familydoctor.org fact sheet on ADHD: What parents should know.
This article has been reviewed by Dr. Betsy Busch, MD