Attention-Deficit/Hyperactivity Disorder (ADHD)

ADHD has no known single specific cause, but genetic (inherited) factors are often present. Research indicates that ADHD likely involves abnormalities in neurotransmitters (substances that transmit nerve impulses within the brain). Some other risk factors include low birth weight (under 3 pounds [1500 grams]), head injury, brain infection, iron deficiency, obstructive sleep apnea Obstructive sleep apnea Sleep apnea is a serious disorder in which breathing repeatedly stops long enough to disrupt sleep and often temporarily decrease the amount of oxygen and increase the amount of carbon dioxide... read more , and lead exposure, as well as exposure to alcohol, tobacco, or cocaine before birth. ADHD also is associated with traumatic events during childhood, for example, violence, abuse, or neglect.

Some people have raised concerns about whether food additives and sugar may cause ADHD. Although some children seem to become overactive or impulsive after eating foods containing sugar, studies have confirmed that the brain differences that lead to ADHD are present at birth and that food and environmental factors do not cause the disorder.

ADHD is primarily a problem with sustained attention, concentration, and task persistence (ability to finish a task). Affected children may also be overactive and impulsive. Preschool children with ADHD may have problems with communication and appear to have social interaction problems. As children reach school age, they may seem inattentive. They may fidget and squirm. They may be impulsive and talk out of turn. During later childhood, such children may move their legs restlessly, move and fidget their hands, talk impulsively, and forget easily, and they may be disorganized. They are generally not aggressive.

About 20 to 60% of children with ADHD have learning disabilities Learning Disorders Learning disorders involve an inability to acquire, retain, or broadly use specific skills or information, resulting from deficiencies in attention, memory, or reasoning and affecting academic... read more affecting reading, math, or written language, and most have academic problems such as poor grades due to disorganization or incomplete homework (executive skills). Work may be messy, with careless mistakes and an absence of considered thought. Affected children often behave as if their mind is elsewhere and they are not listening. They often do not follow through on requests or complete schoolwork, chores, or other duties. There may be frequent shifts from one incomplete task to another.

Affected children may have issues with self-esteem, depression, anxiety, or opposition to authority by the time they reach adolescence. About 60% of young children have such problems as temper tantrums Temper Tantrums Temper tantrums are violent emotional outbursts, usually in response to frustration. Frustration, tiredness, and hunger are the most common causes. Children may scream, cry, thrash, roll on... read more , and most older children have a low tolerance for frustration.

The diagnosis of ADHD is based on the number, frequency, and severity of signs. Children must have 6 or more signs of inattention or of hyperactivity and impulsivity (or 6 from each group to diagnose the combined type of ADHD; see Signs of ADHD Signs of ADHD ). Signs must be present in at least two separate environments (typically, home and school) so that a child's reaction to specific problems in one situation is not mistaken for ADHD. Occurrence of signs just at home or just at school and nowhere else does not qualify as ADHD because such signs may be caused by the specific situation. Signs must also be more pronounced than would be expected for the child’s developmental level and must be present for 6 months or more. Often, diagnosis is difficult because it depends on the judgment of the observer. Also, children who are primarily inattentive may escape notice until their academic performance becomes adversely affected.

There is no laboratory test for ADHD. Questionnaires about various aspects of behavior and development can help doctors and psychologists make the diagnosis. Because learning disorders are common, many children receive psychologic testing both to help determine whether ADHD exists and to detect the presence of a specific learning disorder, either as a cause for inattention or as a coexisting problem.

A physical examination and sometimes various blood and other tests to rule out other disorders are also done.

Importantly, the vast majority of children with ADHD become creative and productive adults, and people who have ADHD may adjust better to work than to school situations. However, if the disorder is untreated in childhood, the risk of alcohol or substance abuse or suicide may increase.

Children with ADHD generally do not outgrow their inattentiveness, although children with hyperactivity tend to become somewhat less impulsive and hyperactive with age. However, most adolescents and adults learn to adapt to their inattentiveness. About one third of people find that they continue to benefit from the use of stimulant drugs.

Other problems that may emerge or persist in adolescence and adulthood include poor academic achievement, disorganization (known as poor executive skills), low self-esteem, anxiety, depression, and difficulty in learning appropriate social behaviors.

Children are treated with both behavioral therapy and stimulant drugs. Drugs help to relieve symptoms and allow children to participate more easily in school and other activities. Younger children, especially, benefit from combination therapy. For preschool-aged children, behavioral therapy alone may be all that they need.

The federal Individuals with Disabilities Education Act (IDEA) requires public schools to provide free and appropriate education to children and adolescents with ADHD. Education must be provided in the least restrictive, most inclusive setting possible—that is, a setting in which the children have every opportunity to interact with nondisabled peers and have equal access to community resources. The Americans with Disability Act and Section 504 of the Rehabilitation Act also provide for accommodations in schools and other public settings.

The following are English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.