Attention-Deficit/Hyperactivity Disorder
In Children and Adolescents
This is one of a series of fact sheets on the mental,
emotional, and behavior disorders that can appear in childhood or adolescence. The
Center for Mental Health Services extends appreciation to the National
Institute of Mental Health, National institutes of Health, for contributing to
the preparation of this fact sheet. Any questions or comments about its
contents may be directed to the Center for Mental Health Services’ Knowledge
Exchange Network (see contact information below).
What is Attention-Deficit/Hyperactivity Disorder?
Young people with attention-deficit/hyperactivity disorder
typically are overactive, unable to pay attention, and impulsive. They also
tend to be accident prone. Children or adolescents with
attention-deficit/hyperactivity disorder may not do well in school or even
fail, despite normal or above-normal intelligence. Attention-deficit/hyperactivity
disorder is sometimes referred to as ADHD.
What are the Signs of Attention-Deficit/Hyperactivity Disorder?
There are actually three different types of
attention-deficit/hyperactivity disorder, each with different symptoms. The types are referred to as inattentive, hyperactive-impulsive, and combined attention-deficit/hyperactivity
disorder.
Children with the inattentive type:
* have short attention spans;
* Are easily distracted;
* Do not pay attention to details;
* Make lots of mistakes;
* Fail to finish things;
* Are forgetful;
* Don’t seem to listen; and
* Cannot stay organized
Children with the hyperactive-impulsive type:
* Fidget and squirm;
* Are unable to stay seated or play quietly;
* Run or climb too much or when they should not;
* Talk too much or when they should not;
* Blurt out answers before questions are completed;
* Have trouble taking turns; and
* Interrupt others.
Combined attention-deficit/hyperactivity disorder, the most common
type, is a combination of the inattentive and the hyperactive-impulsive types.
A diagnosis of one of the attention-deficit/hyperactivity
disorders is made when a child has a number of the above symptoms, and the
symptoms began before the age of 7 and lasted at least 6 months. Generally,
symptoms have to be seen in at least two different settings (for example, at
home and at school) before a diagnosis is made.
How Common is Attention-Deficit/Hyperactivity
Disorder?
Attention-deficit/hyperactivity disorder is found in as many as
1 in every 20 children. Studies have shown that boys with
attention-deficit/hyperactivity disorder outnumber girls with the disorder
about three to one.
Children and adolescents with attention-deficit/hyperactivity
disorder also have oppositional or conduct disorder, and about a fourth have an
anxiety disorder. As many as one-third have depression, and about one -fifth
have a learning disability. Sometimes a child or adolescent will have two or
more of the disorders in addition to attention-deficit/hyperactivity disorder.
Also, children with attention-deficit/hyperactivity disorder are at risk for
developing personality disorders and substance abuse disorders when they are
adolescents or adults.
Attention-deficit/hyperactivity disorder is a major reason why
children are referred for mental health care. Boys are more likely to be
referred for treatment than girls, in part because many boys with
attention-deficit/hyperactivity disorder also have conduct disorder. The mental
health services and special education required by children and adolescents with
attention-deficit/hyperactivity disorder cost millions of dollars each year.
Underachievement and lost productivity can cost these young people and their
families even more.
What Causes Attention-Deficit/Hyperactivity Disorder?
Many causes of attention-deficit/hyperactivity disorder have
been studied, but no one cause seems to apply to all young people with the
disorder. Factors such as viruses, harmful chemicals in the environment,
genetics, problems during pregnancy or delivery, or other things that impair
brain development may play a role.
What Help Is Available for Families?
Many treatments---some with good scientific basis, some
without---have been recommended for children and adolescents with
attention-deficit/hyperactivity disorder. The best proven treatments are
medication and behavior treatments.
Medication. The most widely used drugs for treating attention-deficit/hyperactivity disorder are stimulants, such as amphetamine (Dexedrine, Dextrostat, Desoxyn), methylphenidate (Ritalin), and pemoline (Cylert). Stimulants increase the activity in parts of the brain that are underactive in children and adolescents with attention-deficit/hyperactivity disorder. Experts believe that this is why stimulants improve attention and reduce
class=Section3>
impulsive, hyperactive, or aggressive
behavior. Individuals may respond better to one medication than another. For
example, clonidine (Catapres)
is often used, although its effectiveness has not been clearly shown. A few
antidepressants may also work for some patients. Tranquilizers like thioridazine (Mellaril) have also
been shown to work for some young people. Care must be used in prescribing and
monitoring all medication. These medications are not the only medications that
may be prescribed for this disorder.
Like most medications, those used to treat
attention-deficit/hyperactivity disorder have side effects. When taking these
medications, some children may lose weight, have a smaller appetite, and
temporarily grow more slowly. Others may have trouble falling asleep. However,
many doctors believe the benefits of medication outweigh the possible side
effects. Side effects that do occur can often be handled by reducing the
dosage.
Behavior Treatment. Behavior
treatments include:
* Teaching parents and teachers how to manage and modify the child’s
or adolescent’s behavior, such as rewarding good behavior;
* A daily report card to link the home and school efforts (where the
parent rewards the child or adolescent for good school performance and
behavior);
* Summer and Saturday programs;
* Special classrooms that use intensive behavior modification; and
* Specially trained classroom aides.
It is clear that both stimulants and behavior treatment can be helpful in the short run (a few weeks or
months). However, it is not clear how long the benefit lasts. The Federal
Governments National Institute of Mental Health is supporting research on the
long-term benefits of various treatments as well as research to find out
whether medication and behavior treatment are more effective when combined.
There is also research on new medicines and other new treatments. Other Federal
agencies carrying out research on attention-deficit/hyperactivity disorder
include the Center for Mental Health Services and the Department of Education.
A child or
adolescent in need of treatment or services and his or her family may need a
plan of care based on the severity and duration of symptoms. Optimally, this
plan is developed with the family, service providers, and a service
coordinator, who is referred to as a case manager. Whenever possible, the child
or adolescent is involved in decisions.
Tying
together all the various supports and services in a plan of care for a
particular child and family is commonly referred to as a “system of care.” A
system of care is designed to improve the child’s ability to function in all
areas of life---at home, at school, and in the community.
Can
Attention-Deficit/Hyperactivity Disorder Be Prevented?
Because
there are so many suspected causes of attention-deficit/hyperactivity disorder,
prevention may be difficult. However, it always is wise to obtain good prenatal
care and stay away from alcohol, tobacco, and other harmful chemicals during
pregnancy and to get good general health care for the child. These
recommendations may be particularly important if
attention-deficit/hyperactivity disorder is suspected in other family members.
Knowing that attention-deficit/hyperactivity disorder is in the family can
alert parents to take early action to prevent bigger problems.
What Else
Can Parents Do?
When it comes
to attention-deficit/hyperactivity disorder, parents and other caregivers
should be careful not to jump to conclusions. A high energy level alone in a
child or adolescent does not mean that he or she has
attention-deficit/hyperactivity disorder. The diagnosis depends on whether the
child or adolescent can focus well enough to complete tasks that suit his or
her age and intelligence. This ability is most likely to be noticed by a
teacher. Therefore, input from teachers should be taken seriously.
If parents
or other caregivers suspect attention-deficit/hyperactivity disorder, they
should:
* Make an appointment with a psychiatrist, psychologist,
child neurologist, or behavioral pediatrician for an evaluation. (Check with
the child’s doctor for a referral.)
* If the young person is diagnosed with
attention-deficit/hyperactivity disorder, be patient. The disorder may take a
long time to improve.
* Instill a sense of competence in the child or
adolescent. Promote his or her strengths, talents, and feelings of self-worth.
* Remember that failure, frustration, discouragement,
low self-esteem, and depression, in many cases, cause more problems than the
disorder itself.
* Get accurate information from libraries, hotlines, or
other sources.
* Ask questions about treatments and services.
* Talk with other families in the community.
* Find family network organizations.
It is
important that people who are not satisfied with the mental health care they
are receiving discuss their concerns with the provider, to ask for information,
and/or to seek help from other sources.
Important
Messages About Children’s and Adolescents’ Mental
Health:
* Every child’s mental health is important.
* Many children have mental health problems.
* These problems can be recognized and treated.
* Caring families and communities working together can
help.
* Information is available---for free publications,
references, and referrals to local and national resources and
organizations---call 1.800.789.2647;
* TTY 301.443.9006; or go to www.mentalhealth.org.
For more
information about Mental Illnesses -
Contact:
The
NAMI of Greater
Phone: 312-563-0445