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What is attention-deficit/hyperactivity disorder (ADHD)?

Does your child have trouble with impulse control or paying attention in school? Do some people even describe them as overly active? There is the chance that they may have a common brain developmental condition called attention-deficit/hyperactivity disorder (ADHD). This type of disorder can also affect adults and is responsible for controlling how we focus and control our behavior.

Who suffers from this type of disorder?

ADHD is the most common mental illness diagnosed in children impacting over six million annually. Research shows this disorder may be diagnosed as early as three years old. It appears to impact young boys more than girls. It is usually diagnosed when they begin school since they may begin showing problems with paying attention or controlling their behavior in the classroom.

Can adults have ADHD?

About four percent of adults also have ADHD; however, their presentation may differ from children. Adults may be described as having poor time management skills or having difficulties with multitasking.

What are the different types of ADHD?

Three different types of ADHD are recognized at this time:

Inattentive Presentation: symptoms of inattention but not hyperactivity-impulsivity, which usually involves problems with focus and completing tasks. This type is more frequent in female patients.
Hyperactive-Impulsive Presentation: symptoms of hyperactivity-impulsivity but not inattention which usually involves difficulty sitting still or constantly being on the go. This type is mostly seen in preschool-aged children.
Combined Presentation: symptoms of inattention and hyperactivity-impulsivity.

Causes

What causes ADHD?

Just like other mental disorders, the exact cause of ADHD is not well understood at this time. However, it is believed that multiple risk factors may contribute to the development of this mental illness.

What risk factors are there for developing ADHD?

Neurological factors - there is some belief that brain injury may cause ADHD.
Genetic factors - parents who have ADHD may notice similar symptoms in their children.
Environmental factors - exposure to environmental chemicals in young children or pregnant women such as lead has been linked to the development of ADHD.
Substance and alcohol abuse - individuals that participate in drug and alcohol use during pregnancy are known to have a higher chance of having children that suffer from ADHD.

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Symptoms

What are the common symptoms of ADHD?

Many children will experience difficulty focusing on assignments or problems with behavior at some point in their lives. ADHD is usually a concern when those behaviors do not improve. Some symptoms for ADHD may include:

Being forgetful
Constant loss in thought (daydreaming)
Inability to sit still
Talkative
Makes multiple mistakes on assignments
Risk-taker
Difficulty waiting for their turn
Difficulty getting along with others

Diagnosis

How is ADHD diagnosed?

Currently, there is no specific medical test available to diagnose this disorder. There also is not one particular sign or symptom that can be used to diagnose ADHD. Proper diagnosis requires several steps that must be performed by a licensed mental healthcare provider. This usually involves a thorough medical history and physical exam.

What other mental illness may look like ADHD?

A thorough exam is needed to make an accurate diagnosis as ADHD may mimic other mental illnesses. Other similar mental illnesses include:

Anxiety
Depression
Sleeping disorders
Learning disabilities

What are the DSM-5 criteria used to diagnose ADHD?

In order to diagnose ADHD, differentiation between inattention and hyperactivity/impulsivity must be made.

Inattention:

Inability to pay close attention to details.
Constantly makes careless mistakes in schoolwork, at work, or with other activities.
Inability to stay focused on tasks or play activities.
Appears not to listen when directly spoken to.
Constantly sidetracked and fails to finish work, chores, or duties in the workplace or at school.
Trouble staying organized.
Loses things necessary to complete tasks.
Easily distracted.
Forgetful.

Hyperactivity/impulsivity:

Inability to sit still and may constantly fidget or tap hands or feet.
Cannot sit for long periods of time.
Feeling restless, or a child may run and play during inappropriate times.
Inability to play or take part in activities quietly.
Talks excessively.
May blurt out answers before a question has been provided.
Has trouble waiting their turn during activities.
Constantly interrupts others, especially with conversations or games.

Six or more symptoms must be present for at least six months to diagnose a child with ADHD. It is also suggested that these symptoms should be noted before the age of 12 and occur in multiple settings. The child's behavior must also negatively impact their life and can not be due to other mental disorders.

Treatment

What are the treatment options available for ADHD?

ADHD is a very manageable disorder when treated properly. Early intervention is recommended as soon as a diagnosis is made to provide the best results. Combination therapy appears to be a popular option for treatment at this time. Here are some treatment options available:

Behavior management is often the initial treatment option for ADHD, especially in small children under the age of six. This treatment usually involves parent management. This therapy focuses on eliminating disruptive behaviors that may negatively impact relationships with others and encourages positive behaviors. This therapy has been shown to be just as effective as medication.
Medication is an effective way to manage ADHD and is usually reserved for those older than six years old. It can improve relationships with others that the disruptive behaviors may have negatively impacted. Non Stimulants and stimulants are the two common types of medications used for ADHD. These medications should only be administered by a healthcare provider such as our licensed mental health specialists at TeleMed2U. Medications may have serious side effects, and each child may respond differently to these medications. Hence, a healthcare provider is the best person to manage this.

For children older than six, treatment with behavior management and medication is the gold standard. Schools may also be involved with treatment to provide better coping skills for the child and parents.

If you think you may benefit from better management of your child’s compulsive behavior, there are licensed mental healthcare providers at TeleMed2U available to help. ADHD is very manageable when addressed early and with the help of mental health experts like ours.

References

Center for Disease Control and Prevention. (2021, January). What is ADHD? https://www.cdc.gov/ncbddd/adhd/facts.html

National Institute of Mental Health. (n.d.). Attention-Deficit/Hyperactivity Disorder. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/

U.S. Food and Drug Administration. (2016, October).Dealing with ADHD: What You Need to Know.https://www.fda.gov/consumers/consumer-updates/dealing-adhd-what-you-need-know

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Roy Kedem started his premedical studies at Harvard, and research in genetics and gene sequencing at Harvard, Beth Israel. He attended medical school in the UK at the Cambridge Overseas Medical Program in 1998. Dr Kedem then completed his residency in Internal Medicine at Columbia College of Physicians and Surgeons in Stamford, Connecticut and his fellowship in Hospital Medicine at the Cleveland Clinic in Cleveland, Ohio.

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