Attention-Deficit Hyperactivity Disorder or Hyperactivity (ADHD), disorder
beginning in childhood, characterized by a persistent inability to sit still,
focus attention on specific tasks, and control impulses. Children with ADHD show
these behaviors more frequently and severely than other children of the same
age. A person with ADHD may have difficulty with school, work, friendships, or
family life. ADHD has also been referred to as attention-deficit disorder,
hyperkinesis, minimal brain dysfunction, and minimal brain damage.
Attention-deficit hyperactivity disorder is one of the most common mental
disorders of childhood, affecting 3 to 5 percent of school-age children. The
disorder occurs at least four times more often in boys than in girls. Although
the symptoms sometimes disappear with age, ADHD can persist into adolescence and
adulthood. Some estimates show that up to 2 percent of adults have ADHD. II
DIAGNOSIS Diagnosing ADHD is difficult because most children are inattentive,
hyperactive, and impulsive at least some of the time. In diagnosing ADHD,
experts use guidelines listed in the Diagnostic and Statistical Manual of Mental
Disorders. These guidelines require that a child show behaviors typical of ADHD
before the age of seven. The behaviors must last for at least six months, and
must occur more frequently than in other children of the same age. The behaviors
also must occur in at least two settings, such as classroom and home, rather
than just at a single setting. Controversy exists over the diagnosis of ADHD.
Physicians in the United States diagnose the disorder more often than doctors
elsewhere in the world. Critics regard this discrepancy as evidence that
physicians and psychologists too often apply psychiatric labels to children who
are naturally more active or simply nuisances to teachers and parents. III
CHARACTERISTICS Children and adults with ADHD consistently show various degrees
of inattention, hyperactivity, and impulsiveness. Inattention means that people
with ADHD have difficulty keeping their minds on one thing. They may get bored
with homework or other tasks after a few minutes, make careless mistakes, have
trouble listening, and seem to daydream. However, children with ADHD sometimes
can concentrate on and complete new or unusually interesting tasks.
Hyperactivity involves almost constant motion, as if driven by a motor. Children
may squirm and fidget at their desks in school, get up often to roam around the
room, constantly touch things, disturb other people, tap pencils, and talk
constantly. ADHD also makes children unusually impulsive, so that they act
before thinking. They may run into the street without looking, blurt out
inappropriate comments in class, interrupt conversations, and be unusually
clumsy or accident-prone. Children with ADHD often have severe learning problems
because of their difficulties in paying attention, following instructions, and
completing tasks. In addition, their disruptive, demanding behavior makes them
unpopular with peers. Children with ADHD often receive constant criticism and
correction from teachers and parents, who believe the behavior, is intentional.
The combination of negative feedback, poor academic achievement, and social
problems may contribute to low self-esteem and other emotional problems. IV
CAUSES Scientists do not know what causes ADHD. However, they have discredited
many theories that once were widely accepted. One theory contended that ADHD
resulted from minor head injuries or undetectable brain damage due to infections
or complications during birth. Experts called ADHD "minimal brain
damage" and "minimal brain dysfunction" when this theory was
popular in the early 1970s. Another theory linked ADHD with consumption of
refined sugar and food additives. Scientists questioned this theory when studies
showed that few children with ADHD benefited from diets restricting sugar and
food colorings. Most experts also reject the idea that poor parenting or a
dysfunctional home environment causes ADHD. Most scientists regard ADHD as a
biological disorder caused by abnormalities in the brain. Studies have shown
that areas of the brain that control attention span and limit impulsive behavior
are less active in people with ADHD. In addition, ADHD seems to run in families,
suggesting that genetic factors may play an important role (seeGenetics). One
study showed that about one-third of fathers who had ADHD in childhood have
children with ADHD. V TREATMENT Although there is no cure for ADHD, a variety of
treatments may help children with this disorder. These include medication,
counseling, social skills training, and other methods. A Medication Drugs are
the most common treatment for ADHD and can help reduce symptoms of the disorder.
Physicians usually prescribe one of three drugs: methylphenidate (Ritalin),
dextroamphetamine (Dexedrine or DextroStat), and pemoline (Cylert). These drugs
are normally stimulants, yet they ease hyperactivity and other symptoms in 90
percent of children with ADHD. The drugs work by altering levels of
neurotransmitters, brain chemicals that transmit nerve signals. A newer
stimulant used to treat ADHD, Adderall, combines dextroamphetamine and
amphetamine. Medical experts regard stimulants as safe. The most common side
effects include stomachaches, loss of appetite, nervousness, and insomnia. Drug
therapy may slow a child’s rate of growth temporarily, but growth usually
returns to normal during adolescence. Low doses of stimulants do not cause a
"high" sensation, sedate the child, or cause addiction. Experts often
recommend that children take medication only during school, with medication
breaks on weekends and holidays to reduce unwanted side effects. Doctors may
prescribe other types of drugs if stimulants do not prove effective. Critics
argue that physicians medicate too many children who do not have ADHD. They
point out that allergies, depression, anxiety, and conflicts with teachers or
parents, and other problems can make normal children seem hyperactive,
impulsive, and distracted. B Other Therapies Most children with ADHD need more
than medication. Drugs only relieve symptoms of ADHD, which usually return when
medication is discontinued. Although drugs help a child to concentrate and
complete schoolwork, they cannot increase a child’s knowledge, teach academic
skills, or directly alter underlying learning disorders or other problems.
Experts cite the need for more information on whether medication improves a
child’s chances for a successful career. Children may benefit from several
different kinds of therapy. Psychological counseling, for instance, can help
them recognize and deal with negative feelings that result from their symptoms.
Social skills training can help them recognize how their behavior affects other
people and help them develop more appropriate behavior. Children with ADHD also
may benefit from special academic tutors who show them how to break school
assignments down into small parts that can be completed one at a time. Because
children with ADHD often cause family turmoil, parents and other family members
may benefit from therapy or support groups in which other parents share their
experiences. Parental skills training can teach parents to manage a child’s
behavior with praise and other rewards, and with penalties such as
"time-outs" in which a child must sit alone to calm down. VI ADHD IN
ADULTS Many children with ADHD continue to have problems as adolescents and
adults. Adults with ADHD may be unusually impatient and restless and may become
bored before finishing a task. They may constantly arrive late for appointments,
lose things, change jobs often, and fail to organize their time or set
priorities, and have difficulty maintaining friendships and other relationships.
Studies suggest they are more likely than others to develop other mental
illnesses such as anxiety and depression, as well as substance-abuse problems
such as alcoholism and drug dependence.