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What Is ADHD?

Lisa's son Jack had always been a handful. Even as a preschooler, he would tear through the house like a tornado, shouting, roughhousing, and climbing the furniture. No toy or activity ever held his interest for more than a few minutes and he would often dart off without warning, seemingly unaware of the dangers of a busy street or a crowded mall.

It was exhausting to parent Jack, but Lisa hadn't been too concerned back then. Boys will be boys, she figured. But at age 8, he was no easier to handle. It was a struggle to get Jack to settle down long enough to complete even the simplest tasks, from chores to homework. When his teacher's comments about his inattention and disruptive behavior in class became too frequent to ignore, Lisa took Jack to the doctor, who recommended an evaluation for attention deficit hyperactivity disorder (ADHD).

ADHD is a common behavioral disorder that affects about 10% of school-age children. Boys are about three times more likely than girls to be diagnosed with it, though it's not yet understood why.

Kids with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what's expected of them but have trouble following through because they can't sit still, pay attention, or focus on details.

Of course, all kids (especially younger ones) act this way at times, particularly when they're anxious or excited. But the difference with ADHD is that symptoms are present over a longer period of time and happen in different settings. They hurt a child's ability to function socially, academically, and at home.

The good news is that with proper treatment, kids with ADHD can learn to successfully live with and manage their symptoms.

Symptoms

ADHD used to be known as attention deficit disorder, or ADD. In 1994, it was renamed ADHD and broken down into three subtypes, each with its own pattern of behaviors:

1. an inattentive type, with signs that include:

2. a hyperactive-impulsive type, with signs that include:

3. a combined type, a combination of the other two type, is the most common

Although it can be challenging to raise kids with ADHD, it's important to remember they aren't "bad," "acting out," or being difficult on purpose. And they have difficulty controlling their behavior without medicine or behavioral therapy.

Diagnosis

Because there's no test that can detect ADHD, a diagnosis depends on a complete evaluation. Many kids with ADHD are evaluated and treated by primary care doctors, including pediatricians and family practitioners, but may be referred to specialists like psychiatrists, psychologists, or neurologists. These specialists can help if the diagnosis is in doubt, or if there are other concerns, such as Tourette syndrome, a learning disability, anxiety, or depression.

To be considered for a diagnosis of ADHD:

The behaviors also must not only be linked to stress at home. Kids who have experienced a divorce, a move, an illness, a change in school, or other significant life event may suddenly begin to act out or become forgetful. To avoid a misdiagnosis, it's important to consider whether these factors played a role when symptoms began.

First, your child's doctor may do a physical examination and take a medical history that includes questions about any concerns and symptoms, your child's past health, your family's health, any medicines your child is taking, any allergies your child has, and other issues.

The doctor also may check hearing and vision so other medical conditions can be ruled out. Because some emotional conditions (such as extreme stress, depression, and anxiety) can look like ADHD, you'll probably fill out questionnaires to help rule them out.

You'll be asked many questions about your child's development and behaviors at home, school, and among friends. Other adults who see your child regularly (like teachers, who are often the first to notice ADHD symptoms) probably will be consulted, too. An educational evaluation, which usually includes a school psychologist, might be done. It's important for everyone involved to be as honest and thorough as possible about your child's strengths and weaknesses.

Causes of ADHD

ADHD is not caused by poor parenting, too much sugar, or vaccines.

ADHD has biological origins that aren't yet clearly understood. No single cause has been identified, but researchers are exploring a number of possible genetic and environmental links. Studies have shown that many kids with ADHD have a close relative who also has the disorder.

Although experts are unsure whether this is a cause of the disorder, they have found that certain areas of the brain are about 5% to 10% smaller in size and activity in kids with ADHD. Chemical changes in the brain also have been found.

Research also links smoking during pregnancy to later ADHD in a child. Other risk factors may include premature delivery, very low birth weight, and injuries to the brain at birth.

Some studies have even suggested a link between excessive early television watching and future attention problems. Parents should follow the American Academy of Pediatrics' (AAP) guidelines, which say that children under 2 years old should not have any "screen time" (TV, DVDs, videos, computers, or video games) and that kids 2 years and older should be limited to 1 to 2 hours per day, or less, of quality television programming.

Related Problems

One of the difficulties in diagnosing ADHD is that it's often found along with other problems. These are called coexisting conditions, and about two thirds of kids with ADHD have one. The most common coexisting conditions are:

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)

At least 40% of kids with ADHD also have oppositional defiant disorder, which is characterized by stubbornness, outbursts of temper, and acts of defiance and rule breaking. Conduct disorder is similar but features more severe hostility and aggression. Kids who have conduct disorder are more likely to get in trouble with authority figures and, later, possibly with the law. Oppositional defiant disorder and conduct disorder are seen most commonly with the hyperactive and combined subtypes of ADHD.

Mood Disorders

About 20% of kids with ADHD also experience depression. They may feel isolated, frustrated by school failures and social problems, and have low self-esteem. About 15% to 20% of kids with ADHD also have bipolar disorder, which involves rapidly changing moods, irritability, and aggression.

Anxiety Disorders

Anxiety disorders affect about 30% of kids with ADHD. Symptoms include excessive worry, fear, or panic, which can lead to physical symptoms such as a racing heart, sweating, stomach pains, and diarrhea. Other forms of anxiety that can accompany ADHD are obsessive-compulsive disorder and Tourette syndrome, as well as motor or vocal tics (movements or sounds that are repeated over and over). A child who has symptoms of these other conditions should be evaluated by a specialist.

Learning Disabilities

About half of all kids with ADHD also have a specific learning disability. The most common learning problems affect reading (dyslexia) and handwriting. Although ADHD isn't categorized as a learning disability, its effects on concentration and attention can make it even harder for kids to do well in school.

If your child has ADHD and a coexisting condition, the doctor will carefully consider that when developing a treatment plan. Some treatments are better than others at addressing specific combinations of symptoms.

Treating ADHD

ADHD can't be cured, but it can be successfully managed. Your child's doctor will work with you to develop an individualized, long-term plan. The goal is to help your child learn to control his or her own behavior and to help families create an atmosphere in which this is most likely to happen.

In most cases, ADHD is best treated with a combination of medicine and behavior therapy. Any good treatment plan will include close follow-up and monitoring, and your doctor might make changes along the way. Because it's important for parents to actively participate in their child's treatment plan, parent education is also an important part of ADHD management.

Sometimes the symptoms of ADHD become less severe as a person grows older. Hyperactivity tends to ease as kids become young adults, although the problems with organization and attention often remain. More than half of kids who have ADHD will continue to have symptoms as young adults.

Medications

Several different types of medicines can be used to treat ADHD:

Medicines can affect kids differently, and a child may respond well to one but not another. When finding the correct treatment, the doctor might try a few medicines in various doses, especially if your child is being treated for ADHD along with another disorder.

Behavioral Therapy

Research has shown that medications used to help curb impulsive behavior and attention difficulties are more effective when combined with behavioral therapy.

This therapy attempts to change behavior patterns by:

Here are examples of behavioral strategies that may help a child with ADHD:

Alternative Treatments

The only ADHD therapies proven effective in scientific studies so far are medicines and behavioral therapy. But your doctor may recommend additional treatments and interventions based on your child's symptoms and needs. Some kids with ADHD, for example, might need special educational interventions such as tutoring and occupational therapy. Every child's needs are different.

Other alternative therapies promoted and tried by parents include megavitamins, diet changes, allergy treatments, chiropractic treatment, attention training, visual training, and traditional one-on-one "talking" psychotherapy. However, scientific research has not found these treatments to be effective, and most have not been studied carefully, if at all.

Parents should always be wary of any therapy that promises an ADHD "cure." If you're interested in trying something new, speak with your doctor first.

ADHD in the Classroom

As your child's most important advocate, you should become familiar with your child's medical, legal, and educational rights.

Kids with ADHD are eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. Keep in touch with teachers and school officials to monitor your child's progress.

In addition to using routines and a clear system of rewards, here are some other tips to share with teachers for classroom success:

Supporting Your Child, Yourself

Parenting a child with ADHD often brings special challenges. Kids with ADHD may not respond well to typical parenting practices. Also, because ADHD tends to run in families, parents may also have some problems with organization and consistency and need active coaching to help learn these skills.

Experts recommend parent education and support groups to help family members accept the diagnosis and to teach them how to help kids organize their environment, develop problem-solving skills, and cope with frustrations. Training also can teach parents to respond to a child's most trying behaviors with calm disciplining techniques. Individual or family counseling also can be helpful.

By learning as much as you can about ADHD and building partnerships with others involved in your child's care, you'll be a stronger advocate for your child. Take advantage of all the support and education that's available, and you'll help steer your child toward success.

Reviewed by: Shirin Hasan, MD
Date reviewed: July 2014

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Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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