Attention-deficit/hyperactivity disorder (ADHD)

Causes

The exact cause of ADHD is not known. Changes may happen as the brain develops. Genes or events in the world around a person may both play a role.

Child's Brain

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Risk Factors

Things that raise the risk of ADHD are:

• Having a parent, brother, or sister with ADHD
• Smoking, alcohol, or drug use in a child's mother during pregnancy
• Toxins from the environment (like lead) during pregnancy or after
• Premature birth and low birth weight
• Brain injury

Symptoms

ADHD is often first noticed during childhood. Some children with mild symptoms may not be aware they have ADHD until they are older. Symptoms are present in more than one setting, such as home and school.

Symptoms based on type of ADHD are:

• Inattentive
  • Easily distracted by sights and sounds
  • Little or no attention to detail
  • Does not seem to listen when spoken to
  • Often makes careless mistakes
  • Problems with follow through on instructions or tasks
  • Does not like activity that needs longer periods of mental effort
  • Loses or forgets things needed for tasks
  • Forgetful in day to day activities
• Hyperactive-Impulsive
  • Restless, tends to fidget and squirm
  • Not able to stay seated, prefers to run and climb
  • Blurts out answers before hearing the entire question
  • Hard time playing quietly
  • Talks more than needed
  • Interrupts others
  • Has difficulty waiting in line or waiting for a turn
• Combined ADHD—a mix of the symptoms above.

All children have some of these problems at some point. Children with ADHD have more severe symptoms. They will also occur more often.

Other health or behaviors that are more common in those with ADHD include:

• Depression
• Anxiety
• Seizures
• Conduct disorder—having a hard time following social rules
• Oppositional defiant disorder—negative, angry, and defiant behaviors
• Learning and language disorders
• Physical problems, such as sleep apnea
• Trouble sleeping
• Substance use disorder—common in older children with untreated ADHD
• Tobacco use

Diagnosis

There is no standard test for ADHD. A trained health provider will make a diagnosis. They will observe the child and talk to family, caregivers, and teachers.

A doctor will also rule out any other health issues that may be causing problems.

Treatment

ADHD is a lifelong condition. The effects of ADHD can be managed with treatment. The goal of treatment is to improve the ability to grow or succeed and have healthy relationships. Doctors should work together with parents, school staff, and other health professionals. Together, they can set realistic goals and monitor the child's progress. Proper treatment can prevent problems later in life.

Treatments include:

Sleep

Children who do not sleep enough may suffer from worse behavioral problems. A key part of treatment is to have children with ADHD get plenty of sleep.

Medicine

Medicine may be used alone or with therapy in people over 6 years of age. It can help to control behavior and increase focus.

Stimulants are the most common type of medicine used to treat ADHD. They increase activity in parts of the brain that seem to be less active in those with ADHD. There are different types of medicine. The medical team will work with patients to find what works best. They will also work to balance the benefits and risks of each medicine.

Other medicine choices are:

• Selective norepinephrine reuptake inhibitors—to improve attention and decrease impulsiveness and hyperactivity
• Antidepressants—to manage depression symptoms
• Antipsychotics—to treat aggressive behavior
• Certain blood pressure lowering medication—to treat impulsivity

Behavior Therapy

Therapy may be all that is needed for younger children. Therapy can also help children who take medicine do better.

Therapy will help by teaching new social and problem-solving skills. Parents and teachers will also be shown ways to help their children adapt. This may include changes in the classroom, as well as changes to how they parent. For example, an air cushion on a child's seat at school allows the child to move their body without distracting other students. Moving their body may help them increase their attention span.

ADHD coaching can also be helpful for older children. Coaches work to help them organize and be more successful.

Prevention

There are no current guidelines to prevent ADHD because the cause is not clear.