Attention Deficit Hyperactivity Disorder
(ADHD)

Attention deficit hyperactivity disorder (ADHD) is a condition that makes it hard to pay attention, sit still, or think before acting.

A Tale of Two Students

Justin and Katie are both seventh-grade students with ADHD. They act quite differently at school, however. Justin has a very hard time sitting still and staying in his seat. His classmates and teachers think of him as "hyper." Justin gets bored easily, so he tends to talk too much and get into trouble. He also bothers the other students around him, which leads them to get angry at him.

Katie does not wiggle and fidget the way Justin does. She has lots of trouble keeping her mind on her work and paying attention to the teacher, however. Katie also forgets which assignments she is supposed to do. She finds it tougher than most to keep up with her backpack, books, and school supplies. Sometimes she loses her homework, and sometimes she just forgets to turn it in.

What Is ADHD?

ADHD (also called ADD by many people) is a condition that can show itself as trouble with a poor attention span, easy distractability, hyperactivity ^* , and/or impulsiveness. People with ADHD may have only one or two of these problems, or they may have all three. Those with an attention problem have a hard time keeping their mind on any one thing for long. They may get bored with a task after only a few minutes. People who are hyperactive seem to be in constant motion. They may feel restless and squirm or fidget a lot. People who are overly impulsive seem not to think before they say or do things. They may take dangerous risks or blurt out embarrassing comments without thinking.

Of course, everyone has trouble paying attention or sitting still now and then. However, such problems occur more often and are more severe in people with ADHD. They begin before age seven, although they may not be recognized as signs of ADHD until later. The problems show up both at home and away, and they can lead to trouble with school, work, or relationships with family, friends, and teachers.

What Causes ADHD?

Scientists do not know for sure what causes ADHD. However, they believe that certain parts of the brain do not work the same way in people with ADHD as in people without it. Such people may have an altered balance of key brain chemicals, called neurotransmitters ^* , that affect how the brain works. Some research also suggests that in some cases use of alcohol or drugs by the mother during pregnancy can harm development of the baby's brain cells. This may be one cause of ADHD, although it is likely there are many causes.

A person's genetic makeup may be involved. ADHD seems to run in families. Children with ADHD usually have at least one parent, brother, sister, or other close relative with the disorder. Scientific studies have also found that, if one identical twin has ADHD, the other twin is likely to have it as well.

What Does Not Cause ADHD?

Experts used to think that attention problems were caused by slight brain damage or minor head injuries. However, we now know that most people with ADHD have no sign of brain damage or history of head injury. Another theory was that overactive behavior was caused by refined sugar and food additives. However, scientists found that eating a special diet seemed to help only about 5 percent of children with ADHD, mostly very young children or those with food allergies. It is true, however, that too much caffeine (found in coffee, tea, and some sodas) or some red/yellow dyes can add to hyperactive behaviors.

These things usually do not cause ADHD:

• Too much sugar
• Food allergies
• Too much television
• Poor teachers or schools
• Poor parents or home life

Who Gets ADHD?

ADHD is one of the most common of all conditions in childhood. It affects 3 to 5 percent of school-age children. This means that, on average, at least one child in every classroom in the United States needs help for the disorder. Two to three times more boys than girls have ADHD.

Many parents first notice overactive behavior when their child starts to walk as a toddler. However, such behavior usually is not labeled as ADHD until the child reaches elementary school. Without treatment, the disorder usually stays about the same through childhood and the early teen years. Problems caused by ADHD often improve during the late teen years and adulthood. Many adults are left with only a few signs of ADHD, but a few still have the full disorder.

What Are the Signs of ADHD?

Inattention (in-a-TEN-shun) means a poor attention span. These are some signs of inattention:

• Not paying close attention to details
• Making careless mistakes
• Having trouble keeping the mind on tasks
• Seeming not to listen when spoken to
• Not following instructions
• Not finishing schoolwork or chores
• Having trouble getting organized
• Avoiding or disliking schoolwork
• Being easily distracted
• Losing things
• Being forgetful

Hyperactivity (hy-per-ack-TIV-i-tee) means overly active behavior. These are some signs of hyperactivity:

• Fidgeting with the hands or feet
• Squirming when seated
• Not staying seated when expected to
• Running or climbing around too much
• Feeling restless a lot
• Having trouble doing quiet activities
• Seeming to be on the go all the time
• Talking too much

Impulsivity (im-pul-SIV-i-tee) means having less control over behavior. These are some signs of impulsivity:

• Blurting out answers before questions are finished
• Having trouble waiting for a turn
• Butting into other people's conversations or games

How Is ADHD Diagnosed?

Many things besides ADHD can cause similar kinds of problems. For example, depression can lead to trouble paying attention, while anxiety can make it hard to sit still. A learning disability can lead to poor school performance, while small seizures can cause mental lapses. Even an ear infection that leads to on-again-off-again hearing loss can look like ADHD. In addition, everyone has trouble staying focused and getting organized at times. This is why it is so important that ADHD be diagnosed by a trained medical or mental health professional.

A doctor or counselor usually watches the child or young adult's behavior and asks the patient to answer several questions, some of which deal with current signs of ADHD. Other questions deal with early childhood, medical problems, and family history. Parents and teachers may also be asked for examples of their experiences with the patient. Although there is no sure test for ADHD, the patient may be asked to take a number of tests, possibly including a computer test that measures the ability to pay attention. Instructions to press a key when a certain letter or shape appears on the screen can measure ability to pay attention. A medical doctor may do further tests to rule out other disorders, such as hearing loss because of ear infections, mild seizures, anxiety, or depression.

How Is ADHD Treated?

ADHD is usually treated with both medication and counseling, although sometimes only one or the other is needed. Medication helps people with ADHD focus and pay attention. Counseling helps them cope with problems related to ADHD. For example, the aim of counseling might be to improve study skills, boost self-esteem, or learn how to get along better with others.

Benefits of medication

The medications most often used to treat ADHD fall into a class of drugs known as stimulants (STIM-yoo-lants). Such drugs may have an arousing effect when taken at higher doses by adults. When taken by children with ADHD, however, they have the opposite effect. The drugs can help such children calm down and improve their ability to focus and learn. No one knows exactly how these drugs work to control ADHD. However, they may work by increasing the amount and activity of some of the brain chemicals known as neurotransmitters. Nine out of ten typical children with ADHD get better on one of these drugs. If one stimulant medicine does not help, another can be tried.

If stimulant medicines do not work, or if there are problems such as depression along with ADHD, other kinds of medicine may be used.

Risks of medication

When taken as directed by a doctor, stimulant medicines are considered safe. They usually do not make the patients "high" or jittery. They may cause other unwanted side effects ^* , however. Some patients may lose weight, feel less hungry, or temporarily grow more slowly. Others may have trouble falling asleep. If such side effects occur, they can often be handled by changing the dose or drug. A doctor needs to keep close tabs on the growth of any patient taking these medicines.

Stimulant medications sometimes are abused by teenagers, who take them at higher doses and in other ways than prescribed. This can be very dangerous, especially when the medicine is abused along with other drugs.

In recent years, there has been much debate about whether stimulant medicines are prescribed too often. Critics argue that some children who do not have true ADHD may be given the drugs as a way to control their difficult behavior. However, a study by the American Medical Association, published in 1998, found that this problem is not widespread.

Benefits of counseling

Counseling involves talking to a trained mental health professional about problems. Children with ADHD often do not feel very good about themselves. They may struggle with their schoolwork, or they may find it hard to make and keep friends. They may get into a lot of trouble with parents and teachers. Talking to a counselor can help them work out such problems. A counselor can offer ideas on making better grades, dealing with teasing, and getting along at school and home.

One form of counseling that is often used for ADHD is cognitive behavioral therapy (COG-i-tiv bee-HAYV-yoor-al THER-a-pee). This type of counseling lets people work directly to change their current behavior. Cognitive behavioral therapy might involve practical help, such as helping a person learn to think through tasks and keep a schedule. It might also involve teaching new behaviors, by giving praise or rewards each time the person acts in a desired way.

How Can Schools Help?

ADHD is considered a disability under federal law if it seriously interferes with a student's ability to learn. As a result, students with ADHD may be eligible for special school services. In order to get this help, a student usually has to take special tests. These may include an IQ test, which measures the student's ability to learn, and an achievement test, which measures what the student has actually learned about different subjects. Once testing is completed, school officials meet with the student's parents to go over the results and decide whether special services are needed. They discuss the student's problem areas as well as steps the school will take to help.

Children with ADHD are often as "smart" as other children, but their problems in school can stem from having a hard time paying attention and sitting still. Some make very good grades, but others struggle to do well. These children may need to be evaluated for learning differences, even after medicine or counseling are begun. Teachers can help such students by setting goals and giving rewards for reaching them. Students with ADHD may also need more one-on-one teaching and shorter work periods.

What About Self-Help?

People with ADHD can do things to make their lives easier. There is a good side to having this disorder. People with ADHD are often full of energy and ideas. The trick is to channel this energy in a positive way.

Coping at School

Some students with ADHD find that it is helpful to:

• Let their teachers know about ADHD, and ask for their help.
• Ask the teacher to repeat instructions, if needed, rather than guessing.
• Write down homework assignments in a notebook, and mark them off as they are done.
• Put homework in a backpack as soon as it is finished.
• Break large assignments down into small, simple tasks.
• Do homework in a quiet place, and take regular, short breaks.
• Sit at the front of the class, where it is easier to pay attention
• Take notes, which makes it easier to stay focused on the material.
• Tape reminder notes to a school locker.

Coping at Home

Many people with ADHD find it helpful to:

• talk to friends and family about ADHD, and ask for their help
• have a routine for doing regular chores, such as getting ready for school
• make a daily list of things to do, then plan the best order for doing them
• use a chart to stay on track, marking off tasks as they are finished
• store similar items, such as all video games, together in one place
• find physical activities, such as sports, to burn off excess energy
• tape reminder notes to the bathroom mirror.

What About the Future?

There is no "cure" for ADHD. Half of all children with ADHD will still show signs of the disorder as adults. However, these signs may lessen over time, and such adults can be helped by the same medicines and counseling that help children. In addition, as children with ADHD grow up, they often learn how to direct their enormous energy into useful activities, such as sports or work.