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 an estimated 8% to 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 attend to 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 occur in different settings. They impair 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.
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:
- inability to pay attention to details or a tendency to make careless errors in schoolwork or other activities
- difficulty with sustained attention in tasks or play activities
- apparent listening problems
- difficulty following instructions
- problems with organization
- avoidance or dislike of tasks that require mental effort
- tendency to lose things like toys, notebooks, or homework
- forgetfulness in daily activities
2. a hyperactive-impulsive type, with signs that include:
- fidgeting or squirming
- difficulty remaining seated
- excessive running or climbing
- difficulty playing quietly
- always seeming to be “on the go”
- excessive talking
- blurting out answers before hearing the full question
- difficulty waiting for a turn or in line
- problems with interrupting or intruding
3. a combined type, which involves a combination of the other two types and 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 medication or behavioral therapy.
Because there’s no test that can determine the presence of ADHD, a diagnosis depends on a complete evaluation. Many children and adolescents diagnosed with ADHD are evaluated and treated by primary care doctors including pediatricians and family practitioners, but your child may also be referred to one of several different specialists (psychiatrists, psychologists, neurologists) especially when 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:
- a child must display behaviors from one of the three subtypes before age 7
- these behaviors must be more severe than in other kids the same age
- the behaviors must last for at least 6 months
- the behaviors must occur in and negatively affect at least two areas of a child’s life (such as school, home, day-care settings, or friendships)
The behaviors must also 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 in the onset of symptoms
First, your child’s doctor will take a medical history by performing a physical examination and asking you about any concerns and symptoms, your child’s past health, your family’s health, any medications your child is taking, any allergies your child may have, and other issues.
The doctor may also check hearing and vision so other medical conditions can be ruled out. Because some emotional conditions, such as extreme stress, depression, and anxiety, can also look like ADHD, you’ll 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, may also 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.
Recent 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 or videotapes, 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.
One of the difficulties in diagnosing ADHD is that it’s often found in conjunction 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 35% 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.
About 18% of kids with ADHD, particularly the inattentive subtype, also experience depression. They may feel inadequate, isolated, frustrated by school failures and social problems, and have low self-esteem.
Anxiety disorders affect about 25% of kids with ADHD. Symptoms include excessive worry, fear, or panic, which can also 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.
About half of all kids with ADHD also have a specific learning disability. The most common learning problems are with reading (dyslexia) and handwriting. Although ADHD isn’t categorized as a learning disability, its interference with concentration and attention can make it even more difficult for a child to perform 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.
to be continued…