Topic Overview
What is attention deficit hyperactivity disorder (ADHD)?
Attention deficit hyperactivity disorder (ADHD) is a condition in which
a person has trouble paying attention and focusing on tasks, tends to act
without thinking, and has trouble sitting still. It may begin in early
childhood and can continue into adulthood. Without treatment, ADHD can cause
problems at home, school, work, and with relationships. In the past, ADHD was
called attention deficit disorder (ADD).
What causes ADHD?
The exact cause is not clear,
but ADHD tends to run in families.
What are the symptoms?
The three types of ADHD
symptoms include:
-
Trouble paying attention. People with ADHD are easily distracted and have a hard time
focusing on any one task.
-
Trouble sitting still for even a short time. This is called hyperactivity. Children with ADHD may
squirm, fidget, or run around at the wrong times. Teens and adults often feel
restless and fidgety and are not able to enjoy reading or other quiet
activities.
-
Acting before thinking. People
with ADHD may talk too loud, laugh too loud, or become angrier than the
situation calls for. Children may not be able to wait for their turn or to
share. This makes it hard for them to play with other children. Teens and
adults seem to "leap before they look." They may make quick decisions that have
a long-term impact on their lives. They may spend too much money or change jobs
often.
How is ADHD diagnosed?
ADHD is often diagnosed
when a child is between 6 and 12 years old. Teachers may notice symptoms in
children who are in this age group.
First, the child will have a
physical exam to make sure that he or she does not have other problems such as
learning disabilities,
depression, or anxiety disorder. The doctor will use
guidelines from the American Psychiatric Association to diagnose ADHD. The
doctor may also look at written reports about the child’s behavior. Parents,
teachers, and others who have regular contact with the child prepare these
reports.
How is it treated?
There is no cure for ADHD, but
treatment may help control the symptoms. Treatment may include medicines and
behavior therapy. Parents and other adults need to closely watch children after
they begin to take medicines for ADHD. The medicines may cause side effects
such as loss of appetite, headaches or stomachaches, tics or twitches, and
problems sleeping. Side effects usually get better after a few weeks. If they
don't, the doctor can lower the dose.
Therapy focuses on making
changes in the environment to improve the child’s behavior. Often, counseling
and extra support at home and at school help children succeed at school and
feel better about themselves.
How does ADHD affect adults?
Many adults don't
realize that they have ADHD until their children are diagnosed. Then they begin
to notice their own symptoms. Adults with ADHD may find it hard to focus,
organize, and finish tasks. They often forget things. But they also often are
very creative and curious. They love to ask questions and keep learning. Some
adults with ADHD learn to manage their lives and find careers that let them use
those strengths.
But many adults have trouble at home and work. As
a group, adults with ADHD have higher divorce rates. They also are more likely
to smoke and have more substance abuse problems than adults without ADHD. Fewer
adults with ADHD enter college, and fewer graduate. Treatment with medicine,
counseling, and behavior therapy can help adults with ADHD.
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Frequently Asked Questions
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Learning about ADHD:
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Being diagnosed:
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Getting treatment:
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Ongoing concerns:
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Living with ADHD:
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Cause
The exact cause of
attention deficit hyperactivity disorder (ADHD) is not
known. But inherited genetic factors are likely responsible. Ongoing research
is focused on identifying
genes that cause a person to be susceptible to
ADHD.
Using various imaging tests, researchers have been able to
observe the brain at work. They have found a possible link between ADHD
and:
- Brain structure.
- The function of
chemicals in the brain that help regulate attention and activity (dopamine and
norepinephrine).
- Differences in function of some of the areas of
the brain that affect attention and impulse control.
A mother's use of cigarettes, alcohol, or other drugs during pregnancy may increase the risk for ADHD. Also, exposure to lead may cause symptoms associated with
ADHD.1
Although many parents believe
that foods with sugar and food additives make their children more hyperactive,
these foods have not been shown to cause ADHD.2
A study by the
National Institute of Mental Health found that certain parts of the brains of
children with ADHD develop normally but about 3 years later than in children
without ADHD.3 This may be why some children seem to
grow out of the disorder.
Some people have
misconceptions about ADHD, such as that children with
ADHD are lazy or dumb. Talk with a doctor about questions or concerns you have
about these issues.
Symptoms
The symptoms of
attention deficit hyperactivity disorder (ADHD) may
include:
-
Inattention, which is having a short
attention span and being easily distracted.
-
Impulsivity, which
can cause a person to do dangerous or unwise things without thinking about the
consequences.
-
Hyperactivity, which
is inappropriate or excessive activity.
These symptoms affect people in all age groups who have
ADHD. But typical behavior varies by age.
- In
preschool-age children, symptoms may be hard to
identify. Normal behavior in young children periodically includes all of the
major symptoms. ADHD is distinguished from normal behavior by the severity and
consistency of symptoms.
-
Children between the ages of 6 and 12
usually show more obvious signs of ADHD than other age groups. School
expectations can make symptoms more noticeable. For some children, school is
the first setting where academic performance and socialization abilities are
assessed. But it often is more difficult to detect ADHD when inattention is the
primary symptom and the child is otherwise well-behaved. The presence of ADHD
may be indicated by:
- Low grades or test scores, including achievement
tests.
- Poor organization and study
skills.
- Socialization problems and feeling rejected by
peers.
- Dislike of school and frustration with school work.
-
Teens between the ages of 13 and 18 may
be in better control of disruptive behavior related to hyperactivity. Other
problems that began in earlier years may continue or become worse when ADHD is
not treated. Teens with inattention problems who previously managed to cope may
start to fall behind in schoolwork. This is especially true when major changes
occur, such as starting at a new school or going to college.
-
Symptoms of ADHD in adults may not be as noticeable. Many adults with ADHD have not
been diagnosed and treated. They can develop problems such as
depression and difficulty keeping a job.
There are several
other conditions with symptoms similar to ADHD. For example, sometimes
bipolar disorder and ADHD can be confused. It can be
hard to know whether symptoms are caused by ADHD, another condition,
or both.
What Happens
Preschool age
Normally,
children 3 to 4 years of age are often inattentive,
hyperactive, and impulsive—all the symptoms of
attention deficit hyperactivity disorder (ADHD).
Differentiating between what is normal for the age and what may be caused by
ADHD can be difficult in children this young.
School-age and teen years
ADHD is most often
diagnosed in
children between ages 6 and 12. After a child starts
school, the symptoms of ADHD become more noticeable. During this period, ADHD
can disrupt many aspects of a child's life. Learning and academic performance,
adjusting to change, sleeping, and getting along with others are all potential
problem areas.
Symptoms of ADHD usually remain the same through
early adolescence. Approximately 60% to 85% of children with ADHD continue to
have symptoms into
the teen years.4 Children with ADHD are often
described as less mature than their peers and may lag behind in reaching
milestones typical for the age group.
But some symptoms typically
improve or become less obvious. For example, someone who had very disruptive
hyperactive behavior during elementary school may only fidget or feel restless
in high school.
Teens with ADHD have more problems when they are
driving cars. They get more speeding tickets and have serious car accidents
more often. They should be monitored closely by a licensed adult when they are
learning to drive.
Adults
Symptoms of
ADHD can last into adulthood and include difficulty focusing, organizing, and
finishing tasks. But adults often are able to adjust in the workplace better
than they did in the classroom as children.
Many adults do not
realize that they have ADHD until their children are diagnosed and they begin
to recognize their own symptoms. Some adults with ADHD learn to manage their
lives and find careers in which they can use their strengths—intellectual
curiosity and creativity—to their advantage. But many adults have difficulties
at home and work. As a group, adults with ADHD have higher divorce rates, are
more likely to smoke, and have more substance abuse problems than adults
who do not have ADHD. Also compared with their peers, fewer enter college and
fewer graduate. Treatment with medicine, counseling, and behavioral therapies
can be helpful.
Effects on family
Raising a child who has ADHD can
be a challenge. Parents must consistently monitor their child and respond to
problem behavior appropriately. If other issues are causing stress within a
family (such as divorce, violence, or drug or alcohol abuse), it may be even
more difficult to deal with a child who has ADHD.
Conditions that often accompany ADHD
There is
mounting evidence that people with ADHD commonly have one or more other
disorders such as
dyslexia,
oppositional defiant disorder,
conduct disorder,
anxiety, and
depression.
Treatment for ADHD can help
control symptoms, allowing a child to grow and develop normally. Treatment also
can decrease the frustration, discouragement, and failure that many people with
ADHD experience throughout their lives.
What Increases Your Risk
So far, it appears that the
greatest risk factor for developing
attention deficit hyperactivity disorder (ADHD) is
having an inherited tendency for the condition.
Environmental factors, such as certain parenting
methods, may influence how symptoms of ADHD are expressed, but these do not
cause ADHD.
A stressful family situation may contribute to a
child's symptoms. A child may feel guilty because of his or her symptoms and
the problems they cause, which can increase the risk of developing another
condition, such as
anxiety, along with ADHD.
When To Call a Doctor
Call a doctor if:
- You notice that you or your child has symptoms
of
attention deficit hyperactivity disorder (ADHD) that
began before age 7.
- Your child is showing signs of ADHD, such as
inattention,
impulsivity, and/or
hyperactivity, that are causing problems at home or
school. Parents and teachers often notice this behavior during the child's
first few years in school.
- Your child shows signs of other mental
health disorders, such as
depression or
anxiety, that last more than a few weeks or seem to be
getting worse.
- Your child is having academic or behavioral problems
at school.
Watchful Waiting
Preschool children
For young children who show
signs of attention deficit hyperactivity disorder, watchful waiting is
appropriate. It is difficult to diagnose ADHD in children younger than age 5.
Young children generally have short attention spans, and their normal range of
behavior includes periods of high activity and impulsivity. If you notice any
ADHD symptoms in your preschooler that do not seem age-appropriate, work with
your child to improve behavior. Keep a record of your child's behavior for 6
months to see if it improves. If it continues or has consequences, such as
being expelled from day care or preschool, talk with your doctor about having
your child evaluated.
School-age and teen years
Watchful waiting is
not appropriate for school-age children and teens with ADHD symptoms. Children
need attention from a doctor if they have behavior problems that occur in more
than one setting, such as poor relationships with parents and poor academic
performance.
Problems caused by inattention may not become
significant until the teen years, when greater self-reliance is expected. A
change in school (such as advancing to junior high or high school) or a new
environment (such as moving to another city) can trigger problems with
inattention. If you think your child may have an inattention problem, see a
doctor to find out if ADHD is the cause.
Adults
Watchful waiting may not be appropriate
if you are an adult and think that you may have ADHD. Consider how long you
have experienced symptoms, and think about any major changes or difficult
situations that are affecting your life. Your symptoms may improve when you
have addressed and worked on those issues. But talk to a doctor if your
symptoms concern you. If you have other symptoms, such as
depression or anxiety, a doctor can help diagnose and
treat your problems.
Who To See
Health professionals who can diagnose and treat
attention deficit hyperactivity disorder (ADHD) with medicine include:
Health professionals who do not prescribe medicines but
can provide behavioral therapy or family counseling include:
-
Psychologists
. Psychologists also
frequently diagnose ADHD.
- Behavioral specialists.
-
Social workers
.
- Psychiatric nurse specialists.
- Licensed
professional counselors.
- Family therapists.
Ask your doctor about his or her training
and experience related to ADHD. Diagnosing and treating ADHD requires an
ability to identify and distinguish behaviors that can be subtle and
complicated. Also, make sure your doctor has enough time to
evaluate you or your child. Accurate diagnosis and successful treatment of ADHD
takes repeated office visits and observations. It is also necessary that your
doctor be able to coordinate between other health professionals,
family members, teachers, and caregivers.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
The American Psychiatric Association
(APA) has established the symptoms and criteria for diagnosing
attention deficit hyperactivity disorder (ADHD). These
criteria divide the condition into three basic types based on major
symptoms:5
- ADHD, predominantly inattentive
type
- ADHD, predominantly hyperactive-impulsive
type
- ADHD, combined type
Also, some people are diagnosed with "ADHD, not
otherwise specified" when symptoms of inattention, hyperactivity, and/or
impulsivity are present but do not fit into one of the three types.
A doctor will use criteria for diagnosing attention deficit
hyperactivity disorders to determine whether a child has ADHD. Information used
to diagnose the condition includes:
It can be hard to determine whether a child's
behavior problems are caused by ADHD,
other conditions with similar symptoms, or a combination of ADHD and another
condition. Several
verbal and written tests for associated disorders are
used to help with this determination.
Also, children with
ADHD may have difficulty learning to read, write, or do math problems. Testing
for
learning disabilities will help teachers develop the
best educational plan for a child with these difficulties.
Other
tests may be done to identify other medical problems that might explain the
child's symptoms, such as:
- Hearing or vision impairment. This type of
disability often interferes with school achievement.
-
Lead
exposure. Children who have even small amounts of
lead in their bodies can have symptoms similar to ADHD.
- Low red
blood cell counts (anemia). This condition can cause low energy and poor
concentration. It can be diagnosed with results from a
complete blood count (CBC).
- Thyroid
disease. Blood tests can help find out if a person has too much or too little
thyroid hormone, which also can affect energy and attention. This is more
common in adults than children.
-
Seizures
.
Seizures can affect brain function and result in unusual behavior. In rare
cases, a person with ADHD symptoms may have an
electroencephalogram (EEG) to find out if seizures are
occurring.
Parents often question whether ADHD is overdiagnosed. Many
doctors and researchers believe that the increase in ADHD diagnoses results
from improved detection techniques, especially the standardization of
assessment criteria. Current and future research may help answer this
question.
Many adults with ADHD have never been diagnosed or
treated. ADHD is a lifelong condition that, left untreated, can lead to low
self-esteem, frustration, school or job failure, drug abuse, and
depression. To diagnose ADHD in an adult, a doctor may
use the Wender Utah Rating Scale (WURS), a written test that consists of 25
questions about childhood difficulties that are often seen with the condition.
The scale evaluates the presence and severity of ADHD symptoms during
childhood.
Adults with untreated ADHD are at an increased risk of
abusing drugs or alcohol. If an adult is suspected of
having or is diagnosed with ADHD, he or she may also be screened for alcohol
and drug abuse.
Early Detection
The American Academy of Pediatrics guidelines
recommend that doctors ask parents about behavior and school performance during
regularly scheduled well-child visits. This helps identify early signs of ADHD.
If you are concerned about how your child's temperament, learning skills, or
behavior is developing, talk with your doctor during your next visit.
Before meeting with your doctor, think about at what age your child's
symptoms began. Also, you and other caregivers should record when the
behavior occurs and how long it lasts. An important component of evaluation for
ADHD is considering the kinds of problems that result from the behaviors and to
what extent they affect academic performance and social behavior.
Some adults do not recognize their own symptoms of ADHD until their child
is diagnosed with the condition. If your child is diagnosed with ADHD or you
think you have symptoms, talk with your doctor about being screened for ADHD.
Treatment Overview
Initial treatment
Successful treatment of
attention deficit hyperactivity disorder (ADHD) begins
with an accurate diagnosis and understanding of a child's weaknesses and
strengths. Learning about ADHD will help you and your child's siblings better
understand how to help your child.
The American Academy of
Pediatrics (AAP) guidelines recommend medicine and/or behavior therapy to treat
children with ADHD.6
Your
child's doctor may recommend that your child take a
stimulant medicine, such as amphetamine (for example,
Dexedrine, Adderall) or methylphenidate (for example, Ritalin, Concerta,
Metadate CD). These medicines improve symptoms in about 70% of children who
have the condition.1
Although it may
seem contradictory, stimulants usually decrease hyperactivity and impulsivity
and improve focus. Some parents worry about their children becoming addicted to
stimulants. Research has shown that these medicines, when taken correctly, do
not cause dependence. But parents should closely supervise the use of ADHD
medicines, because abuse by siblings, classmates, and adults has been
reported.
Parents are also often concerned about medicine side
effects, including loss of appetite, nervousness, tics or twitches, and
problems sleeping. Children should be closely monitored after they start
medicines, to assess whether they are receiving the correct dose. These side
effects usually decrease after a few weeks on the medicines, or the dosage can
be lowered to offset side effects. For more information, see:
-
ADHD: Should My Child Take Medicine for ADHD?
Atomoxetine (Strattera) is a nonstimulant medicine
that may be prescribed if stimulant medicines are not effective or have
bothersome side effects. Strattera is not a controlled drug, which means
refills on prescriptions and telephone prescriptions are allowed.
The AAP guidelines also encourage
behavior therapy6. Through behavior therapy, parents
learn strategies, such as positive reinforcement, to improve a child's
behaviors. Children learn to develop problem solving, communication, and
self-advocacy skills. Behavior therapy is more helpful when used with medicine
than it is when used by itself.
Counseling may help children and
adults with ADHD recognize problem behaviors and learn ways to deal with them.
For both parents and children, counseling can be a place to air frustrations
and deal with stress.
Some children with ADHD also have other
conditions, such as
anxiety or
oppositional defiant disorder. Behavioral therapy can
help treat some of these conditions.
Elementary school teachers are often the first to recognize ADHD symptoms,
because in the classroom more demands are placed on children to sit still, pay
attention, listen, and follow class rules. Many times teachers recommend to
parents that a child be tested or see a doctor.
Most
children with ADHD qualify for
educational services within the public schools. If
your child qualifies, you will meet with school personnel to identify goals and
establish an individualized education program (IEP). IEPs are based on the
evaluation of a child's disability and his or her specific needs. This usually
means your school will try to accommodate your child's extra needs, which may
be as minor as placing him or her at the front of the class or as involved as
providing classroom staff to assist your child.
Your doctor will
talk with you about setting realistic and measurable goals for your child's
behavior at school and at home. Each child must be considered individually,
taking into account his or her specific problems and needs.
If
your child is preschool age, your doctor may encourage behavioral therapy in an
effort to curb symptoms and avoid using medicine at an early age. But if
behavioral therapy is not effective in controlling symptoms, some doctors
recommend medicines. Studies have shown that the
stimulant medicine methylphenidate (such as Ritalin) is safe and effective for
preschool-age children.7
Stimulant medicines may be related to slower growth in children, especially in the first year of taking the medicine. But most children seem to catch up in height and weight by the time they are adults. Your child's doctor will keep track of your child's growth and watch for problems.1
Ongoing treatment
Regular communication among
parents, teachers, and doctors benefits a child who has
attention deficit hyperactivity disorder
(ADHD).
Teens will benefit from continuing to take a
stimulant medicine—such as amphetamine (for example,
Dexedrine, Adderall) or methylphenidate (for example, Ritalin, Concerta,
Metadate CD, Focalin)—or nonstimulant
atomoxetine (Strattera) if either type of medicine has
been helpful in the past.
Parents can also be reassured that
taking stimulant medicine for ADHD does not increase the risk for substance
abuse later. In fact, some studies have found less alcohol and drug abuse in children and teens with ADHD who had taken stimulant medicines than in those who did not receive medicine.8 For more information, see:
-
ADHD: Should My Child Take Medicine for ADHD?
Staying closely involved with your teen and continuing
behavior therapy takes a lot of hard work but may pay
off in the long run. The teen years present many challenges, including
increased schoolwork and the need to be more attentive and organized. Making
good decisions becomes especially important during these years when peer
pressure, emerging sexuality, and other issues surface. Use consequences that
are meaningful to your teenager, such as losing privileges or having increased
chore assignments. Parents and teens can work together to establish reasonable,
obtainable goals and negotiate appropriate rewards when those goals are
met.
ADHD in adulthood
Attention deficit hyperactivity
disorder (ADHD) often goes undiagnosed in adults. The right treatment can help
those who have struggled with the condition for years. Like children with ADHD,
adults may benefit from medicine combined with psychological support, including
education about the disorder, support groups and/or counseling, and skills
training. Skills training can include time management, organizational
techniques, and academic and
vocational counseling.
Studies have found
that about 58% of adults who have ADHD report a better ability to focus and
less hyperactivity and impulsivity when they take
stimulant medicines.9 If
stimulant medicines have bothersome side effects or are not effective, your
doctor might recommend
atomoxetine (Strattera), a nonstimulant medicine.
Strattera is not a controlled drug, which means refills and telephone
prescriptions are allowed.
Certain antidepressants, such as
bupropion (for instance, Wellbutrin) or tricyclics (for example, imipramine,
nortriptyline, desipramine), are sometimes also recommended for adults who have
ADHD.
What To Think About
FDA Advisories
- The U.S. Food and Drug
Administration (FDA) has issued an
advisory on Strattera. The FDA does not recommend that people
stop using this medicine. It advises parents and other
caregivers to closely watch for
warning signs of suicide in children and teens taking
this medicine.
- The FDA has issued an advisory about atomoxetine and the risks of liver injury, orthostatic hypotension, and syncope. Call your doctor if you have nausea or belly pain. Also, call your doctor if you feel dizzy or lightheaded or if your skin is yellowing.
There are several
myths that can interfere with a realistic perception
of ADHD. It is important to understand that ADHD is a medical condition that
cannot be consistently controlled without treatment. Help your child with ADHD
to learn about the condition and the importance of following treatment plans.
Your child is more likely to successfully control symptoms when he or she
actively participates in treatment, such as taking medicines on time.
Some people use treatment methods that have not been proved helpful,
such as diet restrictions. Do not substitute these practices for conventional
medical treatment. Some treatments are potentially physically and emotionally
harmful or are unproved. Using them not only can be dangerous but may also prevent
you from using proven methods of treatment. Talk with a doctor about the
concerns or questions you or your child has about ADHD or its treatment.
Prevention
There is no known way to prevent
attention deficit hyperactivity disorder (ADHD).
Avoiding alcohol, drugs, and smoking during pregnancy may help prevent a child
from developing behavior similar to ADHD as well as many other health
problems.
Although you cannot prevent ADHD, you can help your
child have fewer learning and attention problems by:
- Having good medical care and practicing
healthy habits during pregnancy.
- Learning
and applying good parenting skills, including setting consistent behavior
limits.
- Maximizing preschool learning and attention skills by
reading to your child and providing new learning experiences such as puzzles
and board games. The development of attention skills can be increased with
these types of activities rather than by watching television.
Also,
nurturing techniques that begin at birth and continue
throughout childhood will help your child reach his or her potential regardless
of whether ADHD is a concern.
Home Treatment
Many home treatment methods can help
reduce your child's attention deficit hyperactivity disorder (ADHD)
symptoms. The approaches differ for children and adults. But treatment for all
ages emphasizes understanding the condition, creating a daily structure, and
using support systems.
When your child has ADHD, work together to
improve behavior and functioning at home and school. Also, it is
important for you to know that helping yourself will also help your
child.
Tips for self-care
-
Take care of yourself. It is often
challenging to raise a child who has ADHD. Caring for your own physical and mental
health is an important part of helping your child and will help provide the
needed energy.
-
Educate yourself about ADHD. Learn as
much as you can about the condition and your child's specific symptoms. You
will be better able to help your child if you understand the
condition.
-
Learn behavior management skills.
Children usually need help learning how to interact appropriately with other
people. You can help your child by learning behavior management skills. An
important component of behavior management is establishing
natural and logical consequences for
misbehavior.
Tips for your child
-
Helping your child build self-esteem.
Behaviors caused by ADHD can affect a child's feelings about himself or
herself. You can help your child develop healthy self-esteem by encouraging a
sense of belonging, confidence in learning, and an awareness of his or her
contributions.
-
Helping your child get the most out of school. The symptoms of ADHD can interfere with a child's ability to
succeed in school. Promoting school success will help your child academically,
socially, and developmentally.
-
Helping your child get things done. Children with ADHD have more difficulty than other children in
paying attention to instructions. And they frequently get distracted before
they can complete a task. Your patience, persistence, and creative thinking can
help your child learn skills and accomplish tasks at home and school.
Medications
Medicines are used to help control the
symptoms of
attention deficit hyperactivity disorder (ADHD):
hyperactivity,
impulsivity, and
inattention.
Most often, stimulant
medicines are used to treat ADHD. These medicines are effective for people of
all ages, although more research is needed on how adults respond. In general,
stimulant medicines improve symptoms in about 70% of people who have
ADHD.1 There are often quick and dramatic improvements
in behavior.
Other types of medicines may be used to treat
ADHD.
- Atomoxetine (Strattera) is a nonstimulant medicine for
ADHD.
- Some antihypertensives, designed to treat high blood
pressure, can also help control aggressive and impulsive behaviors in some
people.
- The antidepressant bupropion or a tricyclic antidepressant
may be needed if psychostimulants do not improve symptoms.
Medicine may be needed to treat other mental health
conditions, such as
anxiety disorders, that often occur along with
ADHD.
If you are giving your child medicine for ADHD, be sure that it is taken consistently. Also, you will need to
regularly monitor the effects of the medicine and communicate closely with your
child's doctor.
For more information, see:
-
ADHD: Should My Child Take Medicine for ADHD?
Medication Choices
The following medicines are used to treat attention
deficit hyperactivity disorder (ADHD):
-
Stimulants, such as Ritalin, Concerta, Metadate CD,
Focalin, Dexedrine, Adderall, and Daytrana
-
Atomoxetine
(Strattera), an approved nonstimulant medicine for children, teens, and adults
with ADHD
-
Antihypertensives, such as Catapres and
Tenex, which may be used to treat aggression and impulsivity not controlled by
ADHD medicines
- Antidepressants, such as bupropion (for example,
Wellbutrin)
FDA Advisories. The U.S. Food and
Drug Administration (FDA) has issued:
- An
advisory on Strattera. It suggests parents and other
caregivers closely watch for
warning signs of suicide in children and teens taking
this medicine.
- An
advisory on antidepressants. It advises that adults,
teens, and children who take this medicine be closely watched for warning signs of suicide.
The FDA does not recommend that people stop using these
medicines. Instead, a person taking these medicines should be watched for
warning signs of suicide.
All medicines approved for the
treatment of ADHD come with an FDA warning about possible heart-related or
mental health problems. Before starting a medicine for ADHD, tell your doctor
if you or your child has any heart problems, heart defects, or mental health
problems.
The FDA has issued an advisory about Strattera and the risks of liver injury, orthostatic hypotension, and syncope. Call your doctor if you have nausea or belly pain. Also, call your doctor if you feel dizzy or lightheaded or if your skin is yellowing.
What To Think About
All of a child's behavior
problems may not be controlled by medicine for ADHD. The child may still have a
higher level of some behavior problems than other children the same age. Also, it has not been proved that medicine improves the long-term
educational, occupational, and social functioning of a person who has
ADHD.
New longer-acting medicines allow many people to take one
pill a day for their ADHD symptoms, avoiding the multiple dosages that were
standard in the past.
Stimulant medicines may be related to slower growth in children, especially in the first year of taking the medicine. But most children seem to catch up in height and weight by the time they are adults. Your doctor will keep track of your child's growth and watch for problems.1 As with any
medicine, parents should think about not only the benefits of these medicines but also the potential risks.
Most
medicines to treat ADHD are approved by the FDA for children age 3 and older.
But there are few studies on the use of ADHD medicine for children age 5 and
younger. Most doctors do not prescribe medicines for a child who has ADHD
symptoms until he or she starts school. Younger children are more likely to
have side effects from medicines. But they may be prescribed for younger
children when symptoms severely affect a child's behavior and quality of
life.
Some medicines used to treat ADHD (such as stimulants) can
be abused. Make sure your child knows not to sell or give medicine to other
people. An adult should supervise the medicine.
Other Treatment
Other methods of treatment
that may be used for
attention deficit hyperactivity disorder include
behavior management, social skills training, and counseling.
Treatment for ADHD is based on your or your child's symptoms and problem
behaviors. Medicine is the most effective treatment for the major ADHD symptoms
of inattention, impulsivity, and hyperactivity. Other treatment is sometimes
recommended if:
- Symptoms are mild.
- Symptoms do not
respond to medicine.
- Medicines cause significant side
effects.
- Another condition, such as
anxiety, occurs along with ADHD. Medicine combined
with other treatment often is used.
Other Treatment Choices
Behavioral interventions
Behavioral
interventions help train parents, teachers, and other adults responsible for a
child with ADHD. Programs emphasize the need to establish routines and rules
for behavior and to closely monitor how a child responds. The adult
consistently delivers rewards or consequences depending upon how the child
complies with the rules. This type of treatment has been shown to be more
effective than
cognitive-behavioral therapy techniques.
Cognitive-based therapies depend more upon the child to self-direct behavioral
changes. A child with ADHD is not likely to have the
skills to change his or her behavior without help and guidance from adults.
Behavioral interventions most often used to help treat ADHD in a
child include:
-
Behavior management. Time-out and
reward systems can help a child with ADHD learn appropriate behaviors for the
classroom and home. Parent training in behavior management skills is conducted
during a series of 6 to 12 counseling sessions of 1 to 2 hours a
week.
-
Social skills training. These techniques help the
child learn to be less aggressive and impulsive, to manage anger, and to behave in a
more socially acceptable way.
- Counseling, including
family therapy. All household members can benefit from
learning methods to deal effectively with ADHD behavior.
Behavioral intervention for adults focuses on
assistance with organizational skills and healthy relationships.
Complementary and alternative medicine
Complementary and alternative medicine is used by some
therapists or others who do not operate within mainstream medical practice. But
none of these complementary therapies have been shown through clinical research
to be effective in treating ADHD and should not replace proven conventional
methods. More research is needed before any can be recommended as primary
treatment for ADHD. But a person with ADHD may
benefit from safe, nontraditional therapies used in addition to conventional
medical treatment. For example, acupuncture or biofeedback may help relieve
stress and muscle tension and improve a person's overall well-being and quality
of life.
If you are thinking about using complementary and
alternative medicine to help treat ADHD, be open with your doctor about the
subject. He or she can help direct you to treatments that are safe to use in
combination with proven techniques. Only those treatments that best help
control ADHD symptoms without causing physical or emotional harm should be
used.
What To Think About
Overall, medicines are the most
effective treatment for ADHD, although individuals vary in their response to
medicine. Behavioral training, training and education for parents, and
counseling are sometimes used as the primary treatment for mild symptoms.
Usually, these methods are used in addition to medicine for people with
moderate to severe symptoms.
Parents may understandably be
reluctant to give their child medicine. But studies show that for short-term
use, these medicines are safe and can positively affect behavior and improve
the quality of life for people with ADHD and for their families. It is
important to talk openly with your doctor about any concerns in order to best
understand and treat ADHD.
Other Places To Get Help
Organizations
|
American Academy of Child and Adolescent
Psychiatry
|
| 3615 Wisconsin Avenue NW |
| Washington, DC 20016-3007 |
| Phone: |
202-966-7300 |
| Fax: |
202-966-2891 |
| Email: |
communications@aacap.org |
| Web Address: |
www.aacap.org |
| |
|
This organization assists parents and families in understanding
developmental, behavioral, emotional, and mental disorders that can affect
children and teens.
|
|
|
Centers for Disease Control and Prevention (CDC):
National Center on Birth Defects and Developmental Disabilities
(NCBDDD)
|
| 1600 Clifton Road |
| Atlanta, GA 30333 |
| Phone: |
1-800-232-4636 (1-800-CDC-INFO) |
| TDD: |
1-888-232-6348 |
| Email: |
cdcinfo@cdc.gov |
| Web Address: |
www.cdc.gov/ncbddd |
| |
|
NCBDDD aims to find the cause of and prevent birth
defects and developmental disabilities. This agency works to help people of all
ages with disabilities live to the fullest. The Web site has information on
many topics, including genetics, autism, ADHD, fetal alcohol spectrum
disorders, diabetes and pregnancy, blood disorders, and hearing loss.
|
|
|
KidsHealth for Parents, Children, and
Teens
|
| 10140 Centurion Parkway North |
| Jacksonville, FL 32256 |
| Phone: |
(904) 697-4100 |
| Fax: |
(904) 697-4125 |
| Web Address: |
www.kidshealth.org |
| |
|
This Web site is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This Web site
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly e-mails about your area of interest.
|
|
|
National Dissemination Center for Children with
Disabilities
|
| 1825 Connecticut Avenue NW |
| Suite 700 |
| Washington, DC 20009 |
| Phone: |
1-800-695-0285 (Voice/TTY)
(202) 884-8200 (Voice/TTY) |
| Fax: |
(202) 884-8441 |
| Email: |
nichcy@aed.org |
| Web Address: |
www.nichcy.org |
| |
|
The National Dissemination Center for Children with
Disabilities (NICHCY) is the national information and referral center that
provides information on disabilities and disability-related issues for
families and professionals. The focus is on children and
youth, birth to age 22.
|
|
|
National Institute of Mental Health
(NIMH)
|
| 6001 Executive Boulevard |
| Room 8184, MSC 9663 |
| Bethesda, MD 20892-9663 |
| Phone: |
1-866-615-6464 toll-free
(301) 443-4513 |
| Fax: |
(301) 443-4279 |
| TDD: |
1-866-415-8051 toll-free |
| Email: |
nimhinfo@nih.gov |
| Web Address: |
www.nimh.nih.gov |
| |
|
The National Institute of Mental Health (NIMH) provides
information to help people better understand mental health, mental disorders,
and behavioral problems. NIMH does not provide referrals to mental health
professionals or treatment for mental health problems.
|
|
References
Citations
-
Greenhill LL, Hechtman LI (2009). Attention-deficit/hyperactivity disorder. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3560–3572. Philadelphia: Lippincott Williams and Wilkins.
-
National Institute of Mental Health (2008). Attention Deficit Hyperactivity Disorder (NIH Publication No. 08-3572). Available online: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/adhd_booklet.pdf.
-
Shaw P, et al. (2007). Attention-deficit/hyperactivity
disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Sciences, 104(49):
19649–19654.
-
American Academy of Child and Adolescent Psychiatry
(2007). Practice parameter for the assessment and treatment of children and
adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7): 894–921.
-
American Psychiatric Association (2000).
Attention-deficit and disruptive behavior disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th
ed., text rev., pp. 85–103. Washington, DC: American Psychiatric
Association.
-
Committee on Quality Improvement, American Academy of Pediatrics (2001). Clinical Practice Guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 108(4): 1033–1044.
-
Vitiello B, et al. (2007). Effectiveness of methylphenidate in the 10-month continuation phase of the preschoolers with ADHD treatment study (PATS). Journal of Child and Adolescent Psychopharmacology, 17(5): 593–603.
-
Upadhyaya HP (2008). Substance use disorders in children and adolescents with attention-deficit/hyperactivity disorder: Implications for treatment and the role of the primary care physician. Primary Care Companion Journal of Clinical Psychiatry. 10(3): 211–221.
-
Weiss M, Murray C (2003). Assessment and management of
attention-deficit hyperactivity disorder in adults. Canadian Medical Association Journal, 168(6): 715–722.
Other Works Consulted
- Greenhill LL, Hechtman LI (2009). Attention-deficit/hyperactivity disorder. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3560–3572. Philadelphia: Lippincott Williams and Wilkins.
- Keen D, Hadjikoumi I (2008). ADHD in children and adolescents, search date June 2007. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
- National Institute of Mental Health (2008). Attention Deficit Hyperactivity Disorder (NIH Publication No. 08-3572). Available online: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/adhd_booklet.pdf.
- Rappley MD (2005). Clinical practice: Attention deficit—hyperactivity
disorder. New England Journal of Medicine, 352(2):
165–173.
- Sadock BJ, et al. ( 2007). Attention-deficit
disorders. In Kaplan and Sadock's Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 1206–1217.
Philadelphia: Lippincott Williams and Wilkins.
- Stubbe D (2007). Attention deficit hyperactivity
disorder. Child and Adolescent Psychiatry, pp. 57–68.
Philadelphia: Lippincott Williams and Wilkins.
- Wilens TE, et al. (2004).
Attention-deficit/hyperactivity disorder in adults. JAMA, 292(5): 619–623.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
John Pope, MD - Pediatrics |
|
Specialist Medical Reviewer
|
Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics |
|
Last Revised
|
March 1, 2011 |