Attention deficit hyperactivity disorder (ADHD) is a chronic behavioral disorder of childhood onset (by age seven). It is characterized by behavior that is hyperactive, impulsive, and/or inattentive. These behaviors must persist for at least six months and be present in two environments (home, work, or school). ADHD affects children, adolescents, and adults.
Causes
The cause of ADHD is unknown. It most likely is caused by a chemical imbalance in the brain. There also appears to be a genetic factor since ADHD can run in families.
All children display some of the symptoms of ADHD sometimes. Children with ADHD, however, have symptoms that are noticeably more severe and consistent. Unlike normal children with lots of energy, children with ADHD often have difficulty in school and with their family and peers.
Behaviors linked to ADHD can last into adulthood. In adulthood, ADHD symptoms can continue to cause relationship difficulties, as well as problems with job performance and retention.
There are three types of ADHD (based on the symptoms displayed):
There is no standard test to diagnose ADHD. The diagnosis is made by a trained mental health professional. Family and teachers are involved as well.
The American Academy of Pediatrics recommends that the following guidelines be used for diagnosis in children 6-12 years of age:
Diagnosis should be initiated if a child shows signs of difficulty in:
School
Academic achievement
Relationships with peers and family
During diagnosis, the following information should be gathered directly from parents, caregivers, teachers, or other school professionals:
Assessment of symptoms of ADHD in different settings (home and school)
Age at which symptoms started
How much the behavior affects the child's ability to function
The healthcare professional should examine the child for:
Other conditions that might be causing or aggravating symptoms
Learning and language problems
Aggression
Disruptive behavior
Depression or anxiety
Psychotic symptoms
Personality disorder
For a diagnosis of ADHD to be made, symptoms must:
Be present in two or more of the child's settings
Interfere with the child's ability to function for at least six months
Fit a list of symptoms detailed in the most recent version of the
Diagnostic and Statistical Manual (DSM)
of the American Psychiatric Association
ADHD diagnosis is often complicated by the presence of other, sometimes co-existing, disorders such as learning disorder, conduct disorder, depression, anxiety disorder, and adjustment disorder.
Treatment
Therapies aim to improve the child's ability to function. Guidelines from the American Academy of Pediatrics encourage physicians to work as a team with parents and school personnel. Together, they can set realistic treatment goals and evaluate the child's response.
Treatments include:
Medication
Medications can help control behavior and increase attention span. Stimulants are the most common treatment for ADHD. They increase activity in parts of the brain that appear to be underactive in children with ADHD. Stimulant medications include:
Lisdexamfetamine dimesylate (Vyvanse)—This medication was recently approved to treat adults with ADHD. It can also be used to treat children aged 6-12 years.*²
In February 2007, the US Food and Drug Administration (FDA) directed the manufacturers of all drugs approved for the treatment of ADHD to develop Patient Medication Guides to alert patients to possible cardiovascular risks and adverse psychiatric symptoms associated with the medicines. There have been reports of sudden death in patients with underlying serious heart problems or defects and of
stroke
or
heart attack
in adults with certain risk factors. Another FDA review revealed a slight increased risk (about 1 per 1,000) for drug-related psychiatric adverse events, such as hearing voices, becoming suspicious for no reason, or becoming manic, even in patients who did not have previous psychiatric problems. If you have any questions about possible adverse effects of ADHD medications, speak with your doctor.
Because of the rare risk of serious heart problems, the American Heart Association suggests that children have an electrocardiogram (ECG) before starting stimulant medication for ADHD.*¹
Other drugs include:
Antidepressants—such as imipramine (Janimine, Tofranil), venlafaxine (Effexor), and bupropion (Wellbutrin)
Children who take medication and practice behavioral techniques do better than those who just use medication. Sometimes behavioral therapy includes working one-on-one with a therapist. Together they practice social and problem-solving skills. Counselors will also teach parents and teachers to modify the child's behavior through positive reinforcement. This could involve change in the classroom as well as in parenting style. Often, daily report cards are exchanged between parents and teachers.
Prevention
There are no guidelines for preventing ADHD because the cause is unknown. Proper treatment can prevent problems later in life with school, relationships, and drug and alcohol abuse.
RESOURCES:
Attention Deficit Disorder Association http://www.add.org
Children and Adults With Attention-Deficit/Hyperactivity Disorder (CHADD) http://www.chadd.org
CANADIAN RESOURCES:
About Kids Health http://www.aboutkidshealth.ca/
Canadian Psychiatric Association http://www.cpa-apc.org
References:
American Academy of Child and Adolescent Psychiatry website. Available at:
http://www.aacap.org/.
American Academy of Pediatrics website. Available at:
http://www.aap.org/.
American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.
American Psychiatric Association website. Available at:
http://www.psych.org/.
Attention deficit hyperactivity disorder. National Institute of Mental Health website. Available at:
http://www.nimh.nih.gov/publicat/adhd.cfm
#treat. Accessed February 9, 2008.
FDA directs ADHD drug manufacturers to notify patients about cardiovascular adverse events and psychiatric adverse events. FDA News. US Food and Drug Administration website. Accessed on February 13, 2008. Available at: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01568.html.
Methylphenidate and clonidine help children with ADHD and tics. National Institute of Neurological Disorders and Stroke website. Available at:
http://www.ninds.nih.gov/news_and_events/news_articles/news_article_adhd.htm. Accessed February 13, 2008.
The National Mental Health Association website. Available at:
http://www.nmha.org/.
Rappley M. Attention deficit-hyperactivity disorder.
NEJM. 2005; 352:165-173.
*¹
4/30/2008 DynaMed Systematic Literature Surveillance
DynaMed's Systematic Literature Surveillance: Vetter V, Elia J, Erickson C, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs. Circulation. American Heart Association website. Available at: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189473. Accessed April 30, 2008.
*²
4/30/2008 DynaMed Systematic Literature Surveillance
DynaMed's Systematic Literature Surveillance: FDA approval letter. US Food and Drug Administration website. Available at: http://www.fda.gov/cder/foi/appletter/2008/021977s001ltr.pdf. Accessed April 30, 2008.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
