10 Key Questions About Attention Deficit Hyperactivity Disorder (ADHD)
Attention deficit hyperactivity disorder (ADHD) is a condition that begins in early childhood with symptoms of inattention, impulsivity, hyperactivity and/or the inability to control one’s own behavior. ADHD affects between 3 and 5 percent of children, or approximately 2 million children in the United States. Children with ADHD may have difficulty at school, at home and in social settings. Between 30 and 70 percent of children with ADHD have symptoms that persist into adulthood.
The most common characteristics of those with ADHD include:
- Poor attention; excessive distractibility
- Physical restlessness or hyperactivity
- Excessive impulsivity; saying or doing things without thinking
- Excessive and chronic procrastination
- Difficulty getting started on tasks
- Difficulty completing tasks
- Frequently losing things
- Poor organization, planning, and time management skills
- Excessive forgetfulness
Not everyone with ADHD has all of these symptoms or the same level of impairment from their symptoms.
ADD/ADHD is a serious health risk to you, your child or other loved ones. If you feel there may be an issue that needs to be addressed, please download and complete the appropriate screening test/survey.
Upon completion, please return to Dr. Kallal’s office for a consultation.
ADD and ADHD are distinct conditions, though they share many of the same symptoms. Their differences do not make one better or worse than the other, but gaining a proper understanding of each condition will arm you with the information you need to create the best treatment regimen possible.
You have ADD: you have trouble at company meetings, you find yourself constantly daydreaming and being snapped back to paying attention when someone says your name. You consistently lose your keys, forget appointments and are one of the most disorganized people in the office. Your co-worker, on the other hand, has ADHD. He is constantly moving, constantly talking and never seems to complete anything, just moves from one project to the next. He always looks busy but he says he never feels like he has accomplished anything. Even though you are so different, you both have the same disorder. It is baffling to think that you both take the same medication and it helps decrease his symptoms of hyperactivity while providing you with more motivation.
ADD is commonly used to refer to Attention Deficit Disorder without hyperactivity and ADHD is often used to describe Attention Deficit Disorder with hyperactivity. Both are considered to be a type of the same condition. There are some major differences between ADD and ADHD:
ADD without hyperactivity (ADHD, Predominantly Inattentive Type), includes symptoms such as inability to sustain attention, making careless mistakes, avoiding tasks that require sustained mental effort, and becoming easily distracted.
ADHD (ADHD, Predominantly Hyperactive-Impulsive Type), has symptoms such as fidgeting, being constantly in motion, restlessness, talking excessively, blurting out answers, and interrupting others.
In addition to the above symptoms, there are a number of characteristics that are often shared by both ADD and ADHD:
- Difficulty in school
- Lack of organizational skills
- Regularly losing items
- Poor social skills
- Low self-esteem
- Relationship problems
Behavioral problems are more often associated with ADHD, while ADD has a high incidence of co-existing emotional conditions such as depression and anxiety. ADHD is normally diagnosed at an earlier age, as hyperactivity is much more recognizable. Problems associated with ADD may be misunderstood and mislabeled as extreme shyness and therefore not diagnosed until later, sometimes in middle school or high school or not until adulthood.
Relationship issues also seem to occur in both ADHD and ADD. The high energy level of ADHD can allow an individual to attract many people, although they may have more of a problem developing a close emotional bond. People with ADD, on the other hand, have a harder time making friends with others because of their quiet manner, but once they do, they are more easily able to create deep friendships.
At one time, it was thought that ADHD was a boy’s disorder and ADD was the girl’s disorder. This is now known not to be true, there are boys suffering from symptoms of ADD and girls that are hyperactive.
Overall, there are distinctive characteristics and symptoms for ADHD and ADD. There are also similarities. One is not worse or better than the other, there is simply a difference in behavior patterns. Treatment, when properly done, will not differentiate between ADD and ADHD but will target the specific areas of difficulty in a person’s life and work to improve their lives.
(2004). The Disorder Named AD/HD. from National Resource Center on AD/HD Web site: http://www.help4adhd.org/en/about/what/WWK1
(2004). AD/HD Predominantly Inattentive Type (WWK8). from National Resource Center on AD/HD Web site: http://www.help4adhd.org/en/about/what/WWK8
(2005). Peer Relationships and ADHD. from Centers for Disease Control and Prevention Web site: http://www.cdc.gov/ncbddd/adhd/peer.htm
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders. ADHD is a broad term, and the condition can vary from person to person. There are an estimated 6.4 million diagnosed children in the United States, according to the Centers for Disease Control and Prevention.
This condition is sometimes called attention deficit disorder (ADD), but this is an outdated term. The term was once used to refer to someone who had trouble focusing but was not hyperactive. The American Psychiatric Association released the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in May 2013. The DSM-5 changed the criteria to diagnose someone with ADHD.
Keep reading to learn more about the types and symptoms of ADHD.
Types of ADHD
There are three types of ADHD:
Inattentive ADHD is what’s usually meant when someone uses the term ADD. This means a person shows enough symptoms of inattention (or easy distractibility) but isn’t hyperactive or impulsive.
This type occurs when a person has symptoms of hyperactivity and impulsivity but not inattention.
Combined ADHD is when a person has symptoms of inattention, hyperactivity, and impulsivity.
Inattention, or trouble focusing, is one symptom of ADHD. A doctor may diagnose a child as inattentive if the child:
- is easily distracted
- is forgetful, even in daily activities
- is unable to give close attention to details in school work or other activities and makes careless mistakes
- has trouble keeping attention on tasks or activities
- ignores a speaker, even when spoken to directly
- doesn’t follow instructions
- fails to finish schoolwork or chores
- loses focus or is easily side-tracked
- has trouble with organization
- dislikes and avoids tasks that require long periods of mental effort, such as homework
- loses vital things needed for tasks and activities
Hyperactivity and impulsivityA doctor may diagnose a child as hyperactive or impulsive if the child:
- appears to be always on the go
- talks excessively
- has severe difficulty waiting for their turn
- squirms in their seat, taps their hands or feet, or fidgets
- gets up from a seat when expected to remain seated
- runs around or climbs in inappropriate situations
- is unable to quietly play or take part in leisure activities
- blurts out an answer before someone finishes asking a question
- intrudes on and interrupts others constantly
Inattention, hyperactivity, and impulsivity are important symptoms for an ADHD diagnosis. In addition, a child or adult must meet the following criteria to be diagnosed with ADHD:
- displays several symptoms before the age of 12
- has symptoms in more than one setting, such as school, at home, with friends, or during other activities
- shows clear evidence that the symptoms interfere with their functioning at school, work, or in social situations
- has symptoms that are not explained by another condition, such as mood or anxiety disorders
Adults with ADHD have typically had the disorder since childhood, but it may not be diagnosed until later in life. An evaluation usually occurs at the prompting of a peer, family member, or co-worker who observes problems at work or in relationships.
Adults can have any of the three subtypes of ADHD. Adult ADHD symptoms can differ from those of children because of the relative maturity of adults, as well as physical differences between adults and children.
Learn more: 12 Signs of adult ADHD »
The symptoms of ADHD can range from mild to severe, depending on a person’s unique physiology and environment. Some people are mildly inattentive or hyperactive when they perform a task they don’t enjoy, but they have the ability to focus on tasks they like. Others may experience more severe symptoms. These can affect school, work, and social situations.
Symptoms are often more severe in unstructured group situations than in structured situations with rewards. For example, a playground is a more unstructured group situation. A classroom may represent a structured and rewards-based environment.
Other conditions, such as depression, anxiety, or a learning disability may worsen symptoms.
Some people report that symptoms go away with age. An adult with ADHD who was hyperactive as a child may find that they’re now able to remain seated or curb some impulsivity.
Determining your type of ADHD puts you one step closer to finding the right treatment. Be sure to discuss all your symptoms with your doctor so you get an accurate diagnosis.
Causes of ADHD
Because attention deficit hyperactivity disorder (ADHD) symptoms—inattention, impulsivity, and/or hyperactivity—affect a child’s ability to learn and get along with others, some people think an ADHD child’s behavior is caused by a lack of discipline, a chaotic family life, or even too much TV. In fact, research suggests that ADHD is largely a genetic disorder. However, some environmental factors may play a role as well. Here, we separate fact from fiction about the causes of ADHD.
Research does suggest a possible link between ADHD and pesticides. A 2010 study in Pediatrics found that children with higher urine levels of organophosphate, a pesticide used on produce, had higher ADHD rates. Another 2010 study showed that women with higher urine levels of organophosphate were more likely to have a child with ADHD. The studies suggest a possible link, but can’t prove that pesticides cause ADHD. Marcy Rosenzweig Leavitt, PsyD, who works with ADHD patients in private practice in the Los Angeles area, recommends buying organic varieties of fruits and vegetables, especially those prone to high levels of pesticides (or scrubbing nonorganic produce before eating).
Smoking, drinking in pregnancy
Fetal exposure to alcohol and tobacco is thought to play a role in ADHD. Children exposed to tobacco smoke prenatally are 2.4 times as likely to have ADHD as those who are not, research suggests.
“Fetuses exposed to alcohol can develop fetal alcohol effects or fetal alcohol syndrome, and the prominent features for both are the symptoms you see in ADHD,” says Mark L. Wolraich, MD, chief of the section of developmental and behavioral pediatrics at the University of Oklahoma Health Sciences Center, in Oklahoma City.
Lead, a neurotoxin, has been removed from most homes and schools, but traces of it are still everywhere. A 2009 study found that children with ADHD tend to have higher blood-lead levels than other kids.
“Lead can be toxic to developing brain tissue and may have sustained effects on the behavior of children exposed to these substances at early ages,” says Leavitt, who practices under the supervision of Richard Oelberger, PhD. “Still, it is unlikely that such exposure accounts for differences in brain development in the vast majority of children and adolescents with ADHD.”
Many European countries have banned certain preservatives after research linked hyperactivity in young children to food with mixtures of some artificial food colors and the preservative, sodium benzoate.
The FDA says food additives are safe when used “properly,” and most additives aren’t required to be clearly labeled on packaging. Experts think only a small number of children will benefit from avoiding brightly colored processed foods, which tend to have more additives.
“Consult with your child’s doctor before putting your child on a particular diet,” says Leavitt. Reducing consumption of these additives may or may not help hyperactive behavior; many factors play a role in ADHD.
Parents often blame sugar for a child’s hyperactive behavior, but it’s time to stop.
“The overwhelming number of studies have not been able to demonstrate behavior changes due to sugar consumption in children,” says Dr. Wolraich.
A study in the Journal of Abnormal Child Psychology found that mothers who thought their children were given sugar rated their children’s behavior as more hyperactive than mothers who were told their children were given a sugar substitute—regardless of whether their children actually consumed real sugar.
Limit sugar if you’re concerned about calorie consumption or dental cavities, not because of ADHD.
TV or video games
There’s no proof that too much TV or video-game time causes ADHD, although research has found that school- and college-age students who spent more time in front of a screen had more attention problems than those who did not.
In theory, the constant stimulation of TV and video games may make it harder for kids to pay attention. But experts emphasize that screen time alone can’t explain ADHD. “There is an association between (ADHD and) the number of hours young children watch TV or play video games, but more study is required to determine if it is a causal relation or it’s because children with ADHD gravitate more toward those activities,” says Dr. Wolraich.
ADHD symptoms can be confused with rebellious or bad behavior, so it’s not uncommon to try to blame the parents for a child’s conduct. But according to the National Resource Center on ADHD, there’s no strong evidence that parenting style contributes to ADHD.
“While it’s true that parenting style and social circumstances may aggravate ADHD behaviors, parental style is not the cause of ADHD,” says Leavitt, who says parents who set consistent behavioral limits, use reward and consequence behavior tools, and provide a clear set of expectations can help reduce ADHD symptoms.
On the other hand, a stressful home environment or parents who refuse to accept ADHD as a diagnosed condition can make the symptoms worse.
“Brain injury that results from a serious blow to the head, a brain tumor, a stroke, or disease can cause problems with inattention and poor regulation of motor activity and impulses,” says Leavitt.
And according to the National Institute of Mental Health (NIMH), children who have suffered certain types of brain trauma may show symptoms similar to ADHD. But because only a small portion of children with ADHD have suffered a traumatic brain injury, it’s not considered a major risk factor.
Although it was once popularly believed that food allergies or sensitivities cause ADHD, the research so far has been unable to support the idea that diet plays a significant role in ADHD, Leavitt says.
Still, certain dietary components may affect behavior, and a recent Australian study suggested that adolescents with diets high in fat, refined sugar, and sodium were two times as likely to be diagnosed with ADHD as other kids. Additional studies have also linked diets deficient in omega-3 fatty acids, which are important for brain development and function, to ADHD symptoms.
The evidence strongly suggests that ADHD is passed down from parents, not parenting style.
“There is a very strong heritability to ADHD,” affirms Smith. “It may be one of the most heritable psychiatric disorders.” In fact, a child with ADHD is four times as likely to have had a relative who was also diagnosed with ADHD, and results from studies of multiple twins indicate that ADHD often runs in families.
Ongoing research is looking to pinpoint the genes responsible for ADHD. A new study by scientists at Cardiff University in Wales found that children with ADHD are more likely to have missing or duplicated segments of DNA.
Because there’s no objective ADHD test, parents, doctors, and educators continue to debate over whether ADHD is overdiagnosed.
Some say doctors are too quick to diagnose a child’s behavioral problems as ADHD without considering other possible causes. North Carolina State University researchers found that children who are several months younger than their peers could be mistakenly diagnosed with ADHD when, in fact, they are just less mature than their classmates.
Nonetheless, according to Dr. Wolraich, “most of the evidence is that ADHD is underdiagnosed and undertreated.”
While smoking, alcohol, and pesticides may be a problem, researchers are looking at other toxins too.
For instance, Boston University School of Public Health researchers found a link between polyfluoroalkyl chemicals (PFCs)—industrial compounds widely used in products like stain-resistance coatings and food packaging—and ADHD. Phthalates—found in items like toys, food packaging, and cosmetics—have also been linked to ADHD.
But as with many factors, the evidence only points to a correlation and can’t prove that these chemicals contribute to ADHD.
There is no single test that can be used to diagnose attention deficit hyperactivity disorder in children and adults. ADHD is diagnosed after a person has shown some or all of the symptoms of ADHD on a regular basis for more than six months. In addition, symptoms must be present in more than one setting and have been present since the age of 12. Depending on the number and type of symptoms, a person will be diagnosed with one of three subtypes of ADHD: Primarily Inattentive, Primarily Hyperactive or Combined subtype.
Diagnosing ADHD in Children
Health care providers, such as pediatricians, psychiatrists, and child psychologists, can diagnose ADHD with the help of standard guidelines from the American Academy of Pediatrics or the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). The diagnosis involves gathering information from several sources, including schools, caregivers, and parents. The health care provider will consider how a child’s behavior compares with that of other children the same age, and he or she may use standardized rating scales to document these behaviors.
Some symptoms that suggest ADHD in children include inattention, hyperactivity, and/or impulsivity. Many children with ADHD:
- Are in constant motion
- Squirm and fidget
- Make careless mistakes
- Often lose things
- Do not seem to listen
- Are easily distracted
- Do not finish tasks
To diagnose ADHD, your child should receive a full physical exam, including vision and hearing screenings. Also, the FDA has approved the use of the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, a noninvasive scan that measures theta and beta brain waves. The theta/beta ratio has been shown to be higher in children and adolescents with ADHD than in children without it. The scan, approved for use in those aged 6 to 17 years, is meant to be used as a part of a complete medical and psychological exam.
In addition, the health care provider should take a complete medical history to screen for other conditions that may affect a child’s behavior. Certain conditions that could mimic ADHD or cause the ADHD-like behaviors are:
- Recent major life changes (such as divorce, a death in the family, or a recent move)
- Undetected seizures
- Thyroid problems
- Sleep problems
- Lead toxicity
By Eve Kessler, Esq. based on a presentation by Alan Wachtel, MD
At a glance
- When left untreated ADHD is among the most debilitating disorders to live with
- The risks of not treating ADHD include academic, social, and emotional problems in childhood
- The problems may follow a person into adulthood impacting job performance, marital and family relationships, mental health, and automobile safety
- Children with ADHD who are not treated are more likely to self-medicate with drugs and alcohol
Children with ADHD who fare the best are those who have effective parents, are correctly diagnosed, and receive a combination of psychological, behavioral, educational, and pharmacological interventions. Yet even when treated, ADHD has a significant impact on an individual from childhood through adulthood.
When ADHD is left unmanaged, every area of life is negatively affected. In fact, research shows that untreated ADHD is one of the most highly impairing disorders to live with.
To Medicate or Not To Medicate
Many families struggle with whether or not to medicate their child. For these families, conducting a risk-benefit analysis is helpful.
When defining risk, concentrate on the larger picture. Don’t just focus on whether it is too risky to give your child medication. Every drug has its negative side effects and costs (one can overdose on Tylenol).
Instead, ask, “What are the risks of not treating my child?” Consider the potential implications of inattention, impulsiveness, and hyperactivity over a lifetime—on school and academic achievement, self-esteem and satisfaction, sexual behavior (unwanted pregnancies, STDs), family and social relationships, marriage and divorce, occupational status, job performance and job loss, and driving ability, accidents and automobile crashes.
ADHD Medications & Other Substances
If left untreated, adolescents will self-medicate. There is a 100% increased risk of substance abuse among this group of teens.
The sequence generally begins with tobacco and alcohol, turns to marijuana, then moves to cocaine, changing quickly from use to abuse. Because cocaine creates focus in the ADHD brain, a teenager who self-medicates with cocaine will become calm and centered enough to read a book or concentrate on a task.
Why wouldn’t he want to continue using it?
Of course, adolescents who are taking prescription medication for their ADHD are not immune to substance use. However, in research studies, treated teens become indistinguishable from their typical peers; in other words, they behave like other curious adolescents. These teens may or may not experiment with drugs, but if they do, they are not doing it to meet a neurobiological need.
Studies have found no compelling evidence that treating adolescents with ADHD medications will start them down a path to addiction. Conversely, research has confirmed that prescribing appropriate medications to children with ADHD does not lead to an increased risk of substance experimentation, use, dependency, or abuse.
Teens with ADHD who are treated become more sensitive to their bodies, respectful of their physical needs, and open to keeping themselves healthy.
Implications for Adults
The serious impact of failing to treat ADHD continues throughout adulthood. Adults with unmedicated ADHD are 78% more likely to be addicted to tobacco and 58% more likely to use illegal drugs than those without ADHD.
Seventy-nine percent of adults with ADHD who were not treated as children experience symptoms of anxiety, depression, and physical ailments compared with 51% of adults without ADHD.
Other Lifelong Problems
The educational implications of untreated ADHD are profound. Up to 58% of children who were not medicated for their ADHD failed a grade in school. In one study, 46% had been suspended from school. As many as 30% of adolescents with untreated ADHD fail to complete high school, compared with 10% of those without ADHD.
Thirty-eight percent of young adults with unmedicated ADHD have been pregnant or have caused an unwanted pregnancy, compared with 4% of those without ADHD. Seventeen percent of young adults with ADHD have contracted a sexually transmitted disease, as opposed to 4% of those without.
The epidemic of traffic fatalities has also been linked to untreated ADHD. Driving is the most dangerous activity that teenagers do, and car accidents are the leading cause of death among young adults in North America. With driving performance seriously impacted by inattention, impulsiveness, and hyperactivity, young drivers with untreated ADHD have two to four times as many motor vehicle crashes as their peers without ADHD. Recent research places their risk of destroying a car even higher than that of an adult who is legally drunk.
The three major symptoms of ADHD also interfere with personal relationships, negatively affect family cohesiveness, reduce the chances of personal success and satisfaction, and put healthy marriages at risk. Those with untreated ADHD are twice as likely to divorce as their treated or typical peers.
This article is based on a presentation by Alan Wachtel, MD, sponsored by Smart Kids with Learning Disabilities. Dr. Wachtel is a psychiatrist and noted expert on the treatment of ADHD. He is the author of The Attention Deficit Answer Book: The Best Medications and Parenting Strategies for Your Child. Eve Kessler, Esq., an attorney with The Legal Aid Society, NYC, is President of SPED*NET Wilton (CT) and a Contributing Editor of Smart Kids.