Attention Deficit / Hyperactivity Disorder (ADHD) is a chronic condition seen in nine percent of children and about five percent of adults; it occurs more frequently in males. It is characterized by inattentive, impulsive and hyperactive behavior that interferes with normal functioning in daily life, at school and on the job.
The more severe cases of ADHD are found in younger children around the age of four. Moderate ADHD is reported for children around six, and mild cases for the median age of seven. About a third of the children diagnosed with ADHD retain this diagnosis into adulthood.
Recent research has established ADHD as a brain disorder where there is an impairment in the self management system or executive function of the brain. Not only the prefrontal cortex, but other parts of the brain that control attention, movement and social judgment are affected. This new understanding of brain functions explains the variability of behaviors found in individuals where certain tasks are handled with no problem while others present great difficulty.
Research has also established that what was seen as a childhood disorder is not the case in adolescents or adults who functioned normally during childhood but were impaired at older ages.
Types of Attention Deficit Hyperactive Disorder
There are essentially three types of Attention Deficit/Hyperactive Disorder:
1. Inattentive
The Inattentive type is easily distracted and therefore has difficulty focusing attention and is unable to maintain concentration over time. Therefore, the child may not finish chores or schoolwork, and is forgetful in completing assigned tasks and following through. This child has difficulty listening to others and staying on topic. An ADHD child described the experience as drawing a blank in the middle of a sentence.
Often missing details and making careless mistakes, the inattentive type also has problems with scheduling and organizing tasks and activities. This leads to poor study habits. The adult ADHD person of the inattentive type may have difficulty sustaining focus, be disorganized, have a messy work space and fail to follow through on work instructions.
Girls who have ADHD tend to be the inattentive type.
2. Hyperactive-Impulsive
The Hyperactive-Impulsive type has great difficulty sitting or remaining still and can’t stop talking or moving about. They may be fidgeting and squirming in their seats, then leave their seats when they were to remain seated. Hyperactivity is a common symptom in preschool ADHD children. They can often be seen running, dashing around or climbing. They are constantly in motion, or talking nonstop.
The ADHD persons of this type are generally unable to stay on task. They are prone to interrupting and taking risks impulsively. They may speak or act without waiting for their turn, or interrupt others in conversations or in games.
Of the three types, the hyperactive-impulsive type without distractibility is the least common.
3. Combination
The Combination type is found in the majority of children with ADHD. Behaviors showing inattention, hyperactivity and impulsiveness are present in various combinations and interferes with functioning at home and in school.
Because these behaviors are common in many children in the course of their development, the standards given in the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association is used to diagnose persons with ADHD. The Manual lists nine types of Inattention and nine types of Hyperactivity/Impulsivity. A person must have six in each to be given the diagnosis of Combined ADHD. The Manual also specifies that these symptoms must have been present for six months.
Questions and Answers for Attention Deficit/Hyperactivity Disorder
Q: How is the presence of Attention Deficit/Hyperactive Disorder established?
A: Children ages 4 to 18 can be examined and diagnosed by a pediatrician or primary care clinician who will apply the standard guidelines developed by the American Academy of Pediatrics (AAP). The doctor will look at detailed information about the child’s past and present behaviors provided by parents, teachers, and other caregivers. The doctor will also conduct a physical and neurological examination. Psychoeducational testing may also be done by a specialist.
Q: Is there an effective treatment for ADHD?
A: There is no cure for ADHD, but enough is known to greatly reduce symptoms and bring about improvements in functioning. Medications can reduce hyperactivity and impulsivity, or may improve attention and physical coordination. Parents should work closely with the prescribing doctor to monitor and adjust the dosage as necessary. AAP has recommended that young children, four to five years of age, should first be treated using behavior therapy, and that medications be introduced only if needed after nine months.
Q: What can be done at home to help the ADHD child?
A: Parents can make the home “ADHD-friendly” by setting routines and rules that are consistent and clear. They might set up a bulletin board on which to post a schedule, and changes can be posted in advance. It’s helpful to have a place for everything, and to follow the same routine every day. Good behavior should be praised, and rewards given when rules are followed. A home organized for clarity can be helpful to everyone.
Q: What can be done at school to help the ADHD child?
A: Parents should communicate with the school and the child’s teacher to share information on the child’s hardships and to form an understanding of the child’s challenges in the school. Working closely with the teacher, the parent can then develop a behavior plan that would also be practiced at home. This plan should provide a structure and clear expectations to keep the child’s symptoms in check. Specific goals and daily rewards will provide the frame for the child’s success.
Q: Can a child outgrow this condition?
A: Recent research using brain imaging showed what researchers called “delayed peak volume”, or smaller brain structures in ADHD children, but not in ADHD adults. It was theorized that brain development of children with ADHD was delayed, but caught up as they grew to adulthood. This would explain why most ADHD children no longer have significant symptoms by their mid-20’s.
Q: What challenges do the college student ADHD or adult ADHD face?
A: As ADHD children grow, the hyperactive and impulsive symptoms often improve, but inattention symptoms remain or get worse. This creates particular difficulties for the student in high school or college where studies require more sustained attention. As the ADHD person moves into adult life, the challenges of interpersonal interaction are greater, and self management is required for success.
Q: How can a family optimize the ADHD situation and achieve a win-win solution?
A: Having an ADHD member in the family can be disruptive and if not dealt with effectively, can be damaging to the ADHD child and cause serious problems in the family’s functioning. However, if parents and other family members address it as a challenge and join together to create an optimal situation for the ADHD child, everyone benefits.
Parents should work closely with the pediatrician and participate in the long term treatment plan. This may involve monitoring closely the effects of different medication, keeping the doctor informed, undergoing behavior therapy and carrying out effective practices, and working with the school.
Q: What resources are there for parents of ADHD children?
A: The American Academy of Pediatrics article, “Understanding ADHD: Information for Parents” explains ADHD to parents and refers them to other resources and support groups.
The ADHD Resource Center of the American Academy of Child and Adolescent Psychiatry puts out “Facts for Families” and also books and videoclips to inform and support parents of ADHD children. Two helpful books are:
ADHD: What Every Parent Needs to Know, by American Academy of Pediatrics and Michael I. Reiff;
Taking Charge of ADHD, Third Edition: The Complete, Authoritative Guide for Parents, by Russell A. Barkley
