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Attention-deficit/hyperactivity disorder (ADHD) in children

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. ADHD includes a combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.

Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.

While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome.

Symptoms Causes Risk factors Complications Prevention

Attention-deficit/hyperactivity disorder (ADHD) has been called attention-deficit disorder (ADD) in the past. But ADHD is now the preferred term because it describes both of the primary features of this condition: inattention and hyperactive-impulsive behavior. In some children, signs of ADHD are noticeable as early as 2 or 3 years of age.

Signs and symptoms of ADHD may include:

  • Difficulty paying attention
  • Frequently daydreaming
  • Difficulty following through on instructions and apparently not listening
  • Frequently has problems organizing tasks or activities
  • Frequently forgetful and loses needed items, such as books, pencils or toys
  • Frequently fails to finish schoolwork, chores or other tasks
  • Easily distracted
  • Frequently fidgets or squirms
  • Difficulty remaining seated and seemly in constant motion
  • Excessively talkative
  • Frequently interrupts or intrudes on others' conversations or games
  • Frequently has trouble waiting for his or her turn

ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.

Normal behavior vs. ADHD

Most healthy children are inattentive, hyperactive or impulsive at one time or another. It's normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest.

The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're tired. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they're different from their friends or siblings.

Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.

When to see a doctor

If you're concerned that your child shows signs of ADHD, see your pediatrician or family doctor. Your doctor may refer you to a specialist, but it's important to have a medical evaluation first to check for other possible causes of your child's difficulties.

If your child is already being treated for ADHD, he or she should see the doctor regularly until symptoms have largely improved, and then every three to four months if symptoms are stable. Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping, increased irritability, or if your child's ADHD has not shown much improvement with initial treatment.

While the exact cause of ADHD is not clear, research efforts continue.

Multiple factors have been implicated in the development of ADHD. It can run in families, and studies indicate that genes may play a role. Certain environmental factors also may increase risk, as can problems with the central nervous system at key moments in development.

Risk factors for ADHD may include:

  • Blood relatives (such as a parent or sibling) with ADHD or another mental health disorder
  • Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings
  • Maternal drug use, alcohol use or smoking during pregnancy
  • Maternal exposure to environmental poisons — such as polychlorinated biphenyls (PCBs) — during pregnancy
  • Premature birth

Although sugar is a popular suspect in causing hyperactivity, there's no reliable proof of this. Many things in childhood can lead to difficulty sustaining attention, but that is not the same as ADHD.

ADHD can make life difficult for children. Children with ADHD:

  • Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults
  • Tend to have more accidents and injuries of all kinds than children who don't have the disorder
  • Have poor self-esteem
  • Are more likely to have trouble interacting with and being accepted by peers and adults
  • Are at increased risk of alcohol and drug abuse and other delinquent behavior

Coexisting conditions

ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than are other children to also have conditions such as:

  • Learning disabilities, including problems with understanding and communicating
  • Anxiety disorders, which may cause overwhelming worry, nervousness and worsening of ADHD symptoms until the anxiety is treated and under control
  • Depression, which frequently occurs in children with ADHD
  • Bipolar disorder, which includes depression as well as manic behavior
  • Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant and hostile behavior toward authority figures
  • Conduct disorder, marked by antisocial behavior such as stealing, fighting, destroying property, and harming people or animals
  • Tourette syndrome, a neurological disorder characterized by repetitive muscle or vocal tics

To help reduce your child's risk of ADHD:

  • During pregnancy, avoid anything that could harm fetal development. Don't drink alcohol, smoke cigarettes or use drugs. Avoid exposure to environmental toxins, such as polychlorinated biphenyls (PCBs).
  • Protect your child from exposure to pollutants and toxins, including cigarette smoke, agricultural or industrial chemicals, and lead paint (found in some old buildings).
  • Limit screen time. Although still unproved, it may be prudent for children to avoid excessive exposure to TV and video games in the first five years of life.

If your child has ADHD, to help reduce problems or complications:

  • Be consistent, set limits and have clear consequences for your child's behavior.
  • Put together a daily routine for your child with clear expectations that include such things as bedtime, morning time, mealtime, simple chores and TV.
  • Avoid multitasking yourself when talking with your child, make eye contact when giving instructions, and set aside a few minutes every day to praise your child.
  • Work with teachers and caregivers to identify problems early, to decrease the impact of the condition on your child's life.
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