Definition and Overview
In the United States, approximately 4.7 million children between the ages of three and 17 have been diagnosed with Attention Deficit Hyper-Activity Disorder (ADHD). This disorder is one of the most common childhood disorders and may continue throughout adolescence and well into adulthood. ADHD is characterized by an extreme difficulty in remaining focused and paying attention, difficulty in controlling or maintaining appropriate behavior conducive to particular environments, and very high levels of energy and activity.
Today, brain imaging technology such as magnetic resonance imaging (MRI) has enabled scientists to better understand the underlying causes of ADHD. For example, scientists have observed that in some children, ADHD is directly related to how the brain is wired or structured. For other children diagnosed with ADHD, brain development follows a normal but delayed pattern. For some, development may be delayed by as many as three years.
According to the National Institutes of Health, the delay appears to be centered in the frontal cortex, which is the area of the brain that supports the ability to suppress inappropriate actions, maintain focus and memory moment to moment, organize, and plan ahead. Furthermore, scientists have observed that the motor cortex, which is the part of the brain controlling movement, often matures at an accelerated rate in children with ADHD. This disparity in brain development may account for the restlessness and inattention associated with ADHD.
Symptoms and Diagnosis
ADHD is characterized by demonstrated high levels and repeated instances of inattention, hyperactivity, and impulsivity. For those diagnosed with ADHD, these behaviors are severe and occur more frequently when compared to the average child, who may exhibit occasional inattention or hyperactivity. In order for a formal diagnosis to take place, a child must have demonstrated these types of symptoms for six or more months and to an extent that is greater than other children within the same age group. In addition, the child must demonstrate these symptoms in a minimum of two different settings. A complete diagnosis requires a history of behavior, which includes detailed reports from parents, caregivers, teachers, and other professionals who have obtained direct evidence of the symptoms. Due to the overdiagnosis of ADHD (and, according to some, underdiagnosis), it is always recommended for the child to be tested for other accompanying conditions, such as learning difficulties, while undergoing testing for ADHD. In addition, a complete physical examination, screening tests, and a mediation trial period are all components of a final and formal diagnosis.
Children who are inattentive may become easily distracted, frequently forget details, want to move quickly from one activity to the next, regardless of whether or not an instruction was given or the work was completed. They may become bored with an assignment or task after only a few minutes, unless they are engaged with something they find satisfying or enjoyable. The ability to focus attention on organization, learn something new, and complete tasks is especially challenging for the inattentive. Those who are inattentive experience problems with following through on homework assignments and often lose essential materials (such as pencils, paper, notebooks, etc.) needed in order to complete activities. Processing information and following specific instructions are also difficult for those who are inattentive.
Children struggling with hyperactivity are constantly in motion. They experience difficulty with remaining seated and still when given an instruction or the setting/environment calls for such action. Fidgeting and squirming in their seats, continually picking up objects, and dashing around are all signs of a hyperactive child. They may talk nonstop, at a fast pace, and experience difficulty ceasing talking. Completing quiet tasks or activities are often extremely challenging.
Children who are impulsive tend to be extremely impatient. They may blurt out inappropriate comments or responses to questions, show their emotions without an ability to control or restrain them when necessary, and act without foresight or regard for consequences. Waiting their turn when, for example, engaged in a game or activity is especially difficult for the impulsive child. In addition, children who are impulsive often disrupt others’ conversations and activities.
A combination of medication, most commonly methylphenidate (Ritalin), and cognitive-behavioral therapy is the best approach for improving the symptoms of ADHD. Throughout the early stages of ADHD, medication is certainly helpful; however, research indicates that the benefits of medication wear off with time. Many scientists and other professional now believe that ADHD symptoms may improve naturally over time, regardless of the treatment approach. Certain behavioral techniques and dietary changes have been especially beneficial for relieving symptoms of ADHD. It is challenging for doctors to predict which medications will produce the most beneficial results; therefore, treatment is individualized and performed on a trial and error basis, a sometimes long, complex, and arduous process, requiring close observation and cooperation between all participants, including family members, teachers, counselors, and other relevant professionals.
Mayo Clinic: Treatments and Drugs