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Attention Deficit Hyperactivity Disorder (ADHD, ADD) is a prevalent childhood disorder, which can continue into adulthood, affecting approximately 11% of children 4-17 years of age and approximately 4% of the adult population. The average age of onset is age 7, but children reported by their parents as having more severe ADHD are typically diagnosed earlier. Boys are three to four times more likely to be diagnosed with ADHD than girls. The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that 5% of children have ADHD. However, studies in the US have estimated higher rates in community samples. These studies show that the rate of ADHD diagnosis has been steadily increasing for the past several years. ADHD diagnosis increased an average of 3% per year from 1997 to 2006 to 5% per year from 2003 to 2011. The increase in diagnosis is joined by an increase in the percentage of children with ADHD, from 7.8% in 2003 to 9.5% in 2007 to 11.0% in 2011. Prevalence of ADHD diagnosis also varies substantially by state, from a low of 5.6% in Nevada to a high of 18.7% in Kentucky.
The rate of prescription for ADHD medication has also increased over the past years, from 4.8% in 2007 to 6.1% in 2011. More US children were receiving ADHD treatment (medication and or therapy/counseling) in 2011 compared to 2007; however, as many as 17.5% of children with current ADHD were not receiving either medication for ADHD or mental health counseling in 2011. Rates of medication prescriptions vary by state, from a low of 2% in Nevada to a high of 10.4% in Louisiana.
ADHD has three subtypes:
Studies have shown that the brains of individuals with ADHD develop differently than those without ADHD. In ADHD patients, certain areas of the brain, including those used in thinking, paying attention, and planning, develop about three years more slowly than non-ADHD patients. Scientists believe that this accounts for many of the ADHD symptoms, including inability to focus and hyperactivity. The exact cause of this different developmental pattern has not been identified, though studies have suggested possible links with genetics, environmental elements, brain injuries, food additives, and smoking cigarettes. To learn more about the causes that may be behind ADHD, read about ADHD risk factors.
Potential risk factors for ADHD include:
There is no single test to diagnose ADHD. Symptoms of ADHD vary from person to person, and regular child-like behavior can often be mistaken for ADHD. ADHD symptoms are often noticed first by parents or teachers; who may observe the child’s inability to focus or tendency to act out in class. General physicians and/or specialists can help to determine whether or not the child’s symptoms are a result of ADHD or another condition. Often, ADHD-like symptoms can be triggered by life events such as family death or divorce, or by health conditions such as vision/hearing problems, inner ear infections, or anxiety/depression.
The following are the diagnostic criteria for ADHD patients as outlined by the Diagnostic and Standard Manual for Mental Disorders.
For a diagnosis of inattentive ADHD, patients must experience 6 or more of the following symptoms:
For a diagnosis of hyperactive – impulsive ADHD, patients must experience 6 or more of the following symptoms:
For a diagnosis of inattentive & hyperactive – impulsive ADHD, patients must experience a combination of the above symptoms. Additionally, the following criteria must be met:
Primary care clinicians should also assess the patient for other conditions that might occur along with ADHD. These include:
ADHD can occur in children, teens, and adults. The symptoms of ADHD at each stage of life can present themselves differently.
Children and Teens with ADHD According to the National Institute of Mental Health, children with ADHD may exhibit the following symptoms:
Adults with ADHD Adult ADHD symptoms are experienced and perceived in a different manner than are childhood ADHD symptoms. Many of the symptoms of ADHD experienced during childhood can continue on into adulthood.
The following symptoms may be signs of adult ADHD:
Approximately 1/3 of children with ADHD grow out of the disorder as they near adulthood. Another 1/3 continue to experience some symptoms, and the final 1/3 suffer severe symptoms.
Managing symptoms with medications, cognitive therapy, and life coaching significantly improves quality of life. Unfortunately just 11% of adults with this disorder receive treatment. Thus it is not surprising that nearly 50% of adults with ADHD also have an anxiety disorder, almost 40% have a mood disorder and 15% develop substance-abuse issues.
Though the symptoms of ADHD can be disruptive, there are strategies you can implement to help manage this disorder.
As with many disorders, there is no single screening test for ADHD. Your doctor will take your medical history, give you a physical exam, perhaps talk to your spouse and other family members to aid in the assessment of your behavior. Part of the clinical assessment will likely include a rating scale.
There are no proven ways to prevent ADHD, although avoiding smoking and drinking during pregnancy may help lower the risk of your child developing ADHD.
Psychotherapy and Non-Medical Treatments for ADHD There are a number of behaviorally aimed therapies that can help lessen ADHD symptoms. These include:
Medication Treatment for ADHD The same kinds of medications used to treat childhood ADHD are used for adults. The ages listed indicate FDA approval for the specified age group.
Stimulants According to the National Institute of Mental Health, although it may seem counterintuitive to treat hyperactivity with a stimulant, these medications actually activate brain circuits that support attention and focused behavior. Medications also may improve physical coordination.
Short – acting stimulants:
Extended release and long-acting stimulants:
Non – stimulant medications
Side Effects for ADHD Medications
According to the National Institute for Mental Health, most side effects of ADHD medications are minor and disappear when dosage levels are lowered.
Minor side effects include:
Possible Rare, Serious Side effects: The National Institute of Mental Health reports that in 2007 the FDA required that all makers of ADHD medications develop Patient Medication Guides because a review of data found that ADHD patients with heart conditions had a slightly higher risk of the following:
The review also found a slightly higher risk (about 1 in 1,000) for medication-related psychiatric problems in patients who had no history of psychiatric problems, such as:
In addition, the non-stimulant ADHD medication called atomoxetine (Strattera) carries a warning that children and teenagers with ADHD who take the drug are more likely to have suicidal thoughts than children and teenagers with ADHD who do not take atomoxetine. Call a doctor right away if your child shows any of the following symptoms:
In addition to medication and therapy, there are a number of alternative treatments that may help treat the symptoms of ADHD. Talk to your physician about any possible drawbacks and potential benefits to some of these alternative treatments:
Here are some helpful tips to make living with ADHD easier:
If you or your children suffer from classic symptoms of ADHD such as lack of focus, restlessness, or forgetfulness, contact a doctor for an evaluation.
Call your doctor if you or your children have side effects of ADHD medications, especially sudden and unusual changes and behavior including thoughts of self – harm and feelings of agitation.
Here are some questions to ask:
For more information about ADHD:
Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) is a nationally recognized non-profit authority on ADHD with local and virtual chapters and a virtual conference series with experts.
The Attention Deficit Disorder Association is dedicated to helping adults with ADHD lead better lives. The organization, which was founded in 1989, holds and annual conference and offers an online resource guide, webinars, an online store with books on ADHD.
ADHD & You offers advice for people with ADHD, parents and caregivers, and educators and other school personnel. There is a section for Spanish-speaking visitors.
The National Center for Learning Disabilities has advice and resources about ADHD as well as information about how ADHD can co-exist with other learning disabilities.
Studying with ADHD
For information about medications for ADHD:
The National Institute of Mental Health lists FDA-approved medications for ADHD along with the possible side effects.
Daily Strength offers an ADHD/ADD online support group.
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