ADHD affects three to five percent of American children, most of them boys. Its three key symptoms – poor attention, hyperactivity, and impulsive behavior are seen in varying degrees in each child who is affected. For example, some children with ADHD have problems paying attention in class, while others find it hard to sit still. Doctors often speak of three separate types of ADHD: inattentive type, hyperactive-impulsive type, and combined type.
Depending on the type of ADHD, a child may have problems listening to directions, completing assignments, or working alone without being distracted. He may lose things, forget things, or routinely make careless mistakes. He may fidget, squirm, or run around in class. He may blurt out answers, interrupt, or have problems waiting for his turn.
Symptoms of ADHD usually begin before age seven. In order for the symptoms to be considered ADHD, they must interfere with the way a child functions, either at school or with friends. Symptoms must also be seen in more than one setting (for example, at home and at school, or at school and at baseball practice).
Boys are up to nine times more likely to have ADHD than girls, but no one knows why. Scientists have a long list of potential risk factors for ADHD, including family history of ADHD, stressful home environment, and brain injury. However, the experts have not found one definite explanation that would account for all cases.
Most often, ADHD is diagnosed based on history – the sum of teachers’ and parents’ reports about how a child behaves in different settings. These reports are especially important, because for the short time of a doctor’s visit your child may show no symptoms of ADHD. He may be able to “behave himself” and “pay attention” for an hour or so in the doctor’s office, or have no problems relating to the doctor in a one-to-one situation. This is not unusual, since confirming ADHD is only one part of the reason for a doctor’s evaluation. Another equally important part is to make sure the problem is not being caused by other conditions with similar symptoms.
Parents, teachers, and doctors often need to work together in helping a child with ADHD. This takes time, effort, and coordination. Treatment of ADHD usually depends on combining a medication (to improve attention span and stop restlessness or “hyperactivity”) with practical behavioral techniques at school and at home.
“He never finishes his work. He’s always distracted.”
“She wants everything, right away.”
“He calls out answers in class. He never waits for his turn.”
“He doesn’t sit still. He’s always on the go.”
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ADHD is sometimes treated with medications (stimulants, antidepressants, and others). Each of the medications act in a different way to modify levels of brain chemicals and improve ADHD behaviors.
Stimulants, including small amounts of amphetamines and methylphenidate (Ritalin), have been used and tested the most and are probably the safest and most effective of the ADHD medications. Medical research has shown that stimulants work well in improving attention and reducing impulsive behavior and hyperactivity. Stimulants also seem to improve academic performance of children with ADHD – they get better grades, with math sometimes improving more than reading.
Antidepressants are good second-choice medications; studies have shown that they also help children with ADHD. Other medications used to treat ADHD are usually chosen when stimulants and antidepressants either don’t work or are causing unpleasant side effects. Treatments like following special diets or taking megadoses of vitamins have not proven themselves, but some are still being studied.
No single ADHD medication always works for every child, so doctors depend on parents’ and teachers’ input in prescribing medication for ADHD. Sometimes more than one medication must be tried before a child’s behavior improves, and side effects always need to be evaluated. Medications are also available in longer acting forms, which may allow your child to go through a school day without a dose of medication from the school nurse. No matter what medication your doctor prescribes, even successful treatment needs to be re-evaluated each year, especially if there is any reason to suspect that the medication is no longer needed or the dosage can be reduced.
Even if your child is already taking medication for ADHD, there is still more that can be done. You and your child’s teachers can use special techniques, called behavior modification, to help him recognize and change his own behaviors. This can mean a reward system or point system to “catch him being good.” Good behavior would either earn him a small prize or give him “points” toward special school or home privileges. Most children with ADHD do best when medication and behavior modification are used together. They also have a special need for good relationships with children their own age – so having friends can be very important.
As they grow, children with ADHD have a greater risk of anxiety, depression, and drug abuse. About 25% also have problems learning, and as many as 50% have some kind of conduct problem. Experts are still studying how ADHD affects these children when they become adults. Most agree that at least some of the symptoms improve. Accurate diagnosis, appropriate medication, and behavioral interventions can lead to positive results.