Often ADHD coexists with other conditions such as depression, anxiety, conduct disorder, and oppositional defiant disorder (the latter two in children.) Some symptoms may overlap with other medical conditions.
ADHD symptoms vary from person to person but consist of some combination of inattention, hyperactivity, and impulsivity.
- Inattention. People who are inattentive have a hard time keeping their mind on one thing and may get bored with a task after only a few minutes. Focusing conscious, deliberate attention to organizing and completing routine tasks may be difficult. You may notice restlessness, procrastination, problems remembering obligations, trouble staying seated during meetings or activities, or starting multiple projects at the same time but rarely finishing them.
- Hyperactivity. People who are hyperactive always seem to be in motion. They can't sit still; they may dash around or talk incessantly. Children with ADHD are unable to sit still and pay attention in class. They may roam around the room, squirm in their seats, wiggle their feet, touch everything, or noisily tap a pencil. They may also feel intensely restless.
- Impulsivity. People who are overly impulsive seem unable to think before they act. As a result, they may blurt out answers to questions or inappropriate comments, or run into the street without looking. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they are upset. They often have difficulty making and keeping friends.
ADHD is a complex condition and is therefore sometimes difficult to diagnose. And occasionally, ADHD is not recognized until adulthood.
Even in adults, symptoms of ADHD look different depending on the person experiencing them.
A diagnosis of ADHD in childhood and adolescence is usually made after discussing symptoms at length with the child and parents -- and possibly teachers -- and observing the child's behaviors. Information about any family history of similar problems will be gathered as well. The doctor will consider other possibilities, including other medical or psychiatric conditions. Like most psychiatric problems, there is no specific test for ADHD.
A diagnosis of ADHD is often first suggested by teachers. Schools are federally mandated to perform an appropriate evaluation if a child is suspected of having a disability that impairs academic functioning. This policy was recently strengthened by regulations implementing the 1997 reauthorization of the Individuals with Disabilities Act (IDEA), which guarantees appropriate services and a public education to children with disabilities from ages 3 to 21. For the first time, IDEA specifically lists ADHD as a qualifying condition for special education services. If the assessment performed by the school is inadequate or inappropriate, parents may request that an independent evaluation be conducted at the school's expense. Furthermore, some children with ADHD qualify for special education services within the public schools, under the category of "Other Health Impaired." In these cases, the special education teacher, school psychologist, school administrators, classroom teachers, along with parents, must assess the child's strengths and weaknesses and design an Individualized Education Program. These special education services for children with ADHD are available though IDEA.
A battery of tests is given to assess a child's neurological and psychological status. They should be administered by a pediatrician with experience in diagnosing and treating ADHD. Tests include:
- A medical and social history of both the child and his family
- A physical exam and neurological assessment including screenings of vision, hearing, and verbal and motor skills. Additional tests may also be performed if there is a possibility that hyperactivity is related to some other physical problem.
- An evaluation of intelligence, aptitude, personality traits, or processing skills. These evaluations are often completed by the parents and teachers if the child is of school age.
- You may also be advised to check with an allergist if any allergies are suspected.
In adults, ADHD is diagnosed after careful clinical evaluation by your physician.
The best treatment is thought to be a combination of medication and psychological therapies. Close cooperation among therapists, doctors, teachers, and parents is very important, and team meetings are useful.
Stimulants. Although there is considerable controversy about their possible overuse, stimulants are the most commonly prescribed medications. They include Adderall, Cyclert, Dexedrine, Dextrostat, and Ritalin. (Strange as it seems, stimulants often calm hyperactivity.) A doctor needs to monitor the dosage closely, both to check for the right level and to watch for side effects. Recently, new formulations of these medicines have been approved -- allowing the child to take the medicine only once a day, if desired.
Non-Stimulants. Strattera is a nonstimulant medication that appears to work as well as the stimulants in treating ADHD and is the only drug approved to treat the condition in adults.
Psychological Therapy. Of the psychological therapies, behavior modification may be best, particularly if the therapist helps parents learn some of the techniques for behavior control. It is often given in conjunction with specific educational interventions, such as help with learning skills. Psychotherapy is a valuable option, particularly if the child suffers from low self-esteem.
- Join a support group. Connect with the national organization called Children and Adults With Attention-Deficit/Hyperactivity Disorder.
- Because an ADHD child may process directions and other information in faulty ways, he is apt to be bombarded with corrections, leaving him with a low opinion of himself. Do whatever you can to promote your child's self-esteem.
- Praise and reward good behavior promptly.
- Be consistent with discipline, and make sure baby-sitters follow your methods.
- Make instructions simple and specific ("Brush your teeth; now, get dressed"), instead of general ("Get ready for school").
- Encourage your child's special strengths, particularly in sports and out-of-school activities.
- Have set routines for meals, sleep, play, and TV.
- Don't let homework monopolize all of his time after school; play and exercise are important.
- Simplify your child's room. Store toys out of sight.
Reviewed by Charlotte E. Grayson, MD, October 2003.
Copyright © 2003, Medscape Patient Education