Pediatric Attention-Deficit / Hyperactivity Disorder (ADHD)

Three major types of ADHD include the following:

• ADHD, combined type. This is most common type of ADHD, characterized by impulsive and hyperactive behaviors as well as inattention and distractibility.
• ADHD, inattentive and distractible type. This type of ADHD is characterized predominately by inattention and distractibility without hyperactivity.
• ADHD, impulsive/hyperactive type. The least common type of ADHD, this is characterized by impulsive and hyperactive behaviors without inattention and distractibility.

ADHD is a brain-based biological disorder that is one of the most researched areas in child and adolescent mental health. The precise cause of the disorder, however, is still unknown. Some evidence suggests that ADHD is genetic. Low levels of dopamine (a brain chemical), which is a neurotransmitter (transfers impulses along the nerves) are found in children with ADHD. Brain imaging studies using PET scanners (positron emission tomography; a form of brain imaging that makes it possible to observe the human brain at work) show that brain metabolism in children with ADHD is lower in the areas of the brain that control attention, social judgment and movement.

Estimates suggest that between 3-5% of all children have ADHD. Boys are two to three times more likely to have ADHD than girls.

Many parents of children with ADHD experienced symptoms of ADHD when they were younger. It is not unusual for ADHD to be found in brothers and sisters. Most families seek help when their child's symptoms begin to interfere with learning and adjustment to the expectations of school and age-appropriate activities.

Most symptoms seen in children with ADHD also occur at times in children without this disorder. In children with ADHD, however, these symptoms occur more frequently and interfere with learning, school adjustment, and, sometimes, with the child's relationships with others. The following are the most common symptoms of ADHD. Each child, however, may experience symptoms differently. The three categories of symptoms of ADHD include the following:

Inattention 

• Short attention span for age (difficulty sustaining attention)
• Difficulty listening to others
• Difficulty attending to details
• Easily distracted
• Forgetfulness
• Poor organizational skills for age
• Poor study skills for age

Impulsivity

• Often interrupts others
• Has difficulty waiting for his/her turn in school and/or social games
• Tends to blurt out answers instead of waiting to be called upon
• Takes frequent risks and often without thinking before acting

Hyperactivity

• Seems to be in constant motion; runs or climbs, at times with no apparent goal except motion
• Has difficulty remaining in his/her seat even when it is expected
• Fidgets with hands or squirms when in his/her seat; fidgeting excessively
• Talks excessively
• Has difficulty engaging in quiet activities
• Loses or forgets things repeatedly and often
• Inability to stay on task; shifts from one task to another without bringing any to completion

The symptoms of ADHD may resemble other medical conditions or behavior problems. Many of these symptoms may occur in children and teens that do not have ADHD. A key element in diagnosis is that the symptoms must significantly impair adaptive functioning in both home and school environments. Always consult your child's physician for a diagnosis.

ADHD is the most commonly diagnosed behavior disorder of childhood. A pediatrician, child psychiatrist or a qualified mental health professional usually identifies ADHD in children. A detailed history of the child's behavior from parents and teachers, observations of the child's behavior and psychoeducational testing contribute to making the diagnosis of ADHD.

Because ADHD is a group of symptoms, diagnosis often depends on evaluating results from several different types of evaluations, including physical, neurological and psychological. Certain tests may be used to rule out other conditions, and some may be used to test intelligence and certain skill sets. Consult your child's physician for more information.

Specific treatment for attention-deficit/hyperactivity disorder will be determined by your child's physician based on:

• Your child's age, overall health and medical history
• Extent of your child's symptoms
• Your child's tolerance for specific medications or therapies
• Expectations for the course of the condition
• Your opinion or preference

Major components of treatment for children with ADHD include parental support and education in behavioral training, appropriate school placement and medication. Treatment with a psychostimulant is highly effective in 75-90% of children with ADHD.

Treatment may include:

Psychostimulant Medications

Psychostimulant medications are used for their ability to balance chemicals in the brain that prohibit the child from maintaining attention and controlling impulses. They help stimulate or help the brain to focus and may be used to reduce the major characteristics of ADHD, listed above.

Psychostimulant medications commonly used to treat ADHD include the following:

• Methylphenidate (Ritalin, Metadate, Concerta)
• Dextroamphetamine (Dexedrine)
• Pemoline (Cylert)
• A mixture of amphetamine salts (Adderall)

Psychostimulants have been used to treat childhood behavior disorders since the 1930s. They have been studied widely. Stimulants take effect in the body quickly, work for one to four hours, and then leave the body quickly. Doses of stimulant medications need to be timed to match the child's school schedule – to help the child pay attention for a longer period of time and improve classroom performance. 

The common side effects of stimulants may include, but are not limited to, the following:

• Insomnia
• Decreased appetite
• Stomach aches
• Headaches
• Jitteriness
• Rebound activation (when the effect of the stimulant wears off, hyperactive and impulsive behaviors may increase for a short period of time)

Most side effects of stimulant use are mild, decrease with regular use, and respond to dose changes. Always discuss potential side effects with your child's physician. Antidepressant medications may also be administered for children and adolescents with ADHD to help improve attention while decreasing aggression, anxiety, and/or depression.

Psychosocial Treatments

Parenting children with ADHD may be difficult and can present challenges that create stress within the family. Classes in behavior management skills for parents can help reduce stress for all family members. Training in behavior management skills for parents usually occurs in a group setting which encourages parent-to-parent support.

Behavior management skills may include the following:

• Use of time out
• Point systems
• Contingent attention (responding to the child with positive attention when desired behaviors occur; withholding attention when undesired behaviors occur)

Teachers may also be taught behavior management skills to use in the classroom setting. Training for teachers usually includes use of daily behavior reports that communicate in-school behaviors to parents. 

Behavior management techniques tend to improve targeted behaviors (such as completing school work or keeping the child's hands to himself/herself), but usually are not helpful in reducing overall inattention, hyperactivity or impulsivity.

Preventive measures to reduce the incidence of ADHD in children are not known at this time. Early detection and intervention, however, can reduce the severity of symptoms, decrease the interference of behavioral symptoms on school functioning, enhance the child's normal growth and development and improve the quality of life experienced by children or adolescents with ADHD.