Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children. ADHD also affects many adults. Symptoms of ADHD include inattention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting) and impulsivity (hasty acts that occur in the moment without thought).
An estimated 5 percent of children and 2.5 percent of adults have ADHD. ADHD is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork. It can also affect adults. It is more common among boys than girls.
Compass Youth & Family is fully equipped to provide psychological testing services, designed to help you or your child determine which factors have been the most influential for your current concerns. The testing process evaluates not only the presence of psychological conditions –ADHD as well as Learning Disorders or Autism Spectrum Disorder – but also how various lifestyle factors may be a trigger for the symptoms.
Symptoms and Diagnosis
Many ADHD symptoms, such as high activity levels, difficulty remaining still for long periods of time and limited attention spans, are common to young children in general. The difference in children with ADHD is that their hyperactivity and inattention are noticeably greater than expected for their age and cause distress and/or problems functioning at home, at school or with friends.
Research has shown that ADHD is caused by neurological (nervous system) and biological (related to the body) factors, though the exact causes are not yet known.
Risk factors for ADHD include the following:
- Hereditary: If one or both parents have been diagnosed with ADHD, their children are more likely to show signs of it, as well.
- Biological: Studies suggest that ADHD comes from a chemical imbalance or problem with the way certain neurotransmitters (chemicals in the brain that help control behavior) work, especially dopamine.
- Environment: Exposure to toxins (poisons) in the environment (for example, lead) is linked to ADHD in children.
- Prenatal (during pregnancy) exposure: Smoking and/or drug and alcohol use during pregnancy are associated with ADHD in children.
Although the following factors may contribute to ADHD or make it worse, they are not causes:
- Everyday things in the child’s life, such as the home or school setting
- Poor parenting or poor teaching (such as too much punishment)
- Food additives*
*Note: A small number of children with ADHD may be sensitive to food dyes, artificial flavors, preservatives, or other food additives. Children with specific sensitivities and/or allergies may have fewer ADHD symptoms on a diet without food additives. Generally, food additives are not considered a cause of ADHD.
ADHD is diagnosed as one of three types: inattentive type, hyperactive/impulsive type or combined type. A diagnosis is based on the symptoms that have occurred over the past six months.
Inattentive type – six (or five for people over 17 years) of the following symptoms occur frequently:
- Doesn’t pay close attention to details or makes careless mistakes in school or job tasks.
- Has problems staying focused on tasks or activities, such as during lectures, conversations or long reading.
- Does not seem to listen when spoken to (i.e., seems to be elsewhere).
- Does not follow through on instructions and doesn’t complete schoolwork, chores or job duties (may start tasks but quickly loses focus).
- Has problems organizing tasks and work (for instance, does not manage time well; has messy, disorganized work; misses deadlines).
- Avoids or dislikes tasks that require sustained mental effort, such as preparing reports and completing forms.
- Often loses things needed for tasks or daily life, such as school papers, books, keys, wallet, cell phone and eyeglasses.
- Is easily distracted.
- Forgets daily tasks, such as doing chores and running errands. Older teens and adults may forget to return phone calls, pay bills and keep appointments.
Hyperactive/impulsive type – six (or five for people over 17 years) of the following symptoms occur frequently:
- Fidgets with or taps hands or feet, or squirms in seat.
- Not able to stay seated (in classroom, workplace).
- Runs about or climbs where it is inappropriate.
- Unable to play or do leisure activities quietly.
- Always “on the go,” as if driven by a motor.
- Talks too much.
- Blurts out an answer before a question has been finished (for instance may finish people’s sentences, can’t wait to speak in conversations).
- Has difficulty waiting his or her turn, such as while waiting in line.
- Interrupts or intrudes on others (for instance, cuts into conversations, games or activities, or starts using other people’s things without permission). Older teens and adults may take over what others are doing.
There is no lab test to diagnose ADHD. The symptoms are not the result of person being defiant or hostile or unable to understand a task or instructions. Diagnosis involves gathering information from parents, teachers and others, filling out checklists and having a intake interview with a licensed clinician.
The Causes of ADHD
Scientists have not yet identified the specific causes of ADHD. There is evidence that genetics contribute to ADHD. For example, three out of four children with ADHD have a relative with the disorder. Other factors that may contribute to the development of ADHD include being born prematurely, brain injury and the mother smoking, using alcohol or having extreme stress during pregnancy.
ADHD and the School-Aged Child
Teachers and school staff can provide parents and doctors with information to help evaluate behavior and learning problems, and can assist with behavioral training. However, school staff cannot diagnose ADHD, make decisions about treatment or require that a student take medication to attend school. Only parents and guardians can make those decisions with the appropriate mental health professionals.
Students whose ADHD impairs their learning may qualify for special education under the Individuals with Disabilities Education Act or for a Section 504 plan (for children who do not require special education) under the Rehabilitation Act of 1973. Children with ADHD can benefit from study skills instruction, changes to the classroom setup, alternative teaching techniques and a modified curriculum.
ADHD and Adults
Many adults with ADHD do not realize they have the disorder. A comprehensive evaluation typically includes a review of past and current symptoms, a medical exam and history, and use of adult rating scales or checklists. Adults with ADHD are treated with medication, psychotherapy or a combination. Behavior management strategies, such as ways to minimize distractions and increase structure and organization, and involving immediate family members can also be helpful.
Diagnosis and Treatment
When diagnosing ADHD (attention deficit hyperactivity disorder), three steps are typically followed. The first step is to determine what symptoms are present. The second step is to determine what cannot be ruled out as the source or cause of those symptoms. And the third step is to determine if any other condition accompanies the primary symptoms. ADHD is determined to be present if a cluster of six of nine symptoms of inattention are present and/or a cluster of six of nine symptoms for inattention and impulsivity is present. The clustering of symptoms is critical to an appropriate diagnosis. This is determined by using a combination of direct clinical interview, narrow-band rating scales (such as the ADHD Rating Scale), broad-band rating scales (such as the Child Behavior Checklist), and the observations of more than one person (typically this is a parent and a primary change agent, such as a teacher or family member). The exact underlying cause of ADHD is, at present, not known. ADHD is a neurophysiological condition which is largely biogenetic. It is addressed with both behavioral and pharmacological interventions.
The first step is to participate clinical diagnostic interview done by a Licensed Psychologist such as Dr. Mannon . If the patient is a child, there may some surveys sent home for their primary caregivers and teachers to complete. If ADHD is diagnosed, the therapist will work with you and your doctor on a comprehensive treatment plan. Behavioral therapy and medication have been proven to be the most effective treatments of the symptoms of ADHD. Studies have found that a combination of behavioral therapy and medication works best for most people, particularly those with moderate to severe ADHD.
Behavioral therapy focuses on managing the symptoms of ADHD. For children, treatment usually consists of teaching parents and teachers how to provide positive feedback for desired behaviors and consequences for negative ones. Although behavioral therapy requires careful coordination, it can help children learn how to control their behavior and make good choices. Adults with ADHD may benefit from psychotherapy and from behavioral strategies that improve structure and organization.
Behavioral therapy for ADHD include the following:
- Behavior modification: The child’s behavior is analyzed, and strategies are designed to increase appropriate behaviors and decrease inappropriate behaviors.
- Behavioral parent training: This trains parents to respond to a child’s behaviors in ways that will strengthen growth and development and encourage a positive parent-child relationship. Parent training often occurs at the same time as behavior modification or social skills training for the child.
- Social skills training: This teaches social skills that will improve the child’s ability to act positively and effectively in school, at home, and with peers. It also provides a setting to practice the skills in a safe, accepting atmosphere.
- School interventions: A specialist can work with your child’s educational team to conduct an evaluation (multi-factored evaluation, or MFE) to create an IEP, 504 plan, or classroom-based interventions.
- Organizational skills training: It’s often helpful to teach older children skills that will help them improve time management and organization skills and increase efficiency at home and at school.
Medication is may be used to treat ADHD in children as young as 5. It may take some time to determine what works best for your child. As with all medicines, children taking these drugs must be carefully monitored by their parents and doctors.
*Dr. Mannon is a Licensed Psychologist in the state of Texas. Psychologist do not have prescribing privileges in the State of Texas. Dr. Mannon can collaborate with your doctor on a management plan that includes medication and psychotherapy.
*Mrs. Herstein M.S. is a Licensed Professional Counselor in the state of Texas. Licensed Professional Counselors do not have prescribing privileges in the State of Texas. Mrs. Herstein can collaborate with your doctor on a management plan that includes medication and psychotherapy.
Currently, stimulant drugs (psychostimulants) are the most commonly prescribed medications for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These medications help improve the signs and symptoms of inattention and hyperactivity — sometimes effectively in a short period of time. Stimulant drugs are available in short-acting and long-acting forms. A long-acting patch of methylphenidate (Daytrana) is available that can be worn on the hip.
Two non-stimulant medications, atomoxetine and guanfacine, have also been shown to be effective in treating ADHD symptoms. These medications are alternatives for those who do not respond well to stimulants or if a non-stimulant is preferred.
The right dose varies from child to child, so it may take some time to find the correct dose. And the dose may need to be adjusted if significant side effects occur or as your child matures. Although rare, several heart-related deaths have occurred in children and teenagers taking stimulant medications. The possibility of increased risk of sudden death is still unproved, but if it exists, it’s believed to be in people who already have underlying heart disease or a heart defect.
Concerns have been raised that there may be a slightly increased risk of suicidal thinking in children and teenagers taking non-stimulant ADHD medication or antidepressants.
Strategies for Managing ADHD
Families must understand that children will adapt their behavior to their parents’ behavior. Children can learn rules, follow them, cooperate with siblings, and complete homework and chores more often when effective family strategies are put to use in the home.
Such positive changes don’t come easily—changes in behavior often take time and focused effort. Excellent behavior management strategies for the home can be found in the book 1-2-3 Magic by Dr. Thomas Phelan.
Parents may find the following strategies helpful for managing ADHD in the home:
- Give clear and specific directions and limits. Children with ADHD need to know exactly what others expect from them.
- “Catch” your child being good. Punishing a child only teaches what not to do. Recognizing and acknowledging positive behaviors is an effective way to teach and increase appropriate behavior.
- Set up an effective behavior system. Create a consistent system to reward appropriate behavior and respond to misbehavior with alternatives such as “time out” or loss of privileges. Corporal punishment (spanking) is not advised, as it is not effective.
- Stick to a schedule. Follow the same routine every day, from wake-up time to bedtime. The schedule should include time for homework and play.
- Use a calendar or planner. Create a place to write down important reminders, responsibilities, and events. These tools may be especially helpful for adolescents and young adults who struggle with time management.
- Organize items that are needed every day. Have a place for everything and keep everything in its place. This includes clothing, backpacks, and school supplies. An organization checklist may be helpful.
- Pick out a homework area. Set up in a quiet area without clutter or distractions.
- Use less verbal prompting. Give clear and brief instructions. Find ways to silently redirect a child to tasks, such as a gesture, a special sign, or brief “instruction lists” taped to a mirror the child uses.
- Set a timer. Have a time frame for working on homework. If the child does not finish, take a break and set a new time to finish.
- Allow breaks. Allow time to rest and recharge, especially if a child has long assignments or homework in many classes.
- Praise effort and completion. Reward the child’s completed work instead of punishing incomplete work.
Teaching a child with ADHD: Tips for the classroom
Teachers may want to use these strategies for managing a child with ADHD in school:
- Use consistent classroom rules. Create a system to reward the child for following classroom rules. Respond to breaking of classroom rules in a consistent way, with alternatives such as “time out” or loss of privileges.
- Seat the child to succeed. Placing the child at the front of the class or near good peer role models can cut down on distraction and set the child up for success.
- Clearly state instructions and expectations. Children with ADHD need to know exactly what others expect from them. Give brief and specific instructions for activities or assignments. Combine verbal instructions with written instructions.
- Provide immediate feedback whenever possible. Children with ADHD respond best to feedback that is timely and specific. Positive or negative feedback is best when it is given right after the child’s behavior.
- Use less verbal prompting. If the child is frequently “off-task,” find ways to silently redirect him or her, such as a gesture or special sign.
- “Catch” the child being good. Praise the child for appropriate behaviors, such as following classroom rules, completing an assignment, or contributing to a classroom discussion. Timely praise is an effective way to teach and emphasize appropriate classroom behaviors.
- Use a daily report card. Research has shown that daily report cards are an effective tool to manage behaviors for children with ADHD. The Electronic Daily Report Card (https://e-drc.com/) is a free online resource to help teachers and parents set up and use a daily report card.