Attention Deficit Hyperactivity Disorder, Pediatric

Attention deficit hyperactivity disorder (ADHD) is a mental health disorder that starts during childhood. It is a condition that can make it hard for children to pay attention and concentrate or to control their behavior. ADHD is a common reason for behavior and learning problems in school.

• Inattentive. With this type, children have difficulty paying attention.
• Hyperactive-impulsive. With this type, children have a lot of energy and have difficulty controlling their behavior.
• Combination type. Some children may have symptoms of both types.

ADHD is a lifelong condition. If it is not treated, this disorder can affect a child's academic achievement, employment, and relationships.

What are the causes?

The exact cause of this condition is not known. Most experts believe a person's genes and environment contribute to ADHD.

What increases the risk?

• Having a first-degree relative such as a parent, brother, or sister, with the condition.
• Being born before 37 weeks of pregnancy (prematurely) or at a low birth weight.
• Being born to a mother who smoked tobacco or drank alcohol during pregnancy.
• Having experienced a brain injury.
• Being exposed to lead or other toxins in the womb or early in life.

What are the signs or symptoms?

Symptoms of this condition depend on the type of ADHD.

• Problems with organization.
• Difficulty staying focused and being easily distracted.
• Often making simple mistakes.
• Difficulty following instructions.
• Forgetting things and losing things often.

• Fidgeting and difficulty sitting still.
• Talking out of turn, or interrupting others.
• Difficulty relaxing or doing quiet activities.
• High energy levels and constant movement.
• Difficulty waiting.

Children with the combination type have symptoms of both of the other types.

Children with ADHD may feel frustrated with themselves and may find school to be particularly discouraging. As children get older, the hyperactivity may lessen, but the attention and organizational problems often continue. Most children do not outgrow ADHD, but with treatment, they often learn to manage their symptoms.

How is this diagnosed?

This condition is diagnosed based on your child's ADHD symptoms and academic history. Your child's health care provider will do a complete assessment. As part of the assessment, your child's health care provider will ask parents or guardians for their observations.

• Ruling out other reasons for the child's behavior.
• Reviewing behavior rating scales that have been completed by the adults who are with the child on a daily basis, such as parents or guardians.
• Observing the child during the visit to the clinic.

A diagnosis is made after all the information has been reviewed.

How is this treated?

• Parent training in behavior management for children who are 4–12 years old. Cognitive behavioral therapy may be used for adolescents who are age 12 and older.
• Medicines to improve attention, impulsivity, and hyperactivity.
  • Parent training in behavior management is preferred for children who are younger than age 6. A combination of medicine and parent training in behavior management is most effective for children who are older than age 6.
• Tutoring or extra support at school.
• Techniques for parents to use at home to help manage their child's symptoms and behavior.

ADHD may continue into adulthood, but treatment may improve your child's ability to cope with the challenges.

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines only as told by your child's health care provider.
• Talk with your child's health care provider about the possible side effects of your child's medicines and how to manage them.

Eating and drinking

• Offer your child a healthy, well-balanced diet.
• Have your child avoid drinks that contain caffeine, such as soft drinks, coffee, and tea.

Activity

• Have your child exercise regularly. Exercise can help to reduce stress and anxiety.
• Encourage types of exercise suggested by the health care provider.

Lifestyle

• Make sure your child gets a full night of sleep.
• Help manage your child's behavior by providing structure, discipline, and clear guidelines. Many of these will be learned and practiced during parent training in behavior management.
• Help your child learn to be organized. Some ways to do this include:
  • Keep daily schedules the same. Have a regular wake-up time and bedtime for your child. Schedule all activities, including time for homework and time for play. Post the schedule in a place where your child will see it. Mark schedule changes in advance.
  • Have a regular place for your child to store items such as clothing, backpacks, and school supplies.
  • Encourage your child to write down school assignments and to bring home needed books. Work with your child's teachers for assistance in organizing school work.
• Attend parent training in behavior management to develop helpful ways to parent your child.
• Stay consistent with your parenting.

General instructions

• Learn as much as you can about ADHD. This will improve your ability to help your child and to make sure they get the support needed.
• Work as a team with your child's teachers so your child gets necessary help with school. This may include:
  • Tutoring.
  • Teacher cues to help your child remain on task.
  • Seating changes so your child is working at a desk that is free from distractions.
• Keep all follow-up visits. Your child's health care provider will need to monitor your child's condition and adjust treatment over time.

Contact a health care provider if:

• Your child has side effects from the medicines, such as:
  • Repeated muscle twitches (tics), coughs, or speech outbursts.
  • Sleep problems.
  • Loss of appetite.
  • Dizziness.
  • Unusually fast heartbeat.
  • Stomach pains.
  • Headaches.
• Your child is struggling with anxiety, depression, or substance abuse.
• Your child has new or worsening behavioral problems.

Get help right away if:

• Your child has a severe reaction to a medicine.

These symptoms may be an emergency. Do not wait to see if the symptoms will go away. Get help right away. Call 911.

• Go to your nearest emergency room.
• Call 911.
• Call the National Suicide Prevention Lifeline at 1-800-273-8255 or 988. This is open 24 hours a day.
• Text the Crisis Text Line at 741741.

Summary

• ADHD causes problems with attention, impulsivity, and hyperactivity.
• If it is not treated, ADHD can affect a child's academic achievement, employment, and relationships.
• Diagnosis is based on behavioral symptoms, academic history, and an assessment by a health care provider.
• ADHD may continue into adulthood, but treatment may improve your child's ability to cope with challenges.
• ADHD can be helped with consistent parenting, working with resources at school, and working with a team of health care professionals who understand ADHD.