Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD)

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What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) makes it difficult for children to control their behavior and stay focused. ADHD is usually diagnosed when children first go to school, a time when they must sit for longer periods and pay attention in class. Parents are often aware years earlier that their child has a problem.

Having ADHD doesn’t mean your child has a problem with intelligence or ability to reason. Children with ADHD usually have normal or above-normal intelligence, and many are gifted.

Attention Deficit Hyperactivity Disorder (ADHD) used to be called Attention Deficit Disorder (ADD), but that term isn’t really used any more. Today the term ADHD is used with an add-on comment of “with the hyperactivity” or “without hyperactivity.” The differences are related to the fidgety behavior or ”hyperactivity“ some children have. Hyperactivity is more than just being “active.” It is activity much greater than children typically have. Below are the types of ADHD.

According to the American Psychiatric Association (2000), there are three types of ADHD:

  • Inattentive type: Many children with ADHD have problems paying attention. Children with the inattentive type of ADHD often:
    • Don’t pay close attention to details and make careless mistakes.
    • Cannot focus on the same task for long.
    • Don’t follow through on instructions or finish schoolwork or chores.
    • Cannot organize tasks and activities well.
    • Get distracted easily.
    • Often lose things such as toys, school work and books.
  • Hyperactive-impulsive type: Being more active than other children is probably the most visible sign of ADHD. The hyperactive child is “always on the go.” As he or she gets older, the activity level may go down. These children are also impulsive meaning they often act before thinking, like running across the street without looking.

Hyperactivity and impulsivity tend to go together. Children with the hyperactive-impulsive type of ADHD often may:

    • Fidget and squirm more than other children.
    • Have a hard time staying in their seats.
    • Run around or climb constantly or when they are told not to.
    • Have trouble playing quietly.
    • Talk too much.
    • Blurt out answers before questions have been completed.
    • Have trouble waiting their turn.
    • Interrupt others when they’re talking.
    • Butt in on the games others are playing.
  • Combined type: Children with the combined type of ADHD have symptoms of both these types described above. They have problems with paying attention, with hyperactivity and with controlling their impulses. Of course, from time to time, all children are inattentive, impulsive and too active. With children who have ADHD though, these behaviors are the rule, not the exception.

These behaviors can cause a child to have problems at home, at school and with friends. As a result, many children with ADHD will feel anxious, unsure of themselves and depressed. These feelings are not symptoms of ADHD. They come from having problems again and again at home and in school.

APA, 2000

How can I tell if my child has ADHD?

The main signs of ADHD are:

This includes children who have trouble keeping their minds on what they are doing and often skip from one activity to the next without completing anything. They don’t pay attention to details and often make mistakes. They have problems organizing and planning and often lose or misplace their schoolwork, pens, toys or other things.

Hyperactive children always seem to be in motion. Sitting still seems nearly impossible. They may dash around, wriggle in their seats, roam around the room or talk without stopping. They wiggle their feet or tap their pencils. They are often restless, bouncing around from one activity to the next or trying to do several things at once,

These children often blurt out answers before questions have been completed. They have difficulty waiting for their turn. They often butt into conversations or games. They get into fights for little or no reason.

It can be tricky to diagnose ADHD properly, especially in very young children. Many children without ADHD have these symptoms, although usually not as intensely. These symptoms can be caused by problems unrelated to ADHD. However, it is important that your child get a complete evaluation by well-qualified professionals.

Some things doctors look at before making a diagnosis of ADHD are:

  • The problems are noticed before the child is 7 years old and present for at least six months.
  • The child’s problems have been seen in two or more areas of the child’s life, such as school, social settings (such as friends’ houses, parties or restaurants), or home. These difficulties are causing big problems at home, school or social settings.
  • The difficulties are not caused by other disorders or a medical condition.

What can I do to help my child with ADHD?

You have made an important first step by reading more information on ADHD. Another step you can take is to talk to a parent of a child with ADHD. They have gone through what you are going through now and may be able to help. You also can get great help from parent support and advocacy groups. To locate advocay and support groups near you please call 2-1-1 and ask for Help Me Grow. The earlier we begin to help children, the better the results for the child and the rest of the family.

  • Get my child evaluated: It is important to rule out other factors for your child’s behavior. Speak with your child’s doctor or pediatrician about having a full evaluation (testing) done. This may include tests done by professionals including a developmental and behavioral pediatrician, a psychologist, a child psychiatrist and a neurologist.
  • Work with my child’s service providers: Service providers include doctors, therapists, teachers, social workers or other professionals who work directly with your child. Remember that you know more about your child than anyone else and are the main influence in your child’s life. Feel free to ask questions and make comments. Be specific about what you know about your child and what you want for him or her. Be honest about what you expect, any worries you may have, or about anything you don’t understand.
  • Get more information: Visit more websites. Read or listen to a book. Watch a video on ADHD. Include your child and family. Talk with another parent. Help Me Grow can help you meet other parents and get services for you child and family. For more information call 2-1-1 and ask for Help Me Grow.
  • Teach my child to keep to a schedule: Keep your child on a regular schedule. Set specific times for waking up, eating, playing, doing homework, watching TV and going to bed. Write the schedule down. Put the schedule on a bulletin board so your child can see it and refer to it often. When possible, have your child help create the schedule with you. Your child more likely will follow a schedule that he or she had a hand in making.
  • Teach my child how to be organized: Children with ADHD can get overwhelmed with big tasks and may give up. Teach your child how to break down big jobs into a series of smaller steps or tasks. For example, instead of saying, “Clean your room,” you could tell your son to pick up his clothes off the floor, put them in the laundry hamper and then pick up his toys and put them away. A schedule board can help. For younger children, use a picture scheduler (a schedule for your child that uses pictures and symbols to represent tasks).
  • Be consistent with my child: This is another tough one. Sometimes we feel like giving in to our children’s demands because we are tired of arguing. But all children, especially children with ADHD, thrive when their lives are regular and can be predicted. Make clear, fair rules. Be steady in enforcing the rules.
  • Make sure my child understands me: Parents know that just because we are talking doesn’t always mean our children are listening. Get your child’s attention. Make direct eye contact. Use a clear, calm voice. Ask your child to repeat back to you what he or she thinks you said.
  • Reward my child: Reward good behavior. Praise your child when he or she shows the behaviors you like or for things done well. Does he/she draw well? Like to build things? Good at swimming or running? Great with pets? Praise is important. Feelings of failure, frustration, sadness or loneliness may cause more problems for your child than ADHD itself. Praising your child when doing well can help.

Praise and rewards can be pats on the back, a hug or extra time spent with you. Rewards don’t need to be food or expensive things. Your time and attention is the most valuable reward your child can receive.

  • Watch my child carefully for impulsive behavior: Children with ADHD may need more adult supervision than other children their age. To keep everyone safe, make sure a caring adult always watches over them. Warn the adult watching the children that your child may be more likely to act impulsively. Some children with ADHD have a hard time making or keeping friends because of poor social skills. Reward your child for playing well with other children.
  • Encourage my child to talk about feelings: Children with ADHD often deal with frustration, anxiety and depression. Listen when your child is talking. Give that child your attention, allowing him or her to vent feelings safely as well as giving alternatives such as making drawings or punching pillows. A therapist or psychologist often can engage the child in conversation that he or she may not share with you. If your child is in school, ask the teacher or school counselor to serve as a trusted adult listener for your child.
  • Do something fun together every day: Try to spend time each day just playing and talking with your child. This can be hard to arrange with big families or hectic life styles, but is well worth the time spent. Music is a great way to share time together. Try it in the car. There are many children’s tapes with which everyone can sing together. Your child can learn words at the same time. Music can be soothing or energizing or both. Research tells us that music can be healing, too. Classical music is believed by some to stimulate brain development.

How can my child’s school help?

Schools and parents can help a child with ADHD many ways. Most children with ADHD can be helped with special support — called “accommodations” — in the classroom or by changes in the way teachers organize the classroom. Laws require schools to make these changes and offer supports when needed.

  • If your child is in school, talk with his/her teacher(s) often: Your child’s teacher(s) can be your best ally. Stay in close touch. Work out consistent strategies for home and school. Remember that clear expectations are the key.

Some things you can ask your child’s teacher to do are:

  • Post rules, schedules and assignments. Clear rules and routines help a student with ADHD. Set times for specific tasks. Let you and your child know in advance if there will be changes in the schedule.
  • Show your child how to use an assignment book and a daily schedule. Also teach study skills and learning strategies.
  • Help your child use hyperactivity in ways that are okay to do in a classroom. For example, let your child do some work standing up or at the board.
  • Give directions step-by-step, saying them and writing them out. Many students with ADHD also benefit from doing the steps as separate tasks.
  • Let your child do work on a computer.

How can I help with my child’s school work?

  • Set a homework routine: Pick a regular place for doing homework. Choose a place away from distractions such as other people, TV and video games. Break homework time into small parts with frequent breaks. Some children concentrate best if they have classical music playing in the background. Find what works best for your child. It will be different for each child.
  • Focus on my child’s efforts, not grades: Reward your child for finishing school work, not just for good grades. You can give extra rewards for earning better grades.

How common is ADHD?

About 8-10% of all boys (6 to 12 years old) and 2-3% of girls have ADHD. In a classroom of 25 to 30 children, At least one probably will have ADHD. The National Institutes of Health says more than a million children take prescription medicines to control hyperactive behavior. Up to 60% of children with ADHD will continue to have symptoms into adulthood.

What else should I know about ADHD?

  • About half of children with ADHD also have depression or a learning disability (American Academy of Pediatrics). Many children with ADHD, mostly younger children and boys, develop emotional problems. About 25% feel anxious, worried, tense, fearful or uneasy for no clear reason.
  • Sometimes children, mostly boys, with ADHD are also diagnosed with Oppositional Defiant Disorder (ODD). Children with ODD might fight with their playmates. They also tend to overreact or lash out when they feel badly about themselves. Children with ODD are at risk for later trouble with the police.

What ADHD is not

A diagnosis of ADHD should not be made hurriedly. There are many reasons why children might have problems with attention and behavior. Rule out these other possible causes before a proper diagnosis can be made. Here are some possible reasons for behavior and attention difficulties that are not caused by ADHD:

  • Stress: Changes in a child’s life that are stressful can be such matters as divorce, a new marriage of a parent, illness or death in the family, moving and the birth of siblings.
  • Family problems or problems in the home.
  • Ineffective or poor schooling.
  • Vision, hearing or language impairments.

What causes ADHD?

Friends children
No one knows for sure what causes ADHD. Research suggests that these things might be related to ADHD:

  • Heredity: ADHD tends to run in families. Most children with ADHD have at least one family member with the disorder. One in three fathers with ADHD symptoms in childhood have children with ADHD. A study done on identical twins found when one twin had ADHD, there was a 91% chance that the other identical twin also would have it.
  • Changes in how the brain works: Studies show that the brains of children with ADHD may work differently than those of other children. These children may not have the usual balance of chemicals in the brain that helps to control behavior.
  • Harmful chemicals taken during pregnancy: Lead poisoning, smoking, illegal drugs such as crack cocaine and alcohol drinking have all been linked to ADHD.
  • Difficult birth: Babies who had trouble breathing when born might have been short on oxygen. This kind of birth complication might be one of the causes of ADHD. Low birth weight (less than 3.3 pounds) and prematurity are other possible causes.

Is there a cure or treatment for ADHD?

There is no quick treatment or cure for ADHD. Doctors used to think that children would outgrow ADHD, but that turns out not to be true. Some symptoms improve as children grow older and if they have had help. About half will continue to have difficulty with attention, mood swings, hot tempers and not being able to complete tasks. Having loving, caring, supportive adults helps a child with ADHD become a well-adjusted adult.

The problems involved with having ADHD can be managed or helped with medication and various therapies. Every child with ADHD is different. Work with your health providers to find the right combination of therapies and medications to help your child.

  • Medication: Some children will be prescribed medications by their doctors. Medicine is known by a brand name (also called a trade name) such as Ritalin and the drug name, e.g., methylphenidate (also called a generic name). Your doctor can prescribe several different types and brands of drugs to help children improve attention and the ability to focus. Two other common types of drugs used are dextro-amphetamine-levo-amphetamine (Adderall) and dextroamphetamine (Dexedrine). They also help children control risky or impulsive (acting without thinking) behavior, and the need to be in constant motion that makes it so hard for them to sit still in school (hyperactivity). Please be aware that while pemoline(Cylert) had been used in the past, it has been pulled off the market(PAG due to concerns about liver problems.

Parents understandably can be concerned about giving a young child medication every day. This is another reason why a proper and careful diagnosis of ADHD must first be made. Before trying medications, ask the doctor and other professionals about trying other things such as diet, psychotherapy and support groups. But medication may be necessary to help your child. If one does not work well or has side-effects, your doctor can prescribe another until you find the right one.

  • Therapy: Children with ADHD need help learning how to change the way they act. Your child’s doctor may recommend therapy. Here are a few therapies used with children with ADHD. Click on each therapy for more information.
    • Behavioral Therapy: This type of psychotherapy works on changing and gaining control over unwanted behaviors
    • Social coaching: Children with ADHD often do not pick up on the social cues that allow them to make and keep friends easily. Caring adults in their lives can coach them, helping them focus on the polite, socially acceptable things to do. This can help your child to keep friends and avoid the loneliness many kids with ADHD suffer.
    • Diet therapy: There is disagreement on whether special diets help children with ADHD. There are many books and articles about the Feingold diet, which was started by pediatrician Dr. Benjamin Feingold. He says that certain foods and things put in foods are linked to behavior problems seen in ADHD. Most doctors and self-help organizations do not recommend this approach
    • Massage therapy: Some research has shown that massage therapy may help with on-task behavior in the classroom and reduce depression and anxiety.
    • Tai Chi: A series of Chinese mind-body relaxation exercises. They can help children with ADHD use up some of their boundless energy so they can concentrate better.

Who are some professionals my child may need to see?

Your child may need to see many different health care specialists. For example:

  • Pediatrician: A doctor who specializes in treating children. The word “pediatric” in front of a professional’s title means he or she works with children.
  • Developmental and behavioral pediatrician: A doctor who has studied childhood behavior and developmental disorders such as ADHD as well as specializing in childhood physical diseases and illnesses.
  • Pediatric neurologist: A doctor who specializes in treating children with disorders of the brain and nervous system.
  • Pediatric psychiatrist: A doctor who specializes in diagnosing and, if indicated, treating disorders of thinking, feeling and/or behavior affecting children, adolescents and their families
  • Pediatric psychologist: A professional who specializes in evaluating and treating emotional and behavioral problems and disorders in children. Psychologists also can provide psychological testing and assessments
  • Pediatric neuropsychologist: A professional who specializes in the relationship of abilities, behaviors and mental skills in children
  • Behavior analyst: A professional who specializes in looking at the way children behave and trying to help them improve.
  • Social worker and counselor: A professional who provides counseling and emotional support for the child and family, and may help coordinate services, too.
  • Care coordinator: An individual responsible for organizing the details across agency lines and serves as your contact to help you and your family get services and assistance.

What are some websites where I can learn more about ADHD?

NICHCY Lots of information and fact sheets.

Kidshealth for Parents More information on ADHD by

CHADD (Children and Adults with Attention Deficit Disorder) This program is funded through the Centers for Disease Control and Prevention, the national resource center for information on ADHD.

What are some books that are about ADHD for parents and children?

The following list is only a sampling. Check your local library, bookstores and websites for many more.

Putting on the Brakes: Young People’s Guide to Understanding Attention Deficit Hyperactivity Disorder by Patricia O. Quinn and Judith M. Stern. One of the most difficult things about parenting an ADHD child is explaining attention deficit disorder to that child. The authors have given a powerful resource to parents, a gift to empower them. In simple language, illustrated with eye-catching graphics, “Putting on the Breaks” explains not only the nature of this disorder, but also how children and their families can learn to manage it.

“Putting on the Brakes” Activity Book for Young People With ADHD by Patricia O. Quinn, Judith M. Stern, Neil Russell (illustrator)

Cory Stories: A Kid’s Book About Living With ADHD by Jeanne Kraus, Whitney Martin (illustrator)

Jumpin’ Johnny, Get Back to Work! : A Child’s Guide to ADHD/Hyperactivity by Michael, Ph.D. Gordon

Distant Drums, Different Drummers: A Guide for Young People With ADHD by Barbara D. Ingersoll

Otto Learns About His Medicine: A Story about Medication for Children with ADHD by Matthew R. Galvin, Sandra Ferraro (illustrator)

Book for siblings (brothers or sisters):

I’m Somebody, Too by Jeanne Gehret. A book for a brother or sister of a child with ADHD.

Book for Parents:

Taking Charge of ADHD: The Complete, Authoritative Guide for Parents (Revised Edition) by Russell A. Barkley. The Guilford Press; Revised edition, 2000. Issues with ADHD and advice and tools for parents.

Delivered from Distraction : Getting the Most Out of Life with Attention Deficit Disorder by Edward M. Hallowell, John J. Ratey. Ballantine Books 2005.

The Parent’s Hyperactivity Handbook: Helping the Fidgety Child David M. Paltin – author. Insight Books. New York. 1993.

SOS: Help for Parents, Third Edition by Lynn Clark, John Robb (illustrator). Parents Press; 3rd edition, 2005. (Available in Spanish as SOS: Ayuda Para Padres: Una Guia Practica para Manejar Problemas de Conducta Comunes y Corrientes.) Provides methods for helping children improve their behavior.