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Brain clues to attention disorder

Scientists have found differences in the brains of children

with attention-deficit hyperactivity disorder.
University of California Los Angeles researchers found some
areas of the brains of the children were smaller, but others had
more grey matter.
Other studies have suggested that ADHD is lined to abnormalities in areas of the brain which
control attention.
But the latest study suggests there are also structural changes in areas which control im!ulsive
"he researchers say they were able to combine the latest
scanning technology with com!uter analysis to !rovide more
detailed information about the differences in the brains of
ADHD children.
ADHD is a serious behavioural disorder which e#!erts estimate may affect u! to $% of children.
&eo!le with the condition have a !oor attention s!an and tend to be im!ulsive and restless.
However, the underlying cause is still !oorly understood.
Precise differences
"he U' researchers carried out scans on the brains of () children with ADHD, and *$ children
with no signs of the disorder.
"he ADHD children showed evidence of a reduction in the si+e two areas of the brain , one of
each side , called the dorsal !refrontal cortices.
'imilarly, there was evidence of a si+e reduction in the anterior tem!oral areas , also found on
each side of the brain.
However, the scans also showed substantial increases in grey matter in large !ortions of the
!osterior tem!oral and inferior !arietal cortices in children with ADHD.
&rofessor Bradley &eterson, of Columbia University, -ew .or, who wored on the study, said
the findings showed that abnormalities occurred not /ust in areas of the brain nown to control
attention, but also in regions which control im!ulsive behaviour.
0"hese findings may hel! us understand the sites of action of the medications used to treat
ADHD, !articularly stimulant medications.
01n con/unction with other imaging techni2ues, the findings may hel! us to develo! new
thera!eutic agents given our nowledge of the cellular and neurochemical mae,u! of brain
regions where we detected the greatest abnormalities.0
Fuller picture
ADHD is lined to brain
This should give food for
thought to those who view
ADHD as a 2st century
Dr 3ar Berelowit+
Dr 3ar Berelowit+, a child and adolescent consultant !sychiatrist at the 4oyal 5ree Hos!ital,
told BBC -ews Online the research hel!ed give scientists a fuller !icture of the !hysical causes
of ADHD.
0"his tells us more than we new already about the !arts of the brain that are affected by
ADHD,0 he said.
0Children with ADHD have sym!toms of over,activity, im!ulsivity and !oor concentration, but
!revious scans have only highlighted differences in !art of the brain related to one of these
!roblem areas , attention.
0"his suggested that we were either missing something in the brain, or we did not understanding
the clinical !roblems sufficiently.
0-ow the clinical condition and the brain imaging are beginning to /oin u! and can e#!lain one
Dr Berelowit+ said that the study should also convince !eo!le who doubted that ADHD was a
real clinical disorder.
0"his should give food for thought to those who view ADHD as a (6st century construct.0
However, he stressed that further studies were re2uired to confirm the findings, and stressed that
giving children with sym!toms of ADHD brain scans would not be hel!ful at this stage.
!elco"e to the ADD ADHD #nfor"ation
<e have great information on Attention Deficit Hyperactivity
Disorder organi+ed into 6= easy lessons. "ae the time to go
through all ten of the lessons. Once you do, you will now a
great deal about ADD ADHD , and how to overcome it.
Let>s begin right now with $%SS&' &'%( !HAT #S
ATT%'T#&' D%F#)#T H*P%+A)T#,#T* D#S&+D%+-
What Is Attention Deficit Hyperactivity
Disorder -
Attention Deficit Hyperactivity Disorder, often called ADD or ADHD, is a
diagnostic label that we give to children and adults who have significant problems in
four main areas of their lives:
Attention Deficit Hyperactivity Disorder is a neurologically based disorder.
"his !osition has become controversial as many would lie to dismiss the diagnosis of
Attention Deficit Hyperactivity Disorder altogether saying that there is no evidence of
neurological differences, or that there are no medical tests to diagnose ADD ADHD. or that the
diagnostic criteria is too broad.

5or now we will sim!ly re!ort that there is a tremendous amount of research to su!!ort the
statement that, indeed, Attention Deficit Hyperactivity Disorder is a neurologically based
ADHD is not the result of 0bad !arenting0 or obno#ious, willful defiance on the !art of the
.es, a child may be willfully defiant whether he has Attention Deficit Hyperactivity
Disorder or not. Defiance, rebelliousness, and selfishness are usually 0moral0 issues, not
neurological issues. <e mae no e#cuses for 0immoral,0 0selfish,0 or 0destructive0
behaviors, whether from individuals with ADD ADHD or not.
1t may also be true that the !arents may need further training. <e are constantly ama+ed at
how many young !arents today grew u! in homes where their !arents were gone all day. <e
now see 0grown u! latch ey ids0 trying to !arent as best as they can, but without having
had the benefit of growing u! with good !arental role models. "his is a !roblem as well. But
it is not Attention Deficit Hyperactivity Disorder. 1t is Attention Deficit Hyperactivity
Disorder that we will be e#!loring here at the ADD ADHD #nfor"ation $ibrary.
Defining Terms: Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder is a "edical condition. caused by genetic
factors that result in certain neurological differences.
Attention Deficit Hy!eractivity Disorder comes in various forms. "oday they all fall under
the category of Attention Deficit Hyperactivity Disorder /ADHD0. and then the main
category is subdivided into ADHD 1nattentive "y!e, or ADHD 1m!ulsive,Hy!eractive "y!e,
or ADHD Combined "y!e. 1n the recent !ast the terms attention deficit disorder 0with0 or
0without0 hy!eractivity were also commonly used. Attention Deficit Hy!eractivity Disorder
comes in various forms, and truly, no two ADD or ADHD 1ids are e2actly ali1e.

3eneral Description of Attention Deficit Hyperactivity
Attention Deficit Hy!eractivity Disorder , ADD ADHD , might affect one, two, or several
areas of the brain, resulting in several different 0styles0 or 0!rofiles0 of children ?and adults@
with ADD ADHD.
"hese different !rofiles im!act !erformance in these four areas7
5irst, !roblems with Attention.
'econd, !roblems with a lac of 1m!ulse Control.
"hird, !roblems with Over,activity or motor restlessness,
5ourth, a !roblem which is not yet an 0official0 !roblem found in the diagnostic
manuals, but ought to be7 being easily Bored.
A few other important characteristics of this disorder are:
6@ "hat it is SEEN IN MOST SITUATIONS, not /ust at school, or /ust in the home. <hen
the !roblem is seen only at home, we then would wonder if !erha!s the child is de!ressed, or
if the child is /ust being non,com!liant with the !arentsA
(@ "hat the !roblems are a!!arent BEFORE the AGE OF SEVEN ?)@.
'ince Attention Deficit Hy!eractivity Disorder is thought to be a neurologically based
disorder, we would e#!ect that outside of ac2uiring its sym!toms from a head in/ury, the
individual with Attention Deficit Hy!eractivity Disorder would have been born with the
disorder. Bven though the disorder might not become much of a !roblem until the second or
third grade when the school wor becomes more demanding, one would e#!ect that at least
some of the sym!toms were noted before the age of seven.
Attention Deficit Hyperactivity Disorder - "ADD" or "ADHD" - affects about five
percent (5! of the chi"dren in the #nited $tates% and about three percent
(&! of a"" adu"ts in the #$A'
How Big of a Problem is Attention Deficit
Hyperactivity Disorder?
About 9C% of all children referred to mental health clinics are referred for Attention Deficit
Hy!eractivity Disorder, or ADHD. 1t is one of the most !revalent of all childhood !sychiatric
As we mentioned, it affects about C% of children, about 9% of adults. .ou may see !ublished
estimates stating that Attention Deficit Hy!eractivity Disorder may effect as many as 6=% to
(C% of children in America, but these numbers are not really su!!orted by research data, and
are !robably inflated for the !ur!ose of trying to sell something.
"he C% number is a solid number su!!orted by research. Bven at C% each classroom in
America will have one or two ?(@ ADHD ids in the class. 'o it is a very real, and very
significant !roblem across America.
!y Does "t #eem T!at T!ere Are $ore %!ildren it! Attention Deficit
Hyperactivity Disorder & ADD ADHD & T!an 'ver Before?
Bven though the !ercentage of !eo!le with Attention Deficit Hy!eractivity Disorder is liely
the same as in the !ast, here are three liely reasons why it seems that 0there is more ADD0
than ever before7
.ou are more aware of !roblems lie this as a !arent than you were as a child. .ou have
grown u! nowA "he news and entertainment media have taled about Attention Deficit
Hy!eractivity Disorder a lot more than in the !ast, raising your awareness levelA Children
who were Drug B#!osed in utero, or 5etal Alcohol 'yndrome children have many of the
same !roblems as children with Attention Deficit Hy!eractivity Disorder, and are often
misdiagnosed by !hysicians as being ADD ADHD.
A recent study by the (ationa"
Institute of Dru) Abuse reported the
fo""owin): 5'5 of women
*+,-*.+D usin) i""icit dru)s whi"e
they were pre)nant/ 01'1
*+,-*.+D usin) a"coho"% and 23'4
*+,-*.+D usin) tobacco whi"e

1n our rural California county it is estimated that 6=% of all children born in the county were
e#!osed to drugs or alcohol in utero by their mothers.
"here are no nown 0safe levels0 of drug, alcohol, or tobacco use while !regnant. "he use of
drugs or alcohol are es!ecially dangerous to the develo!ing baby and can often cause
neurological !roblems. <hen these children enter school, they often dis!lay !roblems with
attention, im!ulse control, tem!er, learning, and behavior. They are often "isdiagnosed as
having a genetically based Attention Deficit Hyperactivity Disorder.
<hat they really suffer from are structural brain in4uries thans to their mother>s !ast

Anti&#ocial Be!aviors and Attention Deficit Hyperactivity Disorder
behaviors are
common Abo!t
"#$ o%
Attention &e%icit
&isor*er +i*s
are also
o))ositional or
*e%iant Some
are even ,ettin,
in tro!ble -ith
the la-

1m!ulsive,Hy!eractive ADHD ids are the most liely to get into trouble than are the
inattentive ids.
"he inattentive ids tend to be non,com!liant due to not being motivated enough to
remember the things he was ased to do.
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(eneral "ntroduction: !at %auses Attention Deficit
Hyperactivity Disorder?
"he most recent models that attem!t to describe what is ha!!ening
in the brains of !eo!le with Attention Deficit Hyperactivity
Disorder suggest that several areas of the brain may be affected by
the disorder. "hey include the frontal lobes. the inhibitory
"echanis"s of the corte2. the li"bic syste". and the reticular
activating syste". Bach of these areas of the brain is associated
with various functions.
"here are several areas of the brain !otentially im!acted, and there
are several !ossible 0ty!es0 of ADHD. Daniel Amen, a medical
doctor using '&BC" scans as identified si# different ty!es of
ADHD, each with its own set of !roblems, and each different from
the other 0ty!es.0
1n our office we used si2 different 5types5 of ADHD, identifying
each 0ty!e0 with a character from the <innie the &ooh stories
?&ooh is inattentive, "igger is hy!eractive, Beyore is de!ressive,
and so on@.
"he frontal lobes hel! us to !ay attention to tass, focus
concentration, mae good decisions, !lan ahead, learn and
remember what we have learned, and behave a!!ro!riately for the
"he inhibitory mechanisms of the corte# ee! us from being
hy!eractive, from saying things out of turn, and from getting mad
at ina!!ro!riate times, for e#am!les. "hey hel! us to 0inhibit0 our
It has been sai* that .#$ o% the brain is there to inhibit
the other /#$
Your child will
be more focused
have more self-
learn faster
do better at
home and
at school

<hen the inhibitory mechanisms of the brain aren>t woring as
hard as they ought to, then we can see results of what are
sometimes called 0dis,inhibition disorders0 such as im!ulsive
behaviors, 2uic tem!er, !oor decision maing, hy!eractivity, and
so on.
"he limbic system is the base of our emotions and our highly
vigilant loo,out tower. 1f over,activated, a !erson might have
wide mood swings, or 2uic tem!er outbursts. He might also be
0over,aroused,0 2uic to startle, touching everything around him,
A normally functioning limbic system would !rovide for normal
emotional changes, normal levels of energy, normal slee! routines,
and normal levels of co!ing with stress. A dysfunctional limbic
system results in !roblems with those areas.
"he Attention Deficit Hyperactivity Disorder might affect one,
two, or all three of these areas, resulting in several different
0styles0 or 0!rofiles0 of children ?and adults@ with ADD ADHD.
Here !rovide more detail on the 'eurology of Attention Deficit
Hyperactivity Disorder - ADD ADHD.

Attention Deficit Hyperactivity Disorder in #c!ool
Often the Attention Deficit Hy!eractivity Disorder child has
s!ecial educational needs, though not always. 3ost Attention
Deficit Hy!eractivity Disorder ids can be successful in the
regular classroom with some hel!.
<e tend to see Lower academic achievement for 1.D. 1f they ought
to be A students, they>re getting C>s instead. 1f they ought to be B
students, they>re getting D>s instead.
Also it0s im)ortant to +no- that Attention &e%icit
'()eractivit( &isor*er an* I1 are t-o *i%%erent thin,s

Attention Deficit Hyperactivity Disorder is not related to #.6. 'ome !arents are convinced
that if their child has ADD ADHD it means that they are retarded. On the other hand, other
!arents say, 01>ve heard that ADD ids are really very, very bright. 1 thin my child must have
ADD,0 as if they wanted to wear a button that said, 03y child is smarter than your child
because he has ADD.0
<ell, that>s ridiculous.
'ome Attention Deficit Hyperactivity Disorder ids are below average 1.D., and some are
even retarded.
'ome ADD ADHD ids are above average 1.D., and some are even 2uite brilliant.
But the awful truth for a !arent to hear is that 7&ST 1ids are A,%+A3% #.6.
That8s why they call it 5average.5
And "ost Attention Deficit Hyperactivity Disorder 1ids have average #.6. as well. "hey
/ust have a real tough time in the classroom setting.
1n fact, if you thin about it, the classroom setting is !robably the worst !ossible setting for
these ids. "here are a lot of distractions, they are told to sit still, don>t move, don>t tal, to !ay
attention to boring worsheets, and ee! on tas until the wor is finished. -one of these
things come easily to Attention Deficit Hy!eractivity Disorder ids.
3any Attention Deficit Hy!eractivity Disorder ids 0hit a wall0 in school as the school year
!rogresses. Bvery wee they /ust get a little farther and farther behind, until they>re so far
behind that it>s im!ossible to catch u!.
"he disorder is most often recogni+ed and referred for treatment in third grade. "his is when
ids most often hit the 0academic wall.0 1n third grade they are e#!ected to do more and more
wor on their own, and they are given more homewor to do as well.
<e also see many referrals in seventh grade, or when the child leaves Blementary 'chool for
Eunior High 'chool, with several classes and several teachers. 3any Attention Deficit
Hy!eractivity Disorder ids who found ways to com!ensate in Blementary 'chool are totally
lost in Eunior High 'chool.
Here is a lin to ADD in". an outstanding <eb 'ite with over 9:: )lassroo"
#nterventions to help your ADD ADHD Student succeed.

!ill *our )hild %ver &ut-grow His Attention Deficit
Hyperactivity Disorder-
'tudies indicate that about 9: to ;: percent of Attention Deficit Hyperactivity Disorder
1ids will outgrow "ost of the sy"pto"s by the time he or she is in their (=>s. "he old
school thining was that once a child reaches !uberty they no longer need any hel! for ADD
ADHD, but this is sim!ly not true. However, there is one final growth s!urt of the brain,
!articularly in the frontal lobes, at about 6; or (= years old. 1t is not much, but for those with
Attention Deficit Hy!eractivity Disorder it /ust might mae a big difference.
"he Hyperactivity may diminish may become more of a restlessness or fidgetiness and be
more a!!ro!riate. "he i"pulsivity may remain, though, and it is often the biggest com!laint
of adults with the disorder. 1t causes a variety of !roblems from often interru!ting others in
conversations to 2uitting /obs for little reason and without other em!loyment already lined u!.
Difficulties with attention may also !ersist. 1t is often described as a constant 0brain,fog0
which maes tass such as balancing chec boos and doing ta#es very difficult. A visit to
'tarbucs, however, often hel!s to im!rove focus enough for adults to get their wor done.
Fladly, most adults with Attention Deficit Hyperactivity Disorder can find /obs where their
strengths can shine, and they can be successful.
1!estions that -e -ill ans-er in %ollo-in, section on the Ne!rolo,( o%
Attention &e%icit '()eractivit( &isor*er incl!*e2
<hat causes these various systems of the brain to get out of balanceG
<hy would they become under aroused or over aroused as the case may beG
1s there one central system that controls or regulates these other systemsG
)et*s continue on to t!e +eurology of ADD ADHD

Lisa>s son Eac had always been a handful. Bven as a !reschooler, he would tear through the
house lie a tornado, shouting, roughhousing, and climbing the furniture. -o toy or activity ever
held his interest for more than a few minutes and he would often dart off without warning,
seemingly unaware of the dangers of a busy street or a crowded mall.
1t was e#hausting to !arent Eac, but Lisa hadn>t been too concerned bac then. Boys will be
boys, she figured. He>ll grow out of it. But here he was, now :, and still no easier to handle.
Bvery day it was a struggle to get Eac to settle down long enough to com!lete even the sim!lest
tass, from chores to homewor. <hen his teacher>s comments about his inattention and
disru!tive behavior in class became too fre2uent to ignore, Lisa too Eac to the doctor, who
recommended an evaluation for attention deficit hy!eractivity disorder ?ADHD@.
ADHD is a common behavioral disorder that affects an estimated :% to 6=% of school,age
children. Boys are about three times more liely than girls to be diagnosed with it, though it>s
not yet understood why. Children with ADHD act without thining, are hy!eractive, and have
trouble focusing. "hey may understand what>s e#!ected of them but have trouble following
through because they can>t sit still, !ay attention, or attend to details.
Of course, all children ?es!ecially younger ones@ act this way at times, !articularly when they>re
an#ious or e#cited. But the difference with ADHD is that sym!toms are !resent over a longer
!eriod of time and occur in different settings. "hey im!air a child>s ability to function socially,
academically, and at home.
"he good news is, with !ro!er treatment, children with ADHD can learn to successfully live
with and manage their sym!toms.
!hat Are the Sy"pto"s-
ADHD used to be nown as attention deficit disorder, or ADD. 1n 6;;*, it was renamed
ADHD and broen down into three subty!es, each with its own !attern of behaviors7
. an inattentive type, with signs that include7
inability to !ay attention to details or a tendency to mae careless errors in schoolwor or
other activities
difficulty with sustained attention in tass or !lay activities
a!!arent listening !roblems
difficulty following instructions
!roblems with organi+ation
avoidance or dislie of tass that re2uire mental effort
tendency to lose things lie toys, noteboos, or homewor
forgetfulness in daily activities
2. a hyperactive-i"pulsive type, with signs that include7
fidgeting or s2uirming
difficulty remaining seated
e#cessive running or climbing
difficulty !laying 2uietly
always seeming to be 0on the go0
e#cessive taling
blurting out answers before hearing the full 2uestion
difficulty waiting for a turn or in line
!roblems with interru!ting or intruding
<. a co"bined type, which involves a combination of the other two ty!es and is the most
Although it can often be challenging to raise ids with ADHD, it>s im!ortant to remember they
aren>t 0bad,0 0acting out,0 or being difficult on !ur!ose. And children who are diagnosed with
ADHD have difficulty controlling their behavior without medication or behavioral thera!y.
How #s #t Diagnosed-
3ost cases of ADHD are treated by !rimary care doctors. Because there>s no test that can
determine the !resence of ADHD, a diagnosis de!ends on a com!lete evaluation. <hen the
diagnosis is in doubt, or if there are other concerns, such as "ourette syndrome, a learning
disability, or de!ression, a child may be referred to a neurologist, !sychologist, or !sychiatrist.
Ultimately, though, the !rimary care doctor gathers the information, maes the diagnosis, and
starts treatment.
"o be considered for a diagnosis of ADHD7
a child must dis!lay behaviors from one of the three subty!es before age )
these behaviors must be more severe than in other ids the same age
the behaviors must last for at least $ months
the behaviors must occur in and negatively affect at least two areas of a child>s life ?such
as school, home, day,care settings, or friendshi!s@
"he behaviors must also not be lined to stress at home. Children who have e#!erienced a
divorce, a move, an illness, a change in school, or other significant life event may suddenly
begin to act out or become forgetful. "o avoid a misdiagnosis, it>s im!ortant to consider whether
these factors !layed a role in the onset of sym!toms
5irst, your child>s doctor will !erform a !hysical e#amination of your child and as you about
any concerns and sym!toms, your child>s !ast health, your family>s health, any medications your
child is taing, any allergies your child may have, and other issues. "his is called the medical
history, and it>s im!ortant because research has shown that ADHD has a strong genetic lin and
often runs in families.
.our child>s doctor may also !erform a !hysical e#am as well as tests to chec hearing and
vision so other medical conditions can be ruled out. Because some emotional conditions, such as
e#treme stress, de!ression, and an#iety, can also loo lie ADHD, you>ll !robably be ased to
fill out 2uestionnaires that can hel! rule them out as well.
.ou>ll also liely be ased many 2uestions about your child>s develo!ment and his or her
behaviors at home, at school, and among friends. Other adults who see your child regularly ?lie
teachers, who are often the first to notice ADHD sym!toms@ will !robably be consulted, too. An
educational evaluation, which usually includes a school !sychologist, may also be done. 1t>s
im!ortant for everyone involved to be as honest and thorough as !ossible about your child>s
strengths and weanesses.
!hat )auses ADHD-
ADHD is not caused by !oor !arenting, too much sugar, or vaccines.
ADHD has biological origins that aren>t yet clearly understood. -o single cause of ADHD has
been identified, but researchers have been e#!loring a number of !ossible genetic and
environmental lins. 'tudies have shown that many children with ADHD have a close relative
who also has the disorder.
Although e#!erts are unsure whether this is a cause of the disorder, they have found that certain
areas of the brain are about C% to 6=% smaller in si+e and activity in children with ADHD.
Chemical changes in the brain have been found as well.
4ecent research also lins smoing during !regnancy to later ADHD in a child. Other ris
factors may include !remature delivery, very low birth weight, and in/uries to the brain at birth.
'ome studies have even suggested a lin between e#cessive early television watching and future
attention !roblems. &arents should follow the American Academy of &ediatrics> ?AA&@
guidelines, which say that children under ( years old should not have any 0screen time0 ?"H,
DHDs or videota!es, com!uters, or video games@ and that ids ( years and older should be
limited to 6 to ( hours !er day, or less, of 2uality television !rogramming.
!hat Are So"e +elated Proble"s-
One of the difficulties in diagnosing ADHD is that it>s often found in con/unction with other
!roblems. "hese are called coe#isting conditions, and about two thirds of all children with
ADHD have one. "he most common coe#isting conditions are7
&ppositional Defiant Disorder /&DD0 and )onduct Disorder /)D0
At least 9C% of all children with ADHD also have oppositional defiant disorder, which is
characteri+ed by stubbornness, outbursts of tem!er, and acts of defiance and rule breaing.
Conduct disorder is similar but features more severe hostility and aggression. Children who have
conduct disorder are more liely get in trouble with authority figures and, later, !ossibly with the
law. O!!ositional defiant disorder and conduct disorder are seen most commonly with the
hy!eractive and combined subty!es of ADHD.
7ood Disorders /such as depression0
About 6:% of children with ADHD, !articularly the inattentive subty!e, also e#!erience
de!ression. "hey may feel inade2uate, isolated, frustrated by school failures and social
!roblems, and have low self,esteem.
An2iety Disorders
An#iety disorders affect about (C% of children with ADHD. 'ym!toms include e#cessive worry,
fear, or !anic, which can also lead to !hysical sym!toms such as a racing heart, sweating,
stomach !ains, and diarrhea. Other forms of an#iety that can accom!any ADHD are obsessive,
com!ulsive disorder and "ourette syndrome, as well as motor or vocal tics ?movements or
sounds that are re!eated over and over@. A child who has sym!toms of these other conditions
should be evaluated by a s!ecialist.
$earning Disabilities
About half of all children with ADHD also have a s!ecific learning disability. "he most
common learning !roblems are with reading ?dysle#ia@ and handwriting. Although ADHD isn>t
categori+ed as a learning disability, its interference with concentration and attention can mae it
even more difficult for a child to !erform well in school.
1f your child has ADHD and a coe#isting condition, the doctor will carefully consider that when
develo!ing a treatment !lan. 'ome treatments are better than others at addressing s!ecific
combinations of sym!toms.
How #s #t Treated-
ADHD can>t be cured, but it can be successfully managed. .our child>s doctor will wor with
you to develo! an individuali+ed, long,term !lan. "he goal is to hel! your child learn to control
his or her own behavior and to hel! families create an atmos!here in which this is most liely to
1n most cases, ADHD is best treated with a combination of medication and behavior thera!y.
Any good treatment !lan will re2uire close follow,u! and monitoring, and your child>s doctor
may mae ad/ustments along the way. Because it>s im!ortant for !arents to actively !artici!ate in
their child>s treatment !lan, !arent education is also considered an im!ortant !art of ADHD
'everal different ty!es of medications may be used to treat ADHD7
Sti"ulants are the best,nown treatments , they>ve been used for more than C= years in
the treatment of ADHD. 'ome re2uire several doses !er day, each lasting about * hoursA
some last u! to 6( hours. &ossible side effects include decreased a!!etite, stomachache,
irritability, and insomnia. "here>s currently no evidence of any long,term side effects.
'onsti"ulants were a!!roved for treating ADHD in (==9. "hese a!!ear to have fewer
side effects than stimulants and can last u! to (* hours.
Antidepressants are sometimes a treatment o!tionA however, in (==* the 5DA issued a
warning that these drugs may lead to a rare increased ris of suicide in children and
teens. 1f an antide!ressant is recommended for your child, be sure to discuss these riss
with your doctor.
3edications can affect ids differently, and a child may res!ond well to one but not another.
<hen determining the correct treatment for your child, the doctor might try various medications
in various doses, es!ecially if your child is being treated for ADHD along with another disorder.
=ehavioral Therapy
4esearch has shown that medications used to hel! curb im!ulsive behavior and attention
difficulties are more effective when they>re combined with behavioral therapy.
Behavioral thera!y attem!ts to change behavior !atterns by7
reorgani+ing your child>s home and school environment
giving clear directions and commands
setting u! a system of consistent rewards for a!!ro!riate behaviors and negative
conse2uences for ina!!ro!riate ones
Here are some e#am!les of behavioral strategies that may hel! a child with ADHD7
)reate a routine. "ry to follow the same schedule every day, from wae,u! timeto
bedtime. &ost the schedule in a !rominent !lace, so your child can see where he or she is
e#!ected to be throughout the day and when it>s time for homewor, !lay, and chores.
Help your child organi>e. &ut schoolbags, clothing, and toys in the same !lace every
day so your child will be less liely to lose them.
Avoid distractions. "urn off the "H, radio, and com!uter games, es!ecially when your
child is doing homewor.
$i"it choices. Offer your child a choice between two things ?this outfit, meal, toy, etc.,
or that one@ so that he or she isn>t overwhelmed and overstimulated.
)hange your interactions with your child. 1nstead of long,winded e#!lanations and
ca/oling, use clear, brief directions to remind your child of his or her res!onsibilities.
?se goals and rewards. Use a chart to list goals and trac !ositive behaviors, then
reward your child>s efforts. Be sure the goals are realistic ?thin baby ste!s rather than
overnight success@.
Discipline effectively. 1nstead of yelling or s!aning, use timeouts or removal of
!rivileges as conse2uences for ina!!ro!riate behavior. .ounger children may sim!ly
need to be distracted or ignored until they dis!lay better behavior.
Help your child discover a talent. All ids need to e#!erience success to feel good
about themselves. 5inding out what your child does well , whether it>s s!orts, art, or
music , can boost social sills and self,esteem.
Alternative Treat"ents
Currently, the only ADHD thera!ies that have been !roven effective in scientific studies are
medications and behavioral thera!y. But your child>s doctor may recommend additional
treatments and interventions de!ending on your child>s sym!toms and needs. 'ome ids with
ADHD, for e#am!le, may also need s!ecial educational interventions such as tutoring,
occu!ational thera!y, etc. Bvery child>s needs are different.
A number of other alternative thera!ies are !romoted and tried by !arents including7
megavitamins, body treatments, diet mani!ulation, allergy treatment, chiro!ractic treatment,
attention training, visual training, and traditional one,on,one 0taling0 !sychothera!y. However,
the scientific research that has been done on these thera!ies has not found them to be effective,
and most of these treatments have not been studied carefully, if at all.
&arents should always be wary of any thera!y that !romises an ADHD 0cure,0 and if they>re
interested in trying something new, they should be sure to s!ea with their child>s doctor first.
Parent Training
&arenting any child can be tough at times, but !arenting a child with ADHD often brings s!ecial
challenges. Children with ADHD may not res!ond well to ty!ical !arenting !ractices. Also,
because ADHD tends to run in families, !arents may also have some !roblems with organi+ation
and consistency themselves and need active coaching to hel! learn these sills.
B#!erts recommend !arent education and su!!ort grou!s to hel! family members acce!t the
diagnosis and to teach them how to hel! their child organi+e his or her environment, develo!
!roblem,solving sills, and co!e with frustrations. &arent training can also teach !arents to
res!ond a!!ro!riately to their child>s most trying behaviors and to use calm disci!lining
techni2ues. 1ndividual or family counseling may also be hel!ful.
ADHD in the )lassroo"
As your child>s most im!ortant advocate, you should become familiar with your child>s medical,
legal, and educational rights. Children with ADHD are eligible for s!ecial services or
accommodations at school under the 1ndividuals with Disabilities in Bducation Act ?1DBA@ and
an anti,discrimination law nown as 'ection C=*. Iee! in touch with your child>s teachers and
school officials to monitor your child>s !rogress and ee! them informed about your child>s
1n addition to using routines and a clear system of rewards, here are some other ti!s to share
with teachers for classroom success7
+educe seating distractions. Lessening distractions might be as sim!le as seating your
child near the teacher instead of near the window.
?se a ho"ewor1 folder for parent-teacher co""unications. "he teacher can include
assignments and !rogress notes, and you can chec to mae sure all wor is com!leted
on time.
=rea1 down assign"ents. Iee! instructions clear and brief, breaing down larger tass
into smaller, more manageable !ieces.
3ive positive reinforce"ent. Always be on the looout for !ositive behaviors. As the
teacher to offer !raise when your child stays seated, doesn>t call out, or waits his or her
turn, instead of critici+ing when he or she doesn>t.
Teach good study s1ills. Underlining, note taing, and reading out loud can hel! your
child stay focused and retain information.
Supervise. Chec that your child goes and comes from school with the correct boos and
materials. As that your child be !aired with a buddy who can hel! him or her stay on
=e sensitive to self-estee" issues. As the teacher to !rovide feedbac to your child in
!rivate, and avoid asing your child to !erform a tas in !ublic that might be too
#nvolve the school counselor or psychologist. He or she can hel! design behavioral
!rograms to address s!ecific !roblems in the classroom.
=eing *our )hild8s =iggest Supporter
.ou>re a stronger advocate for your child when you foster good !artnershi!s with everyone
involved in your child>s treatment , that includes teachers, doctors, thera!ists, and even other
family members. "ae advantage of all the su!!ort and education that>s available, and you>ll be
able to hel! your child with ADHD navigate his or her way to success.
4eviewed by7 <. Douglas "ynan, &hD
Date reviewed7 3arch (==C
Attention Deficit Hy!eractivity Disorder ?ADHD@ is a condition that becomes a!!arent in some
children in the !reschool and early school years. 1t is hard for these children to control their
behavior and8or !ay attention. 1t is estimated that between 9 and C !ercent of children have
ADHD, or a!!ro#imately ( million children in the United 'tates. "his means that in a classroom
of (C to 9= children, it is liely that at least one will have ADHD.
ADHD was first described by Dr. Heinrich Hoffman in 6:*C. A !hysician who wrote boos on
medicine and !sychiatry, Dr. Hoffman was also a !oet who became interested in writing for
children when he couldn>t find suitable materials to read to his 9,year,old son. "he result was a
boo of !oems, com!lete with illustrations, about children and their characteristics. 0"he 'tory
of 5idgety &hili!0 was an accurate descri!tion of a little boy who had attention deficit
hy!eractivity disorder. .et it was not until 6;=( that 'ir Feorge 5. 'till !ublished a series of
lectures to the 4oyal College of &hysicians in Bngland in which he described a grou! of
im!ulsive children with significant behavioral !roblems, caused by a genetic dysfunction and
not by !oor child rearingJchildren who today would be easily recogni+ed as having ADHD.

'ince then, several thousand scientific !a!ers on the disorder have been !ublished, !roviding
information on its nature, course, causes, im!airments, and treatments.
A child with ADHD faces a difficult but not insurmountable tas ahead. 1n order to achieve his
or her full !otential, he or she should receive hel!, guidance, and understanding from !arents,
guidance counselors, and the !ublic education system. "his document offers information on
ADHD and its management, including research on medications and behavioral interventions, as
well as hel!ful resources on educational o!tions.
Because ADHD often continues into adulthood, this document contains a section on the
diagnosis and treatment of ADHD in adults.
"he !rinci!al characteristics of ADHD are inattention, hyperactivity, and i"pulsivity. "hese
sym!toms a!!ear early in a child>s life. Because many normal children may have these
sym!toms, but at a low level, or the sym!toms may be caused by another disorder, it is
im!ortant that the child receive a thorough e#amination and a!!ro!riate diagnosis by a well,
2ualified !rofessional.
'ym!toms of ADHD will a!!ear over the course of many months, often with the sym!toms of
im!ulsiveness and hy!eractivity !receding those of inattention, which may not emerge for a year
or more. Different sym!toms may a!!ear in different settings, de!ending on the demands the
situation may !ose for the child>s self,control. A child who 0can>t sit still0 or is otherwise
disru!tive will be noticeable in school, but the inattentive daydreamer may be overlooed. "he
im!ulsive child who acts before thining may be considered /ust a 0disci!line !roblem,0 while
the child who is !assive or sluggish may be viewed as merely unmotivated. .et both may have
different ty!es of ADHD. All children are sometimes restless, sometimes act without thining,
sometimes daydream the time away. <hen the child>s hy!eractivity, distractibility, !oor
concentration, or im!ulsivity begin to affect !erformance in school, social relationshi!s with
other children, or behavior at home, ADHD may be sus!ected. But because the sym!toms vary
so much across settings, ADHD is not easy to diagnose. "his is es!ecially true when
inattentiveness is the !rimary sym!tom.
According to the most recent version of the Diagnostic and Statistical Manual of Mental
?D'3,1H,"4@, there are three !atterns of behavior that indicate ADHD. &eo!le with
ADHD may show several signs of being consistently inattentive. "hey may have a !attern of
being hy!eractive and im!ulsive far more than others of their age. Or they may show all three
ty!es of behavior. "his means that there are three subty!es of ADHD recogni+ed by
!rofessionals. "hese are the predo"inantly hyperactive-i"pulsive type ?that does not show
significant inattention@A the predo"inantly inattentive type ?that does not show significant
hy!eractive,im!ulsive behavior@ sometimes called ADDJan outdated term for this entire
disorderA and the co"bined type ?that dis!lays both inattentive and hy!eractive,im!ulsive
Hyperactive children always seem to be 0on the go0 or constantly in motion. "hey dash around
touching or !laying with whatever is in sight, or tal incessantly. 'itting still at dinner or during
a school lesson or story can be a difficult tas. "hey s2uirm and fidget in their seats or roam
around the room. Or they may wiggle their feet, touch everything, or noisily ta! their !encil.
Hy!eractive teenagers or adults may feel internally restless. "hey often re!ort needing to stay
busy and may try to do several things at once.
#"pulsive children seem unable to curb their immediate reactions or thin before they act. "hey
will often blurt out ina!!ro!riate comments, dis!lay their emotions without restraint, and act
without regard for the later conse2uences of their conduct. "heir im!ulsivity may mae it hard
for them to wait for things they want or to tae their turn in games. "hey may grab a toy from
another child or hit when they>re u!set. Bven as teenagers or adults, they may im!ulsively
choose to do things that have an immediate but small !ayoff rather than engage in activities that
may tae more effort yet !rovide much greater but delayed rewards.
'ome signs of hyperactivity-i"pulsivity are7
5eeling restless, often fidgeting with hands or feet, or s2uirming while seated
4unning, climbing, or leaving a seat in situations where sitting or 2uiet behavior is
Blurting out answers before hearing the whole 2uestion
Having difficulty waiting in line or taing turns.
Children who are inattentive have a hard time ee!ing their minds on any one thing and may get
bored with a tas after only a few minutes. 1f they are doing something they really en/oy, they
have no trouble !aying attention. But focusing deliberate, conscious attention to organi+ing and
com!leting a tas or learning something new is difficult.
Homewor is !articularly hard for these children. "hey will forget to write down an assignment,
or leave it at school. "hey will forget to bring a boo home, or bring the wrong one. "he
homewor, if finally finished, is full of errors and erasures. Homewor is often accom!anied by
frustration for both !arent and child.
"he D'3,1H,"4 gives these signs of inattention7
Often becoming easily distracted by irrelevant sights and sounds
Often failing to !ay attention to details and maing careless mistaes
4arely following instructions carefully and com!letely losing or forgetting things lie
toys, or !encils, boos, and tools needed for a tas
Often si!!ing from one uncom!leted activity to another.
Children diagnosed with the &redominantly 1nattentive "y!e of ADHD are seldom im!ulsive or
hy!eractive, yet they have significant !roblems !aying attention. "hey a!!ear to be
daydreaming, 0s!acey,0 easily confused, slow moving, and lethargic. "hey may have difficulty
!rocessing information as 2uicly and accurately as other children. <hen the teacher gives oral
or even written instructions, this child has a hard time understanding what he or she is su!!osed
to do and maes fre2uent mistaes. .et the child may sit 2uietly, unobtrusively, and even a!!ear
to be woring but not fully attending to or understanding the tas and the instructions.
"hese children don>t show significant !roblems with im!ulsivity and overactivity in the
classroom, on the school ground, or at home. "hey may get along better with other children than
the more im!ulsive and hy!eractive ty!es of ADHD, and they may not have the same sorts of
social !roblems so common with the combined ty!e of ADHD. 'o often their !roblems with
inattention are overlooed. But they need hel! /ust as much as children with other ty!es of
ADHD, who cause more obvious !roblems in the classroom.
#s #t +eally ADHD-
-ot everyone who is overly hy!eractive, inattentive, or im!ulsive has ADHD. 'ince most !eo!le
sometimes blurt out things they didn>t mean to say, or /um! from one tas to another, or become
disorgani+ed and forgetful, how can s!ecialists tell if the !roblem is ADHDG
Because everyone shows some of these behaviors at times, the diagnosis re2uires that such
behavior be demonstrated to a degree that is ina!!ro!riate for the !erson>s age. "he diagnostic
guidelines also contain s!ecific re2uirements for determining when the sym!toms indicate
ADHD. "he behaviors must a!!ear early in life, before age ), and continue for at least $ months.
Above all, the behaviors must create a real handica! in at least two areas of a !erson>s life such
as in the schoolroom, on the !layground, at home, in the community, or in social settings. 'o
someone who shows some sym!toms but whose schoolwor or friendshi!s are not im!aired by
these behaviors would not be diagnosed with ADHD. -or would a child who seems overly
active on the !layground but functions well elsewhere receive an ADHD diagnosis.
"o assess whether a child has ADHD, s!ecialists consider several critical 2uestions7 Are these
behaviors e#cessive, long,term, and !ervasiveG "hat is, do they occur more often than in other
children the same ageG Are they a continuous !roblem, not /ust a res!onse to a tem!orary
situationG Do the behaviors occur in several settings or only in one s!ecific !lace lie the
!layground or in the schoolroomG "he !erson>s !attern of behavior is com!ared against a set of
criteria and characteristics of the disorder as listed in the D'3,1H,"4.
'ome !arents see signs of inattention, hy!eractivity, and im!ulsivity in their toddler long before
the child enters school. "he child may lose interest in !laying a game or watching a "H show, or
may run around com!letely out of control. But because children mature at different rates and are
very different in !ersonality, tem!erament, and energy levels, it>s useful to get an e#!ert>s
o!inion of whether the behavior is a!!ro!riate for the child>s age. &arents can as their child>s
!ediatrician, or a child !sychologist or !sychiatrist, to assess whether their toddler has an
attention deficit hy!eractivity disorder or is, more liely at this age, /ust immature or unusually
ADHD may be sus!ected by a !arent or caretaer or may go unnoticed until the child runs into
!roblems at school. Fiven that ADHD tends to affect functioning most strongly in school,
sometimes the teacher is the first to recogni+e that a child is hy!eractive or inattentive and may
!oint it out to the !arents and8or consult with the school !sychologist. Because teachers wor
with many children, they come to now how 0average0 children behave in learning situations
that re2uire attention and self,control. However, teachers sometimes fail to notice the needs of
children who may be more inattentive and !assive yet who are 2uiet and coo!erative, such as
those with the !redominantly inattentive form of ADHD.
Professionals !ho 7a1e the Diagnosis.
#f ADHD is suspected. to who" can the fa"ily turn- !hat 1inds of specialists do they
1deally, the diagnosis should be made by a !rofessional in your area with training in ADHD or in
the diagnosis of mental disorders. Child !sychiatrists and !sychologists,
develo!mental8behavioral !ediatricians, or behavioral neurologists are those most often trained
in differential diagnosis. Clinical social worers may also have such training.
"he family can start by taling with the child>s !ediatrician or their family doctor. 'ome
!ediatricians may do the assessment themselves, but often they refer the family to an a!!ro!riate
mental health s!ecialist they now and trust. 1n addition, state and local agencies that serve
families and children, as well as some of the volunteer organi+ations listed at the end of this
document, can hel! identify a!!ro!riate s!ecialists.
)an Diagnose
)an prescribe
"edication. if needed
Provides counseling
or training
&sychiatrists yes yes yes
&sychologists yes no yes
&ediatricians or 5amily
yes yes no
-eurologists yes yes no
Clinical 'ocial worers yes no yes
Inowing the differences in 2ualifications and services can hel! the family choose someone who
can best meet their needs. "here are several ty!es of s!ecialists 2ualified to diagnose and treat
ADHD. Child !sychiatrists are doctors who s!eciali+e in diagnosing and treating childhood
mental and behavioral disorders. A !sychiatrist can !rovide thera!y and !rescribe any needed
medications. Child !sychologists are also 2ualified to diagnose and treat ADHD. "hey can
!rovide thera!y for the child and hel! the family develo! ways to deal with the disorder. But
!sychologists are not medical doctors and must rely on the child>s !hysician to do medical
e#ams and !rescribe medication. -eurologists, doctors who wor with disorders of the brain and
nervous system, can also diagnose ADHD and !rescribe medicines. But unlie !sychiatrists and
!sychologists, neurologists usually do not !rovide thera!y for the emotional as!ects of the
<ithin each s!ecialty, individual doctors and mental health !rofessionals differ in their
e#!eriences with ADHD. 'o in selecting a s!ecialist, it>s im!ortant to find someone with s!ecific
training and e#!erience in diagnosing and treating the disorder.
<hatever the s!ecialist>s e#!ertise, his or her first tas is to gather information that will rule out
other !ossible reasons for the child>s behavior. Among !ossible causes of ADHD,lie behavior
are the following7
A sudden change in the child>s lifeJthe death of a !arent or grand!arentA !arents>
divorceA a !arent>s /ob loss
Undetected sei+ures, such as in !etit mal or tem!oral lobe sei+ures
A middle ear infection that causes intermittent hearing !roblems
3edical disorders that may affect brain functioning
Underachievement caused by learning disability
An#iety or de!ression.
1deally, in ruling out other causes, the s!ecialist checs the child>s school and medical records.
"here may be a school record of hearing or vision !roblems, since most schools automatically
screen for these. "he s!ecialist tries to determine whether the home and classroom environments
are unusually stressful or chaotic, and how the child>s !arents and teachers deal with the child.
-e#t the s!ecialist gathers information on the child>s ongoing behavior in order to com!are these
behaviors to the sym!toms and diagnostic criteria listed in the D'3,1H,"4. "his also involves
taling with the child and, if !ossible, observing the child in class and other settings.
"he child>s teachers, !ast and !resent, are ased to rate their observations of the child>s behavior
on standardi+ed evaluation forms, nown as behavior rating scales, to com!are the child>s
behavior to that of other children the same age. <hile rating scales might seem overly
sub/ective, teachers often get to now so many children that their /udgment of how a child
com!ares to others is usually a reliable and valid measure.
"he s!ecialist interviews the child>s teachers and !arents, and may contact other !eo!le who
now the child well, such as coaches or baby,sitters. &arents are ased to describe their child>s
behavior in a variety of situations. "hey may also fill out a rating scale to indicate how severe
and fre2uent the behaviors seem to be.
1n most cases, the child will be evaluated for social ad/ustment and mental health. "ests of
intelligence and learning achievement may be given to see if the child has a learning disability
and whether the disability is in one or more sub/ects.
1n looing at the results of these various sources of information, the s!ecialist !ays s!ecial
attention to the child>s behavior during situations that are the most demanding of self,control, as
well as noisy or unstructured situations such as !arties, or during tass that re2uire sustained
attention, lie reading, woring math !roblems, or !laying a board game. Behavior during free
!lay or while getting individual attention is given less im!ortance in the evaluation. 1n such
situations, most children with ADHD are able to control their behavior and !erform better than
in more restrictive situations.
"he s!ecialist then !ieces together a !rofile of the child>s behavior. <hich ADHD,lie behaviors
listed in the most recent D'3 does the child showG How oftenG 1n what situationsG How long
has the child been doing themG How old was the child when the !roblem startedG Are the
behavior !roblems relatively chronic or enduring or are they !eriodic in natureG Are the
behaviors seriously interfering with the child>s friendshi!s, school activities, home life, or
!artici!ation in community activitiesG Does the child have any other related !roblemsG "he
answers to these 2uestions hel! identify whether the child>s hy!eractivity, im!ulsivity, and
inattention are significant and long,standing. 1f so, the child may be diagnosed with ADHD.
A correct diagnosis often resolves confusion about the reasons for the child>s !roblems that lets
!arents and child move forward in their lives with more accurate information on what is wrong
and what can be done to hel!. Once the disorder is diagnosed, the child and family can begin to
receive whatever combination of educational, medical, and emotional hel! they need. "his may
include !roviding recommendations to school staff, seeing out a more a!!ro!riate classroom
setting, selecting the right medication, and hel!ing !arents to manage their child>s behavior.
!hat )auses ADHD-
One of the first 2uestions a !arent will have is 0<hyG <hat went wrongG0 0Did 1 do something
to cause thisG0 "here is little com!elling evidence at this time that ADHD can arise !urely from
social factors or child,rearing methods. 3ost substantiated causes a!!ear to fall in the realm of
neurobiology and genetics. "his is not to say that environmental factors may not influence the
severity of the disorder, and es!ecially the degree of im!airment and suffering the child may
e#!erience, but that such factors do not seem to give rise to the condition by themselves.
"he !arents> focus should be on looing forward and finding the best !ossible way to hel! their
child. 'cientists are studying causes in an effort to identify better ways to treat, and !erha!s
someday, to !revent ADHD. "hey are finding more and more evidence that ADHD does not
stem from the home environment, but from biological causes. Inowing this can remove a huge
burden of guilt from !arents who might blame themselves for their child>s behavior.
Over the last few decades, scientists have come u! with !ossible theories about what causes
ADHD. 'ome of these theories have led to dead ends, some to e#citing new avenues of
%nviron"ental Agents.
'tudies have shown a !ossible correlation between the use of cigarettes and alcohol during
!regnancy and ris for ADHD in the offs!ring of that !regnancy. As a !recaution, it is best
during !regnancy to refrain from both cigarette and alcohol use.
Another environmental agent that may be associated with a higher ris of ADHD is high levels
of lead in the bodies of young !reschool children. 'ince lead is no longer allowed in !aint and is
usually found only in older buildings, e#!osure to to#ic levels is not as !revalent as it once was.
Children who live in old buildings in which lead still e#ists in the !lumbing or in lead !aint that
has been !ainted over may be at ris.
=rain #n4ury.
One early theory was that attention disorders were caused by brain in/ury. 'ome children who
have suffered accidents leading to brain in/ury may show some signs of behavior similar to that
of ADHD, but only a small !ercentage of children with ADHD have been found to have suffered
a traumatic brain in/ury.
Food Additives and Sugar.
1t has been suggested that attention disorders are caused by refined sugar or food additives, or
that sym!toms of ADHD are e#acerbated by sugar or food additives. 1n 6;:(, the -ational
1nstitutes of Health held a scientific consensus conference to discuss this issue. 1t was found that
diet restrictions hel!ed about C !ercent of children with ADHD, mostly young children who had
food allergies.
A more recent study on the effect of sugar on children, using sugar one day and a
sugar substitute on alternate days, without !arents, staff, or children nowing which substance
was being used, showed no significant effects of the sugar on behavior or learning.
1n another study, children whose mothers felt they were sugar,sensitive were given as!artame as
a substitute for sugar. Half the mothers were told their children were given sugar, half that their
children were given as!artame. "he mothers who thought their children had received sugar rated
them as more hy!eractive than the other children and were more critical of their behavior.
Attention disorders often run in families, so there are liely to be genetic influences. 'tudies
indicate that (C !ercent of the close relatives in the families of ADHD children also have
ADHD, whereas the rate is about C !ercent in the general !o!ulation.
3any studies of twins
now show that a strong genetic influence e#ists in the disorder.
4esearchers continue to study the genetic contribution to ADHD and to identify the genes that
cause a !erson to be susce!tible to ADHD. 'ince its ince!tion in 6;;;, the Attention,Deficit
Hy!eractivity Disorder 3olecular Fenetics -etwor has served as a way for researchers to share
findings regarding !ossible genetic influences on ADHD.
+ecent Studies on )auses of ADHD.
'ome nowledge of the structure of the brain is hel!ful in understanding the research scientists
are doing in searching for a !hysical basis for attention deficit hy!eractivity disorder. One !art
of the brain that scientists have focused on in their search is the frontal lobes of the cerebrum.
"he frontal lobes allow us to solve !roblems, !lan ahead, understand the behavior of others, and
restrain our im!ulses. "he two frontal lobes, the right and the left, communicate with each other
through the corpus callosum, ?nerve fibers that connect the right and left frontal lobes@.
"he basal ganglia are the interconnected gray masses dee! in the cerebral hemis!here that serve
as the connection between the cerebrum and the cerebellum and, with the cerebellum, are
res!onsible for motor coordination. "he cerebellum is divided into three !arts. "he middle !art
is called the vermis.
All of these !arts of the brain have been studied through the use of various methods for seeing
into or imaging the brain. "hese methods include functional magnetic resonance imaging ?f341@
!ositron emission tomogra!hy ?&B"@, and single !hoton emission com!uted tomogra!hy
?'&BC"@. "he main or central !sychological deficits in those with ADHD have been lined
through these studies. By (==( the researchers in the -13H Child &sychiatry Branch had
studied 6C( boys and girls with ADHD, matched with 69; age, and gender,matched controls
without ADHD. "he children were scanned at least twice, some as many as four times over a
decade. As a grou!, the ADHD children showed 9,* !ercent smaller brain volumes in all regions
Jthe frontal lobes, tem!oral gray matter, caudate nucleus, and cerebellum.
"his study also showed that the ADHD children who were on medication had a white matter
volume that did not differ from that of controls. "hose never,medicated !atients had an
abnormally small volume of white matter. "he white matter consists of fibers that establish long,
distance connections between brain regions. 1t normally thicens as a child grows older and the
brain matures.
Although this long,term study used 341 to scan the children>s brains, the researchers stressed
that 341 remains a research tool and cannot be used to diagnose ADHD in any given child. "his
is true for other neurological methods of evaluating the brain, such as &B" and '&BC".
Disorders that So"eti"es Acco"pany ADHD
$earning Disabilities.
3any children with ADHDJa!!ro#imately (= to 9= !ercentJalso have a s!ecific learning
disability ?LD@.
1n !reschool years, these disabilities include difficulty in understanding certain
sounds or words and8or difficulty in e#!ressing oneself in words. 1n school age children, reading
or s!elling disabilities, writing disorders, and arithmetic disorders may a!!ear. A ty!e of reading
disorder, dyslexia, is 2uite wides!read. 4eading disabilities affect u! to : !ercent of elementary
school children.
Tourette Syndro"e.
A very small !ro!ortion of !eo!le with ADHD have a neurological disorder called "ourette
syndrome. &eo!le with "ourette syndrome have various nervous tics and re!etitive mannerisms,
such as eye blins, facial twitches, or grimacing. Others may clear their throats fre2uently, snort,
sniff, or bar out words. "hese behaviors can be controlled with medication. <hile very few
children have this syndrome, many of the cases of "ourette syndrome have associated ADHD. 1n
such cases, both disorders often re2uire treatment that may include medications.
&ppositional Defiant Disorder.
As many as one,third to one,half of all children with ADHDJmostly boysJhave another
condition, nown as o!!ositional defiant disorder ?ODD@. "hese children are often defiant,
stubborn, non,com!liant, have outbursts of tem!er, or become belligerent. "hey argue with
adults and refuse to obey.
)onduct Disorder.
About (= to *= !ercent of ADHD children may eventually develo! conduct disorder ?CD@, a
more serious !attern of antisocial behavior. "hese children fre2uently lie or steal, fight with or
bully others, and are at a real ris of getting into trouble at school or with the !olice. "hey
violate the basic rights of other !eo!le, are aggressive toward !eo!le and8or animals, destroy
!ro!erty, brea into !eo!le>s homes, commit thefts, carry or use wea!ons, or engage in
vandalism. "hese children or teens are at greater ris for substance use e#!erimentation, and
later de!endence and abuse. "hey need immediate hel!.
An2iety and Depression.
'ome children with ADHD often have co,occurring an#iety or de!ression. 1f the an#iety or
de!ression is recogni+ed and treated, the child will be better able to handle the !roblems that
accom!any ADHD. Conversely, effective treatment of ADHD can have a !ositive im!act on
an#iety as the child is better able to master academic tass.
=ipolar Disorder.
"here are no accurate statistics on how many children with ADHD also have bi!olar disorder.
Differentiating between ADHD and bi!olar disorder in childhood can be difficult. 1n its classic
form, bi!olar disorder is characteri+ed by mood cycling between !eriods of intense highs and
lows. But in children, bi!olar disorder often seems to be a rather chronic mood dysregulation
with a mi#ture of elation, de!ression, and irritability. 5urthermore, there are some sym!toms that
can be !resent both in ADHD and bi!olar disorder, such as a high level of energy and a reduced
need for slee!. Of the sym!toms differentiating children with ADHD from those with bi!olar
disorder, elated mood and grandiosity of the bi!olar child are distinguishing characteristics.

The Treat"ent of ADHD
Bvery family wants to determine what treatment will be most effective for their child. "his
2uestion needs to be answered by each family in consultation with their health care !rofessional.
"o hel! families mae this im!ortant decision, the -ational 1nstitute of 3ental Health ?-13H@
has funded many studies of treatments for ADHD and has conducted the most intensive study
ever undertaen for evaluating the treatment of this disorder. "his study is nown as the
3ultimodal "reatment 'tudy of Children with Attention Deficit Hy!eractivity Disorder
"he -13H is now conducting a clinical trial for younger children ages 9 to C.C years
?"reatment of ADHD in &reschool,Age Children@.
The Multimodal Treatment Study of Children with Attention Deficit Hyperactivity
"he 3"A study included C); ?;C,;: at each of $ treatment sites@ elementary school boys and
girls with ADHD, who were randomly assigned to one of four treatment !rograms7 ?6@
medication management aloneA ?(@ behavioral treatment aloneA ?9@ a combination of bothA or ?*@
routine community care. 1n each of the study sites, three grou!s were treated for the first 6*
months in a s!ecified !rotocol and the fourth grou! was referred for community treatment of the
!arents> choosing. All of the children were reassessed regularly throughout the study !eriod. An
essential !art of the !rogram was the coo!eration of the schools, including !rinci!als and
teachers. Both teachers and !arents rated the children on hy!eractivity, im!ulsivity, and
inattention, and sym!toms of an#iety and de!ression, as well as social sills.
"he children in two grou!s ?medication management alone and the combination treatment@ were
seen monthly for one,half hour at each medication visit. During the treatment visits, the
!rescribing !hysician s!oe with the !arent, met with the child, and sought to determine any
concerns that the family might have regarding the medication or the child>s ADHD,related
difficulties. "he !hysicians, in addition, sought in!ut from the teachers on a monthly basis. "he
!hysicians in the medication,only grou! did not !rovide behavioral thera!y but did advise the
!arents when necessary concerning any !roblems the child might have.
1n the behavior treatment,only grou!, families met u! to 9C times with a behavior thera!ist,
mostly in grou! sessions. "hese thera!ists also made re!eated visits to schools to consult with
children>s teachers and to su!ervise a s!ecial aide assigned to each child in the grou!. 1n
addition, children attended a s!ecial :,wee summer treatment !rogram where they wored on
academic, social, and s!orts sills, and where intensive behavioral thera!y was delivered to
assist children in im!roving their behavior.
Children in the combined thera!y grou! received both treatments, that is, all the same assistance
that the medication,only received, as well as all of the behavior thera!y treatments.
1n routine community care, the children saw the community,treatment doctor of their !arents>
choice one to two times !er year for short !eriods of time. Also, the community,treatment doctor
did not have any interaction with the teachers.
"he results of the study indicated that long,term combination treatments and the medication,
management alone were su!erior to intensive behavioral treatment and routine community
treatment. And in some areasJan#iety, academic !erformance, o!!ositionality, !arent,child
relations, and social sillsJthe combined treatment was usually su!erior. Another advantage of
combined treatment was that children could be successfully treated with lower doses of
medicine, com!ared with the medication,only grou!.
Treat"ent of Attention Deficit Hyperactivity Disorder in Preschool-Age
)hildren /PATS0.
Because many children in the !reschool years are diagnosed with ADHD and are given
medication, it is im!ortant to now the safety and efficacy of such treatment. "he -13H is
s!onsoring an ongoing multi,site study, 0&reschool ADHD "reatment 'tudy0 ?&A"'@. 1t is the
first ma/or effort to e#amine the safety and efficacy of a stimulant, methyl!henidate, for ADHD
in this age grou!. "he &A"' study uses a randomi+ed, !lacebo,controlled, double,blind design.
Children ages 9 to C who have severe and !ersistent sym!toms of ADHD that im!air their
functioning are eligible for this study. "o avoid using medications at such an early age, all
children who enter the study are first treated with behavioral thera!y. Only children who do not
show sufficient im!rovement with behavior thera!y are considered for the medication !art of the
study. "he study is being conducted at -ew .or 'tate &sychiatric 1nstitute, Due University,
Eohns Ho!ins University, -ew .or University, the University of California at Los Angeles,
and the University of California at 1rvine. Bnrollment in the study will total 6$C children.
!hich Treat"ent Should 7y )hild Have-
5or children with ADHD, no single treatment is the answer for every child. A child may
sometimes have undesirable side effects to a medication that would mae that !articular
treatment unacce!table. And if a child with ADHD also has an#iety or de!ression, a treatment
combining medication and behavioral thera!y might be best. Bach child>s needs and !ersonal
history must be carefully considered.
5or decades, medications have been used to treat the sym!toms of ADHD.
"he medications that seem to be the most effective are a class of drugs nown as stimulants.
5ollowing is a list of the stimulants, their trade ?or brand@ names, and their generic names.
0A!!roved age0 means that the drug has been tested and found safe and effective in children of
that age.
Trade 'a"e 3eneric 'a"e Approved Age
Adderall am!hetamine 9 and older
?long acting@
$ and older
CylertK !emoline $ and older
De#edrine de#troam!hetamine 9 and older
De#trostat de#troam!hetamine 9 and older
5ocalin de#methyl!henidate $ and older
3etadate B4
?e#tended release@
$ and older
3etadate CD
?e#tended release@
$ and older
4italin methyl!henidate $ and older
4italin '4
?e#tended release@
$ and older
4italin LA
?long acting@
$ and older
KBecause of its !otential for serious side effects affecting the liver, Cylert should not ordinarily
be considered as first,line drug thera!y for ADHD.
"he U.'. 5ood and Drug Adminstration ?5DA@ recently a!!roved a medication for ADHD that is
not a stimulant. "he medication, 'tratteraL, or atomo#etine, wors on the neurotransmitter
nore!ine!hrine, whereas the stimulants !rimarily wor on do!amine. Both of theses
neurotransmitters are believed to !lay a role in ADHD. 3ore studies will need to be done to
contrast 'trattera with the medications already available, but the evidence to date indicates that
over )= !ercent of children with ADHD given 'trattera manifest significant im!rovement in
their sym!toms.
'ome !eo!le get better results from one medication, some from another. 1t is im!ortant to wor
with the !rescribing !hysician to find the right medication and the right dosage. 5or many
!eo!le, the stimulants dramatically reduce their hy!eractivity and im!ulsivity and im!rove their
ability to focus, wor, and learn. "he medications may also im!rove !hysical coordination, such
as that needed in handwriting and in s!orts.
"he stimulant drugs, when used with medical su!ervision, are usually considered 2uite safe.
'timulants do not mae the child feel 0high,0 although some children say they feel different or
funny. 'uch changes are usually very minor. Although some !arents worry that their child may
become addicted to the medication, to date there is no convincing evidence that stimulant
medications, when used for treatment of ADHD, cause drug abuse or de!endence. A review of
all long,term studies on stimulant medication and substance abuse, conducted by researchers at
3assachusetts Feneral Hos!ital and Harvard 3edical 'chool, found that teenagers with ADHD
who remained on their medication during the teen years had a lower lielihood of substance use
or abuse than did ADHD adolescents who were not taing medications.
"he stimulant drugs come in long, and short,term forms. "he newer sustained,release stimulants
can be taen before school and are long,lasting so that the child does not need to go to the
school nurse every day for a !ill. "he doctor can discuss with the !arents the child>s needs and
decide which !re!aration to use and whether the child needs to tae the medicine during school
hours only or in the evening and on weeends too.
1f the child does not show sym!tom im!rovement after taing a medication for a wee, the
doctor may try ad/usting the dosage. 1f there is still no im!rovement, the child may be switched
to another medication. About one out of ten children is not hel!ed by a stimulant medication.
Other ty!es of medication may be used if stimulants don>t wor or if the ADHD occurs with
another disorder. Antide!ressants and other medications can hel! control accom!anying
de!ression or an#iety.
'ometimes the doctor may !rescribe for a young child a medication that has been a!!roved by
the 5DA for use in adults or older children. "his use of the medication is called 0off label.0
3any of the newer medications that are !roving hel!ful for child mental disorders are !rescribed
off label because only a few of them have been systematically studied for safety and efficacy in
children. 3edications that have not undergone such testing are dis!ensed with the statement that
0safety and efficacy have not been established in !ediatric !atients.0
Side %ffects of the 7edications.
3ost side effects of the stimulant medications are minor and are usually related to the dosage of
the medication being taen. Higher doses !roduce more side effects. "he most common side
effects are decreased a!!etite, insomnia, increased an#iety, and8or irritability. 'ome children
re!ort mild stomach aches or headaches.
A!!etite seems to fluctuate, usually being low during the middle of the day and more normal by
su!!ertime. Ade2uate amounts of food that is nutritional should be available for the child,
es!ecially at !ea a!!etite times.
1f the child has difficulty falling aslee!, several o!tions may be triedJa lower dosage of the
stimulant, giving the stimulant earlier in the day, discontinuing the afternoon or evening dosage,
or giving an ad/unct medication such as a low,dosage antide!ressant or clonidine. A few
children develo! tics during treatment. "hese can often be lessened by changing the medication
dosage. A very few children cannot tolerate any stimulant, no matter how low the dosage. 1n
such cases, the child is often given an antide!ressant instead of the stimulant.
<hen a child>s schoolwor and behavior im!rove soon after starting medication, the child,
!arents, and teachers tend to a!!laud the drug for causing the sudden changes. Unfortunately,
when !eo!le see such immediate im!rovement, they often thin medication is all that>s needed.
But medications don>t cure ADHDA they only control the sym!toms on the day they are taen.
Although the medications hel! the child !ay better attention and com!lete school wor, they
can>t increase nowledge or im!rove academic sills. "he medications hel! the child to use
those sills he or she already !ossesses.
Behavioral thera!y, emotional counseling, and !ractical su!!ort will hel! ADHD children co!e
with everyday !roblems and feel better about themselves.
Facts to +e"e"ber About 7edication for ADHD.
3edications for ADHD hel! many children focus and be more successful at school,
home, and !lay. Avoiding negative e#!eriences now may actually hel! !revent addictions
and other emotional !roblems later.
About := !ercent of children who need medication for ADHD still need it as teenagers.
Over C= !ercent need medication as adults.
7edication for the )hild with =oth ADHD and =ipolar Disorder.
'ince a child with bi!olar disorder will !robably be !rescribed a mood stabili+er such as lithium
or De!aoteL, the doctor will carefully consider whether the child should tae one of the
medications usually !rescribed for ADHD. 1f a stimulant medication is !rescribed, it may be
given in a lower dosage than usual.
The Fa"ily and the ADHD )hild
3edication can hel! the ADHD child in everyday life. He or she may be better able to control
some of the behavior !roblems that have led to trouble with !arents and siblings. But it taes
time to undo the frustration, blame, and anger that may have gone on for so long. Both !arents
and children may need s!ecial hel! to develo! techni2ues for managing the !atterns of behavior.
1n such cases, mental health !rofessionals can counsel the child and the family, hel!ing them to
develo! new sills, attitudes, and ways of relating to each other. 1n individual counseling, the
thera!ist hel!s children with ADHD learn to feel better about themselves. "he thera!ist can also
hel! them to identify and build on their strengths, co!e with daily !roblems, and control their
attention and aggression. 'ometimes only the child with ADHD needs counseling su!!ort. But
in many cases, because the !roblem affects the family as a whole, the entire family may need
hel!. "he thera!ist assists the family in finding better ways to handle the disru!tive behaviors
and !romote change. 1f the child is young, most of the thera!ist>s wor is with the !arents,
teaching them techni2ues for co!ing with and im!roving their child>s behavior.
'everal intervention a!!roaches are available. Inowing something about the various ty!es of
interventions maes it easier for families to choose a thera!ist that is right for their needs.
Psychotherapy wors to hel! !eo!le with ADHD to lie and acce!t themselves des!ite their
disorder. 1t does not address the sym!toms or underlying causes of the disorder. 1n
!sychothera!y, !atients tal with the thera!ist about u!setting thoughts and feelings, e#!lore
self,defeating !atterns of behavior, and learn alternative ways to handle their emotions. As they
tal, the thera!ist tries to hel! them understand how they can change or better co!e with their
=ehavioral therapy /=T0 hel!s !eo!le develo! more effective ways to wor on immediate
issues. 4ather than hel!ing the child understand his or her feelings and actions, it hel!s directly
in changing their thining and co!ing and thus may lead to changes in behavior. "he su!!ort
might be !ractical assistance, lie hel! in organi+ing tass or schoolwor or dealing with
emotionally charged events. Or the su!!ort might be in self,monitoring one>s own behavior and
giving self,!raise or rewards for acting in a desired way such as controlling anger or thining
before acting.
Social s1ills training can also hel! children learn new behaviors. 1n social sills training, the
thera!ist discusses and models a!!ro!riate behaviors im!ortant in develo!ing and maintaining
social relationshi!s, lie waiting for a turn, sharing toys, asing for hel!, or res!onding to
teasing, then gives children a chance to !ractice. 5or e#am!le, a child might learn to 0read0 other
!eo!le>s facial e#!ression and tone of voice in order to res!ond a!!ro!riately. 'ocial sills
training hel!s the child to develo! better ways to !lay and wor with other children.
Support groups hel! !arents connect with other !eo!le who have similar !roblems and
concerns with their ADHD children. 3embers of su!!ort grou!s often meet on a regular basis
?such as monthly@ to hear lectures from e#!erts on ADHD, share frustrations and successes, and
obtain referrals to 2ualified s!ecialists and information about what wors. "here is strength in
numbers, and sharing e#!eriences with others who have similar !roblems hel!s !eo!le now
that they aren>t alone. -ational organi+ations are listed at the end of this document.
Parenting s1ills training, offered by thera!ists or in s!ecial classes, gives !arents tools and
techni2ues for managing their child>s behavior. One such techni2ue is the use of toen or !oint
systems for immediately rewarding good behavior or wor. Another is the use of 0time,out0 or
isolation to a chair or bedroom when the child becomes too unruly or out of control. During
time,outs, the child is removed from the agitating situation and sits alone 2uietly for a short time
to calm down. &arents may also be taught to give the child 02uality time0 each day, in which
they share a !leasurable or rela#ing activity. During this time together, the !arent loos for
o!!ortunities to notice and !oint out what the child does well, and !raise his or her strengths and
"his system of rewards and !enalties can be an effective way to modify a child>s behavior. "he
!arents ?or teacher@ identify a few desirable behaviors that they want to encourage in the childJ
such as asing for a toy instead of grabbing it, or com!leting a sim!le tas. "he child is told
e#actly what is e#!ected in order to earn the reward. "he child receives the reward when he
!erforms the desired behavior and a mild !enalty when he doesn>t. A reward can be small,
!erha!s a toen that can be e#changed for s!ecial !rivileges, but it should be something the
child wants and is eager to earn. "he !enalty might be removal of a toen or a brief time,out.
Make an effort to find your child being good. "he goal, over time, is to hel! children learn to
control their own behavior and to choose the more desired behavior. "he techni2ue wors well
with all children, although children with ADHD may need more fre2uent rewards.
1n addition, !arents may learn to structure situations in ways that will allow their child to
succeed. "his may include allowing only one or two !laymates at a time, so that their child
doesn>t get overstimulated. Or if their child has trouble com!leting tass, they may learn to hel!
the child divide a large tas into small ste!s, then !raise the child as each ste! is com!leted.
4egardless of the s!ecific techni2ue !arents may use to modify their child>s behavior, some
general !rinci!les a!!ear to be useful for most children with ADHD. "hese include !roviding
more fre2uent and immediate feedbac ?including rewards and !unishment@, setting u! more
structure in advance of !otential !roblem situations, and !roviding greater su!ervision and
encouragement to children with ADHD in relatively unrewarding or tedious situations.
&arents may also learn to use stress management methods, such as meditation, rela#ation
techni2ues, and e#ercise, to increase their own tolerance for frustration so that they can res!ond
more calmly to their child>s behavior.
So"e Si"ple =ehavioral #nterventions
Children with ADHD may need hel! in organi+ing. "herefore7
Schedule. Have the same routine every day, from wae,u! time to bedtime. "he
schedule should include homewor time and !laytime ?including outdoor recreation and
indoor activities such as com!uter games@. Have the schedule on the refrigerator or a
bulletin board in the itchen. 1f a schedule change must be made, mae it as far in
advance as !ossible.
&rgani>e needed everyday ite"s. Have a !lace for everything and ee! everything in
its !lace. "his includes clothing, bac!acs, and school su!!lies.
?se ho"ewor1 and noteboo1 organi>ers. 'tress the im!ortance of writing down
assignments and bringing home needed boos.
Children with ADHD need consistent rules that they can understand and follow. 1f rules are
followed, give small rewards. Children with ADHD often receive, and e#!ect, criticism. Loo
for good behavior and !raise it.
*our ADHD )hild and School
*ou are your child8s best advocate. "o be a good advocate for your child, learn as much as you
can about ADHD and how it affects your child at home, in school, and in social situations.
1f your child has shown sym!toms of ADHD from an early age and has been evaluated,
diagnosed, and treated with either behavior modification or medication or a combination of both,
when your child enters the school system, let his or her teachers now. "hey will be better
!re!ared to hel! the child come into this new world away from home.
1f your child enters school and e#!eriences difficulties that lead you to sus!ect that he or she has
ADHD, you can either see the services of an outside !rofessional or you can as the local
school district to conduct an evaluation. 'ome !arents !refer to go to a !rofessional of their own
choice. But it is the school>s obligation to evaluate children that they sus!ect have ADHD or
some other disability that is affecting not only their academic wor but their interactions with
classmates and teachers.
1f you feel that your child has ADHD and isn>t learning in school as he or she should, you should
find out /ust who in the school system you should contact. .our child>s teacher should be able to
hel! you with this information. "hen you can re2uestJin writingJthat the school system
evaluate your child. "he letter should include the date, your and your child>s names, and the
reason for re2uesting an evaluation. Iee! a co!y of the letter in your own files.
Until the last few years, many school systems were reluctant to evaluate a child with ADHD.
But recent laws have made clear the school>s obligation to the child sus!ected of having ADHD
that is affecting adversely his or her !erformance in school. 1f the school !ersists in refusing to
evaluate your child, you can either get a !rivate evaluation or enlist some hel! in negotiating
with the school. Hel! is often as close as a local !arent grou!. Bach state has a &arent "raining
and 1nformation ?&"1@ center as well as a &rotection and Advocacy ?&MA@ agency. ?5or
information on the law and on the &"1 and &MA, see the section on su!!ort grou!s and
organi+ations at the end of this document.@
Once your child has been diagnosed with ADHD and 2ualifies for s!ecial education services, the
school, woring with you, must assess the child>s strengths and weanesses and design an
1ndividuali+ed Bducational &rogram ?1B&@. .ou should be able !eriodically to review and
a!!rove your child>s 1B&. Bach school year brings a new teacher and new schoolwor, a
transition that can be 2uite difficult for the child with ADHD. .our child needs lots of su!!ort
and encouragement at this time.
-ever forget the cardinal ruleJyou are your child8s best advocate.
*our Teenager with ADHD
.our child with ADHD has successfully navigated the early school years and is beginning his or
her /ourney through middle school and high school. Although your child has been !eriodically
evaluated through the years, this is a good time to have a com!lete re,evaluation of your child>s
"he teen years are challenging for most childrenA for the child with ADHD these years are
doubly hard. All the adolescent !roblemsJ!eer !ressure, the fear of failure in both school and
socially, low self,esteemJare harder for the ADHD child to handle. "he desire to be
inde!endent, to try new and forbidden thingsJalcohol, drugs, and se#ual activityJcan lead to
unforeseen conse2uences. "he rules that once were, for the most !art, followed, are often now
flaunted. &arents may not agree with each other on how the teenager>s behavior should be
-ow, more than ever, rules should be straightforward and easy to understand. Communication
between the adolescent and !arents can hel! the teenager to now the reasons for each rule.
<hen a rule is set, it should be clear why the rule is set. 'ometimes it hel!s to have a chart,
!osted usually in the itchen, that lists all household rules and all rules for outside the home
?social and school@. Another chart could list household chores with s!ace to chec off a chore
once it is done.
<hen rules are broenJand they will beJres!ond to this ina!!ro!riate behavior as calmly and
matter,of,factly as !ossible. Use !unishment s!aringly. Bven with teens, a time,out can wor.
1m!ulsivity and hot tem!er often accom!any ADHD. A short time alone can hel!.
As the teenager s!ends more time away from home, there will be demands for a later curfew and
the use of the car. Listen to your child>s re2uest, give reasons for your o!inion and listen to his or
her o!inion, and negotiate. Communication, negotiation, and compromise will !rove hel!ful.
*our Teenager and the )ar.
"eenagers, es!ecially boys, begin taling about driving by the time they are 6C. 1n some states, a
learner>s !ermit is available at 6C and a driver>s license at 6$. 'tatistics show that 6$,year,old
drivers have more accidents !er driving mile than any other age. 1n the year (===, 6: !ercent of
those who died in s!eed,related crashes were youth ages 6C to 6;. 'i#ty,si# !ercent of these
youth were not wearing safety belts. .outh with ADHD, in their first ( to C years of driving,
have nearly four times as many automobile accidents, are more liely to cause bodily in/ury in
accidents, and have three times as many citations for s!eeding as the young drivers without
3ost states, after looing at the statistics for automobile accidents involving teenage drivers,
have begun to use a graduated driver licensing system ?FDL@. "his system eases young drivers
onto the roads by a slow !rogression of e#!osure to more difficult driving e#!eriences. "he
!rogram, as develo!ed by the -ational Highway "raffic 'afety Administration and the American
Association of 3otor Hehicle Administrators, consists of three stages7 learner>s !ermit,
intermediate ?!rovisional@ license, and full licensure. Drivers must demonstrate res!onsible
driving behavior at each stage before advancing to the ne#t level. During the learner>s !ermit
stage, a licensed adult must be in the car at all times.
"his !eriod of time will give the learner a
chance to !ractice, !ractice, !ractice. "he more your child drives, the more efficient he or she
will become. "he sense of accom!lishment the teenager with ADHD will feel when the coveted
license is finally in his or her hands will mae all the time and effort involved worthwhile.
-ote7 "he 'tate Legislative 5act 'heetsJFraduated Driver Licensing 'ystem can be found at
web site
ml, or it can be ordered from -H"'A Head2uarters, "raffic 'afety &rograms, A""-7 -"',9(,
*== 'eventh 'treet, '.<., <ashington, DC (=C;=A tele!hone (=(,9$$,$;*:.
Attention Deficit Hyperactivity Disorder in Adults
Attention deficit hy!eractivity disorder is a highly !ublici+ed childhood disorder that affects
a!!ro#imately 9 !ercent to C !ercent of all children. <hat is much less well nown is the
!robability that, of children who have ADHD, many will still have it as adults. 'everal studies
done in recent years estimate that between 9= !ercent and )= !ercent of children with ADHD
continue to e#hibit sym!toms in the adult years.
"he first studies on adults who were never diagnosed as children as having ADHD, but showed
sym!toms as adults, were done in the late 6;)=s by Drs. &aul <ender, 5rederic 4eimherr, and
David <ood. "hese sym!tomatic adults were retros!ectively diagnosed with ADHD after the
researchers> interviews with their !arents. "he researchers develo!ed clinical criteria for the
diagnosis of adult ADHD ?the Utah Criteria@, which combined !ast history of ADHD with
current evidence of ADHD behaviors.
Other diagnostic assessments are now availableA among
them are the widely used Conners 4ating 'cale and the Brown Attention Deficit Disorder 'cale.
"y!ically, adults with ADHD are unaware that they have this disorderJthey often /ust feel that
it>s im!ossible to get organi+ed, to stic to a /ob, to ee! an a!!ointment. "he everyday tass of
getting u!, getting dressed and ready for the day>s wor, getting to wor on time, and being
!roductive on the /ob can be ma/or challenges for the ADHD adult.
Diagnosing ADHD in an Adult.
Diagnosing an adult with ADHD is not easy. 3any times, when a child is diagnosed with the
disorder, a !arent will recogni+e that he or she has many of the same sym!toms the child has
and, for the first time, will begin to understand some of the traits that have given him or her
trouble for yearsJdistractibility, im!ulsivity, restlessness. Other adults will see !rofessional
hel! for de!ression or an#iety and will find out that the root cause of some of their emotional
!roblems is ADHD. "hey may have a history of school failures or !roblems at wor. Often they
have been involved in fre2uent automobile accidents.
"o be diagnosed with ADHD, an adult must have childhood,onset, !ersistent, and current
"he accuracy of the diagnosis of adult ADHD is of utmost im!ortance and should
be made by a clinician with e#!ertise in the area of attention dysfunction. 5or an accurate
diagnosis, a history of the !atient>s childhood behavior, together with an interview with his life
!artner, a !arent, close friend, or other close associate, will be needed. A !hysical e#amination
and !sychological tests should also be given. Comorbidity with other conditions may e#ist such
as s!ecific learning disabilities, an#iety, or affective disorders.
A correct diagnosis of ADHD can bring a sense of relief. "he individual has brought into
adulthood many negative !erce!tions of himself that may have led to low esteem. -ow he can
begin to understand why he has some of his !roblems and can begin to face them. "his may
mean, not only treatment for ADHD but also !sychothera!y that can hel! him co!e with the
anger he feels about the failure to diagnose the disorder when he was younger.
Treat"ent of ADHD in an Adult.
7edications. As with children, if adults tae a medication for ADHD, they often start with a
stimulant medication. "he stimulant medications affect the regulation of two neurotransmitters,
nore!ine!hrine and do!amine. "he newest medication a!!roved for ADHD by the 5DA,
atomo#etine ?'tratteraL@, has been tested in controlled studies in both children and adults and
has been found to be effective.
Antide!ressants are considered a second choice for treatment of adults with ADHD. "he older
antide!ressants, the tricyclics, are sometimes used because they, lie the stimulants, affect
nore!ine!hrine and do!amine. Henlafa#ine ?Bffe#orL@, a newer antide!ressant, is also used for
its effect on nore!ine!hrine. Bu!ro!ion ?<ellbutrinL@, an antide!ressant with an indirect effect
on the neurotransmitter do!amine, has been useful in clinical trials on the treatment of ADHD in
both children and adults. 1t has the added attraction of being useful in reducing cigarette
1n !rescribing for an adult, s!ecial considerations are made. "he adult may need less of the
medication for his weight. A medication may have a longer 0half,life0 in an adult. "he adult may
tae other medications for !hysical !roblems such as diabetes or high blood !ressure. Often the
adult is also taing a medication for an#iety or de!ression. All of these variables must be taen
into account before a medication is !rescribed.
%ducation and psychotherapy. Although medication gives needed su!!ort, the individual must
succeed on his own. "o hel! in this struggle, both 0!sychoeducation0 and individual
!sychothera!y can be hel!ful. A !rofessional coach can hel! the ADHD adult learn how to
organi+e his life by using 0!ro!s0Ja large calendar !osted where it will be seen in the morning,
date boos, lists, reminder notes, and have a s!ecial !lace for eys, bills, and the !a!erwor of
everyday life. "ass can be organi+ed into sections, so that com!letion of each !art can give a
sense of accom!lishment. Above all, ADHD adults should learn as much as they can about their
&sychothera!y can be a useful ad/unct to medication and education. 5irst, /ust remembering to
ee! an a!!ointment with the thera!ist is a ste! toward ee!ing to a routine. "hera!y can hel!
change a long,standing !oor self,image by e#amining the e#!eriences that !roduced it. "he
thera!ist can encourage the ADHD !atient to ad/ust to changes brought into his life by treatment
Jthe !erceived loss of im!ulsivity and love of ris,taing, the new sensation of thining before
acting. As the !atient begins to have small successes in his new ability to bring organi+ation out
of the com!le#ities of his or her life, he or she can begin to a!!reciate the characteristics of
ADHD that are !ositiveJboundless energy, warmth, and enthusiasm.
For 7ore #nfor"ation
Attention Deficit Hy!eractivity Disorder 1nformation and Organi+ations from -L3>s
3edline&lus ?en Bs!aOol@
'till F5. 'ome abnormal !sychical conditions in children7 the Foulstonian lectures. Lancet,
D'3,1H,"4 worgrou!. The Diagnostic and Statistical Manual of Mental Disorders, 5ourth
Bdition, "e#t 4evision. <ashington, DC7 American &sychiatric Association.
Consensus Develo!ment &anel. Defined Diets and Childhood yperactivity. -ational 1nstitutes
of Health Consensus Develo!ment Conference 'ummary, Holume *, -umber 9, 6;:(.
<olraich 3, 3ilich 4, 'tumbo &, 'chult+ 5. "he effects of sucrose ingestion on the behavior of
hy!eractive boys. !ediatrics, 6;:CA 6=$A $C),$:(.
Hoover D<, 3ilich 4. Bffects of sugar ingestion e#!ectancies on mother,child interaction.
"ournal of #bnormal Child !sychology, 6;;*A ((A C=6,C6C.
Biederman E, 5araone 'H, Ieenan I, Inee D, "suang 35. 5amily,genetic and !sychosocial
ris factors in D'3,111 attention deficit disorder. "ournal of the #merican #cademy of Child and
#dolescent !sychiatry, 6;;=A (;?*@7 C($,C99.
5araone 'H, Biederman E. -eurobiology of attention,deficit hy!eractivity disorder. $iological
!sychiatry, 6;;:A **A ;C6,;C:.
"he ADHD 3olecular Fenetics -etwor. 4e!ort from the third international meeting of the
attention,deficit hy!eractivity disorder molecular genetics networ. #merican "ournal of
Medical %enetics, (==(, 66*7()(,()).
Castellanos 5P, Lee &&, 'har! <, Eeffries -O, Freenstein DI, Clasen L', Blumenthal ED,
Eames 4', Bbens C1, <alter E3, Qi/denbos A, Bvans AC, Fiedd E-, 4a!o!ort EL.
Develo!mental tra/ectories of brain volume abnormalities in children and adolescents with
attention,deficit8hy!eractivity disorder. "ournal of the #merican Medical #ssociation, (==(,
<ender &H. #DD& #ttention'Deficit yperactivity Disorder in Children and #dults. O#ford
University &ress, (==(, !. ;.
Feller B, <illiams 3, Qimerman B, 5ra+ier E, Beringer L, <arner IL. &re!ubertal and early
adolescent bi!olarity differentiate from ADHD by manic sym!toms, grandiose delusions, ultra,
ra!id or ultradian cycling. "ournal of #ffective Disorders, 6;;:, C67:6,;6.
"he 3"A Coo!erative Frou!. A 6*,month randomi+ed clinical trial of treatment strategies for
attention,deficit hy!eractivity disorder ?ADHD@. #rchives of %eneral !sychiatry, 6;;;AC$76=)9,
<ilens "C, 5araone, 'H, Biederman E, Funawardene '. Does stimulant thera!y of attention,
deficit8hy!eractivity disorder beget later substance abuseG A meta,analytic review of the
literature. !ediatrics, (==9, 6667676);,6:C.
Barley 4A. Taking Charge of #DD. -ew .or7 "he Fuilford &ress, (===, !. (6.
U.'. De!artment of "rans!ortation, -ational Highway "raffic 'afety Administration. State
Legislative (act Sheet, A!ril (==(.
'ilver LB. Attention,deficit hy!eractivity disorder in adult life. Child and #dolescent
!sychiatric Clinics of )orth #merica, (===7;797 *66,C(9.
<ender &H. &harmacothera!y of attention,deficit8hy!eractivity in adults. "ournal of Clinical
!sychiatry, 6;;:A C; ?su!!lement )@7)$,);.
<ilens "B, Biederman E, '!encer "E. Attention deficit8hy!eractivity disorder across the
lifes!an. #nnual *eview of Medicine, (==(7C97669,696.
#ttention Deficit Disorder in #dults. Harvard 3ental Health Letter, (==(76;AC79,$.
+esource =oo1s
"he following boos were hel!ful resources in the writing of this document. 3any other
informative boos can be found at any good boostore, on a website that offers boos for sale,
or from the ADD <arehouse catalog ?see ne#t !age@.
Taking Charge of #DD, by 4ussell A. Barley, &hD. -ew .or7 "he Fuilford &ress, (===.
#DD& #ttention'Deficit yperactivity Disorder in Children and #dults, by &aul H. <ender,
3D. O#ford University &ress, (==(.
Straight Talk about !sychiatric Medications for +ids, by "imothy B. <ilens, 3D. -ew .or7
"he Fuilford &ress, 6;;;.
"his is a revision of #ttention Deficit yperactivity Disorder, a brochure first !rinted in 6;;*
and re!rinted in 6;;$. "he revision is by 3argaret 'troc, staff member in the &ublic
1nformation and Communications Branch, -ational 1nstitute of 3ental Health ?-13H@.
'cientific review was !rovided by 4ussell A. Barley, &h.D., 3edical University of 'outh
CarolinaA &eter A. Eensen, 3.D., Columbia UniversityA Bdgardo 3envielle, 3.D., and Benedetto
Hitiello, 3.D., staff members, -13H. Bditorial assistance was !rovided by Lisa Alberts and
Constance Burr, &ublic 1nformation and Communications Branch, -13H.
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