Attention deficit/hyperactivity disorder
What is attention deficit/hyperactivity disorder?
Attention Deficit/Hyperactivity Disorder, or ADHD, is a medical condition that makes it hard for people to regulate their attention, organize themselves, and control their impulses. For some people with the hyperactivity component of ADHD, keeping quiet, staying seated, or stopping all body movements is nearly impossible. While everyone may have occasional moments of daydreaming, fidgeting, or forgetfulness, someone with ADHD experiences these difficulties often, in multiple settings, such as home and school, over a period of at least six months.
The symptoms of ADHD are clustered into three main types of the disorder:
- inattentive type – characterized by forgetfulness, distractibility, and difficulty focusing and maintaining attention
- hyperactive/impulsive type – characterized by a tendency to act or speak before considering consequences, by restlessness, and by difficulty staying seated, keeping hands to self, or resisting the need to constantly move
- combined type – characterized by significant difficulties with both regulating attention and controlling hyperactivity/impulsivity
ADHD may significantly affect a child’s life by impairing academic activities, peer relationships, and home life. Estimates of the prevalence of ADHD among children range from 3 to 12 percent. The tendency to develop ADHD involves complex genetic and environmental factors. Although the disorder occurs more frequently in boys than in girls, its prevalence in girls is greater than previously thought.
What does attention deficit/hyperactivity disorder look like in children and adolescents?
During the toddler and pre-school years, difficulties with paying attention, staying still, and controlling impulses are expected in children. For example, children ages two to three are expected to be curious about their environment and to shift their attention from one toy to another. Similarly, young children are expected to move frequently as they explore their world. As children progress through childhood, however, most of them develop the ability to regulate their behavior and sustain concentration on tasks as needed. Children with ADHD, in contrast, do not attain age-appropriate levels of self-control, organization, and concentration. ADHD symptoms generally appear before age seven, although for a variety of reasons, some children are not diagnosed until later.
Children with the inattentive type of ADHD are often not identified until a pattern of concentration problems leads to lower academic performance. These children face a variety of challenges, including frequent forgetfulness and boredom, trouble remembering instructions and responsibilities, problems with focusing and an aversion to mentally challenging tasks. The same child with significant difficulties sustaining attention, organizing tasks, and completing homework, however, may be able to focus attention for long periods of time on pleasurable activities that require focused attention, such as videogames or artistic pursuits.
Children with inattentive symptoms may be described as “daydreamers” or “spaced out.” Often, these children are more socially withdrawn and have more frequent problems with mild anxiety than children with the hyperactive/impulsive type of ADHD. Symptoms of inattentiveness may be difficult for others to detect, and many children–especially girls–with the inattentive type of ADHD are diagnosed much later or are never identified. Girls are more likely to have the inattentive type of ADHD, and for a variety of reasons girls are less likely to be diagnosed with ADHD or treated for their symptoms.
Children with hyperactive/impulsive symptoms of ADHD have difficulty controlling their actions. Their impulsive tendencies are often misunderstood as rudeness, disregard for others, or willful disobedience. These children tend to explore new settings with enthusiasm and touch objects without asking for permission. Their unrestrained behavior may lead to careless accidents (broken possessions or physical injury), the disapproval and irritation of others (due to difficulties waiting one’s turn or respecting others’ rules), and potentially dangerous situations (for example, darting across the street before looking both ways). Because this behavior is often disruptive to others, ADHD with hyperactivity and impulsivity is typically identified more easily than the inattentive type. The hyperactive type of ADHD appears to be more prevalent in boys than in girls.
All children with ADHD may struggle with low frustration tolerance and trouble following rules. Often they are “poor sports” in games, and they may seem intrusive or bossy in their play. As a result, children with ADHD face social challenges because their peers may perceive them as immature and annoying. They may be taunted by peers or tricked into getting into trouble with adults. Whereas older adolescents are able to describe their difficulties due to ADHD, children frequently have trouble identifying their underlying difficulties. Instead, children with ADHD are often only aware that they get into trouble more often than their peers, leading to self-doubt and low self-esteem.
Generally, as a person with ADHD goes through adolescence into adulthood, symptoms of hyperactivity and impulsivity decrease. Until recently it was therefore assumed that ADHD is outgrown in childhood, but it is now known that many children with ADHD continue to experience impairing symptoms into adulthood. When children are diagnosed with the disorder, it is not uncommon for parents to discover their own symptoms of ADHD that were never previously recognized or identified.
Early identification of the underlying disorder and a comprehensive treatment plan can help avert many difficulties. A trained clinician (such as a child psychiatrist, child psychologist or pediatric neurologist) should integrate information from home, school, and the clinical visit to make a diagnosis.