Attention Deficit Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children. It involves differences in the brain, nerve networks, and neurotransmitters. ADHD is a chronic condition that affects a person’s ability to manage emotions, thoughts, and actions.

People with ADHD often struggle to manage behavior, pay attention, control overactivity, regulate mood, stay organized, concentrate, follow directions, and sit still. ADHD is usually diagnosed in childhood and can continue into adulthood. Effective treatment is available, but without it, ADHD can cause serious, long-term complications.

What are the symptoms of ADHD?

Your child’s provider will diagnose ADHD based on specific symptoms. These symptoms must affect at least two areas of life, like school and home, and have been present for at least six months. Providers use these symptoms to identify the type of ADHD: inattentive, hyperactive/impulsive, combined, or unspecified. They follow the guidelines in the DSM-5-TR™ from the American Psychiatric Association to make a diagnosis.

What causes ADHD?

Nerve cells, or neurons, transmit signals through networks in the brain. The default mode network handles automatic attention, while the task-positive mode or executive network manages directed attention. Research shows that these networks work differently in people with ADHD. Neurotransmitters, which help transmit signals between nerve cells, also play a role.

Although these brain differences are known, the exact reasons for them are not fully understood. Genetics appears to play a major role, as ADHD often runs in families. A child with ADHD has a 1 in 4 chance of having a parent with the condition.

Other possible causes and risk factors include:

Lead exposure
Brain anatomy
Substance use during pregnancy
Premature birth
Low birth weight

ADHD is not caused by:

Allergies
Immunizations
Eating too much sugar
Excessive screen time
Poor parenting
Social factors like poverty

How to get diagnosed with ADHD

If you suspect your child may have ADHD, start by scheduling an appointment with their healthcare provider. A pediatrician or specialist can assess if your child has ADHD using guidelines from the American Academy of Pediatrics, which apply to children ages 4 to 17. Diagnosing ADHD in children under 4 is challenging due to rapid changes in behavior and natural overactivity. Diagnosing ADHD in teenagers can also be difficult due to other conditions like depression or anxiety.

There is no specific test for ADHD. The diagnosis involves several steps and gathering information from multiple sources. Observations from various people in different settings, such as home and school, are crucial.

The people involved in assessing your child’s behavior include:

You
Your child
Your child’s healthcare provider
Your child’s teachers and school staff
Other caregivers

Your provider will compare your child’s behavior to that of other children their age. They will use the DSM-5-TR guidelines to diagnose ADHD. According to these guidelines:

Symptoms must occur in at least two settings (e.g., home, school) and cause dysfunction.
At least six symptoms must be present.
Symptoms must significantly impair daily functioning.
Symptoms must have started before age 12.
Symptoms must have been present for at least six months.

How is ADHD treated?

The goal of ADHD treatment is to improve your child’s symptoms for better functioning at home and school. For children ages 4 and 5, providers usually recommend starting with parent training before considering medication. For older children, adolescents, and adults, the best treatment often includes both behavioral therapy and medication.

Behavioral Therapy:

For children under 13, parent training in behavior management is recommended.
For adolescents, other types of therapy like social skills training or executive function training are suggested.
Behavioral therapy aims to strengthen positive behaviors and reduce unwanted ones. Executive function training focuses on improving organizational skills and self-monitoring.

Medication:

Medication can help manage ADHD symptoms and improve interactions with others.
Stimulants: These are the most commonly used and effective ADHD medications, with 70% to 80% of children showing improvement.
Nonstimulants: These work more slowly and generally have a smaller impact but can last up to 24 hours. They may be added if stimulants are not effective.
Antidepressants: Not FDA-approved for ADHD but sometimes prescribed alone or with other ADHD medications.