ADD / ADHD in Children

What is ADD / ADHD?

We all know kids who can’t sit still, who never seem to listen, who don’t follow instructions no matter how clearly you present them, or who blurt out inappropriate comments at inappropriate times. Sometimes these children are labeled as troublemakers, or criticized for being lazy and undisciplined. However, they may have ADD/ADHD.

Attention deficit hyperactivity disorder (ADHD) is a disorder that appears in early childhood. You may know it by the name attention deficit disorder, or ADD. ADD/ADHD makes it difficult for people to inhibit their spontaneous responses—responses that can involve everything from movement to speech to attentiveness.

Is it normal kid behavior or is it ADHD?

The signs and symptoms of ADD/ADHD typically appear before the age of seven. However, it can be difficult to distinguish between attention deficit disorder and normal “kid behavior.”

If you spot just a few signs, or the symptoms appear only in some situations, it’s probably not ADD/ADHD. On the other hand, if your child shows a number of ADD/ADHD signs and symptoms that are present across all situations—at home, at school, and at play—it’s time to take a closer look.

Once you understand the issues your child is struggling with, such as forgetfulness or difficulty paying attention in school, you can work together to find creative solutions and capitalize on strengths.

The primary characteristics of ADD / ADHD

When many people think of attention deficit disorder, they picture an out-of-control kid in constant motion, bouncing off the walls and disrupting everyone around. But this is not the only possible picture.

Some children with ADD/ADHD are hyperactive, while others sit quietly—with their attention miles away. Some put too much focus on a task and have trouble shifting it to something else. Others are only mildly inattentive, but overly impulsive.

The three primary characteristics of ADD / ADHD

The three primary characteristics of ADD/ADHD are inattention, hyperactivity, and impulsivity. The signs and symptoms a child with attention deficit disorder has depends on which characteristics predominate.

Children with ADD/ADHD may be:

• Inattentive, but not hyperactive or impulsive.
• Hyperactive and impulsive, but able to pay attention.
• Inattentive, hyperactive, and impulsive (the most common form of ADD/ADHD).

Children who only have inattentive symptoms of ADD/ADHD are often overlooked, since they’re not disruptive. However, the symptoms of inattention have consequences: getting in hot water with parents and teachers for not following directions; underperforming in school; or clashing with other kids over not playing by the rules.

Spotting ADD / ADHD at different ages

Because we expect very young children to be easily distractible and hyperactive, it’s the impulsive behaviors—the dangerous climb, the blurted insult—that often stand out in preschoolers with ADD/ADHD.

By age four or five, though, most children have learned how to pay attention to others, to sit quietly when instructed to, and not to say everything that pops into their heads. So by the time children reach school age, those with ADD/ADHD stand out in all three behaviors: inattentiveness, hyperactivity, and impulsivity.

Inattentiveness signs and symptoms of ADD/ADHD

It isn’t that children with ADD/ADHD can’t pay attention: when they’re doing things they enjoy or hearing about topics in which they’re interested, they have no trouble focusing and staying on task. But when the task is repetitive or boring, they quickly tune out.

Staying on track is another common problem. Children with ADD/ADHD often bounce from task to task without completing any of them, or skip necessary steps in procedures. Organizing their schoolwork and their time is harder for them than it is for most children.

Kids with ADD/ADHD also have trouble concentrating if there are things going on around them; they usually need a calm, quiet environment in order to stay focused.

Symptoms of inattention in children:

• Doesn’t pay attention to details
• Makes careless mistakes
• Has trouble staying focused; is easily distracted
• Appears not to listen when spoken to
• Has difficulty remembering things and following instructions
• Has trouble staying organized, planning ahead, and finishing projects
• Gets bored with a task before it’s completed
• Frequently loses or misplaces homework, books, toys, or other items

Hyperactivity signs and symptoms of ADD/ADHD

The most obvious sign of ADD/ADHD is hyperactivity. While many children are naturally quite active, kids with hyperactive symptoms of attention deficit disorder are always moving.

They may try to do several things at once, bouncing around from one activity to the next. Even when forced to sit still which can be very difficult for them their foot is tapping, their leg is shaking, or their fingers are drumming.

Symptoms of hyperactivity in children:

• Constantly fidgets and squirms
• Often leaves his or her seat in situations where sitting quietly is expected
• Moves around constantly, often runs or climbs inappropriately
• Talks excessively
• Has difficulty playing quietly or relaxing
• Is always “on the go,” as if driven by a motor
• May have a quick temper or a “short fuse” 
  

Impulsive signs and symptoms of ADD/ADHD

The impulsivity of children with ADD/ADHD can cause problems with self-control. Because they censor themselves less than other kids do, they’ll interrupt conversations, invade other people’s space, ask irrelevant questions in class, make tactless observations, and ask overly personal questions.

Instructions like “Be patient” and “Just wait a little while” are twice as hard for children with ADD/ADHD to follow as they are for other youngsters.

Children with impulsive signs and symptoms of ADD/ADHD also tend to be moody and to overreact emotionally. As a result, others may start to view the child as disrespectful, weird, or needy.

Symptoms of impulsivity in children:

• Acts without thinking
• Blurts out answers in class without waiting to be called on or hear the whole question
• Can’t wait for his or her turn in line or in games
• Says the wrong thing at the wrong time
• Often interrupts others
• Intrudes on other people’s conversations or games
• Inability to keep powerful emotions in check, resulting in angry outbursts or temper tantrums
• Guesses, rather than taking time to solve a problem

Is it really ADD / ADHD?

Just because a child has symptoms of inattention, impulsivity, or hyperactivity does not mean that he or she has ADD or ADHD. Certain medical conditions, psychological disorders, and stressful life events can cause symptoms that look like ADD / ADHD.

Before an accurate diagnosis of ADD / ADHD can be made, it is important that you see a mental health professional to explore and rule out the following possibilities:

• Learning disabilities or problems with reading, writing, motor skills, or language.
• Major life events or traumatic experiences (e.g. a recent move, death of a loved one, bullying, divorce).
• Psychological disorders including anxiety, depression, and bipolar disorder.
• Behavioral disorders such as conduct disorder and oppositional defiant disorder.
• Medical conditions, including thyroid problems, neurological conditions, epilepsy, and sleep disorders.

Positive effects of ADD / ADHD in children

In addition to the challenges, there are also positive traits associated with people who have attention deficit disorder:

• Creativity – Children who have ADD/ADHD can be marvelously creative and imaginative. The child who daydreams and has ten different thoughts at once can become a master problem-solver, a fountain of ideas, or an inventive artist. Children with ADD/ADHD may be easily distracted, but sometimes they notice what others don’t see.
• Flexibility – Because children with ADD/ADHD consider a lot of options at once, they don’t become set on one alternative early on and are more open to different ideas.
• Enthusiasm and spontaneity – Children with ADD/ADHD are rarely boring! They’re interested in a lot of different things and have lively personalities. In short, if they’re not exasperating you (and sometimes even when they are), they’re a lot of fun to be with.
• Energy and drive – When kids with ADD/ADHD are motivated, they work or play hard and strive to succeed. It actually may be difficult to distract them from a task that interests them, especially if the activity is interactive or hands-on.

Keep in mind, too, that ADD/ADHD has nothing to do with intelligence or talent. Many children with ADD/ADHD are intellectually or artistically gifted.

Helping a child with ADD / ADHD

Whether or not your child’s symptoms of inattention, hyperactivity, and impulsivity are due to ADD/ADHD, they can cause many problems if left untreated. Children who can’t focus and control themselves may struggle in school, get into frequent trouble, and find it hard to get along with others or make friends. These frustrations and difficulties can lead to low self-esteem as well as friction and stress for the whole family.

But treatment can make a dramatic difference in your child’s symptoms. With the right support, your child can get on track for success in all areas of life.

Don’t wait to get help for your child

If your child struggles with symptoms that look like ADD/ADHD, don’t wait to seek professional help.You can treat your child’s symptoms of hyperactivity, inattention, and impulsivity without having a diagnosis of attention deficit disorder.

Options to start with include getting your child into therapy, implementing a better diet and exercise plan, and modifying the home environment to minimize distractions.

If you do receive a diagnosis of ADD/ADHD, you can then work with your child’s doctor, therapist, and school to make a personalized treatment plan that meets his or her specific needs. Effective treatment for childhood ADD/ADHD involves behavioral therapy, parent education and training, social support, and assistance at school. Medication may also be used, however, it should never be the sole attention deficit disorder treatment.

Parenting tips for children with ADD / ADHD

If your child is hyperactive, inattentive, or impulsive, it may take a lot of energy to get him or her to listen, finish a task, or sit still. The constant monitoring can be frustrating and exhausting. Sometimes you may feel like your child is running the show. But there are steps you can take to regain control of the situation, while simultaneously helping your child make the most of his or her abilities.

While attention deficit disorder is not caused by bad parenting, there are effective parenting strategies that can go a long way to correct problem behaviors.

Children with ADD/ADHD need structure, consistency, clear communication, and rewards and consequences for their behavior. They also need lots of love, support, and encouragement.

There are many things parents can do to reduce the signs and symptoms of ADD/ADHD without sacrificing the natural energy, playfulness, and sense of wonder unique in every child.

School tips for children with ADD / ADHD

ADD/ADHD, obviously, gets in the way of learning. You can’t absorb information or get your work done if you’re running around the classroom or zoning out on what you’re supposed to be reading or listening to.

Think of what the school setting requires children to do: Sit still. Listen quietly. Pay attention. Follow instructions. Concentrate. These are the very things kids with ADD/ADHD have a hard time doing—not because they aren’t willing, but because their brains won’t let them.

But that doesn’t mean kids with ADD/ADHD can’t succeed at school. There are many things both parents and teachers can do to help children with ADD/ADHD thrive in the classroom. It starts with evaluating each child’s individual weaknesses and strengths, then coming up with creative strategies for helping the child focus, stay on task, and learn to his or her full capability.Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders. ADHD is a broad term, and the condition can vary from person to person. There are an estimated 6.4 million diagnosed children in the United States, according to the Centers for Disease Control and Prevention.

The condition is also known as attention deficit disorder (ADD), though this is considered an outdated term. The American Psychiatric Association released the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in May 2013. The DSM-5 changed the criteria necessary to diagnose someone with ADHD.

Keep reading to learn more about the types and symptoms of ADHD.

CDC researchers have published a National Health Statistics Report, Diagnostic Experiences of Children with Attention-Deficit/Hyperactivity Disorder. It is the first national study presenting greater detail on how ADHD diagnoses take place among a representative sample of children who have ADHD, as described by their parents. Findings from this report can be compared to American Academy of Pediatrics’ (AAP) clinical practice guidelines for ADHD, which recommend using standardized rating scales to diagnose ADHD and information from multiple sources (parents, teachers, other family members, etc.).

CDC researchers found from parent reports that about half of children were diagnosed by a primary care physician, behavior rating scales were used for 9 in 10 children to assess for ADHD, and about 8 in 10 diagnoses incorporated information from an adult other than a family member.

This is important information for healthcare providers, public health officials, and researchers who seek to determine how closely current practice matches with best practice for diagnosing ADHD. These findings provide new information on who is diagnosing ADHD and describes some of the features of those initial diagnostic visits. The estimates suggest that physicians who diagnose ADHD are largely using two recommended practices—behavior rating scales and incorporating feedback from adults other than family members—in their diagnosis of ADHD in children. This information will also inform future efforts to make sure that the diagnosis of ADHD reflects best practice recommendations.

You can read the article here.

Main Findings

Based on the parent’s report about their child’s ADHD diagnosis

·         About three-quarters of children with ADHD were diagnosed before age 9 and one-third of those by age 6;

·         A family member (which can include a parent) was usually the one first concerned about a child’s behavior, than someone from the child’s school or daycare;

·         A primary care physician (usually a pediatrician) first made the diagnosis for about half of the children;

·         Children with ADHD first diagnosed by a psychiatrist were more likely to be under 6 years of age than older;

·         Children with ADHD first diagnosed by a psychologist were more likely to be older than 6 years of age than under 6;

·         Healthcare providers nearly always had a conversation with a parent about their child’s behavior;

·         Healthcare providers used behavior rating scales or checklists to assess 9 in 10 children for ADHD; and

·         An adult outside of the family was usually involved in the diagnostic process.

Q: What is ADHD?

A: Attention deficit hyperactivity disorder (ADHD), or just attention deficit disorder (ADD) are confusing medical terms. Don’t be afraid, though, because if you manage it right, ADHD can become your friend, a major asset in your life.

The terms ADD and ADHD  refer to a syndrome found in both children and adults characterized by distractibility, impulsivity and restlessness or hyperactivity.

In my opinion, ADHD is a terrible term. As I see it, ADHD is neither a disorder, nor is there a deficit of attention. I see ADHD as a trait, not a disability. When it is managed properly, it can become a huge asset in one’s life. I both have ADHD myself and I wrote a book with Catherine Corman profiling a collections of fabulously successful adults all of whom have ADHD, so I know whereof I speak.

As I like to describe it, having ADD is like having a powerful race car for a brain, but with bicycle brakes. Treating ADD is like strengthening your brakes–so you start to win races in your life.
In my work as a psychiatrist who treats ADHD, I see myself not as a doctor who treats a disability, but rather as a doctor who helps people, adults and children alike, identify, develop, and celebrate their talents. That’s why I love my work!

Q: What is the difference between ADD and ADHD?

A: It’s very simple. ADHD includes the symptom of physical hyperactivity or excessive restlessness–that’s the “H”. In ADD (or what is called in the diagnostic manual, ADHD, inattentive subtype), the symptom of hyperactivity is absent. Indeed, people with ADD can be calm and serene, not in the least hyperactive or disruptive. This syndrome is often found in girls and women, but it also occurs in boys and men. It is often missed, because the absence of hyperactivity leads others to assume the child or adult is simply shy, quiet or slow. In fact, they are dynamos in the making!

Q: What are the positive qualities associated with ADD?

A: People with ADD typically are creative, intuitive, original, and full of positive energy. They tend to be independent thinkers. They are persistent to the point of being stubborn. They usually are quite sensitive, but often cover this over with a kind of bravado. They are big-hearted and generous. They often have charisma or a special something, a twinkle in the eye, a zany sense of humor, or an ability to inspire others. With the right kind of guidance, these people can become hugely successful in their lives.

Q: What are the negative qualities associated with ADD?

A: People with ADD typically have trouble paying attention and focusing, especially when they are not interested. On the other hand they can super-focus at times. They also can be impulsive and sometimes hyperactive and disruptive. They can have trouble getting organized, prioritizing their activities, managing time, and completing tasks. They can be unaware of the impact they have on others, and so they can be socially awkward or inappropriate. They can be forgetful, inconsistent in follow-through, and often late. They have trouble with planning and what mental health professionals call “executive functioning.” The good news is that treatment can ameliorate or correct all of this, so that the positive attributes can carry the day.

 Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder of the neurodevelopmental type.^[1][2] It characterized by problems paying attention, excessive activity, or difficulty controlling behavior which is not appropriate for a person's age.^[3] These symptoms begin by age six to twelve, are present for more than six months, and cause problems in at least two settings (such as school, home, or recreational activities).^[4][5] In children, problems paying attention may result in poor school performance.^[3] Although it causes impairment, particularly in modern society, many children have a good attention span for tasks they find interesting.^[6]

Inattention, hyperactivity (restlessness in adults), disruptive behavior, and impulsivity are common in ADHD.^[33][34] Academic difficulties are frequent as are problems with relationships.^[33] The symptoms can be difficult to define as it is hard to draw a line at where normal levels of inattention, hyperactivity, and impulsivity end and significant levels requiring interventions begin.^[35]

According to the DSM-5, symptoms must be present for six months or more to a degree that is much greater than others of the same age^[10] and they must cause significant problems functioning in at least two settings (e.g., social, school/work, or home).^[10] The full criteria must have been met prior to age 12 in order to receive a diagnosis of ADHD.^[10]

ADHD is divided into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined type.^[35][10]

An individual with ADHD inattentive type has most or all of following symptoms, excluding situations where these symptoms are better explained by another psychiatric or medical condition:^[36][10]

·         Be easily distracted, miss details, forget things, and frequently switch from one activity to another

·         Have difficulty maintaining focus on one task

·         Become bored with a task after only a few minutes, unless doing something enjoyable

·         Have difficulty focusing attention on organizing and completing a task or learning something new

·         Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities

·         Not seem to listen when spoken to

·         Daydream, become easily confused, and move slowly

·         Have difficulty processing information as quickly and accurately as others

·         Struggle to follow instructions

·         Have trouble understanding minute details

An individual with ADHD hyperactive/impulsive type has most or all of the following symptoms, excluding situations where these symptoms are better explained by another psychiatric or medical condition:^[36][10]

·         Fidget and squirm in their seats

·         Talk nonstop

·         Dash around, touching or playing with anything and everything in sight

·         Have trouble sitting still during dinner, school, doing homework, and story time

·         Be constantly in motion

·         Have difficulty doing quiet tasks or activities

·         Be very impatient

·         Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences

·         Have difficulty waiting for things they want or waiting their turns in games

·         Often interrupt conversations or others' activities

Symptoms of hyperactivity tend to go away with age and turn into "inner restlessness" in teens and adults with ADHD.^[15]

People with ADHD are more likely to have problems with social skills, such as social interaction and forming and maintaining friendships. This is true for all subtypes. About half of children and adolescents with ADHD experience social rejection by their peers compared to 10–15% of non-ADHD children and adolescents. People with attention deficits are prone to having difficulty processing verbal and nonverbal language which can negatively affect social interaction. They also may drift off during conversations, and miss social cues.^[37]

Difficulties managing anger are more common in children with ADHD^[38] as are poor handwriting^[39] and delays in speech, language and motor development.^[40][41] Although it causes significant impairment, particularly in modern society, many children with ADHD have a good attention span for tasks they find interesting.^[6]

Associated disorders

In children ADHD occurs with other disorders about ? of the time.^[6] Some commonly associated conditions include:

·         Learning disabilities have been found to occur in about 20–30% of children with ADHD. Learning disabilities can include developmental speech and language disorders and academic skills disorders.^[42]ADHD, however, is not considered a learning disability, but it very frequently causes academic difficulties.^[42]

·         Tourette syndrome has been found to occur more commonly in the ADHD population.^[43]

·         Oppositional defiant disorder (ODD) and conduct disorder (CD), which occur with ADHD in about 50% and 20% of cases respectively.^[44] They are characterized by antisocial behaviors such as stubbornness, aggression, frequent temper tantrums, deceitfulness, lying, and stealing.^[45] About half of those with hyperactivity and ODD or CD develop antisocial personality disorder in adulthood.^[46]Brain imaging supports that conduct disorder and ADHD are separate conditions.^[47]

·         Primary disorder of vigilance, which is characterized by poor attention and concentration, as well as difficulties staying awake. These children tend to fidget, yawn and stretch and appear to be hyperactive in order to remain alert and active.^[45]

·         Mood disorders (especially bipolar disorder and major depressive disorder). Boys diagnosed with the combined ADHD subtype are more likely to have a mood disorder.^[48] Adults with ADHD sometimes also have bipolar disorder, which requires careful assessment to accurately diagnose and treat both conditions.^[49]

·         Anxiety disorders have been found to occur more commonly in the ADHD population.^[48]

·         Obsessive-compulsive disorder (OCD) can co-occur with ADHD and shares many of its characteristics.^[45]

·         Substance use disorders. Adolescents and adults with ADHD are at increased risk of developing a substance use problem.^[15] This is most commonly seen with alcohol or cannabis.^[15] The reason for this may be an altered reward pathway in the brains of ADHD individuals.^[15] This makes the evaluation and treatment of ADHD more difficult, with serious substance misuse problems usually treated first due to their greater risks.^[18][50]

·         Restless legs syndrome has been found to be more common in those with ADHD and is often due to iron deficiency anaemia.^[51][52] However, restless legs can simply be a part of ADHD and requires careful assessment to differentiate between the two disorders.^[53]

·         Sleep disorders and ADHD commonly co-exist. They can also occur as a side effect of medications used to treat ADHD. In children with ADHD, insomnia is the most common sleep disorder with behavioral therapy the preferred treatment.^[54][55] Problems with sleep initiation are common among individuals with ADHD but often they will be deep sleepers and have significant difficulty getting up in the morning.^[56] Melatonin is sometimes used in children who have sleep onset insomnia.^[57]

There is an association with persistent bed wetting,^[58] language delay,^[59] and developmental coordination disorder (DCD).^[60] Language delays can include auditory processing disorders such as short-term auditory memory weakness, difficulty following instructions, slow speed of processing spoken language, and difficulties listening in distracting environments.^[61]

The cause of most cases of ADHD is unknown; however, it is believed to involve interactions between genetic and environmental factors.^[62][63] Certain cases are related to previous infection of or trauma to the brain.^[62]

Genetics

Twin studies indicate that the disorder is often inherited from one's parents with genetics determining about 75% of cases.^[18][64][65] Siblings of children with ADHD are three to four times more likely to develop the disorder than siblings of children without the disorder.^[66] Genetic factors are also believed to be involved in determining whether ADHD persists into adulthood.^[67]

Typically, a number of genes are involved, many of which directly affect dopamine neurotransmission.^[68][69] Those involved with dopamine include DAT, DRD4, DRD5, TAAR1, MAOA, COMT, andDBH.^[69][70][71] Other genes associated with ADHD include SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2, and BDNF.^[68][69] A common variant of a gene called LPHN3 is estimated to be responsible for about 9% of cases and when this variant is present, people are particularly responsive to stimulant medication.^[72] The 7 repeat variant of dopamine receptor D4 (DRD4–7R) causes increased inhibitory effects induced by dopamine and is associated with ADHD. The DRD4 receptor is a G protein-coupled receptor that inhibits adenylyl cyclase. The DRD4–7R mutation results in a wide range of behavioralphenotypes, including ADHD symptoms reflecting split attention.^[73]

As ADHD is common, natural selection likely favored the traits, at least individually, and they may have provided a survival advantage.^[74] For example, some women may be more attracted to males who are risk takers, increasing the frequency of genes that predispose to ADHD in the gene pool.^[75] As it is more common in children of anxious or stressed mothers, some argue that ADHD is an adaptation that helps children face a stressful or dangerous environment with, for example, increased impulsivity and exploratory behavior.^[76]

Hyperactivity might have been beneficial, from an evolutionary perspective, in situations involving risk, competition, or unpredictable behavior (i.e. exploring new areas or finding new food sources). In these situations, ADHD could have been beneficial to society as a whole even while being harmful to the individual.^[75] Additionally, in certain environments it may have offered advantages to the individuals themselves, such as quicker response to predators or superior hunting skills.^[77]

People with Down syndrome are more likely to have ADHD.^[78]

Environment

In addition to genetics, some environmental factors might play a role.^[79] Alcohol intake during pregnancy can cause fetal alcohol spectrum disorders which can include ADHD or symptoms like it.^[80]Children exposed to certain toxic substances, such as lead or polychlorinated biphenyls, may develop problems which resemble ADHD.^[81][82] Exposure to Brain structure[edit]

In children with ADHD, there is a general reduction of volume in certain brain structures, with a proportionally greater decrease in the volume in the left-sided prefrontal cortex.^[102][106] The posterior parietal cortex also shows thinning in ADHD individuals compared to controls.^[102] Other brain structures in the prefrontal-striatal-cerebellar and prefrontal-striatal-thalamic circuits have also been found to differ between people with and without ADHD.^{[102][104][105]}

Neurotransmitter pathways

Previously it was thought that the elevated number of dopamine transporters in people with ADHD was part of the pathophysiology but it appears that the elevated numbers are due to adaptation to exposure to stimulants.^[107] Current models involve the mesocorticolimbic dopamine pathway and the locus coeruleus-noradrenergic system.^{[101][102][103]} ADHD psychostimulants possess treatment efficacy because they increase neurotransmitter activity in these systems.^{[102][103][108]} There may additionally be abnormalities in serotoninergic and cholinergic pathways.^[108][109] Neurotransmission ofglutamate, a cotransmitter with dopamine in the mesolimbic pathway,^[110] seems to be also involved.^[111]

Executive function and motivation

The symptoms of ADHD arise from a deficiency in certain executive functions (e.g., attentional control, inhibitory control, and working memory).^{[56][102][103]} Executive functions are a set of cognitive processes that are required to successfully select and monitor behaviors that facilitate the attainment of one's chosen goals.^[56][103] The executive function impairments that occur in ADHD individuals result in problems with staying organized, time keeping, excessive procrastination, maintaining concentration, paying attention, ignoring distractions, regulating emotions, and remembering details.^{[56][102][103]}People with ADHD appear to have unimpaired long-term memory, and deficits in long-term recall appear to be attributed to impairments in working memory.^[56][112] The criteria for an executive function deficit are met in 30–50% of children and adolescents with ADHD.^[113] One study found that 80% of individuals with ADHD were impaired in at least one executive function task, compared to 50% for individuals without ADHD.^[114] Due to the rates of brain maturation and the increasing demands for executive control as a person gets older, ADHD impairments may not fully manifest themselves until adolescence or even early adulthood.^[56]

ADHD has also been associated with motivational deficits in children.^[115] Children with ADHD find it difficult to focus on long-term over short-term rewards, and exhibit impulsive behavior for short-term rewards.^[115] In these individuals, a large amount of positive reinforcement effectively improves task performance.^[115] ADHD stimulants may improve persistence in ADHD children as well.^[115]

ADHD is diagnosed by an assessment of a person's childhood behavioral and mental development, including ruling out the effects of drugs, medications and other medical or psychiatric problems as explanations for the symptoms.^[18] It often takes into account feedback from parents and teachers^[5] with most diagnoses begun after a teacher raises concerns.^[88] It may be viewed as the extreme end of one or more continuous human traits found in all people.^[18] Whether someone responds to medications does not confirm or rule out the diagnosis. As imaging studies of the brain do not give consistent results between individuals, they are only used for research purposes and not diagnosis.^[116]

In North America, DSM-5 criteria are used for diagnosis, while European countries usually use the ICD-10. With the DSM-IV criteria a diagnosis of ADHD is 3–4 times more likely than with the ICD-10 criteria.^[14] It is classified as neurodevelopmental psychiatric disorder.^[15][2] Additionally, it is classified as a disruptive behavior disorder along with oppositional defiant disorder, conduct disorder, andantisocial personality disorder.^[117] A diagnosis does not imply a neurological disorder.^[18]

Associated conditions that should be screened for include anxiety, depression, oppositional defiant disorder, conduct disorder, and learning and language disorders. Other conditions that should be considered are other neurodevelopmental disorders, tics, and sleep apnea.^[118]

Diagnosis of ADHD using quantitative electroencephalography (QEEG) is an ongoing area of investigation, although the value of QEEG in ADHD is currently unclear.^[119][120] In the United States, the Food and Drug Administration has approved the use of QEEG to evaluate the morbidity of ADHD.^[121]

Diagnostic and Statistical Manual

As with many other psychiatric disorders, formal diagnosis is made by a qualified professional based on a set number of criteria. In the United States, these criteria are defined by the American Psychiatric Association in the DSM. Based on the DSM criteria, there are three sub-types of ADHD:^[10]

1.   ADHD predominantly inattentive type (ADHD-PI) presents with symptoms including being easily distracted, forgetful, daydreaming, disorganization, poor concentration, and difficulty completing tasks.^[4][10]

2.   ADHD, predominantly hyperactive-impulsive type presents with excessive fidgetiness and restlessness, hyperactivity, difficulty waiting and remaining seated, immature behavior; destructive behaviors may also be present.^[4][10]

3.   ADHD, combined type is a combination of the first two subtypes.^[4][10]

This subdivision is based on presence of at least six out of nine long-term (lasting at least six months) symptoms of inattention, hyperactivity–impulsivity, or both.^[122] To be considered, the symptoms must have appeared by the age of six to twelve and occur in more than one environment (e.g. at home and at school or work).^[4] The symptoms must be not appropriate for a child of that age^[4][123] and there must be evidence that it is causing social, school or work related problems.^[122]

International Classification of Diseases

In the ICD-10, the symptoms of "hyperkinetic disorder" are analogous to ADHD in the DSM-5. When a conduct disorder (as defined by ICD-10)^[40] is present, the condition is referred to as hyperkinetic conduct disorder. Otherwise, the disorder is classified as disturbance of activity and attention, other hyperkinetic disorders or hyperkinetic disorders, unspecified. The latter is sometimes referred to ashyperkinetic syndrome.^[40]

Adults

Adults with ADHD are diagnosed under the same criteria, including that their signs must have been present by the age of six to twelve. Questioning parents or guardians as to how the person behaved and developed as a child may form part of the assessment; a family history of ADHD also adds weight to a diagnosis.^[15] While the core symptoms of ADHD are similar in children and adults they often present differently in adults than in children, for example excessive physical activity seen in children may present as feelings of restlessness and constant mental activity in adults.^[15]

Differential diagnosis

Symptoms of ADHD such as low mood and poor self-image, mood swings, and irritability can be confused withdysthymia, cyclothymia or bipolar disorder as well as with borderline personality disorder.^[15] Some symptoms that are due to anxiety disorders, antisocial personality disorder, developmental disabilities or mental retardation or the effects of substance abuse such as intoxication and withdrawal can overlap with some ADHD. These disorders can also sometimes occur along with ADHD. Medical conditions which can cause ADHD type symptoms include: hyperthyroidism, seizure disorder, lead toxicity, hearing deficits, hepatic disease, sleep apnea, drug interactions, untreated celiac disease, and head injury.^[24][125]

Primary sleep disorders may affect attention and behavior and the symptoms of ADHD may affect sleep.^[126] It is thus recommended that children with ADHD be regularly assessed for sleep problems.^[127] Sleepiness in children may result in symptoms ranging from the classic ones of yawning and rubbing the eyes, to hyperactivity and inattentiveness.^[128] Obstructive sleep apnea can also cause ADHD type symptoms.^[128]

the organophosphate insecticides chlorpyrifosand dialkyl phosphate is associated with an increased risk; however, the evidence is not conclusive.^[83] Exposure to tobacco smoke during pregnancy can cause problems with central nervous system development and can increase the risk of ADHD.^[84][81]

Extreme premature birth, very low birth weight, and extreme neglect, abuse, or social deprivation also increase the risk^[81][85] as do certain infections during pregnancy, at birth, and in early childhood. These infections include, among others, various viruses (measles, varicella zoster encephalitis, rubella, enterovirus 71).^[86] At least 30% of children with a traumatic brain injury later develop ADHD^[87] and about 5% of cases are due to brain damage.^[88]

Some studies suggest that in a minority of children, artificial food dyes or preservative may be associated with an increased prevalence of ADHD or ADHD-like symptoms^[81][89] but the evidence is weak and may only apply to children with food sensitivities.^[89][90][91] The United Kingdom and the European Union have put in place regulatory measures based on these concerns.^[92] In a minority of children,intolerances or allergies to certain foods may worsen ADHD symptoms.^[93]

Research does not support popular beliefs that ADHD is caused by eating too much refined sugar, watching too much television, parenting, poverty or family chaos; however, they might worsen ADHD symptoms in certain people.^[94]

Society

The diagnosis of ADHD can represent family dysfunction or a poor educational system rather than an individual problem.^[95] Some cases may be explained by increasing academic expectations, with a diagnosis being a method for parents in some countries to get extra financial and educational support for their child.^[88] The youngest children in a class have been found to be more likely to be diagnosed as having ADHD possibly due to their being developmentally behind their older classmates.^[96][97] Behaviors typical of ADHD occurs more commonly in children who have experienced violence and emotional abuse.^[18]

According to social construction theory it is societies that determine the boundary between normal and abnormal behavior. Members of society, including physicians, parents, and teachers, determine which diagnostic criteria are used and, thus, the number of people affected.^[98] This leads to the current situation where the DSM-IV arrives at levels of ADHD three to four times higher than those obtained with the ICD-10.^[14] Thomas Szasz, a supporter of this theory, has argued that ADHD was "invented and not discovered."^[99][100]

Symptoms of ADHD

1. Inattention
2. Hyperactivity
3. Impulsivity

   Inattention

   You might not notice it until a child goes to school. In adults, it may be easier to notice at work or in social situations.

   The person might procrastinate, not complete tasks like homework or chores, or frequently move from one uncompleted activity to another.

   They might also:

   • Be disorganized
   • Lack focus
   • Have a hard time paying attention to details and a tendency to make careless mistakes. Their work might be messy and seem careless.
   • Have trouble staying on topic while talking, not listening to others, and not following social rules
   • Be forgetful about daily activities (for example, missing appointments, forgetting to bring lunch)
   • Be easily distracted by things like trivial noises or events that are usually ignored by others.

   Hyperactivity

   It may vary with age. You might be able to notice it in preschoolers.ADHD symptoms nearly always show up before middle school.

   Kids with hyperactivity may:

   • Fidget and squirm when seated.
   • Get up frequently to walk or run around.
   • Run or climb a lot when it's not appropriate. (In teens this may seem like restlessness.)
   • Have trouble playing quietly or doing quiet hobbies
   • Always be "on the go"
   • Talk excessively

   Toddlers and preschoolers with ADHD tend to be constantly in motion, jumping on furniture and having trouble participating in group activities that call for them to sit still. For instance, they may have a hard time listening to a story.

   School-age children have similar habits, but you may notice those less often. They are unable to stay seated, squirm a lot, fidget, or talk a lot.

   Hyperactivity can show up as feelings of restlessness in teens and adults. They may also have a hard time doing quiet activities where you sit still.

   Impulsivity

   Symptoms of this include:

   • Impatience
   • Having a hard time waiting to talk or react
   • Have a hard time waiting for their turn.
   • Blurt out answers before someone finishes asking them a question.
   • Frequently interrupt or intrude on others. This often happens so much that it causes problems in social or work settings.
   • Start conversations at inappropriate times.

   Impulsivity can lead to accidents, like knocking over objects or banging into people. Children with ADHD may also do risky things without stopping to think about the consequences. For instance, they may climb and put themselves in danger.

   Many of these symptoms happen from time to time in all youngsters. But in children with the disorder they happen a lot -- at home and school, or when visiting with friends. They also mess with the child's ability to function like other children who are the same age or developmental level.

   Getting Diagnosed

   Doctors check for behavior that's:

   • Not typical for the person’s age. (Most children can behave in those ways at some point or another, though.)
   • Has a negative impact on the person’s ability to function at home, in social environments, or at work.

   They also have to consistently display at least six of the above symptoms:

   • For at least 6 months
   • And in at least two settings, such as at home and in schoolAmong the non-genetic factors that may increase a child's risk for developing ADHD are:
     • Smoking or drinking during pregnancy.
     • Birth complications or very low birth weight.
     • Exposure to lead or other toxic substances.
     • Extreme neglect, abuse, or social deprivation.