Q. What is Attention Deficit Hyperactivity Disorder (ADHD)?
A. ADHD refers to a family of related chronic neurobiological disorders that interfere with an individual’s capacity to regulate activity level (hyperactivity), inhibit behavior (impulsivity), and attend to tasks (inattention) in developmentally appropriate ways. The core symptoms of ADHD include an inability to sustain attention and concentration, developmentally inappropriate levels of activity, distractibility, and impulsivity. Children with ADHD have functional impairment across multiple settings including home, school, and peer relationships. ADHD has also been shown to have long-term adverse effects on academic performance, vocational success, and social-emotional development. Children with ADHD experience an inability to sit still and pay attention in class and the negative consequences of such behavior. They experience peer rejection and engage in a broad array of disruptive behaviors. Their academic and social difficulties have far-reaching and long-term consequences. These children have higher injury rates. As they grow older, children with untreated ADHD, in combination with conduct disorders, experience drug abuse, antisocial behavior, and injuries of all sorts. For many individuals, the impact of ADHD continues into adulthood.
Q. What are the symptoms of ADHD?
- Inattention. People who are inattentive have a hard time keeping their mind on one thing and may get bored with a task after only a few minutes. Focusing conscious, deliberate attention to organizing and completing routine tasks may be difficult.
- Hyperactivity. People who are hyperactive always seem to be in motion. They can’t sit still; they may dash around or talk incessantly. Sitting still through a lesson can be an impossible task. They may roam around the room, squirm in their seats, wiggle their feet, touch everything, or noisily tap a pencil. They may also feel intensely restless.
- Impulsivity. People who are overly impulsive, seem unable to curb their immediate reactions or think before they act. As a result, they may blurt out answers to questions or inappropriate comments, or run into the street without looking. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they are upset.
Q. How is ADHD diagnosed?
A. The diagnosis of ADHD can be made reliably using well-tested diagnostic interview methods. Diagnosis is based on history and observable behaviors in the child’s usual settings. Ideally, a health care practitioner making a diagnosis should include input from parents and teachers. The key elements include a thorough history covering the presenting symptoms, differential diagnosis, possible co-existing conditions, as well as medical, developmental, school, psychosocial, and family histories. It is helpful to determine what precipitated the request for evaluation and what approaches had been used in the past. As of yet, there is no independent test for ADHD. This is not unique to ADHD, but applies as well to most psychiatric disorders, including other disabling disorders such as schizophrenia and autism.
Q. How many children are diagnosed with ADHD?
A. ADHD is the most commonly diagnosed disorder of childhood, estimated to affect 3 to 5 percent of school-age children, and occurring three times more often in boys than in girls. On average, about one child in every classroom in the United States needs help for this disorder.
Q. Aren’t there various types of ADHD?
A. According to DSM-IV, the fourth and most recent edition of the DSM, while most individuals have symptoms of both inattention and hyperactivity-impulsivity, there are some individuals in whom one or another pattern is predominant (for at least the past 6 months).
Q. How are schools involved in diagnosing, assessing, and treating ADHD?
A. Physicians and parents should be aware that schools are federally mandated to perform an appropriate evaluation if a child is suspected of having a disability that impairs academic functioning. This policy was recently strengthened by regulations implementing the 1997 reauthorization of the Individuals with Disabilities Act (IDEA), which guarantees appropriate services and a public education to children with disabilities from ages 3 to 21. For the first time, IDEA specifically lists ADHD as a qualifying condition for special education services. If the assessment performed by the school is inadequate or inappropriate, parents may request that an independent evaluation be conducted at the school’s expense. Furthermore, some children with ADHD qualify for special education services within the public schools, under the category of “Other Health Impaired.” In these cases, the special education teacher, school psychologist, school administrators, classroom teachers, along with parents, must assess the child’s strengths and weaknesses and design an Individualized Education Program. These special education services for children with ADHD are available though IDEA.
Q. Is ADHD inherited?
A. Research shows that ADHD tends to run in families, so while there are likely to be genetic influences, it is not strictly inherited like baldness or eye color. Children who have ADHD usually have at least one close relative who also has ADHD. And at least one-third of all fathers who had ADHD in their youth have children with ADHD. Even more convincing of a possible genetic link is that when one twin of an identical twin pair has the disorder, the other is likely to have it too.