Attention-deficit/hyperactivity disorder (ADHD) is a disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active
There are three distinct types of ADHD:
- Predominantly Inattentive presentation: Meaning that is difficult for the person to pay attention in detail, the person wanders off task, lacks persistence, has difficulty sustaining focus, follow instructions or conversations, and is disorganized; and these problems are not due to defiance or lack of comprehension.
- Predominantly Hyperactive presentation: means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
- Impulsive Presentation:means a person makes hasty actions that occur in the moment without first thinking about them and that may have a high potential for harm, or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
- Combined Presentation: Symptoms of the above two types are equally present in the person.
People with symptoms of inattentiveness:
- Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
- Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
- Inattentive when spoken to directly
- Have difficulty following through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
- Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
- Shy away from tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers
- Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
- Are easily distracted by unrelated thoughts or stimuli
- Are forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
People with symptoms of hyperactivity-impulsivity may:
- Fidget and squirm in their seats
- Have difficulty sitting still, will often leave their seats in situations when staying seated is expected, such as in the classroom or the office, unable to finish tasks
- Often feel restless, run or dash around or climb in situations where it is inappropriate or, in teens and adults
- Have difficulty playing or engaging in hobbies quietly
- Be constantly in motion or “on the go,” or act as if “driven by a motor”
- Talk nonstop, interrupt others
- Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in a conversation
- Have difficulty waiting for his or her turn
- Interrupt or intrude on others, for example in conversations, games, or activities
There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of learning disabilities, can have similar symptoms. Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a psychiatric nurse practitioner, a pediatrician, psychologist, or psychiatrist with expertise in ADHD. To be diagnosed with ADHD, certain tests are necessary including hearing and vision tests, to rule out other problems with symptoms like ADHD. Diagnosing ADHD usually includes a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child. In addition, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind typical development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present before age 12.
Causes, in addition to genetics, may include:
- Brain injury
- Exposure to environmental (e.g., lead) during pregnancy or at a young age
- Alcohol and tobacco use during pregnancy
- Premature delivery
- Low birth weight
Treatment is with stimulants and Non-stimulants, and therapies: cognitive behavioral therapies, behavioral therapies, marriage and family counseling, stress management, support groups.