ADHD – Attention Deficit Hyperactivity Disorder

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.

Signs and Symptoms

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others

Types

There are three different types of ADHD, depending on which types of symptoms are strongest in the individual:

• Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

• Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

• Combined Presentation: Symptoms of the above two types are equally present in the person.

Because symptoms can change over time, the presentation may change over time as well.

Causes of ADHD

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies of twins link genes with ADHD.

In addition to genetics, scientists are studying other possible causes and risk factors including:

• 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

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.

Diagnosis

Deciding if a child has ADHD is a process with several steps. 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. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Another part of the process may include a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.

Treatments

In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly training for parents, is recommended as the first line of treatment. What works best can depend on the child and family. Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.

Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with ADHD. In addition to behavioral therapy and medication, having a healthy lifestyle can make it easier for your child to deal with ADHD symptoms. Here are some healthy behaviors that may help:

• Eating a healthful diet centered on fruits, vegetables, whole grains, legumes (for example, beans, peas, and lentils), lean protein sources, and nuts and seeds
• Participating in physical activity for at least 60 minutes each day
• Limiting the amount of daily screen time from TVs, computers, phones, etc.
• Getting the recommended amount of sleep each night based on age

Get Help!

If you or your doctor has concerns about ADHD, you can take your child to a specialist such as a child psychologist or developmental pediatrician, or you can contact your local early intervention agency (for children under 3) or public school (for children 3 and older).

Sharing Concerns

In order to make sure your child reaches his or her full potential, it is very important to get help for ADHD as early as possible.

Other Concerns and Conditions with ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) often occurs with other disorders. About 2 in 3 of children with ADHD referred to clinics have other disorders as well as ADHD.

The combination of ADHD with other disorders often presents extra challenges for children, parents, educators, and healthcare providers. Therefore, it is important for doctors to screen every child with ADHD for other disorders and problems. Talk with your doctor if you have concerns about your child’s symptoms.

The American Academy of Pediatrics recommends that every child with ADHD be screened for other disorders and problems.

 

Behavior or Conduct Problems

Children occasionally act angry or defiant around adults or respond aggressively when they are upset. When these behaviors persist over time, or are severe, they can become a behavior disorder. Children with ADHD are more likely to be diagnosed with a behavior disorder such as Oppositional Defiant Disorder or Conduct Disorder. About 1 in 4 children with ADHD have a diagnosed behavior disorder.

Learning Disorder

Many children with ADHD also have a learning disorder (LD). This is in addition to other symptoms of ADHD, such as difficulties paying attention, staying on task, or being organized, which also keep a child from doing well in school.

Having a learning disorder means that a child has a clear difficulty in one or more areas of learning, even when their intelligence is not affected. Learning disorders include

• Dyslexia – difficulty with reading
• Dyscalculia – difficulty with math
• Dysgraphia – difficulty with writing

Properly diagnosing each disorder is crucial, so that the child can get the right kind of help for each.

Treatment for learning disorders

Children with learning disorders often need extra help and instruction that is specialized for them. Having a learning disorder can qualify a child for special education services in school. Because children with ADHD often have difficulty in school, the first step is a careful evaluation to see if the problems are also caused by a learning disorder. Schools usually do their own testing to see if a child needs intervention. Parents, healthcare providers, and the school can work together to find the right referrals and treatment.

Anxiety

Many children have fears and worries. However, when a child experiences so many fears and worries that they interfere with school, home, or play activities, it is an anxiety disorder. Children with ADHD are more likely than those without to develop an anxiety disorder. Almost 1 in 5 children with ADHD have a diagnosed anxiety disorder.

Depression

Occasionally being sad or feeling hopeless is a part of every child’s life. When children feel persistent sadness and hopelessness, it can cause problems. Children with ADHD are more likely than children without ADHD to develop childhood depression. Children may be more likely to feel hopeless and sad when they can’t control their ADHD symptoms and the symptoms interfere with doing well at school or getting along with family and friends. About 1 in 7 children with ADHD have a diagnosis of depression..

Children with ADHD already have a hard time focusing on things that are not very interesting to them. Depression can make it hard to focus on things that are normally fun. Changes in eating and sleeping habits can also be a sign of depression. For children with ADHD who take medication, changes in eating and sleeping can also be side-effects from the medication rather than signs of depression. Talk with your doctor if you have concerns.

Extreme depression can lead to thoughts of suicide. For youth ages 10-24 years, suicide is the leading form of death.

Difficult Peer Relationships

ADHD can make peer relationships or friendships very difficult. Having friends is important to children’s well-being and may be very important to their long-term development.

Although some children with ADHD have no trouble getting along with other children, others have difficulty in their relationships with their peers; for example, they might not have close friends, or might even be rejected by other children. Children who have difficulty making friends might also more likely have anxiety, behavioral and mood disorders, substance abuse, or delinquency as teenagers.

• Parents of children with ADHD report that their child has almost 3 times as many peer problems as a child without ADHD.
• Parents report that children with ADHD are almost 10 times as likely to have difficulties that interfere with friendships.

How does ADHD interfere with peer relationships?

Exactly how ADHD contributes to social problems is not fully understood. Children who are inattentive sometimes seem shy or withdrawn to their peers. Children with symptoms of impulsivity/hyperactivity may be rejected by their peers because they are intrusive, may not wait their turn, or may act aggressively. In addition, children with ADHD are also more likely than those without ADHD to have other disorders that interfere with getting along with others.

Having ADHD does not mean a child won’t have friends.

Not everyone with ADHD has difficulty getting along with others. For those children who do have difficulty, many things can be done to help them with relationships. The earlier a child’s difficulties with peers are noticed, the more successful intervention may be. Although researchers don’t have definitive answers on what works best for children with ADHD, some things parents might consider as they help their child build and strengthen peer relationships are:

• Pay attention to how children get along with peers. These relationships can be just as important as grades to school success.
• Regularly talk with people who play important roles in your child’s life (such as teachers, school counselors, after-school activity leaders, healthcare providers, etc.). Keep updated on your child’s social development in community and school settings.
• Involve your child in activities with other children. Talk with other parents, sports coaches and other involved adults about any progress or problems that may develop with your child.
• Peer programs can be helpful, particularly for older children and teenagers. Social skills training alone has not shown to be effective, but peer programs where children practice getting along with others can help. Schools and communities often have such programs available. You may want to talk to your healthcare provider and someone at your child’s school about programs that might help.

Risk of Injuries

Children and adolescents with ADHD are likely to get hurt more often and more severely than peers without ADHD. Research indicates that children with ADHD are significantly more likely to

• Get injured while walking or riding a bicycle
• Have head injuries
• Injure more than one part of their body
• Be hospitalized for unintentional poisoning
• Be admitted to intensive care units or have an injury resulting in disability

More research is needed to understand why children with ADHD get injured, but it is likely that being inattentive and impulsive puts children at risk. For example, a young child with ADHD may not look for oncoming traffic while riding a bicycle or crossing the street, or may do something dangerous without thinking of the possible consequences. Teenagers with ADHD who drive are more likely to have problems with driving, including breaking traffic rules, getting traffic tickets, and being in a crash than drivers without ADHD.

There are many ways to protect children from harm and keep them safe. Parents and other adults can take these steps to protect children with ADHD. 

• Always have your child wear a helmet when riding a bike, skateboard, scooter, or skates. Remind children as often as necessary to watch for cars and to teach them how to be safe around traffic.
• Supervise children when they are involved in activities or in places where injuries are more likely, such as when climbing or when in or around a swimming pool.
• Keep potentially harmful household products, medications, and tools out of the reach of young children.
• Teens with ADHD are at extra risk when driving. They need to be extra careful to avoid distractions like driving with other teens in the car, talking on a cell phone, texting, eating, or playing with the radio. Like all teens, they need to avoid alcohol and drug use, and driving when drowsy.
• Parents should discuss rules of the road, why they are important to follow, and consequences for breaking them with their teens. Parents can create parent-teen driving agreements that put these rules in writing to set clear expectations and limits. Learn more about what parents can do from CDC’s Parents Are the Key campaign.
• For more injury prevention tips, visit CDC’s Injury Center.

Autism Spectrum Disorder

Autism spectrum disorder (ASD) refers to a group of complex neurodevelopment disorders characterized by repetitive and characteristic patterns of behavior and difficulties with social communication and interaction. The symptoms are present from early childhood and affect daily functioning.

The term “spectrum” refers to the wide range of symptoms, skills, and levels of disability in functioning that can occur in people with ASD. Some children and adults with ASD are fully able to perform all activities of daily living while others require substantial support to perform basic activities. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5, published in 2013) includes Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorders not otherwise specified (PDD-NOS) as part of ASD rather than as separate disorders. A diagnosis of ASD includes an assessment of intellectual disability and language impairment.

ASD occurs in every racial and ethnic group, and across all socioeconomic levels. However, boys are significantly more likely to develop ASD than girls.

How is ASD diagnosed?

ASD symptoms can vary greatly from person to person depending on the severity of the disorder. Symptoms may even go unrecognized for young children who have mild ASD or less debilitating handicaps.

Autism spectrum disorder is diagnosed by clinicians based on symptoms, signs, and testing according to the Diagnostic and Statistical Manual of Mental Disorders-V, a guide created by the American Psychiatric Association used to diagnose mental disorders. Children should be screened for developmental delays during periodic checkups and specifically for autism at 18- and 24-month well-child visits.

Very early indicators that require evaluation by an expert include:

• no babbling or pointing by age    1
• no single words by age 16 months or two-word phrases by age 2
• no response to name
• loss of language or social skills previously acquired
• poor eye contact
• excessive lining up of toys or objects
• no smiling or social responsiveness

Later indicators include:

• impaired ability to make friends with peers
• impaired ability to initiate or sustain a conversation with others
• absence or impairment of imaginative and social play
• repetitive or unusual use of language
• abnormally intense or focused interest
• preoccupation with certain objects or subjects
• inflexible adherence to specific routines or rituals

If screening instruments indicate the possibility of ASD, a more comprehensive evaluation is usually indicated. A comprehensive evaluation requires a multidisciplinary team, including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose and treat children with ASD. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for ASD, children with delayed speech development should also have their hearing tested.

What causes ASD?

Scientists believe that both genetics and environment likely play a role in ASD. There is great concern that rates of autism have been increasing in recent decades without full explanation as to why. Researchers have identified a number of genes associated with the disorder. Imaging studies of people with ASD have found differences in the development of several regions of the brain. Studies suggest that ASD could be a result of disruptions in normal brain growth very early in development. These disruptions may be the result of defects in genes that control brain development and regulate how brain cells communicate with each other. Autism is more common in children born prematurely. Environmental factors may also play a role in gene function and development, but no specific environmental causes have yet been identified. The theory that parental practices are responsible for ASD has long been disproved. Multiple studies have shown that vaccination to prevent childhood infectious diseases does not increase the risk of autism in the population.

Do symptoms of autism change over time?

For many children, symptoms improve with age and behavioral treatment. During adolescence, some children with ASD may become depressed or experience behavioral problems, and their treatment may need some modification as they transition to adulthood. People with ASD usually continue to need services and supports as they get older, but depending on severity of the disorder, people with ASD may be able to work successfully and live independently or within a supportive environment.

How is autism treated?

There is no cure for ASD. Therapies and behavioral interventions are designed to remedy specific symptoms and can substantially improve those symptoms. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of the individual. Most health care professionals agree that the earlier the intervention, the better.

Educational/behavioral interventions: Early behavioral/educational interventions have been very successful in many children with ASD. In these interventions therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as applied behavioral analysis, which encourages positive behaviors and discourages negative ones. In addition, family counseling for the parents and siblings of children with ASD often helps families cope with the particular challenges of living with a child with ASD.

Medications: While medication can’t cure ASD or even treat its main symptoms, there are some that can help with related symptoms such as anxiety, depression, and obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity in people with ASD. Parents, caregivers, and people with autism should use caution before adopting any unproven treatments.

Sensory Processing Disorders

Some people have difficulty processing and responding to sensory stimuli. Although previously referred to as sensory integration dysfunction, sensory processing disorders are not consistently diagnosed, as they are not technically considered a medical diagnosis.

Individuals with sensory processing issues often exhibit problems with coordination, sensory-seeking or sensory-avoiding behaviors, and sensory modulation.  For example, in some children loud sounds, bright lights or certain textures can cause a negative response.  For other children, their sensory processing issues involve sensory seeking.  The child seeks out stimulation through activity, sounds, or touch.  Children with sensory processing issues may be fussy as babies and exhibit continued challenges as they grow.  Children who have trouble focusing may need less stimulation or more stimulation in order to better focus. Children may act out with tantrums or meltdowns.

Although any child could exhibit some of these symptoms, therapists consider a diagnosis of sensory processing disorder when the symptoms negatively impact normal functioning and disrupt everyday life. Treatment is geared toward the specific needs of the child and involves helping children improve their daily activities and helping them get used to things they can’t tolerate.