Frequently Asked Questions About ADHD

• What is ADHD (attention deficit hyperactivity disorder)?
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  ADHD is a neurobehavioral disorder characterized by inattentiveness, hyperactivity, and distraction. ADHD occurs in 3% to 5% of school age children. An estimated 9% of children ages 13-18 in the U.S had been given a diagnosis of ADHD as of 2010. Boys are more than twice as likely to be diagnosed with the disorder.
  
  There are three types of ADHD: a predominantly inattentive subtype, a predominantly hyperactive-impulsive subtype, and a combined subtype. ADHD is usually diagnosed in childhood, although the condition typically continues, and sometimes is diagnosed for the first time in the adult years.
  
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• What should I look out for if I suspect someone has ADHD?
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  Answer:

  
  Some of the common signs of ADHD include failure to listen to instructions; inability to organize oneself and school work; fidgeting with hands and feet; talking too much; leaving projects, chores, and homework unfinished; and having trouble paying attention to and responding to details.
  
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• Is ADHD caused by bad parenting?
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  Answer:

  
  There is little evidence that ADHD arises solely from social factors or child-rearing methods. Most substantiated causes appear to fall in the realm of neurobiology and genetics. Causes of ADHD include:
  
  Environmental: Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the offspring of that pregnancy. Environmental agent that may be associated with a higher risk of ADHD are lead and pesticide exposure.
  
  Genetics: Attention disorders often run in families, so there are likely to be genetic influences. Studies indicate that 25% of the close relatives in the families of children with ADHD also have ADHD, whereas the rate is about 5% in the general population.
  
  Food Additives and Sugar: It has been suggested that attention disorders are caused by refined sugar or food additives, or that symptoms of ADHD are exacerbated by sugar or food additives. In 1982, the National Institutes of Health held a scientific consensus conference to discuss this issue. It was found that diet restrictions helped about 5% of children with ADHD, mostly young children who had food allergies. A more recent study on the effect of sugar on children, using sugar one day and a sugar substitute on alternate days, without parents, staff, or children knowing which substance was being used, showed no significant effects of the sugar on behavior or learning.
  
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• How is ADHD diagnosed?
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  If ADHD is suspected, the diagnosis should be made by a professional with training in ADHD. This includes child psychiatrists, psychologists, developmental/behavioral pediatricians, behavioral neurologists, and clinical social workers. After ruling out other possible reasons for the child’s behavior, the specialist checks the child’s school and medical records and talks to teachers and parents who have filled out a behavior rating scale for the child. A noninvasive brain scan -- referred to as the NEBA system -- can also be used but only as part of a full physical and psychological exam.
  
  
  
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• What are the symptoms of other disorders commonly seen with ADHD?
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  ADHD often occurs with other disorders. The concurrence of ADHD, oppositional defiant disorder, mood disorders, anxiety, and other mental health problems often presents extra challenges to affected individuals, educators, and health care providers. Diagnosis and treatment are more difficult when ADHD and another condition are present in the same individual.
  
  About half of children with ADHD referred to clinics have other behavior disorders. Oppositional defiant disorder is one of the most common disorders occurring with ADHD. Conduct disorder is less common, can be significantly disruptive, and is difficult to treat. Increased injuries and strained peer relationships are also common in this population.
  
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• What are the symptoms of other disorders common with ADHD?
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  Oppositional Defiant Disorder (ODD): Only a qualified mental health professional can diagnose ODD. ODD usually starts before age 8, but no later than early adolescence. Symptoms may occur most often with people the individual knows well, such as family members or a regular care provider. These behaviors are present beyond what are expected for the child’s age and result in significant difficulties in school, at home, and/or with peers. Examples of ODD behaviors include:
  
  • Losing one’s temper a lot
  • Arguing with adults or refusing to comply with adults’ rules or requests
  • Often getting angry or being resentful or vindictive
  • Deliberately annoying others; easily becoming annoyed with others
  • Often blaming other people for one’s own mistakes or misbehavior
  
  Conduct Disorder (CD): Conduct disorder is a behavioral pattern characterized by aggression toward others and serious violations of rules, laws, and social norms. These behaviors often lead to delinquency or incarceration. The symptoms of CD are apparent in several settings in the person’s life (such as at home, in the community, and at school). While CD is less common than oppositional defiant disorder, it is severe and highly disruptive to the person’s life and to others in his/her life. It is also very challenging to treat. A mental health professional should complete evaluations for CD where warranted, and a plan for intervention should be implemented as early as possible.
  
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• What type of specialists would diagnose and treat ADHD?
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  Answer:

  
  Ideally, the diagnosis should be made by a professional in your area with training in ADHD or in the diagnosis of mental disorders. Child psychiatrists and psychologists, developmental/behavioral pediatricians, or behavioral neurologists are those most often trained in differential diagnosis. Clinical social workers may also have such training.
  
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• How does ADHD interfere with peer relationships?
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  The exact mechanisms of how ADHD contributes to social problems is not fully understood. Several studies have found that children with predominantly inattentive ADHD may be perceived as shy or withdrawn by their peers. Research strongly indicates that aggressive behavior in children with symptoms of impulsivity/hyperactivity may play a significant role in peer rejection. In addition, other behavioral disorders often occur along with ADHD. Children with ADHD and other disorders appear to face greater impairments in their relationships with peers.
  
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• What are some of the more serious consequences of ADHD?
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  Children and adolescents with ADHD can have more frequent and severe injuries than peers without ADHD. Research indicates that children with ADHD are significantly more likely to be injured as pedestrians or while riding a bicycle, to receive head injuries, injure more than one part of the body, and be hospitalized for accidental poisoning. Children with ADHD may be admitted to intensive care units or have an injury result in disability more frequently than other children.
  
  Children with ADHD appear to have significantly higher medical costs than children without ADHD. Health care costs for each child with ADHD may be more than twice as high as medical costs for children without ADHD.
  
  Finally, adolescents with ADHD are more likely to get involved in risky behavior like drug use.
  
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• What is the most common treatment for ADHD?
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  The usual course of treatment for ADHD may include the use of stimulant medications such as Ritalin or Dexedrine, nonstimulant medications such as Strattera and Intuniv; and other medications that include tricyclic antidepressants and Catapres. These medications can decrease the ADHD symptoms of impulsivity and hyperactivity and increase attention. Most experts agree that treatment for ADHD should address multiple aspects of the individual's functioning and should not be limited to the use of medications alone.
  
  Treatment should also include structured classroom management, parent education (to address discipline and limit-setting), and tutoring and/or behavioral therapy for the child.
  
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