Attention Deficit Hyperactivity Disorder (ADHD) In Children

Learn About ADHD In Children

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders.  Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).

In attention, hyperactivity, and impulsivity are the key behaviors of ADHD.   While all children can be inattentive, hyperactive, or impulsive sometimes, children with ADHD manifest these behaviors to a greater degree, such that distress and impairment result. 

Oftentimes the “inattentive” part of ADHD can seem to be exactly the opposite of the “hyperactive” part.  The “inattentive” part of ADHD may involve being easily distracted, missing details, forgetting things, being easily bored, daydreaming, and moving slowly – especially in situations where a “demand” is made to move, do something, or otherwise initiate an action.  In short, children with inattention are easy to overlook, and soon end up on the periphery of wherever they belong – be it at school, home, or at play – especially if they are girls.  On the other hand, the “hyperactive” part involves fidgeting and squirming, talking non-stop, dashing around, being impulsive, and an inability to sit still – especially in situations where a “demand” is made to sit still.  In contrast to the “inattentive” part, the “hyperactive” part is difficult to ignore – especially in boys.  Most often, however, the inattentive and hyperactive parts of the disorder mix themselves together in various ways in a given child.

ADHD is one of the most common childhood disorders, with an average onset at 7 years of age.  Still, once the disorder is recognized, it can be seen to have been present in one form or another well before then.  While it is often “outgrown,” especially during puberty, the condition can and does continue through adolescence and into adulthood. In fact, ADHD affects about 4.1% American adults age 18 years and older in a given year. The disorder affects 9.0% of American children age 13 to 18 years. Boys are at four times the risk of girls.

ADHD can be confused with other childhood conditions, and vice-versa.  A particularly vexing distinction that needs to be made is between bipolar disorder and ADHD.  There is substantial symptom overlap between the two conditions.  Further, the treatment for ADHD can make a child with bipolar disorder worse – sometimes much worse – even accelerating the clinical course of the illness.  Some features to help differentiate between the two include the quality of the thought processes.  Children with bipolar disorder may feel that their thoughts are racing so fast that they cannot keep up with them – which can appear to be inattention.  They may also describe a head full of thoughts, that their thoughts seem to vanish, or that their mind seems to have a mind of its own.  Another clue is social.  Children with bipolar disorder seek out interactions with others, and are frequently “precocious” – preferring to interact with older people, especially adults – but when irritable, they can make cutting observations about others that belies their age.  They are often clever, witty, or otherwise engaging even as they are frustrating to try to direct to a specific goal or activity.  In contrast, the child with ADHD may seem bratty or obdurate.  Finally, the suspicion that a behavioral disturbance is reflective of bipolar disorder should be higher when there is a family history of any serious mental illness, not necessarily bipolar disorder.  

The most common type of medication used for treating ADHD is called a "stimulant." Although it may seem unusual to treat ADHD with a medication considered a stimulant, it actually has a calming effect on children with ADHD, because the pathways in the brain that respond to the stimulant are inhibitory in function.  Many types of stimulant medications are available. A few other ADHD medications are non-stimulants but have in common with stimulants an increase in the action of the neurotransmitter norepinephrine.

Stimulant medications come in different dosage forms, such as a pill, capsule, liquid, or skin patch. Some medications also come in short-acting, long-acting, or extended release varieties. In any variety of a given medication the the active ingredient is the same, but it is released differently in the body. Long-acting or extended release forms often allow a child to take the medication just once a day before school, so they don't have to make a daily trip to the school nurse for another dose. The most commonly reported side effects are decreased appetite, sleep problems, anxiety, and irritability. Some children also report mild stomachaches or headaches. Most side effects are minor and disappear over time or if the dosage level is lowered.  Less common side effects include the development of sudden, repetitive movements or sounds called tics. These tics may or may not be noticeable. Changing the medication dosage may make tics go away. Some children also may have a personality change, such as appearing "flat" or without emotion. Talk with your child's doctor if you see any of these side effects.

Mark J. Woyshville MD

Adapted from and expanded upon information contained within NIMH

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